News in brief
NHS funds need urgent boost, say MPs: A group of MPs said that the government is incorrect to keep claiming it is allocating an extra £10bn to the NHS in England over the next five years, reported the BBC. The Health Committee has written to the chancellor to say that using the figure gives the “false impression that the NHS is awash with cash”. The group said the figure was closer to £4.5bn and called for more NHS funding in November’s Autumn Statement, but the government insisted the £10bn figure was accurate. The £10bn figure is calculated in real terms once inflation has been taken into account and includes £2bn which was announced in the last Parliament. The health committee said that while the figure is not incorrect, it is misleading because it can only be reached by adding an extra year to the spending review period, changing the date from which the real terms increase is calculated and disregarding the total health budget. The committee said a substantial part of the extra funding for the NHS comes from cuts to other areas, such as public health. Anita Charlesworth, director of research and economics at the Health Foundation, said: “With funding growth set to slow sharply from 2018, it’s hard to see how the range and quality of services for patients will be sustained.”
NHS structures ‘complex and confused’: The way the NHS in England is organised is hindering its ability to meet its challenges, a review led by former health secretary Alan Milburn said, reported the BBC. The review, for consultants PwC, called for a gradual evolution of the structures, saying those who worked in the health service supported reform. However, the Department of Health (DH) said its plan for the future would be “delivered within the NHS’ existing structures”. The PwC report was critical of the changes introduced in 2012 by then health secretary Andrew Lansley, which have resulted in the creation of “myriad” national organisations, including: NHS England, NHS Improvement, Health Education England, and Public Health England. The consultancy said it meant hospitals and other services faced the “daunting challenge of managing competing requirements”. The review said many of the functions of these competing organisations could be gradually merged into one and in time regional bodies could be created to take charge of budgets for the NHS and council-run care services. It said this would aid integration between the two systems – seen as key to shifting care out of hospitals and coping with the ageing population. The report acknowledged these changes would take up to a decade, but said the polling it had carried out with NHS staff suggested there was widespread support for reform. Milburn said: “Organisational change is always a risk but without it, the move towards integrated systems will be undermined.” But the DH said there was no need for more reform as there was “a plan for the future” using existing structures that would be funded by the extra money being invested in the NHS during the Parliament.
Health Committee calls for social care funding to help A&E: The government urgently needs to address underfunding of adult social care to alleviate growing pressures on A&E departments, or people will continue to face avoidable admission and delayed discharge from hospital, the Health Committee has concluded, reported PharmaTimes. Last year, only 88% of patients were admitted, transferred or discharged within four hours at major emergency departments across the country, falling well short of the 95% standard and reflecting a widespread decline in performance across the service. The figure “masks great variation in the performance of trusts which cannot be explained by financial challenge, demographics and demand alone”, according to the Health Committee’s report on winter planning for A&E departments. A&E departments in England are managing unprecedented levels of demand, and the pressure on these services are now all year round, as opposed to just winter. The response, found the report, must focus both on managing the patient’s journey through the hospital and on addressing the increasingly inadequate provision of adult social care services available to enable safe discharge. Dr Tajek Hassan, president of the Royal College of Emergency Medicine, said: “We cannot continue to resource emergency departments for the demand that is hoped for instead of the demand that we actually face, which is why we are calling for an A&E transformation fund and for the correct funding of social care.”
Hacked trusts faces criticism over handling of worst cyber hack on NHS: The hospital trust at the centre of the NHS’ most severe cyber security attack to date is facing fundamental questions about its handling of the hack and whether it acted in the best way to contain the virus. Northern Lincolnshire and Goole Foundation Trust (NLAG) was forced to cancel thousands of operations after a virus infected its IT system on Sunday, prompting it to close down the vast majority of its system. The trust has confirmed that services have resumed after a three-day period in which routine operations, outpatient appointments and diagnostics were cancelled at its three hospitals in Grimsby, Scunthorpe and Goole. However senior IT managers and cyber security professionals have raised concerns to Health Service Journal (subscription required) about the trust’s decision not to call NHS Digital immediately to alert them to the threat and not to bring in the Care Computer Emergency Response Team (CareCERT) team. NHS Digital also offers assurance services and an e-learning portal as part of efforts to assist care organisations in being more resilient to potential attacks as part of its CareCERT programme that is in the process of being expanded. However, it was not known if this existing cyber security focus may be revised following the virus issues at NLAG, reported Government Computing. “This issue highlights the fact that there are threats to data security within health and care, as with any other sector. We remain committed to supporting the protection of data with the highest possible security standards, high levels of security expertise from the centre and appropriate training and awareness of the risks for all staff,” said a spokesperson for NHS Digital.
Welsh NHS to be given an additional £50m to help tackle winter pressures: The Welsh NHS is set to be given £50m of additional investment to help “sustain and improve performance” during the busy winter period, reported WalesOnline. Demand on the healthcare service typically soars in winter due to higher rates of certain illnesses and a shortage of medical staff to cover shifts. The influx of patients with complex conditions, particularly the elderly, places a far greater pressure on emergency services, which have readily been described as “at breaking point” by unions. Many routine surgical operations were cancelled last year as a direct result of the additional demands placed on acute care. In a bid to reduce the pressures, cabinet secretary Vaughan Gething has announced the NHS in Wales will receive £50m this winter – up from an extra £45m in 2015. However he also called on the public to only contact the emergency services when it was absolutely necessary. He said: “The NHS will receive £50m this year to sustain performance and meet the increased demand placed on services going into the winter period. We are investing in the NHS but everyone in Wales can play their part by choosing well.” There is a risk public services in Wales could “fall off a cliff” unless more is done to prevent people from falling ill, the future generations commissioner Sophie Howe has said. Howe said all public bodies need to work more closely together to tackle the causes of ill health. There are also concerns services like housing and leisure – which help keep people healthy – are losing out, reported the BBC. More money is having to be switched to the NHS as demands rise. The Welsh government said it recognised “health is more than the NHS”.
Consultation outcome over Caldicott proposals to be released soon: Dame Fiona Caldicott addressed the review of data security, consent and opt-outs and the challenges surrounding the implementation of key recommendations in a session at the EHI Live digital health event, reported Health IT Central. Caldicott revealed expectations that the outcome of the consultation regarding the review would be published by the end of the year. “This will be a big programme of work and that’s why the outcome of the consultation is so important,” she told the audience at EHI Live. The proposals from the latest Caldicott review were accepted in principle by the government, when former health minister George Freeman announced a consultation in July. Following Caldicott’s review, NHS England also took the decision to close the care.data programme; furthermore, a freedom of information request from the IT news site The Register also revealed that the combined total expenditure put into care.data added up to nearly £8m before it was scrapped. Caldicott highlighted that her responsibility as national data guardian is to ensure that both patients and professionals have the right support system, education and training in order to become more engaged, as research shows that there is little knowledge amongst the public about how health and care data is used.
NHS Digital Academy ‘will be virtual organisation’: The recently announced training school for clinical information professionals will be a “virtual organisation”, according to an NHS England lead. Details of the NHS Digital Academy, where chief clinical information officers (CCIO), chief information officers, and other aspirant leaders in IT will be trained and developed, were fleshed out by Harpreet Sood. Sood, the newly-appointed senior fellow to the chair and chief executive of NHS England, said the academy will not create new content but instead will “leverage our current assets and infrastructure”. Speaking at the Annual CCIO Conference at EHI Live in Birmingham, he added that it will “work in conjunction with partners and key stakeholders” to deliver its aims, reported DigitalHealth.net. The NHS Digital Academy Initiative was announced at the Health and Social Care Expo in Manchester in September, by health secretary Jeremy Hunt. He said the plans were to set up a new “a new academy dedicated to training NHS staff in digital skills”. Hunt added that the academy would be hosted by a university, which would be selected through a national competition, but this point was not touched on by Sood. The body is being set up following the Wachter Review of NHS IT which recommended that £42m should be devoted to developing a new cadre of CCIOs, information clinicians and other IT leaders.
NHS England sets up info governance network: NHS leaders trying to redesign the way that care is delivered, and how the social care system can be better integrated with health, are being offered a new online support network, reported UKAuthority. Running on the future NHS collaboration platform, it has been set up to act as a protected discussion and education area for practitioners working on local process redesign initiatives. Speaking about the move on the main NHS England website, Geraint Lewis, the organisation’s chief data officer, details what he sees as the pressure trusts and clinical commissioning groups are coming under to redesign multiple business processes at once. It is being felt most keenly around information governance (IG) – basically, patient data privacy. Lewis and his team think the platform, which draws on lessons learned from colleagues in local government who used a predecessor system, can provide valuable support. “We want to ensure that the vanguards and pioneers feel empowered to take a sensible and proportionate approach to privacy and confidentiality,” he said in the blog post. “There is a widespread view that IG in England has become too Byzantine in its complexity and that, in practice, it is too risk averse and too inflexible to meet the modern needs of patients and clinicians.”
Bryant lays out conditions for helping tech companies into the NHS: NHS Digital wants to improve market conditions to make it easier for businesses to sell technology into the NHS, but in return it will require companies to increase usability, interoperability and security, reported DigitalHealth.net. That was the message from Beverley Bryant, NHS Digital’s director of digital transformation, speaking at EHI Live. Bryant told the conference: “We are looking at how to improve market conditions and give clinical commissioning groups more choice around the software they can buy.” However, she added: “If there are no open market-structured APIs (application programme interface) – we’re not buying it.” She also stressed that small and medium-sized enterprises (SMEs) and start-ups must work with local information governance structures and provide the security the NHS requires. The government has already taken steps to make it easier for innovative organisations to sell to the public sector, and for the NHS to take up new ideas. Last week, it published the Accelerated Access Review, which was set up to find ways to speed up access to innovative drugs, devices and diagnostics for NHS patients. It urged greater collaboration between NHS organisations, suppliers and patients during the development of products. “The historical model where innovators simply throw new products at health care systems and allow them to layer these onto existing pathways is no longer viable,” it said.
Only 4% of GP appointments booked online: Only 4% of GP appointments are currently made online despite NHS England saying last year that 97% of patients were served by practices offering digital bookings, Health Service Journal (HSJ – subscription required) analysis has found. A projected 14 million GP appointments will be made or cancelled online in 2016, out of 340 million estimated total appointments, analysis of official data collected by NHS Digital suggested. Digital uptake remains low, despite a push by NHS England over the last few years. One senior official working on the digital agenda told HSJ far greater transparency around digital uptake was required if the NHS was to maximise the potential benefits of technology. They said: “When the headlines say that GPs are offering online services to 97% of patients, and the reality is that only 4% of GP appointments are booked online, we need to stop kidding ourselves. Only then can we figure out how to how to improve it.” NHS England defended its performance. A spokeswoman said: “It is encouraging that 14 million GP appointments were made online this year. Nearly 9 million patients are currently signed up to use this service and we expect the number of online appointment bookings to continue to rise as more people become aware this option is available.” Multiple market sources told HSJ barriers to the uptake of online booking included the disincentive for GPs, already under increasing demand pressures, to give easy access to largely younger, digitally-savvy patients at the expense of older patients.
Partnership aims to save NHS millions with retail tech: Technology used by retail giants ranging from Tesco to Argos could now save the NHS millions of pounds, as a result of a new partnership between NHS Shared Business Services (NHS SBS) and British technology company Virtualstock. NHS SBS, a Department of Health joint venture with Sopra Steria, has already saved the NHS hundreds of millions of pounds since it was set up in 2005, reported eHealthNews.eu. It now aims to help the health service work towards achieving the £500m to £1bn of procurement savings called for in Lord Carter’s 2016 productivity review, after it entered into a strategic partnership with Virtualstock to enable NHS organisations access to an online technology used by numerous global brands. The technology, which provides a purchase to pay e-commerce platform, will create a competitive online marketplace for NHS users, where as many as 100,000 current suppliers will be able to offer their products and innovations to the NHS. Some of England’s largest hospitals have already agreed to use the platform, and now NHS SBS has access to the system for the hundreds of healthcare organisations it represents across England. This includes every NHS clinical commissioning group, and an extensive number of NHS trusts. NHS SBS managing director David Morris said: “Transforming the way hospitals buy services from their suppliers has been a priority in the NHS for years. NHS SBS already works with a large number of NHS trusts and commissioners across the NHS, and this new service will enable huge savings. Our partnership with Virtualstock means we can deliver highly successful retail best practice and best value for the health service, giving hospitals the tools to start saving billions of pounds.”
Everybody will benefit from exemplars – McNeil: The NHS’ chief clinical information officer (CCIO) has launched a spirited defence of the controversial exemplars programme, reported DigitalHealth.net. Keith McNeil, speaking at EHI Live this week, said there were “no losers” in the selection of 12 centres of global digital excellence, and that “everybody will gain”. The exemplars programme followed the launch of US ‘digital doctor’ Professor Robert Wachter’s review of NHS IT. Wachter advised that trusts should be split into three groups, with central money directed towards so-called Group A and B trusts, to become global and local leaders. In response, health secretary Jeremy Hunt announced that 12 digitally advanced acute trusts had been chosen to access a £100m funding pot, out of a shortlist of 27 invited to apply. The move has raised questions about why only acute trusts were included, and what will happen to Group C trusts – the majority – that are not selected for the programme. “When we invest money in them [the 12 trusts], and there’s only a limited amount,” McNeil elaborated. “We’re going to get a good return from our investment.” Will Smart, the NHS chief information officer, said that a further round of ‘national’ exemplars will include mental health, community, specialist and ambulance trusts. The first 12 exemplars were selected based on a “clearly articulated strategic and clinical vision”, he added. They were trusts that had “thought deeply about what their agenda was and how they were going to deliver it”. McNeil told the Annual CCIO Conference co-located alongside EHI Live at the NEC in Birmingham that he was “actively engaging in mental health right now” in advance of further digital exemplars being funded outside of acute care, including community care, ambulance trusts and mental health.
Department of Health creates ‘lo-fi’ version of service assessment: The digital strategy team at the Department of Health (DH) has revealed it is piloting a new, “leaner” approach to assessing its digital services, which focuses on just three core questions, reported PublicTechnology.net. The DH questions ask: how the service meets user needs; whether it is safe and secure; and if the service can be quickly improved. This is a big reduction from the 18 points set out in the digital services standard first established by the Government Digital Service to ensure digital services are properly able to meet user needs. Although they cover the same broad areas as addressed in the 18 points, they are less specific, and also likely to be seen as being less prescriptive and open to wider interpretation. However, in a blogpost about the new approach, the digital team’s Hong Nyugen said that the team “still value the 18 points in the service standard and will continue to reference them for live assessments”. The change has come about after an evaluation of the department-led service assessments for health.
Stevens announces medtech winners and mobile ECG funding: NHS England chief executive Simon Stevens has announced the first categories of devices and apps to be paid for by the new Innovation and Technology Tariff, reported DigitalHealth.net. He also announced that there will be separate, central funding for clinical commissioning groups to buy mobile ECG (electrocardiogram) devices, so patients can use these to help prevent heart problems. Companies interested in the tariff scheme, which will enable trusts to adopt innovations without having to negotiate terms with their commissioners, were invited to apply via the National Innovation Accelerator programme. Steven’s argued that the ECG could help the 2 million people who have heart conditions, by picking up abnormalities early, and save the NHS significant sums of money. Stevens made a similar point at last month’s Health and Social Care Expo, where he demonstrated an ECG that could attach to a smartphone, for less than £100. Stevens said: “The NHS has a proud record of world firsts in medical innovation, but getting wide uptake has often been far too slow.”
Opinions
The cutting edge – and why the NHS is falling behind it
Becca Antink from the Institute for Public Policy Research, discusses the impact of the Accelerated Access Review (AAR), and how this will affect the British public’s access to life-saving drugs.
In an article to the Health Service Journal (HSJ – subscription required) she says: “The review finds that patients could get new life saving drugs four years earlier than they do at the moment, through a range of sensible measures – which would be a welcome development.
“However, a consultation document, published earlier this month by NHS England and the National Institute for Health and Care Excellence (with much less fanfare) tells a very different story.
“Focusing on ways in which the NHS can control its spiralling drugs bill, it suggests that NICE, who are currently responsible for testing the cost-effectiveness of new medications, may also get a remit to determine their affordability.
“These two documents tell very different stories about the future of innovation in the NHS. The first sets a laudable ambition for the UK to be at the forefront of health and care innovation in the coming years – with British patients getting the best available treatments at the earliest possible point – whilst the second suggests that the reality may be much harsher, with the NHS unable to afford the best new medications.
“It is clear that little effort has been made to address the contradiction between the call for improved processes and investment in access to treatments on the one hand, and a proposal to establish restrictions on the other.
“In a recent meeting with Stevens, Theresa May purportedly made it clear that it was down to him and NHS leaders to make the necessary efficiency savings to close the funding gap.
“If this stance is maintained, it seems inevitable that, despite efforts such as those outlined in the AAR, the NHS will continue to lag behind the cutting edge of medicine and new technologies.”
A network to support the new models of care with information governance
With mixed feelings about information governance (IG), a new collaborative network on the subject will be different, writes NHS England chief data officer Geraint Lewis.
In a blog for the NHS England website, Lewis says a new IG network, backed by the Information Governance Alliance, will involve listening to and supporting vanguards.
“Information governance. Seven syllables that can instantly strike a sense of dismay, despair or despondency into the heart of anyone who wants to improve how their NHS service is organised and delivered.
“Like many people, I have mixed feelings about IG. On the one hand, it clearly has a vital role to play in ensuring that NHS services obey the law of the land and in reassuring patients that the NHS will look after their confidential information carefully, fairly, and securely. On the other hand, however, there is a widespread view that IG in England has become too Byzantine in its complexity and that in practice, it is too risk averse and too inflexible to meet the modern needs of patients and clinicians.
“This network will be different.
“The IG professionals working with me to launch this new network are, to a person, determined to change the face of IG for the better. Our collective aim is to be open, straightforward and helpful. We want to ensure that the vanguards and pioneers feel empowered to take a sensible and proportionate approach to privacy and confidentiality. We’ll do this firstly by challenging some of the myths associated with IG, but also by holding national bodies to account where their guidance is outdated or unwieldy, or where we hear that they are not being responsive enough to the new requirements of the service.
“The IG network will support the vanguards and pioneers by promoting the use of national tools, such as privacy impact assessments, and by refining and promoting local materials, so that sites do not duplicate work that has already been done by their peers elsewhere. We will listen carefully to the vanguards and pioneers to identify where there are problems that we need to resolve and to see where more support and advice is needed.”
The integration generation
The Five Year Forward View heralds a health and care system with new, integrated, cost-efficient models of care that provide a more joined-up experience for patients, write Sue Thomas and Paul Midgley in the Pharma Times.
“How can we move away from an NHS service that is fragmented and often poorly coordinated to one that puts the needs and experiences of people at the heart of service organisation and delivery?”, they ask.
Vanguard sites are already demonstrating the numerous ways in which this can happen, through integrating IT systems, to broadening multidisciplinary teams. But this can cause issues.
“The sheer variety of projects being undertaken by vanguards helps to explain why integration means different things to different people, and that unless planned changes are clearly communicated to stakeholders, misconceptions about what is being proposed can be a huge barrier to change,” they say.
“Harnessing the experience and knowledge of patients, carers and health and social care professionals is vital when changing patient pathways through integration. Indeed, there is strong evidence that effective communication and engagement with patients, carers, the public and other stakeholders helps to improve commissioning decisions, patient satisfaction and service use.
“The NHS needs to review many of its care pathways to ensure patients, carers and families have a meaningful say in how services are delivered but current pressures often prevent this happening. Pharma has a real opportunity for engagement here and should grasp it as soon as possible.”
Blog
Digital leaders aim for the stars, but keep feet firmly on the ground
“The NHS will last as long as there are folk left with faith to fight for it,” once said the NHS’ founder, Nye Bevan. The national media paints a very bleak picture of the NHS and the fight to save it – financial woes, staff shortages, low morale, inspection failings, and patient safety errors. Have our senior health professionals lost the faith, or are they up for the fight? Chris Marsom reflects on this following the EHI Live Conference where health leaders and experts gathered.
