News in brief
End unfair split between NHS and council care, review says: The NHS and social care systems in England should be merged in the most radical overhaul since the 1940s, an independent review says. Currently the NHS is free at the point of need, while payment for care homes and home support is means-tested, reports the BBC. However the Barker Commission said the distinction was unfair and must end. It said the cost of providing free social care could come from a mix of new taxes and cuts to benefits and prescription exemptions. This could include ending the National Insurance exemption for those working past the state retirement age, the expert panel led by economist Dame Kate Barker suggested. Increasing National Insurance contributions for those earning more than £42,000 a year by 1% and for those above the age of 40 by the same amount was also suggested. Winter fuel payments, free TV licences and prescription exemptions given to older people could be curbed, the review also said. It said the merger of the two systems was needed because the ageing population and rise in long-term illnesses had blurred the lines between the two and was now causing “distress and unfairness”. The commission, which was set up by the King’s Fund think-tank, compared the care given to cancer patients, who get their treatment free, with the support needed to help people with dementia, which often falls into the means-tested social care system. Dame Kate said the country was facing “difficult questions” but added the current system was simply “not fit to provide the kind of care we need and want”.
NHS England issues safety alert over fears about discharge reports: NHS England has been forced into issuing a patient safety alert informing GPs around 10,000 incidents it has identified of poor communication from NHS trusts when discharging patients to primary care, some of which put patients in danger of serious harm or even death, reported Pulse. The alert says that all NHS organisations should identify any work they have done to improve communication and appoint a lead to develop and share the protocols, which will be used as part of a national project to develop good practice guidance. It follows an NHS England report last week that identified 10,000 patient safety incidents related to patient discharge, and poor communication at handover was identified as a major risk in 33% of those incidents. GP leaders have said that they have had concerns about the quality of discharge summaries for 20 years, but the move by NHS England demonstrates the severity of the situation. Pulse reported last month that a University of East Anglia-led audit of 3,400 discharge summaries sent to GPs in Norfolk found that 33% of handwritten summaries, and 25% of electronic summaries failed to meet NICE’s minimum clinical communications standards. The alert warns problems like these are threatening patient care. It states: “Review of these incidents identified that patients are sometimes discharged without adequate and timely communication of essential information at point of handover to all relevant staff and teams in primary and social care, including out of hours, and that information is not always acted on in a timely manner. This can result in avoidable death and serious harm to patients due to a failure in continuity of care as well as avoidable readmission to secondary care.”
Half of Scottish GPs offer online meds: Just over half of GP practices in Scotland let patients order repeat prescriptions online or by email, a report by Reform Scotland shows. eHealth Insider reported last week that figures from the Health and Social Care Information Centre suggest that only 5.6% of English patients have been “enabled” to use the same functionality. The report from the Scottish think-tank shows that 51% of GP practices letting patients order repeat medication electronically. It also says that 10% of Scottish GP practices let patients book appointments online. Even so, the report notes that there are vast differences in the way “appointment systems operate between practices, with some only allowing appointments to be booked for that day” and others let patients book up to six weeks in advance. There are also variations in the way that practices operate, depending on whether they are funded directly by NHS boards or operate as private contractors. Commenting on the report, Reform Scotland’s director Geoff Mawdsley said it is “unacceptable” that there is such a variation in the way people can access GP services. “We were surprised that in 2014 just 67% of GP practices have a website and only just over half allowed you to order a repeat prescription online or by email,” he said.
CCGs lukewarm on integrating health and social care roles: Most clinical commissioning group (CCG) leaders are lukewarm about the prospect of merging or sharing substantial health and social care responsibilities, the Health Service Journal (subscription required) CCG Barometer suggests. Respondents were asked about the policy, being considered by Labour, of making health and wellbeing boards (HWB) “system leaders” for services for people with multiple long term conditions, disability or frailty. HWBs would set plans for these services, which CCGs would enact. Other commentators and politicians have also backed a greater role for HWBs. Only 15.6% of respondents said they thought health and care commissioning overall would be improved if the policy was implemented and 29.3% said health and care services would be better integrated. A third said they would personally leave their CCG position and 53.2% said some GP leaders would leave. Just 13.7% said their CCG was likely to give significant NHS commissioning responsibility to local authorities in coming years. Thirty-nine percent said their CCG was likely to take on social care responsibility. Asked to comment about commissioning integration, one respondent said the presence of providers on many HWBs “would make the difficult decisions on decommissioning services and shifting services more difficult”. NHS Clinical Commissioners co-chair Steve Kell said he would be “extremely concerned about seeing another significant top-down reorganisation and losing that clinical leadership” under the changes being considered by Labour.
£44m IT system leads to more missed NHS appointments: New figures show that, in the period to June, health boards in Scotland cancelled 4.2% of appointments, says the Scottish Express. It comes despite a £44million electronic system to replace paper files. The number of patients failing to show up for appointments has also fallen, but still accounts for around 9% of all cancellations. Tory health spokesman Jackson Carlaw, who uncovered the figures, said these cancellations show the new patient management system has failed. Cancellations were raised as far back as 2012, when Alex Salmond assured MSPs the problem was “in the process of being sorted”. Carlaw said: “In a system the size of the NHS everyone accepts unforeseen circumstances resulting in the cancellations. However, the fact thousands of these are occurring on a monthly basis shows a long-standing problem. Alex Salmond vowed to sort this out two years ago, yet there were still 20,000 people in the last quarter told by the NHS that they could not be seen. Appointments are believed to be most commonly cancelled due to double booking, staff absence and patients failing to turn up. The Patient Management System, introduced in 2010, was hailed as a “major step towards a paper-free NHS” that would allow staff to access patient information more easily. A Scottish Government spokesman denied that the cancellations were linked to the system. He said: “Appointments can be postponed for many reasons, including staff illness and patients rescheduling. Where appointments do have to be rescheduled, we expect NHS boards to rearrange them for the earliest opportunity and within the waiting time standard. It is welcome that millions of appointments take place successfully across Scotland every year, including more than 1.5 million first outpatient consultations being undertaken.”
Miliband looks at health tax as defining feature of manifesto: Ed Miliband is to put the NHS at the centre of Labour’s election campaign and is considering an earmarked “health tax” or exempting the health service from deficit reduction to prove that he can deliver a better service, reports the Financial Times (subscription required). Miliband believes the NHS is rising up the list of voters’ concerns but wants to offer a single big policy to prove to voters that Labour will be a better custodian of its future than the Conservatives. The Labour leader is looking at excluding the NHS from Labour’s planned deficit cuts by designating borrowing specifically for the health service, although this may look similar to an expected promise from Tories and Lib Dems to ring-fence the NHS from post-2015 cuts. Labour insiders say Miliband is considering options to go further, including earmarking a specific tax to prove he is serious about boosting health funding. The opposition party, which is a few points ahead of the Tories in the polls, is looking for a way to take the political initiative and capture the public’s imagination without reinforcing its reputation for over-spending taxpayers’ money. Officials have also discussed proposing only small increases in the NHS budget in 2016 and 2017 while promising bigger investment towards the end of the parliament as the economy grows.
35,000 patients wrongly struck off GP registers: Up to 35,000 patients have been wrongly struck off GP registers in the last year in NHS cost-cutting exercises targeting the elderly and vulnerable, an investigation has found. Doctors said patients are increasingly being denied vital check-ups, cancer screening and suffering delays obtaining medication because of botched attempts by authorities to update records and reduce practice funding, according to The Telegraph. In some parts of the country more than one third of patients who were stripped from the lists should never have been deleted, official figures show. GPs said blunders by schemes, which have targeted the elderly and children who failed to attend vaccination appointments, had led to angry scenes in GP surgeries when patients found out what had happened. In some cases, failings meant women went years without screening for cervical cancer, doctors said. In others, attempts were made to stop monitoring children who had been identified as at risk of neglect or abuse. NHS figures disclose that since April last year, 14% of patients who were deleted from lists – ostensibly because they were thought to have died, or moved to a different area – were reinstated after they or their GP protested. Family doctors said NHS authorities, who allocate funding to practices depending on the number of patients on their register, had become increasingly heavy–handed in stripping vulnerable patients from lists.
Medway planning for year’s PAS delay: Medway NHS Foundation Trust has announced its Oasis patient administration system (PAS) will go live in February next year – almost one year later than planned, reports eHealth Insider. In the chief executive’s report for the trust board’s August meeting, acting chief executive Phillip Barnes says the trust has set a revised go-live date of 9 February 2015, following “an additional assessment of its plans” by University Hospitals Birmingham NHS Foundation Trust. “They have provided significant assurance that our plans are robust and that we have an appropriately skilled team to deliver the work,” his report says. Barnes says Birmingham has made a number of recommendations about the support needed for the implementation phase to ensure a successful outcome. He says the introduction of the new PAS will be “the first step in revolutionising the trust’s use of information technology in delivering and improving patient care.” The trust was due to go-live in March as the support contract for its legacy Totalcare PAS from McKesson expired at the end of the month. However, the trust postponed the deployment after it received an extension of the support contract by McKesson.
Apple clamps down on apps selling health data to advertisers ahead of iPhone 6 launch: Apple is attempting to counter growing fears about the exploitation of personal data by placing new restrictions on how medical information collected by its forthcoming HealthKit platform will be used by advertisers. The iPhone maker issued new guidelines to developers clarifying that marketing companies will not be able to use information about customers’ health to deliver targeted ads such as weight loss products, reported The Independent. The clampdown comes as Apple faces new challenges over its security measures and less than a week before the company prepares to launch a new iPhone – and possibly a wearable ‘iWatch’– on September 9th. HealthKit, which will be available in the next iteration of Apple’s mobile operating system iOS 8, will act as a central clearing house for various health and fitness metrics, compiling information as varied as heart-rate and lung capacity to daily activity and vitamin intake. However, developers who want to take advantage of this new platform (represented by Apple’s new Health app) will have to sign up to new rules promising not use information “for any other purpose other than providing health and/or fitness services”. Health and fitness apps have provided the latest boom in the mobile market, with downloads increasing by 62% in June this year, according mobile analytics firm Flurry.
NHS England spends £1.2 million on iPhones and iPads: NHS England’s spending on iPads and iPhones for staff since its formation has skyrocketed to more than £1.2 million, according to new figures released by the Department of Health. The response to a written question from Andrew Gwynne, Labour MP for Denton and Reddish show NHS England has spent £1.21m on Apple products since it was set up in shadow form in 2012 – with £1.05m of this on iPhones. The new figures reveal that the £1.05m spent on iPhones has yielded just 2,300 handsets – a cost per unit of £456 – and in the current financial year it has spent £68,400 on 150 iPhones and £23,000 on 50 iPads. The figures also reveal that the Care Quality Commission has purchased more than 201 iPads since 2011-2012 at a cost of £113,506, spending £32,571 already this year on 73 iPads. NHS England previously told Pulse that smartphones were ‘vital’ for staff to work effectively on the move, and that iPhones in particular met the encryption standards required by the NHS. A spokesperson added: “As a new organisation, we had no existing IT and our newly-recruited staff had to be equipped to do their job.” Deputy chair of the General Practitioner Commmitte’s IT subcommittee Dr Grant Ingrams told Pulse that the unit price was startling considering the size of the orders being made. He said: “I couldn’t find anywhere, even going to your most expensive [department store] you’d find a better price, and for the volume, they should be negotiating a huge discount for that.”
London pioneer sites host data challenge: The Waltham Forest, East London and City integrated care pioneer site is hosting a data challenge to demonstrate the benefits of a move towards more joined-up care report eHealth Insider. The NHS North and East London Commissioning Support Unit (CSU), one of the organisations involved in the integrated care project, says the data challenge will be one of the largest collaborative NHS data exploration events ever held. The collaborative project is made up of Newham, Tower Hamlets and Waltham Forest councils and clinical commissioning groups, Barts Health NHS Trust, North East London NHS Foundation Trust and East London NHS Foundation Trust, and the UCL Partners academic health science network. An NHS North and East London CSU spokesperson said the project team is holding the data challenge day on 9 September to demonstrate the power of joined-up data across health and social care organisations. The challenge will link together data from almost 200 NHS organisations, including GPs and hospitals, covering a third of London. The spokeswoman said teams will undertake “hands-on investigation” of the data, with clinicians, data scientists, statisticians, commissioners and care providers among those who will be involved. At June’s Health + Care conference in London, care secretary Norman Lamb said the pioneer sites are doing “really fascinating and excellent work”, developing shared care records and using technology to provide a single point of contact for care users. Lamb said: “Good data and interpretation of that data is what this is all about, so we’re not basing decisions in a fog. We have a wealth of data within our system, and that data gives us the chance to operate and make decisions on the basis of evidence.”
Monitoring begins on new NHS Spine: After the successful replacement of the NHS Spine last week, the core services and messaging of the infrastructure are now undergoing monitoring and evaluation to ensure the Spine is performing effectively, reports Government Computing. The Health and Social Care Information Centre (HSCIC) has said that if local NHS organisations experience any service difficulties, they should use their existing support route to report the problem. It said, “We are working around the clock to ensure that any outstanding issues are resolved as quickly as possible to minimise any disruption to patient care and the NHS. We are grateful for the ongoing co-operation of system suppliers in addressing these localised issues. If local NHS organisations are experiencing difficulties, they should use their existing support route to report the problem. Specific information has also been provided for users of the Electronic Prescription Service (EPS) and will shortly be provided for NHS Number for Babies (NN4B) services.” A further update on the transition will be issued this week, the HSCIC said. The Spine is a collection of national applications, services and directories that support the NHS in the exchange of information across national and local NHS systems.
Worcester trust extends NHS SBS partnership: Worcester Acute Hospitals NHS Trust has signed a five year agreement with NHS Shared Business Services (NHS SBS) to oversee the administration of its payroll and pensions services, according to Government Computing. The £1.2m contract – agreed earlier this year – is expected to provide “significant savings” on the trust’s expenditure for administering payroll and pensions payments to staff, while forming the basis of a wider ongoing efficiency drive. As part of this efficiency drive, NHS SBS – a joint venture between the Department of Health and Steria – will aim to introduce a number of measures focused on improved technology and the introduction of LEAN-driven processes in the trust’s operations. Worcester Acute will also be adopting NHS SBS’ ePay Solution that has been designed for healthcare bodies to record timesheet and expenses data. The agreement marks the extension of a nine-year collaboration between the trust and NHS SBS for the provision of finance and accounting support. Though the exact level of cost savings anticipated to be made by the trust under the new agreement were not provided at time of press, NHS SBS claimed it currently processes two million payroll transactions annually for 78 clients across the NHS. The joint venture claimed it had a 99.8% accuracy rate for these operations.
Make Fertility Conceivable is the national campaign to tackle male infertility in the UK. Its aim is to help break the taboo surrounding male infertility and make a greater range of effective treatment options available to men. The campaign, launched and headed by Dr Xiao-Ping Zhai, is calling on the UK to pioneer once more and become the world lead in tackling male infertility. Please support the campaign by following them on Twitter at @MakeFertCon, like them on Facebook https://www.facebook.com/makefertilityconceivable and sign their e-petition: http://epetitions.direct.gov.uk/petitions/68672
Opinion
Why are doctors so reluctant to be leaders in the NHS?
Kate Wilson, consultant at Hay Group discusses how many doctors associate leadership roles with a heavier workload, lack of resources and mistrust in management.
“Let’s start with the reality facing many doctors today. Being a doctor is what they’ve trained for and worked towards for most of their professional careers. Talk to them about taking on a leadership role, however, and many won’t have thought about it. Looking at their colleagues trying to balance medical and management careers, they are likely to see a struggle with workload (51% of leaders cite demands on time as a factor deterring them from taking on leadership roles), a lack of required resource (46%), and a lack of trust in management (43%) as challenges. In our survey, the biggest issue medical leaders identify in attracting future talent is not a lack of leadership skills, but the roles themselves; they do not hold appeal.
“This is a far more fundamental challenge than that raised by a lack of leadership experience. Doctors told us they don’t want to give up their medical careers to take on leadership roles, they want to combine them and receive more support earlier to help them do this. They don’t want to lead from the front – they want to be part of the team, supported by peers and managerial colleagues. They also want more help in areas such as human resources, finance and administration. Finally, they want their role to be recognised, valued and celebrated.
“What does this mean for organisations struggling to develop their medical leaders? It starts with them exploring the question: what is the role of our medical leaders and is it doable? It requires organisations to articulate what is required of these roles clearly and realistically, how they will fit with clinical careers, and how doctors will be supported to deliver them.”
Power to the people on communities of care
Paul Hodgkin, founder and chair of Patient Opinion, reflects on and compares the changes brought on new technology with the ones brought on almost two centuries ago by his great, great, great uncle Thomas.
“My great, great, great uncle Thomas Hodgkin was the pathologist who in 1832 first described what ultimately became Hodgkin’s disease. A fierce Quaker and abolitionist, he was one of those setting out on the great voyage to understand the interior of the body. For a visitor from that time – 180 years ago – much of today’s medicine would be indistinguishable from magic. The imaging; the therapeutics; the unfolding majesty of the genome are stunning testaments to how far Thomas’s journey into the body has come.
“For medicine, the golden age is always now. Yet both clinicians and patients know that although this is the best of all possible times to be practicing medicine, there is still much wrong with health care.
“Death, distress, the human processes of caring and creating our meanings through our interactions with disease; no doubt he would recognise all these well enough. And he would recognise too the enduring asymmetry between physician and patient – after all only one of us is ill, only one of us lies on the operating table whilst the other holds the knife. Somehow, health care is full of honourable people trying hard to do their best in a system that, in its individually well-intentioned particulars, creates stunning amounts of waste, carelessness and disillusion.
“It is not just that power and information are shared more equally. Patients are no longer alone. On the darkest of nights they can reach out and touch someone half way round the world who knows exactly what they are talking about because they too have been there.
“Communities of patients, in control of their records, generating their own data from bio-sensors, and no longer isolated but collaborating together at scale will threaten professionals. They also represent the next great hope for reclaiming the humanity within healthcare.”
Care reform: there is no ‘do nothing’ option
The post-war settlement establishing the NHS and a separate social care system has become confusing and deeply unfair says Chris Ham, chief executive of The King’s Fund
“The post-war settlement established the NHS as a comprehensive system of health care, free at the point of use, while the social care system remained means-tested and based on need. This settlement created a divide between health and social care which still exists today. Over 65 years of social, technological and demographic change later, this system has not kept up. Demand for health and social care services is increasing, with many more people living longer and with long-term conditions.
“The system is distressing for the people in society who most need help. People are puzzled to hear that dementia is deemed to be a social care problem, which means that they are likely to have to pay for a large proportion of their care themselves, while other conditions like cancer are seen as health problems, so care is given for free. The way the system works is not only confusing but deeply unfair. Many people end up getting lost in the gaps.
“The problems with the current settlement are systemic. They are driven by a lack of alignment in entitlements to health and social care services, the way that these services are funded, and the way that they are organised. The result is a fragmented system which doesn’t work properly for the people who need it. Social care services in particular are underfunded, with publicly funded care only available to those with high needs and low incomes. This means that many people who need care end up going without, paying for it themselves, or relying on the support of relatives and friends to get the help they need. The costs to people and their families are therefore high and the system is heavily dependent on unpaid carers to survive.
“While the social care system is already facing a funding crisis, the NHS is rapidly approaching one too. There is no ‘do nothing’ option. Fundamental and radical reform to our health and social care services is needed to bring the system up to date. Politicians will need to be honest in confronting the hard choices that the Barker Commission proposes.”
Comparing the NHS
Dr Joe McGilligan, chair of The Commissioning Review editorial board reflects on how the NHS compares with health systems internationally.
“Summer is the time for holidays and recharging the batteries. Sadly on my recent family trip to Egypt I contracted awful food poisoning which taught me many lessons. I realised how well regulated and effective our health service is and how different it is in other countries. I was offered any amount of antibiotics and drugs for symptom relief at a price the pharmacist thought I could afford. I only wanted oral rehydration, and had I not been a medical professional, would have been talked into multiple therapies to “cure” me.
“With the general election 10 months away, the political football that is the NHS is being inflated for another kick about. Already I am hearing calls to pause progress until we know who the political masters are and their ‘new ideas’ to solve the healthcare crisis. Politicians are all for reconfigurations so long as it is in someone else’s back yard. The endless debate about privatising the NHS must end with proper commissioning on outcomes for patients, not incomes for providers. Patients want quality care supported by health, and with the better care fund partnership working, I believe it can be achieved.
“Before his white paper, I asked Andrew Lansley: if GPs are self-employed, hospitals are all foundation trusts and community providers are social enterprises, would anyone be employed by the NHS? His reply was that it did not matter who employed the workers so long as the qualities and values of the NHS were upheld, which are free at the point of delivery irrespective of the ability to pay. Unfortunately we persist in trying to realise a socialist ideology using capitalist business models which will never work. My Egyptian experience has spurred me on to find a workable solution by harnessing the power of clinical commissioning based on needs not wants or the ability to pay. It will take special leadership to avoid being deflected and distracted.
“You would have to be crazy not to try.”
Highland Marketing blog
In this week’s blog, Myriam McLoughlin offers some advice on crisis management and why it is important to hope for the best and prepare for the worst.
