Highland Marketing blog
What does 2017 mean for healthcare? Healthcare technology leaders share their views with the Highland Marketing Healthcare Roundup.
News in brief
NHS could face its worst January as it struggles with festive backlog, warns doctor: The NHS is facing “potentially the worst January” ever as it struggles to deal with the backlog of patients occupying beds over Christmas, a leading doctor has warned. Dr Mark Holland, president of the Society for Acute Medicine, said hospitals had already seen large numbers of elderly patients over the festive period and that the health service was on the brink of a major crisis, reported The Guardian. Holland, who is based in Manchester, said hospitals were operating under a “false sense of security” as elective procedures dipped during the Christmas period, with those beds becoming available for emergency patients. He said the service was going to face the health equivalent of the “credit card bill from hell” after the festive period and called on the government to announce its contingency plans for a “possible worst-case scenario”. Holland, who leads the national body for acute hospital staff, told the Press Association: “There’s this problem over Christmas and New Year where actually, because you get this glut of beds that become available, you’re just building trouble up for ourselves in January. And then … when the flu kicks in, if the winter vomiting virus kicks in, which would potentially close a ward, or if there’s just a cold snap – when any of these things occur we will be under more pressure, but actually we’ll still be spending most of January trying to clear the Christmas and New Year backlog.” This year January could be “one of the worst we have faced” due to record numbers of elderly patients who cannot be discharged because they are waiting for social care, he said.
Social care funding: MPs urge ‘swift’ cross-party review: The heads of three Commons committees have urged the prime minister to find a “political consensus” on funding social care in England before 2020, reported the BBC. They said a cross-party review is the best method of finding a “sustainable way” to fund rising social care costs. The MPs said agreement must be found quickly if it is to be reflected in the next spending round. The government said adult social care will receive an extra £900m funding over the next two years. The Local Government Association estimated there will be a £2.6bn funding gap in providing adult social care in England by 2020 – because of pressures from an ageing population, inflation and the cost of paying the National Living Wage. The government announced in December it would allow councils to raise council tax further to pay for social care – by up to 6% over two years, rather than three. But a letter signed by Clive Betts, chairman of the Communities and Local Government committee, Public Accounts Committee chairman Meg Hillier and her Health Committee counterpart Dr Sarah Wollaston said a long-term solution can only be found if there is cross-party consensus. “Given the scale of rising demand, this immense challenge will face whichever party is in government over the coming decades,” they wrote. They said a review should begin “as soon as possible” adding that the Commons Health Committee had already concluded that the social care system was at “breaking point”.
Mistakes by hospital staff see sharp rise, official NHS figures reveal: Serious mistakes by hospital staff that put vulnerable patients at risk have risen, official NHS statistics have revealed. The number of cases in which NHS England recorded a patient whose health was deteriorating received “sub-optimal” care has more than doubled in the past two years, from 260 in 2013-14 to 588 in 2015-16. In the same timeframe, diagnostic incidents – either a delayed diagnosis or an NHS worker not acting on test results – rose from 654 to 923, while the number of surgical incidents more than doubled from 285 to 740. The figures, obtained through a freedom of information request submitted by former Liberal Democrat health minister Norman Lamb, have highlighted that heightened strain on hospitals, such as staff shortages and cuts in the NHS, could be making staff more likely to make errors. Lamb said the “disturbing” figures showed that thousands of patients in need are being failed due to “intense strain” being put on the NHS by inadequate funding. “The secretary of state [Jeremy Hunt] has stated [his] objective to make the NHS the safest health system in the world, but what we see is serious incidents increasing quite significantly and that’s very disturbing,” he told The Independent. “The one thing that’s completely clear is that the NHS is on its knees financially and it’s in an impossible position. Demand is rising and that amount of money the government makes available is not nearly enough. The danger is that with the system under such impossible strain, we will compromise care and more serious incidents will occur.” Lamb is calling for a cross-party commission to be established on NHS funding that would properly engage with the public on future alternatives, including a possible new tax dedicated to health and social care.
Nearly 700 Scottish patients die while waiting for hospital release: Nearly 700 patients have died waiting to be discharged from Scotland’s hospitals since Scottish National Party ministers promised to eradicate such delays from the NHS, it has been disclosed. Labour obtained official figures showing 683 people died in hospital between the start of March 2015 and the end of September 2016 after being medically fit to leave, reported The Telegraph. However, health minister, Shona Robison, pledged in February 2015 to eradicate the practice of delayed discharge – also known as bed blocking – by the end of that year. The problem occurs when patients are well enough to leave hospital but have to wait for support to be put in place in their own home or for a vacancy at a care home. This means they continue to take up a hospital bed unnecessarily, which could be used for another patient. Despite Robison’s pledge to abolish bed blocking, the latest NHS figures showed 1,576 patients had their discharges delayed in October, up from 1,524 the previous month. Over the course of October, patients spent 43,919 days in hospital as a result of delayed discharge. Labour said the actual death total would likely be higher than 683 as some health boards were unable to disclose their figures as they may have identified individual patients.
Seven-day NHS plan puts weekday surgeries at risk, warns top GP: Britain’s top GP has said surgeries will have to stop seeing patients during the week unless ministers abandon their drive to guarantee access to family doctors at weekends, reported The Guardian. Dr Helen Stokes-Lampard condemned the policy, a key Conservative pledge, as unrealistic and said it was ignoring the lack of demand among patients to see GPs at weekends and a serious shortage of family doctors. The government has promised to ensure that people in every part of England will be able to see a GP from 8am to 8pm every day of the week by 2020 as a key element of its push to create a “truly seven-day NHS” by the end of the current parliament. “It’s unrealistic in the current climate. We haven’t got the people, we haven’t got the resources. If you give people access on a Sunday afternoon they’re not going to have access on a Tuesday morning. They can’t have it all,” the chair of the Royal College of GPs said in an interview. Calling for surgeries weekend opening to be restricted to Saturday mornings, Stokes-Lampard said: “We should be responding to what is needed in an area, and balance that realistically by what can be provided safely. Because quite frankly if you open on a Sunday afternoon but you’re closed on a Tuesday morning, who’s going to benefit?” There is so little demand from patients to see a GP on Sundays that plans to compel at least one surgery in each area to open on that day by 2020 should be dropped, she said. Nor do many people want to attend a surgery on a Saturday afternoon, she added.
Thousands forced to wait outside swamped hospitals as cold spell hits: Heaving accident and emergency (A&E) departments are forcing thousands of patients to wait for hours in ambulances outside hospitals as freezing conditions hit the UK, reported The Telegraph. Health chiefs were forced to apologise after spiralling waiting times in one hospital caused a queue of 20 ambulances unable to offload patients. In London alone, the winter crisis means more than 6,000 patients each week are being left in the back of emergency vehicles because A&E departments are too busy to admit them, new figures revealed. The crisis in hospitals means that ambulance services are then unable to respond to subsequent 999 calls. Britain’s most senior emergency medicine doctor Taj Hassan, president of the Royal College of Emergency Medicine, said departments across the country were “buckling under pressure” with staff “working at the very limits of their abilities”. The first week of January is traditionally one of the busiest periods of the year for the health service, as people seek help for illnesses and injuries picked up during the Christmas period. NHS guidance now states that only patients suffering life-threatening emergencies should be treated in A&E. Doctors at some hospitals have reported on social media that “major incidents” had been declared because of the flood of patients. NHS England did not comment on the claims.
Private companies given more chances to win NHS work: Private sector companies have been invited to bid for 14% more NHS contracts than a year previously, in the latest sign of the changes being made to healthcare provision in Britain. Research for the Financial Times (subscription required) by Bain & Company has found that the number of tenders rose to 248 in the 12 months to August, compared with 217 in the same period a year earlier. This lifted the annual value of work advertised to £5.9bn. But there was also a shift away from mega tenders towards smaller and medium-sized deals in 2016, which meant the value of clinical outsourcing tenders increased by just 3%. This excludes laboratory services, research and development, pharmacy services, training, equipment and consumables. Among the companies taking on the new work were privately owned businesses such as VirginCare and Care UK as well as stock market-listed multinationals including UnitedHealth Group, Acadia Healthcare, Circle, Capita and Interserve. Use of private sector providers is still greatest in community and mental healthcare, which accounts for around half of all the NHS outsourcing deals put out to tender. Not all of the contracts advertised were awarded to the private sector but Rafael Natanek, healthcare partner at Bain & Co in London, said an increasing number of commissioning authorities had developed agreements with private sector suppliers to help them procure services more efficiently. He also forecast that “[a] combination of cost pressures and increased experience around the NHS contracting processes should lead to a rise in the value of deals coming to market”.
NHS Wales to build new health and social care centres with £40m capital fund: A £40m capital funding boost for NHS Wales will help to build a ‘new generation’ of integrated health and social care centres and modernise some existing facilities, the Welsh government has said. The funding increase was included in the Welsh budget announced last month, reported GPOnline. GP leaders in Wales welcomed the £40m capital funding allocation, warning that the gap between existing premises and what was needed to meet patients’ needs was widening. Welsh health minister Vaughan Gething said: “The significant funding announced in the final budget is great news for local health boards in Wales. We know a number of them are looking forward to bringing forward investment in developments to improve the integration of health and social services in their areas. The money announced in the final budget will allow them to do just that.” Gething said no specific detail on projects the extra funding would pay for could be published at this stage, but he added: “We expect the funding announced today will bring forward a pipeline of new projects in every local health board in Wales which will make a real difference for patients.” The new investment will form part of a three-way agreement to be established between the Welsh government, local government and social care employers to work together to create a more stable social care workforce, reported ITV News.
BMA: STPs lack meaningful transformation other than ‘drastic’ service closures: Sustainability and transformation plans (STPs) put the NHS at risk of drastic service closures, Dr Mark Porter, chair of the British Medical Association (BMA), has said as he warned that the NHS needs an urgent funding increase to continue operating, reported National Health Executive. In his New Year’s message, Dr Porter stated that ‘post-truth’ politics are infecting the NHS, with the government in denial of the “obvious” funding deficit. Dr Porter said that STPs, proffered as the solution to the NHS deficit, had “revealed a health service that is in fact unsustainable without urgent further investment, and with little capacity to ‘transform’ in any meaningful way other than by closing services on a drastic scale”. The South West London and Lincolnshire STPs are among those containing plans to close local hospitals. NHS Improvement has also already warned that the requests for new capital in the STPs ‘exceed what is available’. Dr Porter explained that the BMA considered that the draft STPs failed to meet its objectives of being realistic and properly funded and prioritising patient care, and predicted that they would lead to £26bn health and social care cuts. He added: “STPs are meant to bring health and social care together, and in a grim kind of way they do. It is clear from many STPs that each is desperately trying to prop up the other, their crutches cracking under the weight.”
Trusts in mix for millions in digital funding: Fourteen mental health trusts are vying to secure up to £5m of central funding as part of the digital exemplars programme, Health Service Journal (HSJ, subscription required) said. Six of the shortlisted trusts, which include Tavistock and Portman, Northumberland, Tyne and Wear, and South Essex Partnership University foundation trusts, will be selected in the coming weeks, sources familiar with the process told HSJ. Decisions on which trusts will get funding in a second tranche of allocations for acute trusts, as well as a health economy-wide digital exemplar, are also expected in the coming weeks. The mental health trusts will become “national exemplars” and in addition to the funding, will receive other central support to deliver projects that NHS England hopes will provide models for other trusts to follow. The news follows health secretary Jeremy Hunt announcing in September, in response to the Wachter review of NHS IT, 12 acute trusts would receive up to £10m to become “global exemplars”, and a further 20 trusts would become “national” champions of digital technology and get up to £5m.
GPs demand halt to STP process amid fears of ‘severe’ NHS cuts: Dozens of GPs in an east London borough have signed a statement calling for the sustainability and transformation plan (STP) process to be halted, reported GPOnline. More than 30 GPs – nearly one in six of the entire workforce in Tower Hamlets – as well as a number of nurses, managers and other staff from practices in the borough, warned that the requirement on NHS organisations across England to find £22bn in savings was not possible without ‘severe’ cuts to services. The statement, published to coincide with the end-of-December deadline for NHS contracts and operational plans for the next two years to be signed off, called for STPs to be stopped and for NHS services to be adequately funded. “We are not against change that is clinically evidenced but we cannot sanction this financially driven exercise,” the statement said. STPs will have a major impact on general practice, with several forecasting significant reductions in GP numbers in their area in coming years.
Health data breaches on the rise: The NHS is facing a growing number of cyber threats, with more than 70 cyber incidents disclosed in just three months. The latest figures from the Information Commissioner’s Office (ICO), obtained by DigitalHealth.net, showed that the NHS, and other UK health providers, reported 239 “data security incidents” from the quarter, 1st June to 1stOctober, 2016. Cyber incidents accounted for 74 of these reports, the most common category. Health organisations also disclosed 65 occasions when unencrypted devices, such as USB drives or laptops, carrying health data were stolen or misplaced. Since April 2015, when the ICO started keeping records, the health sector had reported more than 1330 data security incidents. This latest quarter marked the second highest number of incidents reported on record. Overall health disclosed more than four times as many security incidents as any other sector during the period to October, with the second placed local government sector reporting just 62 incidents. The ICO said that the high number of incidents in health were influenced by the mandatory data breach reporting in the NHS, which was not a requirement in other sectors. However, overall across all sectors reported data security incidents more generally, and cyber incidents specifically, were on the rise.
NHS trials barcode system to reduce mistakes during treatments: Barcode technology could be rolled out across NHS England in an effort to reduce mistakes and cut costs, reported Sky News. Six NHS trusts are currently trialling the scheme, which is called Scan4Safety. Universal barcodes are attached to medical supplies and equipment – as well as to patients, nurses and doctors. At each stage of a patient’s treatment, the codes are scanned. The technology is designed to help bring down the number of mistakes made during treatments. For example, it could reduce instances of incorrect implants or blood transfusions administered to patients. The Department of Health has not confirmed how much it would cost to roll out the scheme to all of NHS England. However, each trust involved in the pilot has received £2m, suggesting it could cost a total of about £460m to introduce these systems nationwide. Health secretary Jeremy Hunt told Sky News: “The costs will be of that order to begin with, but of course the savings are huge because one of the most expensive things you can do in a trust is to give someone the wrong care. We still have sadly too many avoidable deaths – around 150 every week across the NHS. And what you do with modern technology is you reduce the chances of this happening.”
Michael Thick elected chair CCIO Industry Network: Michael Thick has been elected chair of the CCIO Industry Network, a group of clinicians working for healthcare technology and software suppliers, reported DigitalHealth.net. The chief clinical information officer (CCIO) at supplier IMS MAXIMS said: “As chair of the CCIO Industry Network I want to make sure that in 2017 we focus on breaking down barriers between NHS and supplier CCIOs, to improve patient safety, increase productivity and streamline processes through the use of information.” The CCIO Industry Network was established in 2015 to provide an opportunity for industry CCIOs to collaborate on safety, clinical risk management, and achieving efficiencies and productivity gains from health IT in the NHS. Activities planned for 2017 include webinars, columns and an evening debate series. These will cover usability, interoperability and achieving better outcomes. In December, the CCIO Industry Network advisory panel elected Thick as the chair for 2017. Dr Sean O’Hanlon, chief medical officer for EMIS Health, was elected as vice-chair. Thick said most industry CCIOs came from a NHS clinical background and shared a “common objectives to ensure safe, efficient patient care”. Thick said that the network, which is hosted by Digital Health, was open to industry CCIOs and clinicians working for and advising health IT companies from start-ups to multinationals. “The CCIO Industry Network is here for all clinicians working with or advising suppliers to provide them with a peer support and best practice network.”
London hospital signs Atos deal as part of digital transformation: University College London Hospitals NHS Foundation Trust (UCLH) has signed a 10-year deal with IT services firm Atos to support its increasing use of new technology to improve patient and staff access to IT systems, reported Computer Weekly. The contract supports patient care, education services and research. Under the contract, which has an optional two-year extension, Atos will become UCLH’s main IT services supplier and will provide a managed transformation service. This includes end-user technology, service desk, application management, private cloud datacentre services, information security and service integration and management services. The digital transformation component will include architecture and data services. Neil Griffiths, deputy chief executive at UCLH, said: “This is an important step to create a digitally enabled, exemplar organisation that provides staff and patients with access to the right systems, in the right place, at the right time to enable the delivery of high-quality, efficient and effective patient care.”
Health tech startup Babylon partners with NHS to offer AI-powered service to London patients: Babylon Health, a digital healthcare app, has announced a partnership with the NHS to introduce its artificial intelligence (AI) powered chatbot to more than 1.2 million patients in north central London. The NHS plans to trial Babylon’s chatbot with several London authorities over a period of six months, starting at the end of January. Enabling patients to type in their symptoms, the app responds with questions in order to determine the seriousness of the illness, injury or condition. It can then advise whether the user should seek medical assistance, visit a pharmacy, or manage their medical issue at home. The process usually requires around 12 back-and-forth messages, taking around 1.5 minutes, which is significantly less than the time of the average call with NHS 111, the non-emergency helpline. In an interview with Tech City News, Parsa said Babylon could cut expenditure by the NHS and improve efficiency. He said the NHS has “armies” of call centre workers speaking to people who have contacted 111 about their medical issues, with each call taking 10 to 15 minutes. “It costs the NHS £15. You do it with us, it is free,” Parsa said.
Bidders sought for £190m NHS procurement services: Ten national contracts for the provision of procurement services have been advertised by the Department of Health reported Health Service Journal (subscription required). The contracts, worth a total of £190m over three years, are being tendered as part of a large scale transformation of services currently provided by DHL through NHS Supply Chain. Instead of a single contract, the services have been split into 11 “category towers”, with one lot already awarded to Crown Commercial Service. The current contract ends in October 2018. Private companies and NHS procurement hubs are expected to bid for the contracts. The Health Care Supply Association, which represents NHS procurement staff, has previously raised concerns over the plan, saying it could lead to “fragmentation” of the procurement system and a focus on competition rather than collaboration.
Top 10 NHS IT stories of 2016: 2016 saw one of the biggest stories of the decade, as NHS England decided to pull the plug on Care.data, reported Computer Weekly. In a summary of the top NHS IT stories of 2016, Computer Weekly reflected on the end of the Care.data, the Wachter review, free WiFi across the NHS, the GP Extraction Service, Jeremy Hunt’s promise of £4bn for NHS IT, stolen NHS IT equipment, delays to Scotland’s NHS 24 IT system, cyber security, a pathology IT crash, and uncertainty surrounding the benefits of patient apps.
The big stories on policy and money in 2016: There was plenty of talk of money for health IT, but NHS organisations received more new targets than fresh cash to digitalise in 2016, reported DigitalHealth.net. In a summary of five of the big money and policy moments of the year, the publication reflected on Jeremy Hunt’s promise of £4.2bn for NHS IT, the £100m announced for global digital exemplars, the Innovation and Technology Tariff, Simon Stevens’ “reset” on NHS finances, and the early publication of Shared Planning Guidance.
2017 New Year Honours for health and social care services: People from across the health and care community have been acknowledged for their service in the latest New Year Honours awards, among the people to be awarded include: Sir Cyril Chantler, emeritus professor of Guy’s, King’s, and St Thomas’s Medical School for services to leadership in healthcare; David Behan CBE, chief executive of the Care Quality Commission for services to health and care and Dr Anthony Hill, Hill, lately director of public health, Lincolnshire County Council and NHS Lincolnshire, for services to public health. The full list of New Year Honours is here.
Opinions
What does 2017 hold for social care?
Technology and integration with the NHS could transform the sector, but we must debate alternative sources of funding, writes Mahiben Maruthappu.
In an article for the Guardian Social Care Network, Maruthappu, a London-based doctor and co-founder of technology initiative Cera, says that 2016 will be remembered as the year the UK social care services reached crisis point.
Maruthappu argues that 2017 should be the year that social care and healthcare finally start working together.
“By integrating the two – something that has never happened since the NHS was founded in 1948 – care can become the seamless experience our elderly population deserves. There will of course need to be a culture shift for those working in the system, but the result would mean that medical treatment need no longer be detached from routine care in nursing homes and, importantly, we will be able to squeeze out more pennies from every taxpayer pound.
“There are already promising signs – local authorities should look to Greater Manchester which, in April 2016, became the first locality in England to merge its health and social care sectors and take control of its own budgets.
“The key to achieving this joined-up system is technology. Digital innovation has the potential to transform a sector that is currently disjointed and overcrowded, in which more than 8,000 different companies provide dramatically different standards of care.”
2017 is ‘make-or-break’ for the Five Year Forward View
The King’s Fund’s Chris Ham predicts that the year ahead begins with an ‘epic struggle’ occurring within the NHS, as it looks to sustain current services, transform how care is delivered and fulfil the ambitions of the NHS Five Year Forward View.
In an article in the Health Service Journal reported on The King’s Fund website, he notes: “Brexit and its consequences mean that public finances remain tighter than ever, and domestic issues like health and social care are receiving much less attention than usual at the heart of government.
“The resignations of David Cameron and George Osborne have removed the two members of the Cabinet – apart from Jeremy Hunt – who had a personal commitment to the NHS Five Year Forward View.
“Theresa May and Philip Hammond have much less understanding of the NHS and social care, and unlike their predecessors they lack access to advisers who do. May and Hammond are also known to be unsympathetic to the claims being made for extra funding for health and care, having previously run government departments whose budgets were not protected.
“Against this background, 2017 promises to be another testing year. Leaders at all levels have focused on achieving financial control totals and getting back on track in meeting waiting time targets. They have done so under intense political and media scrutiny and scepticism in some parts of Whitehall about their ability to deliver their plans.”
STP digital plans need a major reboot
The largely vague and un-costed digital components of the sustainability and transformation plans (STPs) need a substantial upgrade, or the NHS will continue to lag behind comparable health systems on technology for years to come, analyses HSJ technology correspondent James Illman.
“Sustainability and transformation plans have fallen well short of their overall goal, so it is not surprising that the digital elements in the plans are also largely undercooked.
“Indeed, the consensus among senior figures working in digital health is that, while there are notable exceptions, very few areas have spelt out a compelling narrative for how they will deliver a digitally mature STP.
“The approach taken in the bulk of the STPs is a cobbling together of previous initiatives and cookie cutter style statements about integrated patient records, e-prescribing and patient access to records, designed to tick the local digital roadmap guidance checklist, rather than tangible delivery plans.
“Even the more advanced plans which do set out cost forecasts raise tricky questions about the huge gap between available and required funding.
“System leaders will have to resist increasingly strong temptation to raid the insufficient but not insignificant amount of funding allocated for the digital agenda to address other pressing concerns – winter pressures being an obvious example.
“With day to day pressure only likely to rise in 2017, it would be easy for local NHS leaders to push technology projects on to the backburner to avoid the cost and short term disruption implications. This will only contribute to an even bigger mess to deal with at a later date.”
