News in brief
Junior doctors dispute – poised for escalation: The fourth round of strike action at hospitals in England has taken place but there seems no prospect of any imminent return to talks, reported the BBC. The two sides in this acrimonious dispute, the government and the British Medical Association, seem firmly entrenched. There is a general assumption that the planned all-out strike by junior doctors at the end of April, the first in NHS history, will inevitably take place. Disputes involving strike action are often punctuated by talks. But, since the health secretary Jeremy Hunt announced in February that a new contract for junior doctors in England would be imposed from August, there has been no contact between the two sides. Hunt and NHS Employers were adamant that they went the extra mile to try to get a deal, offering better terms than previously put forward for doctors working one weekend in four or more. They argued that, after months of negotiations, the BMA refused to discuss the outstanding issue of Saturday pay – and that therefore imposing a new contract was unavoidable. And according to The Guardian Hunt has inflamed the dispute with junior doctors by insisting “the matter is closed” and he will impose the new contract on them, despite unprecedented protests by medics.
NHS would be ‘completely unrecognisable’ within years if UK remains inside the EU: The NHS would be “completely unrecognisable” within years if the UK remains inside the European Union, Lord Owen has warned, reported The Telegraph. The former Labour foreign secretary said the health service will become fragmented and subject to increased competition because of a new trade deal, unless we withdraw from the EU in June. Speaking at the offices of the Vote Leave campaign in London, Lord Owen said he has “no doubt” that the effect on the NHS would be worse if the UK remains inside the 28 member-state bloc. He said: “That is the direction of travel. It is to make it completely unrecognisable. We are agreed in Vote Leave that whatever our political views on the present marketisation of the NHS, these decisions should for the future be for the UK Parliament and devolved administrations to take. It involves your families, it involves your homes, it involves your life. This is not a decision for a remote bureaucracy in Brussels.” Lord Owen argued that Brexit would prevent the UK from having to adopt the Trans-Atlantic Trade and Investment Partnership plan (TTIP), which critics fear could introduce an American style healthcare market to the UK. He also warned that Labour has failed to speak out against TTIP, despite concerns about what it might do to the NHS, claiming the party “didn’t want to know for the last three or four years”.
Welsh Government pledges £43m to primary care: The Welsh Government has pledged £43m over the next year to improve primary care services, including £10m for the country’s 64 primary care clusters, reported Pulse. The £10m will enable groups of GPs to work with other healthcare professionals – including pharmacists, dentists, therapists and nurses – to develop services closer to home and free up time for GPs to care for people with more complex needs, said health and social services minister Professor Mark Drakeford. About £26m of the new funding will go to health boards to implement local plans. Professor Drakeford said: “Our vision for primary care is for more services to be delivered in local communities, closer to people’s homes, with care being delivered by a range of skilled healthcare professionals working together as a team.” The Welsh Government has already announced GP practices in Wales will be getting a 2.2% funding uplift from April, which it said translated to a 1% pay increase.
Hundreds of GPs recruited from India to help government meet pledge to add 5,000 family doctors by 2020: Hundreds of GPs are being recruited from India to help fill the growing crisis in general practice and meet a government pledge to add 5,000 family doctors by 2020, reported the Independent. Health Education England (HEE), the non-departmental body of the Department of Health responsible for NHS training, has signed a “memorandum of understanding” with a major hospital chain in India. The deal with Apollo Hospitals will involve the transfer of up to 400 GPs to England but HEE said that the details “are still under discussion”. The Chennai-based hospital chain, which employs more than 40,000 people and has a £500m turnover, offers a diploma in family medicine which is accredited by the Royal College of General Practitioners. Apollo Hospitals said it signed the memorandum as a “starting point” to explore how both countries can benefit from “the mutual exchange of ideas and clinical staff in improving the education and training of healthcare staff” and patient care. “These are initial discussions but we look forward to announcing the outcomes of this work over the coming months and years as it progresses.” The move to recruit GPs abroad comes after doctors’ leaders claimed this week general practice is in “crisis” and warned that the sector is nearing “saturation point”.
Online portals and shared records are a priority for GP services, says Nuffield Trust: Technology is central to the future of primary care services, but still has a long way to go before it improves the working lives of staff and patient outcomes, according to a report by the Nuffield Trust. The report, on digital requirements for new primary care models, was commissioned by NHS England and sets out a series of possible scenarios for the future of primary care, including improved patient access through mobile working and remote consultations, and “permeable boundaries” between care settings, reported Computer Weekly. It said GP services would have to “fundamentally change in the coming years” because of financial difficulties, increasing patient numbers and a shortage of clinicians and that “technology connecting professionals will enable GPs to work consistently with hospital doctors, and general practice will become increasingly part of the same service as district nursing.” The report also highlighted that there are three types of technology that need to be prioritised, including shared electronic patient records that any professional can access at the point of care, “including when they are physically away from hospitals or GP surgeries”. It called for “video, voice or online communication to allow patients to get in touch and have consultations with primary care professionals more easily, and to be matched up with the staff group who can most efficiently meet their needs”. And the report warned of the problem of innovation and transformation happening in small, short-term pilot schemes that were not sustainable in the long term.
Ireland details €875m EHR plans: Ireland is planning to spend up to €875m (£700m) on building an electronic health record (EHR) over the next five to nine years, reported DigitalHealth.net. The aim is to implement a national EHR, made up of four key parts; an acute electronic patient record (EPR); a community EPR; an integration platform; and a national shared record provided via a portal. The proposal includes a case for a five-year delivery or a nine-year, but this will be decided at a later stage. Costs over five years (from 2016-2022) would be €345m to €467m in capital costs and €302m to €408m in revenue. The nine-year delivery plan (2016-2025) would be slightly less, totalling up to €824m in total. Ireland’s chief information officer for health Richard Corbridge believes the nine-year plan is more achievable as the five-year plan will be particularly challenging around resources. A new National Children’s Hospital will be the first to deploy the chosen acute EPR, which will be configured for paediatrics. Corbridge said that the chosen EPR will need to integrate with current capabilities and implementation will be in a phased, modular way, ending with a single solution set in around ten year’s time. A senior chief clinical information officer representative will provide clinical representation on the EHR programme board, along with two clinical representatives for acute and a clinical representative for community. Corbridge said people are receptive to the need to digitise the health service and eHealth Ireland’s successes over the past year show it can deliver solutions to improve care, but it is still a large amount of investment to be asking for in a difficult financial time.
GP IT suppliers agree to standard open APIs: England’s four principal GP IT system suppliers are committed to developing standard open Application Programming Interfaces (APIs) and are working on a plan detailing when they will be released, NHS England has said. A “composite plan” will be released at the end of this month with the aim of having the initial list of agreed APIs developed and either in testing or live within two years, reported DigitalHealth.net. NHS England’s head of enterprise architecture Inderjit Singh said all four principal suppliers – Emis, TPP, INPS and Microtest – were “fully on board around the need for structured real-time APIs.” The three initial APIs, or standard interface mechanisms, will be around appointment booking, tasks and record access. Singh said priority areas are being driven by demand from the clinical community. They are being developed by NHS England and the Health and Social Care Information Centre in partnership with the principal suppliers and delivered via a programme called GP Connect. NHS England’s senior responsible officer for GP Systems of Choice (GPSoC) Tracey Watson said the latest national GPSoC contract, signed by the suppliers in 2014, detailed the need for supplier-specific APIs.
Communities share £560,000 for digital projects: A total of 20 projects involving 34 councils will receive a share of a £560,000 fund set aside for digital schemes that will transform local services. The Local Government Association (LGA) is funding councils in England to develop digital solutions to support work on national transformation programmes involving troubled families, health and social care integration and welfare reform, reported Digital by Default. The aim is to develop digital solutions which can be reused by other councils and will enable them to operate more efficiently. Examples of funded projects include a tool to identify the top 20 adults with complex adult social care needs and chaotic lives in Hounslow, a project in Wigan to develop a single view of a child’s record across multiple agencies, and expanding the troubled families programme in East Sussex. As councils face the twin challenges of decreasing funding and increasing demand, they have found new ways of using technology to deliver services more effectively and to enable their staff to work in new ways, increasing productivity and reducing costs. Councillor David Simmonds, chairman of the LGA’s Improvement and Innovation Board, said: “This programme seeks to build on this good work by enabling a group of councils to use digital tools and approaches to support their wider work to transform local public services. Local government has made huge progress in enabling residents to carry out transactions online. Councils now need to fully utilise digital technology to help deliver more efficient services to manage rising demand and expectations from their residents. Councils have championed the use of new technology as it emerges and we have highlighted opportunities for central and local government to share digital platforms for common online transactions, such as payments, as part of joining up how we deliver citizen and business focused public services.”
Call for review after £725m NHS contract collapses: The findings, from an NHS England inquiry into a “novel” £725m, five-year contract covering Cambridgeshire and Peterborough, may cast doubt over the health service’s ability effectively to outsource care to other providers as it struggles with a £30bn funding gap by 2020. The report, appearing on the NHS England website, called for a review of “all current and planned clinical commissioning groups (CCGs) and NHS England contracts of this sort as a matter of urgency, prior to entering into any new commitments”. Despite initial expectations that sweeping health reforms, introduced three years ago, would lead to swaths of NHS services being put out to tender, the most authoritative study so far suggests that just 6% went to market in the first 18 months after the changes became law, reported the Financial Times (subscription required). However, the East Anglian contract broke new ground in basing a significant proportion of payment on outcomes and was being closely watched by health leaders and politicians. The contract, which covered all community care for over 18 year olds, acute emergency care for over-65s and older people’s mental health services, was awarded to Uniting Care, an all-NHS consortium, which defeated two shortlisted commercial bidders, Virgin Care and Care UK. The report concluded that it collapsed “for financial reasons” and said all parties involved continued to support the idea behind it: that services for older people should be commissioned in a more seamless way. NHS England said the review “contains useful initial lessons to inform how the NHS approaches similar contracts in future and we will consider its findings carefully”. A second stage of the review would begin as soon as possible to investigate areas including the role of the advisers, it said.
Dudley Group NHS Foundation Trust wants new EPR by 2018: The Dudley Group NHS Foundation Trust has issued a tender for an electronic patient record (EPR) system as part of a “radical new IT strategy”, reported Computer Weekly. The trust is looking for a “clinical wrap EPR” to be used across the organisation, including a patient portal and e-prescribing. In the tender document, the trust said it is seeking “a commercial and well-established solution to ensure compliance with the implementation timescales of a go-live date of 2018”. “Therefore any solution which is not developed for a rapid implementation is unlikely to be successful,” it added. In its IT strategy, which forms part of the trust’s strategic plan, published in 2014, it said it wants an EPR available at the point of care to ensure its services are “safer, more efficient and more effective for patients, carers and staff”. It wants an EPR that can integrate with other services, such as primary, community, secondary and social care, in line with NHS England’s mandate for all NHS organisations to have interoperable electronic records available at the point of care by 2020. The desired system will have a range of modules, including: nursing documentation, electronic observations, order communications, theatre management and clinical decision support. It will also need to cover maternity services in the community and in the hospital, as well as clinical documentation to replace the current paper record.
Mental health trust forced to cut services: A mental health trust in Manchester has cut seven frontline community-based services to save £1m, in one of the first major decisions taken since the city was given total control over its health budget, reported Pulse. Manchester Mental Health and Social Care Trust (MHSC) proposed the cuts in October and, despite a huge public outcry, decided last week to push through with plans. The decision comes as Greater Manchester has been given complete control over its £6bn health budget following the implementation of ’DevoManc’, becoming the first region of England to have devolved healthcare powers. Services to be cut include those for chronic fatigue and psychosexual disorders, as well as gardening therapies. MHSC said: “The trust, like many others across the country, is working under tough financial pressures and it has been a difficult decision for the board to make but one which is supported by our commissioners.” It added that it will reinvest £200,000 into a new citywide wellbeing service. A spokesperson said: “Our priorities are around keeping people safe and well, which is why we are committed to a long-term mental health improvement programme in Manchester.”
New report stresses importance of dementia advisers for patients – Alzheimer’s Society: Every dementia patient should have a specialist adviser, the Alzheimer’s Society told National Health Executive following a new Department of Health survey into the provision of services. The report found that 91% of clinical commissioning groups (CCGs) and local authorities surveyed had a dementia adviser service. Services provided by dementia advisers include signposting to other services, training and advice for carers, and advocacy to help patients get services such as home adaptations. George McNamara, head of integrated care at the Alzheimer’s Society, which provides 75% of adviser services, said: “What this report shows is that dementia advisers are absolutely vital to help people with dementia to live well with the condition.” McNamara said that commissioning dementia advisers saves health and social services money in the long run by reducing unnecessary hospital and care home admissions. As part of its Right to Know campaign, the Alzheimer’s Society is calling for all patients to have access to dementia advisers, as well as for improved diagnosis rates and for all patients to receive a diagnosis within 10 weeks. McNamara also said it was important to ensure that patients have the same adviser throughout the progression of their illness. The report also shows that CCGs are spending more on dementia adviser commissioning than local authorities and employing less staff.
Unplanned admissions DES is failing to reduce emergency activity: GP practices that devise care plans for the majority of their most vulnerable patients have higher rates of unplanned admissions, a Pulse analysis of official figures has shown. Data on the Avoidable Unplanned Admissions DES, published by the Health and Social Care Information Centre (HSCIC) last week, showed that practices that put most of their patients on care plans had a higher rate of unplanned admissions than those who put few patients on care plans. The findings undermine the objective of the DES, which is worth £20,000 for an average practices and aims to reduce the number of unplanned admissions to relieve pressure on hospitals. The GPC said this data proves there was “no link” between the DES and reducing unplanned admissions. NHS England’s DES specifications said: “This enhanced service is designed to help reduce avoidable unplanned admissions by improving services for vulnerable patients and those with complex physical or mental health needs, who are at high risk of hospital admission or re-admission.” But Pulse’s analysis of HSCIC statistics has suggested that those that give more patients written care plans under the DES are more likely to have higher rates of emergency admissions.
Opinion
Five IT fixes we desperately need
Dr David Hogg reveals his five IT fixes he thinks we desperately need.
“Despite good computer systems doing a lot to ensure patient safety, there are frequent occasions when it becomes a rate-limiting step to improving patient care.
“Here’s my top five IT fix requests:
“1. Use standard usernames – Each system appears to require its own type of login. We need this to be standardised. The NHSnet email address is a good place to start for a username or alternatively couldn’t we use the registration number – GMC, NMC, HPCC? The username ‘gmc123456’ makes a lot more sense.
“2. Make wifi freely available – Let’s accept that accessible wifi is indeed established in Maslow’s hierarchy of needs, and provide open wifi (not restricted to NHS devices) to everyone who needs it to do their job effectively.
“3. Stop prohibitive firewalls – We need to realise that prohibiting access to knowledge is standing in the way of personal development – and sometimes patient care and safety.
“4. Sort out remote access – From a retention point of view, remote access is being hailed as a considerable advantage. It also allows for more integrated, effective care
“5. Allow for a decent primary/secondary care IT interface – We should be able to email from EMIS/GP system of your choice and see integration from the outset – if not from patients, then at least other professionals.
“We have seen eye-watering amounts of cash spent and wasted on either half-hearted IT systems, or even failed installations where the contractor still walks away with the millions, and yet no on-the-ground improvement. There are of course some great examples of where IT has worked very well. However, with ramifications for so many aspects of healthcare delivery – including retention of current staff – we need this to be better.”
Our ageing population presents the NHS with its greatest challenge
The newly appointed national clinical director for older people and integrated care, Dr Martin Vernon, looks at what he sees as his main challenges:
“I was brought up in a close-knit rural community among a large and long-lived family. As an impressionable teenager I observed people dealing with a host of long-term medical conditions where the nearest hospital was miles away and largely inaccessible. I was fascinated by the prospect of ageing and struck by the conundrum of how to best care for someone who had complex and quite probably incurable illnesses.
“Much has changed in the NHS since then. The lessons in population ageing and the ‘demographic time bomb’, I first learned at Manchester Medical School in the 1980’s continue to ring loud and true, but with a sense of urgency as never before. When the NHS was founded nearly 70 years ago, one-in-two people died before they reached 65. Now this has dropped to about one-in-eight. By the time they reach 65, men can now expect to live on average for another 18 years and women for 20 years. Population ageing, effective management of long-term conditions and improved life expectancy are of course success stories for the NHS. But they also present significant challenges to us all.
“The average age of people admitted to hospital acutely is over 70 and people over 80 occupy a quarter of bed days in English hospitals. The vast majority of people staying in hospital over two weeks are over 65 and the cost of acute care rises with age. Older people are more likely to be readmitted to hospital and more likely to experience delay in transfer to other health or social care settings including their own homes.
“As the new NCD for Older People I intend to pursue all available opportunities for preventative, collaborative care offered by identification of pre- and moderate frailty. I want to explore how we can make better use of data sharing and so called ‘big data‘ to develop new ways of measurement which also support clinical decision making and improve health and experiences of care outcomes for older people living with frailty. This is, after all, why I went into medicine and I am thrilled to be privileged with the opportunity help take our NHS forwards.”
Digital maturity: what does it mean, and how are we doing?
Displaying all clinical information on a screen is not ambitious enough in defining digital maturity, says Cindy Fedell, director of informatics at Bradford Teaching Hospitals, on DigitalHealth.net.
“The definition of digital maturity in healthcare may be contentious; certainly, different people have different views. Just this past week, someone I was talking with offered the definition: ‘displaying all clinical information on a screen’.
“For me, that is simply not ambitious enough, and we need to make sure that people have greater expectations. It’s all about fulfilling the potential – using technology to make the care and treatment of a patient safer, and using data so that we can learn from both good and bad outcomes.
“When we talk about ‘digital maturity’ and ‘being paperless’ are people actually talking about improving patient outcomes? I’d say not; or at least, not consistently. Saving money, being efficient, improving services, facilitating transitions of care – yes. Using technology and information to make care safer – no, not always.”
