News in brief
IT funds to come from transformation pot: NHS England has indicated that 2016-17 may be the last time that new, central money for IT will be distributed through a dedicated technology fund, reported DigitalHealth.net. In its planning guidance for the coming financial year, the commissioning board said the intention is to shift to a “new, wider, national Sustainability and Transformation Fund”, built around the additional funding for the NHS that the Treasury found in the autumn spending review. Allocations from this new fund will be based on local “Sustainability and Transformation Plans (STP)” which health and care organisations must now complete by June, for assessment in July and publication in October. The planning guidance says these plans should be an “ambitious, local blueprint for accelerating implementation of the Forward View”. The guidance says: “STPs will become the single application and approval process for being accepted onto programmes with transformational funding for 2017-18 onwards. The spending review provided additional, dedicated funding streams for transformational change, building up over the next five years. This projected funding is for initiatives such as the spread of new care models through and beyond the vanguards, primary care access and infrastructure, technology roll-out and to drive clinical priorities.”
Hunt hints at additional funding requirements for seven-day pilots: Seven-day GP access pilots established with one-off investment from the Prime Minister’s Challenge Fund could see an extra injection of funding to maintain them, the health secretary has said. In a debate on health in Parliament, Hunt said the Department of Health was investigating ways to maintain funding and prevent “turning the clock back” on successful extended hours pilots, reported Pulse. Pilot areas that received start-up funding in the first and second wave of the fund were supposed to become self-sustaining by cutting the number of A&E attendances at weekends and evenings that could otherwise be seen by a GP but Pulse has reported that almost half of the pilots have already reduced opening hours, amid lacking patient demand and uncertainty over future funding. Hunt was responding to the Conservative MP for Hereford and South Herefordshire, Jesse Norman, who asked for assurances that his local seven-day working pilots will be “funded to continue” because it’s doing an “extraordinarily good job” for constituents. Hunt said: “We are very pleased with the progress made in Herefordshire and many other areas, and we’re looking at how to maintain funding for those areas. Already 16 million people are benefitting from enhanced access to GPs in the evenings and weekends, and we wouldn’t want to see the clock turned back on that.”
Cross-party review ‘needed for health and care’: A cross-party commission should be set up to review the future of the NHS and social care in England, a trio of former health ministers have said. Ex-health secretaries Stephen Dorrell, Alan Milburn and Lib Dem MP Norman Lamb said without radical change, the future looks bleak. Lamb said even the promises of extra money for the NHS were not enough, reported the BBC. Ministers have pledged £8.4bn above inflation by 2020. However, Lamb said that would still leave the health service short with a growing number of hospitals struggling with deficits and to keep pace with demand, and this is even before the state of social care was taken into account. He claimed those services, paid for by councils, were on the brink with concerns that a number of care home providers were set to leave the market. “The reality is that we will either see the system effectively crash or we confront the existential crisis now.” Dorrell, who is now chairman of the NHS Confederation, and was health secretary in John Major’s government, said he supported Lamb’s bid and predicted the problems being experienced now would “only get worse” in the next decade.
A&E departments across Wales under ‘extreme pressure’: A&E departments across Wales are facing “unprecedented demands”, prompting health boards to urge the public to attend only if necessary. At least five hospitals have declared the highest alert, level four, meaning they are under “extreme pressure”, reported the BBC. It comes as some hospitals in England declared a “black alert”, saying they are “overwhelmed” by demand. The Welsh government said winter plans were working and the situation was “broadly beginning to stabilise”. A spokesman added: “The last few days have seen further, more severe surges in demand following the festive period, especially for emergency ambulance calls, GP out of hours consultations and attendances at emergency departments – all of which have seen a greater proportion of elderly and frail patients with complex needs.” NHS Wales has four main status levels used to determine appropriate responses, level one indicating a “steady state” and level four meaning the service is under “extreme pressure”. Level four alerts have been issued for Ysbyty Maelor in Wrexham, Ysbyty Glan in Clwyd, Prince Charles in Merthyr and Royal Gwent in Newport. A level three alert is in place for Ysbyty Gwynedd in Bangor, with level two alerts for the remaining hospitals.
Child health digital strategy promised: NHS England wants to create a single view of a child’s health record, available online to healthcare professionals and accessible to patients and carers, reported DigitalHealth.net. The commissioning board is developing a five-year Child Health Digital Strategy, due to be published this summer, which will set out plans to bring together information on a child’s health from multiple systems. The services in scope for the strategy include: birth and neonatal care; safeguarding; the Healthy Child Programme; child and adolescent mental health and learning disabilities; acute paediatric care; school health; and primary and community care. NHS England’s head of digital primary care development Tracey Grainger described the current information landscape as “fragmented”, with partial records spread across several different clinical systems. “Because of this there’s no single picture of a child’s health and care history and current needs and, as such, the picture is complex and difficult to access by colleagues outside of the health system, such as education or social care,” she explained. “There’s also still a high volume of paper records going back and forth between different settings, with inevitable duplication of administration and a high margin for error.” She said the new digital strategy will allow the NHS and other services to provide care to children in a much better and more efficient way.
GPs and pharmacists told to reissue prescriptions after P2U failure: The largest NHS-approved online pharmacy in the UK, recently fined £130,000 for selling personal customer data via direct marketers, has asked GPs to reissue prescriptions to patients after a major distribution failure over the holiday period. In a letter sent to healthcare staff on 23 December, NHS England’s head of primary care commissioning, Dr David Geddes, told GPs and pharmacy employees to use the electronic prescription service (EPS) tracker to help patients pick up medicines from alternative sources. Geddes also directed NHS 111 call handlers to advise patients to contact the online pharmacy, Pharmacy2U (P2U), or any other pharmacy in order to access the EPS tracker. Leeds-based P2U experienced “unforeseen difficulties” with processing prescriptions as it transferred its dispensing service to a new automated facility – meaning several patients were left without their medicine from 21 December, reported National Health Executive. The company said it will not be able to deliver any request prescriptions until 11 January. In a statement, its managing director and superintendent pharmacist, Daniel Lee, said: “These exceptional circumstances caused our service to fall below its usual high standard and we are extremely sorry for the inconvenience it has caused. The operational issues are now being resolved and our experienced dispensary team is processing delayed orders as quickly as possible.”
GP Extraction Service ‘another Whitehall failure’, says PAC: The Public Accounts Committee (PAC) has branded the GP Extraction Service (GPES) a failure and said Whitehall is not learning from its past mistakes. Work on the GPES programme, set up by the Department of Health and the now-defunct NHS Information Centre (NHS IC) to collect data from the clinical systems of 8,000 GP practices in England, was originally due to start in 2010, reported ComputerWeekly. The data was intended to be used for a variety of functions, such as quality management and the controversial care.data project to create a central database of anonymous patient records for research and analysis purposes. The system is now run by the Health and Social Care Information Centre (HSCIC), which inherited it from the NHS IC in 2013. A National Audit Office report published last year showed that costs had risen from £14m to £40m during the planning and procurement stage and the full service is still not being provided. According to the PAC report, only two of the eight organisations identified as users of the service have received any data from GPES. PAC chair Meg Hillier said the government must begin tackling such IT failures properly, with the GPES joining a list of projects that faced PAC criticism last year. “Once again we see a failure in a government IT project at huge cost to the taxpayer,” said Hillier. “It is incredible that basic mistakes on contract and project management are still being made, from inadequate testing to woeful governance. We keep calling for lessons to be learned and keep receiving reassurances from senior accounting officers that they are. Yet the same issues occur time after time. It’s simply not good enough.”
Hunt appoints Dalton to engage with junior doctors to avoid strikes: Health secretary Jeremy Hunt has appointed one of his “most respected trust chief executives”, Salford Royal’s Sir David Dalton, to take talks forward with junior doctors on behalf of the government. In a letter written to Dr Mark Porter, BMA Council Chair, after the association called the delayed strikes back on, Hunt said the appointment would “facilitate further constructive discussion”. In the negotiations he will partner with NHS Employers and be assisted by a wider group of trust chief executives and medical directors, reported National Health Executive. “He has a reputation for engaging with staff and stands ready to work with you to agree a fair settlement for doctors and patients,” the secretary of state said.
English GP surgeries reach new patient ‘breaking point’: Hundreds of GP surgeries in England have stopped taking on new patients or have applied to do so, a BBC investigation has found. The British Medical Association (BMA) said many are at “breaking point” as they struggle to fill staff vacancies. At least 100 surgeries applied to NHS England to stop accepting new patients in 2014-15, a Freedom of Information request revealed. NHS England said it was investing £15m to boost the workforce. At the beginning of November, 299 surgeries were indicating on the NHS Choices website – which provides patients with information about surgeries in their local area – that they were not taking on new patients. Dr Chaand Nagpul, chairman of the BMA’s GP committee, said practices were struggling to recruit new doctors. “GP services are reaching breaking point as they struggle to cope with rising patient demand, falling resources and a shortage of GPs,” he said. “Closing their list is the only option to maintain safe care to their local community.” The BBC has learned that among 8,000 practices in England, some are offering a “golden hello” of up to £10,000 to attract new doctors.
Care for elderly given boost by improved access to latest telecare services: Scottish local authorities can now access the next generation of digital care technology to help them deliver the latest in “smart” care services so that elderly citizens can remain independent in their own homes, reported Building Better Healthcare. In what is believed to be a first for the country, Communicare247’s Archangel, a digital platform for integrated care, is now available to local authorities on the Excel procurement framework. They can use the technology to provide the latest telecare services such as remote monitoring, video conferencing, fall sensors, GPS location devices for vulnerable people, plus personal alarms. Scottish local authorities can buy advanced services by using Archangel as the infrastructure to support moves into using more-effective technology to deliver care and support to those most in need. Tom Morton, chief executive of Communicare247, said: “As the Scottish government recognises, without the right technology approach we risk building the country’s integrated care models on increasingly-outdated technology. Now local authorities can demonstrate how Scotland is at the forefront of digital telecare by providing a multitude of services designed around individual needs.”
Birmingham foundation trusts confirm merger plan: Two Birmingham foundation trusts (FTs) have confirmed they will merge following the decision last year for them to share a chief executive, reported Health Service Journal (subscription required). The decision to merge Birmingham Children’s Hospital and Birmingham Women’s Hospital FTs was announced shortly after a £70m programme to rebuild the women’s hospital was scrapped by the trust’s new leadership. Abandoning the programme – called Project VITA – opens up the possibility of building a single new hospital for women’s and children’s services. Under VITA, Birmingham Women’s planned to rebuild many essential services including maternity, fertility and gynaecology, along with accommodation for families. The trust spent £2.2m on VITA over the past three years but no further spending is planned. From this month, the two trusts will begin work on an outline business case for jointly delivering women’s and children’s services through a single organisation, to be completed in “late summer”.
Metavision live at new Cumbria hospital: The recently opened West Cumberland Hospital in Cumbria has gone live with a new computer system for its intensive care unit. The Metavision system from iMDsoft went live at the site in December in a process that was “fairly smooth and uneventful,” according to a spokesperson from North Cumbria University Hospitals NHS Trust, which manages the hospital. The system, which links to observation devices to record patient data for patients in intensive care, is already in use at North Cumbria’s Cumberland Infirmary site in Carlisle. There is one database on the system for both sites and clinicians will work with one integrated patient record across both hospitals. Speaking to DigitalHealth.net, Dr Mark Holliday said that the system is now accessible via the computer-on-wheels devices set up in the ICU, which contains six beds. Metavision is colour-coded on each computer to a separate bed so that doctors know they are looking at the relevant data. Holliday said that he expects one of the main benefits of the system will be the time it will save on handwriting out notes, freeing up clinicians to provide more direct care. He added that the system can be used to prescribe medicines, meaning that illegible handwriting would no longer be an issue and staff can be sure doses are accurate.
Blackpool NHS Foundation Trust selects open source electronic patient records: Blackpool Teaching Hospitals NHS Foundation Trust has selected an open source electronic patient record (EPR) called openMAXIMS for the recording and sharing of patient data across its hospital and community sites, reported DigitalHealthAge. The new EPR will allow over 3,000 clinical staff to share a single digital patient record across its 830-bed hospital sites, supporting the trust’s drive towards being paperless by 2020 and introducing workflow efficiencies across all departments according to the trust. Steven Bloor, chief information officer at the trust, said: “We expect the open source approach to cost at least 60% less, compared to a traditional proprietary route. The trust is a big supporter of the move towards open source within the NHS and always considers open source options first when procuring IT. The Blackpool Teaching Hospitals NHS Foundation Trust said it was also attracted by the open and interoperable nature of openMAXIMS, allowing it to easily integrate with existing systems such as its clinical portal, without any expensive, additional API development. Shane Tickell, CEO of IMS MAXIMS, said: “The roll-out of the new EPR will empower Blackpool to control its future roadmap and deploy technology that firmly meets its ongoing requirements and represents a significant milestone in our long-standing relationship with the trust.”
Eminent enterprise technology leader joins Orion Health as executive vice president for EMEA: Experienced enterprise technology leader Jonathan Selby is to join Orion Health as executive vice president for the Europe, Middle East and Africa (EMEA) region following incumbent Wayne Oxenham’s promotion to president of the firm’s US business. Selby, a highly regarded industry veteran, was responsible for leading InterSystems’ growth in the UK between 2010 and 2013, reported eHealthNews.eu. He will build on the successful business development activity undertaken by Oxenham in the EMEA region for Orion Health, a world-leading electronic health records and healthcare integration solutions provider. Selby, a London Business School alumnus and MBA, will draw on extensive experience from his numerous leadership roles in enterprise technology to grow the brand in the digitally-driven healthcare markets in the UK and throughout the wider EMEA region. Orion Health’s global chief operating officer Graeme Wilson saw Selby’s appointment as testament to the strength of the Orion Health brand. “Attracting someone of Jonathan’s stature to this vital role shows that we continue to build a business that is built on exceptional people, and recognises the investment and impact of our talent management and succession strategy globally,” he said.
1 in 10 Scottish operations cancelled in a month: Scots patients are facing disruptions to care as new figures revealed that one in ten pre-planned operations were cancelled in one month, reported The Scotsman. Official statistics laid bare the strain on stretched resources as 18 operations were cancelled per day in November due to lack of capacity, such as beds or staff. Politicians branded the figures “concerning” and called for more investment in social care to prevent bed blocking – where people cannot be discharged due to lack of support. The number of cancelled procedures has risen over recent months with 3,064 surgeries cut in November compared to 2,643 in May. A total of 540 were cancelled by the hospital due to “capacity or non-clinical reasons”, a slight fall from 549 the month before but up from 479 in May. Patients were responsible for more than a third of cancelled elective procedures. Liberal Democrat health spokesman Jim Hume MSP said: “There can be good reasons why an operation is cancelled or postponed but if this is because of a lack of capacity or a non-clinical reason it is clearly concerning.”
New wave of practice closures could mean 25,000 patients lose their GP: Tens of thousands of patients could be forced to register with another GP, as several practices prepare to close their doors early in 2016. Pulse has learnt that six practices in England and Wales are closing due to GPs retiring early or becoming ill, leaving over 25,000 patients facing the prospect of moving practices. GP leaders say the figures are a concern for patient access to primary healthcare and are the result of years of underfunding. This latest wave of closures comes months after Pulse revealed last year that 160,000 patients were displaced across the country between 2013 and 2015. Last month, NHS England asked all areas to come up with a plan “to address the sustainability and quality of general practice”, but for many patients this could come too late. Dr Robert Morley, executive secretary of Birmingham LMC and chair of the GPC contracts and regulation subcommittee, said a lack of sustainable funding has created “a terrible concern about patient access”.
Sixteen healthcare IT predictions for 2016: Health and Social Care Information Centre chief executive Andy Williams pointed out: “A crystal ball isn’t required to foresee the pivotal role of information, data and technology in supporting efficiencies within the (health and social care) sector next year.” DigitalHealth.net asked health IT experts from across the board what their predictions are for the precise role of technology in 2016. Responses set out the workload of central bodies and the impact of these on IT directors and clinicians ‘at the coalface’, considered thorny issues of information governance and security, and delivered supplier perspectives. They also showed that while the challenges are the same, the responses look a little different in Scotland, Wales and Ireland. Read the predictions from: Andy Williams (HSCIC), Richard Jefferson (NHS England), Andrew Griffiths (Wales), Scott Henderson (NHS Shared Business Services), NHS Providers, Phil Koczan (UCL Partners), Robin Wright (Scotland), Dame Fiona Caldicott (national data guardian), Natalie Bateman (techUK), Phil Booth (MedConfidential), Richard Corbridge (Ireland), Colin Henderson (Orion Health), Justin Whatling (Cerner), Marcus Bolton (System C), Paul Cooper (IMS MAXIMS), Alan Fowles (Nuance).
Opinion
2016 Tech Trends for IT Leaders
Transformation directors and change mangers are needed in addition to CIOs in 2016, says BCS president Jos Creese on Government Computing.
In his 2016 predictions for technology trends, he writes: “CEOs in every sector say that their IT is not keeping pace with business demands. That is why they appoint CDOs, transformation directors and change managers, rather than simply asking their CIO to do the job. IT leaders who fail to understand this and the surrounding politics, will face a rocky ride in 2016.
“Any organisation moving to a digital model will see tough decisions needed around business restructuring, headcount reductions and more effective customer interaction. CEOs want accurate and timely dashboards of business data to take decisions and judge performance. This makes ‘digital’ a board level issue for 2016.”
In a piece that spans his predictions for multiple sectors, Creese makes a wide range of observations on areas including the development of social media as a mainstream business tool and a growth in the importance of wearable devices.
“Business and governments will adopt open IT architectures to share data and systems, enabling more cloud adoption without creating complex support or security risk,” he writes.
“Both personal health monitors and technology used in our health centres and hospitals, will grow with a wealth of new technology solutions from smaller providers and new ambitious government programmes.”
The digital revolution: eight technologies that will change health and care
The past decade has seen rapid development and adoption of technologies that change the way we live. But which technologies will have a similarly transformative impact on health and care asks Cosima Gretton, Academic Foundation doctor and Matthew Honeyman, researcher at The King’s Fund.
“The King’s Fund has looked at some examples of innovative technology-enabled care that are already being deployed in the NHS and internationally to transform care. Now, we examine the technologies most likely to change health and care over the next few years.
“With new technologies like these come new opportunities for our health and care system: improving the accuracy and usefulness of information we can gather on our health as citizens and patients; changing how and where care is delivered; and offering new ways to prevent, predict, detect and treat illness.
“The technologies we’ve highlighted here are not an exhaustive set. Many of them could transform health and care but more evidence is needed on their costs and benefits to deliver on their promise. Ask too much or give too few opportunities for real-world testing and we risk protecting an outdated status quo. Ask too little and we risk spending public money on something ineffective.
“Above all we must not lose sight of the people behind the technology and their needs – the patients, citizens and communities for whom it will be put to work.”
A model to put the NHS right?
There is an alternative solution to avoiding serious system failure writes Jan Filochowski clinical and professional adviser at the Care Quality Commission, in HSJ (subscription required) this week.
Filochowski says the NHS needs a workable business model underpinning a great social model to help meet largely unpredictable healthcare costs and deliver care to the required standards.
He suggests an alternative approach: “The key to finding a business model that works is to understand the type of business the NHS is: open-ended, highly valued, typically with no alternative, growing naturally but relentlessly – and build the model to match: recognizing and accepting real demand, and responding to that by creating not constraining the physical capacity, services and staff to meet it.
“Why? Because without sufficient capacity, high volume complex interrelated services create blockages and waits, becoming progressively inefficient, costing more, providing less.
“This way what is needed is done smoothly, without delay, efficiently, with a cost-based but constraining utilities-style price-setting mechanism, determined by an independent regulator. Removing chronic blockages saves money and thereafter costs rise modestly and proportionately – less quickly than the overspend will rise with the status quo.”
The Five Year Forward View
Dr Mahiben Maruthappu, a practicing doctor and Senior Fellow to the CEO of NHS England takes a look at The Five Year Forward View one year on.
“Just over a year ago the NHS Five Year Forward View was launched – our vision for the future of the health system. We proposed that to achieve the triple aim of improved population health, quality of care and cost-control, this needed to be matched by triple integration, removing the boundaries between mental and physical health, primary and specialist services, health and social care.
“Turning our eyes to the present, the equipoise between financing and efficiency represents one of the most pressing issues facing the future of the NHS. The government’s recent £3.8 billion investment into front-line services is certainly welcome. This will help stabilise pressures on primary and specialist care, while kick-starting transformation in the NHS, enabling momentum around key initiatives such as our Vanguard programme to build and spread. The Chancellor’s announcement that local authorities will be able to increase council taxes by 2% specifically to fund adult social care will also enhance system improvements.
“Looking forward, the next five years signify a phase of implementation – the Forward View has shown what’s necessary, but we now need to put this vision into operation and to develop a more sustainable NHS through new models of care, efficiency savings, and moderation of service demand.
“The widely supported Forward View has provided direction, but it is our delivery in the coming years that will determine how we define, fund and provide British healthcare long into the future.”
Highland Marketing blog
Highland Marketing looks ahead to what 2016 will bring for health technology in the UK.
