News in brief
NHS deficits hit ‘massive’ £930m: NHS trusts in England have racked up a £930m deficit in the first three months of the financial year – twice as much as this time last year, reported the BBC. The figures cover hospital, mental health, ambulance and some community services. They account for about two-thirds of the NHS’s £116bn budget. Last year, NHS trusts overspent by £820m – with the health service as a whole balancing the books only after a cash injection from the Treasury and by raiding the capital budget earmarked for buildings. It has been suggested the deficit among the 239 NHS trusts could top £2bn this year, and the figures released by the two regulators – Monitor and the Trust Development Authority – showed the NHS is on track for that. Financial performance tends to improve as the year goes on. At this stage last year NHS trusts were £451m in the red. David Bennett, chief executive of Monitor, said: “Today’s figures reiterate the sector is under massive pressure and must change to counter it. The NHS simply can no longer afford operationally and financially to operate in the way it has been and must act now to deliver the substantial efficiency gains required.”
Health apps used by NHS staff putting patient data at risk: Highly sensitive and confidential patient data is at risk of being disclosed because doctors and nurses are routinely using their own smartphones for patient care, according to a new report. The practice of using health apps and messaging systems to treat people raises the prospect of inadvertent privacy breaches in the absence of a comprehensive digital security policy, it said. More than 850 clinical staff at five different hospitals in London answered questions on ownership and use of portable devices and mobile health apps in the workplace, reported the Independent. Many doctors and nurses said they had sent patient data over their smartphones using short message script (SMS), app based messaging, such as WhatsApp, and picture messaging using their smartphone camera. Almost two thirds of the doctors had used SMS (65%); a third had used app based messaging; and almost half (46%) had used their phone’s camera and picture messaging to send a photo of a wound or x-ray to a colleague. The corresponding figures for nurses were much lower – around 14%, 6% and 7.5% respectively. Doctors were significantly more likely to send clinical patient data using all these methods, and one in four (27.5%) of the doctors believed they still retained clinical information on their smartphones. Janet Davies, chief executive and general secretary of the Royal College of Nursing, criticised the NHS for “failing to keep pace with advances in digital technology and to take advantage of online tools and e-health”.
Better IT system integration could cut avoidable GP appointments: Integrated systems and better use of technology could reduce unnecessary GP appointments, according to an NHS Alliance report put together jointly with the Primary Care Foundation. The report called for better collaboration between GPs and hospitals, including the way they receive information, reported Computer Weekly. Practice managers surveyed said they would like clearer summaries and simple letters from hospitals, as well as “electronic communication” and “IT systems that talk to each other”. “The ability to implement common systems has been complicated by the NHS’s poor record on developing integrated information systems, with policy veering from centralist systems to local diversity. Neither have served general practice well,” the report said. One practice manager said hospital systems need to be compatible with GP IT systems. NHS England has set out an ambitious plan for the NHS to be digital at the point of care by 2020, including seamless electronic transfer of information between primary and secondary care. The project is being led by clinical commissioning groups, which have to develop “roadmaps” on how they plan to undertake the work in their own health economy. Beverley Bryant, NHS England’s director of digital technology, said there was no point in buying software that failed to allow the transfer information across the health and social care system. “It really is time we started to move off paper,” she said.
Cost of NHS 24 IT system spirals by £41m: Three health boards have come under fire after the public spending watchdog found one had racked up a £41m overspend on a new IT system while another has received emergency cash loans for the past three years, reported The Scotsman. The findings by Audit Scotland revealed that NHS 24’s new IT system took two years longer to deliver than planned, with costs spiralling by 55%. The delay brought in “additional costs and risks” to the service and the Scottish government had to step in with a loan of more than £20m to prop up the project, the report found. Overspending on GP prescribing, workforce and failure to sell off old buildings meant NHS Tayside failed to break even for the third year in a row, relying on a £14m loan from the Scottish government in 2014/15. As well as repaying this loan, NHS Tayside needs to make £27m in savings this year, said auditor general for Scotland Caroline Gardner, who laid the reports before the Scottish Parliament. Improvements have been made at NHS Highland following a critical report from the watchdog last year on the 2013/14 accounts. However, the board was told to reduce its reliance on one-off savings and improve long-term planning. Jenny Marra, Scottish Labour’s equalities spokeswoman, said: “This report lays bare the SNP government’s failure to resource our hospitals properly in the face of rising costs for staff and prescriptions, increasing patient demand and ever more targets.”
Hospital creates new EPR with open source: Taunton and Somerset NHS Foundation Trust has customised openMaxims software for an electronic patient record that could be reused by other organisations, UKAuthority.com reported. The 600 bed Musgrove Park Hospital, part of Taunton and Somerset NHS Foundation Trust, went live with the solution at the beginning of last week, with initial implementation in A&E, outpatients and the 30 inpatient wards. The trust has won the support of Richard Jefferson, head of programme commissioning at NHS England, who said: “We are delighted to see the first deployment of openMaxims going live in an NHS hospital. This represents a landmark moment in the use of open software in the NHS and validates the idea that open source can play a significant role alongside proprietary offerings.” Hospital staff contributed to the design of a number of features, including a wards’ organiser, an organiser for outpatient clinics and the workflow for the patient journey.The launch was preceded by a training programme for 2,500 staff, and a command centre was set up with members from the trust’s IT team and the supplier. IT director Malcolm Senior said: “There are already signs of it providing benefits for patient care in that clinicians are able to enter more real time data. This is giving them a clearer, up-to-date view of what has been done for a patient and reduced clinical risk which is making the hospital ever safer and ever more efficient.”
Enfield CCG issues integrated NHS111 tender for North London: NHS Enfield Clinical Commissioning Group (CCG) has issued a tender for an integrated NHS111 and GP out of hours service to serve five organisations across North London. At the same time, attempts by NHS England to outline new national standards for NHS111 functions that were scheduled to launch last month have been delayed, reported Government Computing. Valued between £50m and £75m, Enfield is undertaking the procurement for five CCGs including itself, Barnet, Camden, Haringey and Islington, in order to transform how urgent care services are delivered. NHS111 provides advice to the public on healthcare services in non life-threatening situations, with NHS England this year conducting engagement exercises with CCGs to try and outline guidance around how the service should be provided going forward. “By developing an integrated service, we will be able to reduce the number of transfers between services, so that patients will receive clinical advice from GPs and other clinicians more quickly, and won’t have to call more than one service,” said the group. While it is ultimately the responsibility of individual CCGs to choose how to implement the standards, NHS England is continuing to try and set out policy to ensure more “consistent” provision of the service across the country, including use of an online component.
DH helps Bolton off ‘burning platforms’: Bollton NHS Foundation Trust has received £8m in funding from the Department of Health (DH) to upgrade its IT systems. The money is part of £30m investment from the DH that also covers refurbishment and expansion of the trust’s A&E department, the relocation of its endoscopy unit, the refurbishment of its day surgery unit, and the redevelopment of parking facilities. Regarding the IT investment, Bolton’s chief information officer Rachel Dunscombe told DigitalHealth.net the £8m is just for “remediation” and to support the exit of the trust from the national contract for clinical systems, which ends in July 2016. She said further funding was required to purchase a new electronic patient record. Bolton splits the investment into “burning platforms” that are to be replaced on a ‘like-for-like’ basis, “burning platforms” that need to be replaced on a strategic basis, and other more general IT investments to create “sustainable, fit for purpose IM&T”. The like-for-like replacements include the trust’s virtual desktop project, which will see the trust implement Microsoft 7 to replace XP, which became unsupported in April 2015. Bolton will also replace all hardware and software associated with community services, which were transferred to the trust earlier this decade to create an integrated acute/community trust.
GPs’ diagnostic skills could be obsolete within 20 years’ time, says Hunt: The health secretary has claimed that GPs in 20 years’ time will not have to make diagnoses due to increasingly powerful diagnostic tools, and the NHS must position itself to be ready for the technology when it becomes available, reported Pulse. Speaking at the Conservative Party Conference 2015 Hunt informed delegates that Silicon Valley tech “gurus” were confident diagnosis by humans would be obsolete within two decades. He also said that this would open up an exciting new prospect for medicine where problems can be identified and tackled before they even become symptomatic, though he did concede there was a lot of work to do to make this realty. The health secretary has long championed wider adoption of technology in the NHS, and at the same session he reminded delegates of his pledge to make the NHS paperless by 2018. Hunt said that the government still had to win the trust of the public, but added that technological developments were “exciting”. He told delegates: “If you talk to technology gurus in California and ask what’s going to change in the next two decades, they say “in 20 years” time, no doctor will ever give a diagnosis.” NHS England recently produced an animation outlining its digital vision for the NHS including health apps that upload information directly to the GP record and telehealth consultations.
UK has best palliative care in the world – but services still ‘inadequate’ for some: The quality of palliative care offered in the UK has been ranked the best of 80 countries around the world, according to research by the Economist Intelligence Unit (EIU). Amongst the reasons for this was the existence of “extensive integration of palliative care into the NHS”, as well as comprehensive national policies, a strong hospice movement, and “deep community engagement” on the issue. The UK also came first in the previous ‘Quality of Death Index’ five years ago, reported National Health Executive. The index, commissioned by Singaporean philanthropic organisation Lien Foundation, is based on “extensive research” and interviews with more than 120 palliative care experts worldwide. Annie Pannelay, of EIU healthcare, said: “A very strong marker in our index is the availability of specialised palliative care workers and this is where the UK scores particularly well. The UK has a long history of providing treatment in palliative care. The other super strong marker is the way that the countries do have a plan for palliative care. That means they are on the dynamic of measuring progress and improving.”
Practices to be relieved of almost all care home patients under CCG plans: Practices in one area will see three-quarters of care home patients removed from their lists under a clinical commissioning group’s (CCGs) plans to create a “virtual GP practice” dedicated to care home residents, reported Pulse. NHS Southend CCG plans to tender a contract for a provider to take on a patient list made up entirely of care home residents, who will have full medical and medication reviews, which will be potentially “weekly for clinically complex patients”. It said that approximately 75% of the 1,800 care home residents would be moved from their current practice’s list to the new service. The CCG said that care home residents were a huge demand on practices, who were not even receiving the full enhanced service payments because they were not coding residents properly, while care homes said they were struggling to register patients. It is using money reclaimed from personal medical services premiums to set up a pilot, which if successful will go to full competitive tender with private providers invited to bid alongside local organisations for the service. As well as the medical reviews, the new service will provide a care plan for each newly registered patient, reviews after A&E attendances or admissions and training for care home staff in managing urgent conditions. Performance will be measured on a variety of indicators including patient satisfaction, reduced A&E attendances and emergency phone calls responded to in less than an hour.
Heart attack test ‘cuts hospital stays’: A blood test can more than halve the number of people admitted to hospital with a suspected heart attack, according to doctors. They have said the rapid test, which looks for a chemical in the blood, would reduce stress for patients, save money and ease pressure on hospital wards, reported the BBC. About one million people attend A&E departments in the UK with chest pain, only for most of them to be sent home after a sometimes lengthy and anxious stay. They have levels of troponin, a chemical released by damaged heart muscle, tested when they are admitted and again 12 hours later. The new test also looks for troponin, but can detect much lower levels and needs to be done only once. So those given the all-clear can go straight home. The study is led by the University of Edinburgh and is taking place in Scottish and US hospitals. Dr Atul Anand, one of the researchers and a physician at the Edinburgh Royal Infirmary, said: “It’s really exciting. When you look at patients who come to medical wards with chest pain, 80% are going home 12 hours later. This avoids the hassle, cost and patient stress.”
‘Rethink’ needed on immigration policy for nurses, says NHS chief: A rethink is needed on immigration policy for nurses, the head of NHS England, Simon Stevens, has said, reported OnMedica. His comments came amid home secretary Theresa May’s speech at the Tory Party conference in which she promised a crackdown on the numbers of migrants claiming asylum in the UK, and said that high numbers of migrants risked undermining employment opportunities for indigenous workers, and social cohesion. Stevens said: “My responsibility is to point out that at a time when the need for nurses is growing, when publicly funded UK nurse training places will take several years to expand, and when agency staff costs are driving hospital overspends right now, we need to better “join up the dots” on immigration policy and the NHS.” Danny Mortimer, chief executive of NHS Employers, welcomed the NHS chief’s words. He explained that NHS Employers had written to Theresa May to highlight the shortage of nurses many NHS trusts were facing going into winter. “We know there are plans to train more nurses in the UK but it takes four years to deliver the training so we will not see the benefit until 2017. We need to ensure that there is sufficient staffing to deliver good patient care in hospitals across the country,” he insisted.
Hunt hires ex-royal college boss amid seven day row: Jeremy Hunt has hired Sir Norman Williams, the immediate past president of the Royal College of Surgeons, as his senior clinical advisor, reported Health Service Journal, (subscription required). It has come as the health secretary fights a high profile battle with some doctors and medical organisations over contracts and seven day services. It is understood Sir Norman will advise on a wide range of clinical issues, but with a particular focus on Hunt’s drive to expand and improve NHS services outside office hours. He is also an expert on, and champion of, patient safety, another focus of the health secretary. Sir Norman took up the Department of Health role in recent weeks, it is understood. One source with knowledge of the appointment said Sir Norman would be able to advise on how policy and statements may be received by clinicians. Sir Norman was RCS president from 2011 to 2014 and was knighted in 2015 new year’s honours. He is an honorary consultant at Barts Health Trust.
Jim Mackey appointed CEO of NHS Improvement: Jim Mackey, CEO of Northumbria Healthcare NHS Foundation Trust, has been named the new boss of NHS Improvement, the recently announced Monitor-NHS TDA merger, reported National Health Executive. Mackey, who has been leading Northumbria since 2005, will be in the full-time post from 1 November 2015 where he will start to bring together expert teams to deliver all of NHS Improvement’s responsibilities. NHS Improvement is set to be in operation from April 2016. Ed Smith, chairman-designate of the organisation, said: “I am delighted to announce the appointment of Jim Mackey as the chief executive of NHS Improvement. He was the unanimous choice of the appointments’ panel. He has an exceptional track record in delivering change in the health sector, with 25 years’ experience in the NHS.” Speaking about his appointment, Mackey said it had been a huge privilege to lead Northumbria. He added that the gap between the quality of care provided within the NHS must be reduced, and “our grip on managing our business and finance must be improved”.
Opinion
UK SMEs can play a crucial role in meeting NHS challenges
NHS hospitals are working with SMEs to tackle significant challenges and serious conditions, achieving great things for patients and healthcare professionals through technology, says Patientrack’s managing director Donald Kennedy.
“When clinicians at Western Sussex Hospitals NHS Foundation Trust sought to become the first in the country to be able to predict when patients were at risk of one of the UK’s most deadly conditions, the hospital turned to a small specialist UK company to enter into a strong collaboration.
“The aim: to allow doctors and nurses for the first time to be alerted to every patient at risk of acute kidney injury, a devastating and costly condition currently linked to 100,000 deaths in England’s hospitals every year. This high impact and fast moving project is an example of precisely what can be done when clinicians combine their research and clinical knowledge with innovation from a focused UK small to medium sized enterprise (SME).
“SMEs, which are seen by government ministers as crucial to economic growth, offer the NHS the means to create innovative best of breed solutions. When combined, these solutions can help address the NHS’s broader needs and its agenda for change.
“SMEs offer the NHS a great opportunity for innovation, and to solve pressing and specific problems in parallel. Projects are delivered concurrently in weeks and months, rather than years. Contrary to some opinions, SMEs can – and do – work to deliver integrated interoperable solutions.
“What NHS organisations and UK SMEs are achieving together is truly remarkable.”
Improving hospital discharge and intermediate care for older people
Acute hospitals are under unbelievable pressure with winter on the way, writes Professor David Oliver from the Royal Berkshire NHS Foundation Trust. In a blog for The King’s Fund, he argues that hospitals are not only faced with the challenges of an ageing population and increasing numbers of people living with complex long-term conditions, frailty or dementia, but also from the pace of lost beds over the past three decades.
“A recent audit by NHS Benchmarking showed that while only 5% of people aged over 65 who are admitted to hospital stay for more than 21 days, that 5% accounts for more than 40% of all bed days.
“It’s a stressful environment for clinicians and operational managers, who are under constant pressure to prevent hospital admissions, discharge patients sooner and get them home when capacity and responsiveness in primary and community health services is lacking. Social care has also suffered and with many people receiving no statutory care despite their needs being classed as ‘substantial’.
“Hospital inpatients are increasingly old. Many are living with frailty and most have a degree of functional impairment. Many such patients leave hospital less mobile and independent than when they were admitted – making rehabilitation after acute illness and injury a core business not just for hospitals but also for their partners in ‘step-down’ intermediate care services. These services also have the potential to provide ‘step-up’ (admission prevention) care, for early supported discharge from the hospital front door or wards.
“We won’t solve the very pressing problems facing the NHS unless we crack these wicked problems. What’s good for the system – joined-up care and a focus on maintaining independence – reflects what older people and their families want to see too.”
Achieving shared ambitions for end of life care
Dr Ros Taylor, the national director at Hospice UK explains how hospices are ready to play their role in delivering the very best end of life care.
“We may be leading the world in terms of services, systems and availability of pain killers at the end of life according to the Economist Intelligence Unit, but a crucial challenge remains: how do we deliver consistently compassionate and effective support for dying people and their families in all settings?
“Excellent end of life care should be widely available, and a recent survey of bereaved relatives by the National Audit Office suggested that most people’s experience of that care is positive. However, as we have seen with the shocking cases highlighted by the recent Parliamentary and Health Service Ombudsman report, the system can still fail to meet patients’ needs, and in some cases to the point of downright neglect.
“Ambitions for Palliative and End of Life Care, a new national framework for local action devised by a wide group of statutory bodies, charities and groups representing patients and professionals – including NHS England and Hospice UK – sets out clearly the actions that local health, social care and community leaders need to take to ensure that everyone has access to the best care possible when they are facing death.
“As one of the NHS England’s strategic partners, Hospice UK is firmly committed to helping to achieve the vision set out in the Ambitions framework.
“We are working closely with NHS England to improve commissioning arrangements between hospices and clinical commissioning groups, (CCG’s) helping enhance data collection for end of life care and also collaborating to help shape a fairer funding system for palliative care.
“Caring for the UK’s growing ageing population presents major challenges for the NHS – so expanding care options beyond hospital will be hugely important too, and hospices play an important part in this
“Dying is inevitable for us all, and hospices stand ready to work with the NHS locally and nationally to deliver on the Ambitions vision, and ensure that excellent care at the end of life is also a certainty.”
Blog
Simon Rollason, programme manager NHS England Midlands and East, writes on the need to take strategy with a pinch of tactics.
