News in brief

Clarity needed over £8bn NHS spending boost: The chancellor has stated that the NHS is the government’s ‘priority’ as he confirmed the health service will receive £8bn more in annual funding by 2020-21, reported National Health Executive. During his Summer Budget 2015, George Osborne said the government will fully fund the NHS’s self-produced Five Year Forward View – a pledge the Conservatives made in the run up to this year’s General Election. The Budget documents revealed that the NHS will receive “staged funding” increases in every year of the Parliament. But the specific level of funding for each year will not be determined until the autumn Spending Review. However, the health industry has stated that there is an “urgent need for clarity” on how the funding will be deployed. Rob Webster, chief executive of the NHS Confederation, said that he welcomed the formal commitment on increasing NHS funding by £8bn by 2020-21, on top of the £2bn delivered in this year’s budget. “The £8bn needs to come in staged increases and we would emphasise this should reflect the bigger cost pressures expected in the first half of this Parliament,” he said.

October target for e-discharge: NHS providers must send discharge summaries to GPs electronically by October this year, NHS England has said. Organisations currently use a combination of secure email and fax, post and electronic messaging to send discharge letters to GPs. From 1 October, only email and e-messaging will be acceptable under the standard NHS contract, reported Digital Inderjit Singh, head of enterprise architecture at NHS England, said the target is part of the call to action around moving off paper towards digital, outlined in the strategy – Personalised Health and Care 2020. He said the focus last year was on use of the NHS Number as the main patient identifier and e-discharge is a key focus for this year. Singh added: “Clinical commissioning groups need to have confidence in their localities that by October, providers are able to send their discharges electronically. Already a significant number do this electronically so this is about moving that bar up across the system. A sample of 70 trusts revealed that more than half were already using e-messaging. The October target is part of a journey which will ultimately end in them sending and receiving structured electronic messaging.”

A key to better care: Pharmacists and pharmacy technicians in all community pharmacies in England will be given access to part of the patient records held by GPs, as part of a £7.5m roll-out from autumn 2015, reported The Pharmaceutical Journal. Each summary care record (SCR) provides a selection of information about a patient’s treatment, including his or her prescribed medicines, any allergies and contraindications. More than 96% of people in England have a SCR, according to the Health and Social Care Information Centre, the quango that will facilitate the community pharmacy implementation in partnership with NHS England. Patients will be able to grant pharmacists and pharmacy technicians permission to view their SCR to confirm information held by the GP that is relevant to their care. At the moment, pharmacists usually need to telephone GP surgeries to corroborate details of patients’ medicines that are readily available in the SCR; often this involves trusting the information provided by receptionists with no clinical qualification. Arguably this accepted activity represents a risk to patient safety.

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All 111 and out of hours tenders suspended: NHS England has told commissioners to suspend all GP out of hours and NHS 111 procurements while it draws up new rules for creating ‘functionally integrated’ urgent care services, Health Service Journal (subscription required) has learned. A letter from commissioning operations director Dame Barbara Hakin said clinical commissioning groups should suspend the procurements, regardless of the stage reached until September. The moratorium has been called to give the national body time to draw up a set of commissioning standards and a clinical model for what is described as a “functionally integrated urgent care access, treatment and clinical advice service”. These new services will join up 24/7 urgent care access with treatment and advice, and incorporate current NHS 111 and out of hours provision, according to the letter, which was sent to clinical commissioning groups and 111 providers. Dame Barbara wrote: “suspension of procurements will allow completion of the consultation and the release of the revised commissioning standards and supporting procurement advice for integrated services.”

NHS England supports innovators in rolling out technologies and ideas: NHS England has announced that 17 healthcare innovators are to receive funding, mentoring and support to roll out their technologies and ideas across the health service, reported The initiative is part of the NHS Innovation Accelerator programme, announced in January 2015, intended to harness emerging technologies, processes and inventions to improve healthcare in England. The competition winners include a genome analysis and decision support tool; a mobile patient engagement system; a system to allow patients to own and control their own electronic medical records; a social network for patients; and a mobile task management tool. The NHS received more than 120 applications to take part in the programme. “The NHS stands on the cusp of a revolution in innovation. At its heart, innovation is the will to be better, to find solutions for existing needs or new problems through more effective products, processes, technology or even the way we deliver services,” said Bruce Keogh, NHS England’s national medical director.

Just 12 GP practices sign up to test in largest pilot region: The largest region involved in the pilots has only been able to attract 12 practices, Pulse has reported. A Freedom of Information request received by GP and data sharing campaigner Dr Neil Bhatia revealed that only two out of 43 practices in NHS Leeds South and East clinical commissioning group (CCG) have signed up to the scheme, while five practices in both NHS Leeds North CCG and NHS Leeds West CCG have agreed to participate. The latest figures mean that just over 100 practices across the country have agreed to take part in the pilot scheme – above the 100 minimum targeted by NHS England, but way short of the 500 maximum specified. Campaigners said that the low uptake in the biggest pilot area was ‘risible’ at this stage, particularly when Leeds was supposed to be the key test site for communicating the scheme in an urban area.

Wales rolls-out patient portal: Wales is nearing the complete roll-out of its My Health Online portal, reported Digital In its latest newsletter, the NHS Wales Informatics Service says the service needs to be implemented at one more GP practice in the Aneurin Bevan Health Board area and this will occur within the month. Once completed, My Health Online will be live at all 458 GP practices in Wales, offering patients the opportunity to do a variety of health-related tasks online, including booking appointments and ordering prescriptions. NHS Wales Informatics Service said that more than 130,000 patients have registered for My Health Online and that interest in both the ability to book appointments and order prescriptions is “growing”. The service, which is available in both English and Welsh, was launched in 2011 backed by £1.7 million of funding from the Welsh Assembly Government.

NHS provides £15m for pharmacists in GP surgeries: General practices in England will benefit from a £15m scheme to provide expert pharmacist support for patients, NHS England has announced. Chief executive Simon Stevens said the scheme will reduce pressure on GPs as the pharmacists help patients with managing long-term conditions, advise them on multiple medications and provide better access to health checks, reported OnMedica. GP leaders said the scheme could have a major impact on patient care and safety, and cut waiting times for GP appointments. NHS England said the three-year scheme, which goes live later this year, will – in those areas where workload pressure on GPs is greatest – provide partial funding for surgeries to directly recruit and employ pharmacists. It will cover 60% for the first 12 months of employment; 40% for the second 12 months; 20% for the third 12 months; and nothing after the first 36 months of support (or fewer months if recruited after 31 March 2016). Simon Stevens said: “This has the potential to be a win-win-win for patients, their GPs and for pharmacists. Tapping into the skills of clinical pharmacists should help expand care and relieve some of the pressure that GPs are clearly under. This isn’t a silver bullet but it is a practical and constructive contribution to the wider challenge.”

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Social enterprise publishes clinical data via online database: A social enterprise which provides community services across south London has published anonymised clinical data onto a website created by the Greater London Authority to aid public scrutiny of the way services are run, reported Health Service Journal (subscription required). Bromley Healthcare is the first provider of NHS services to upload data on appointments and patient outcomes to the London Datastore, which enables people to freely access various datasets about the city. The data published last week shows anonymised appointment information from April 2014 to March 2015 for the organisation’s major services. Bromley Healthcare chief executive Jonathan Lewis said: “We are releasing this first tranche of data for two reasons. Firstly, in February 2013 the Francis Report called for more transparency in the NHS. The NHS exists for patients and is paid for by taxpayers – both have a right to understand exactly what they are getting for their money. Publishing our clinical data makes us truly answerable to those with the biggest stake in our organisation. Second, we have put in place a clinical system that collects huge amounts of very detailed data about our clinical activity and our outcomes. We are looking for a long-term big data partner to help us understand this data so that we can improve how we operate, and develop a set of tools that can transform community healthcare.”

Dementia costs the Welsh economy a staggering £1.4bn every year, new research reveals: Dementia costs the Welsh economy an estimated £1.4bn every year – nearly a quarter of the health and social care spend by the Welsh Government, it has been revealed. A new report by the Alzheimer’s Society, called The Hidden Cost of Dementia in Wales, exposes the financial and human costs of dementia to society for the first time, reported Wales Online. It claims dementia cost an estimated £31,300 per person per year in Wales in 2013, with carers and their families shouldering around two-thirds of the overall total themselves. An estimated 850,000 people in the UK have a form of dementia, and in less than 10 years about one million people will be living with the condition. Sue Phelps, director of Alzheimer’s Society in Wales, said the report’s findings reinforce the need for Wales to have a national dementia strategy. She said: “There are 45,000 people living with dementia in Wales. The report estimates the financial cost of dementia in Wales is £1.4bn, which is nearly a quarter of the health and social care spend by the Welsh Government each year.”

Noble’s Hospital to introduce patient monitoring and early warning tech: Doctors and nurses at Noble’s Hospital in the Isle of Man will be able to take action more quickly when patients show signs of worsening conditions when a new digital observations, early warning and alerting system is introduced, reports Integrated Care Today. The Patientrack system allows nurses to take electronic observations at the bedside, and then automatically calculates early warning scores and alerts clinicians directly so that they can intervene when necessary. Dr Keki Madon, a clinical lead on the project and consultant anaesthetist at Noble’s Hospital, said: “The technology will be configured to respond to clinical requirements and will allow us to move to digital observations and automatic alerts; meaning that frontline staff can spend more of their time directly caring for patients.” Donald Kennedy, managing director at Patientrack said: “The dedication and commitment that healthcare professionals show to continually improving patient safety means that we are finding more opportunities than ever to collaborate with forward thinking hospitals. This latest project with Noble’s Hospital is a great example of a hospital providing frontline staff with the tools they need to deliver even better and safer care.”

Stalis enables successful data migration of over 1,600,000 records to Cerner Millennium at Lewisham and Greenwich NHS Trust: Lewisham and Greenwich NHS trust has contracted Stalis, to conduct the large-scale data migration and archive project ensuring only accurate, valid and complete data was fed into the trust’s new electronic patient record (EPR) system for University Hospital Lewisham, reported eHealth News EU. Based on Stalis’ robust and secure CareXML® platform the migration project involved the transformation and archiving of approximately 950,000 patient records, 530,000 historic and future outpatient appointments and 130,000 inpatient histories into a new consolidated EPR from Lewisham’s previous patient administration system. The CareXML platform supports heath informatics professionals through the highly complex process of extracting, cleansing and exporting data from any healthcare application onto the new live system whilst eliminating any duplicate records. Elisa Steele, Director of IT for Lewisham and Greenwich NHS Trust said: “We recognised that the data migration was an integral part of our IT strategy in helping us to reduce data duplication within the local healthcare economy and improving access to patient records. Stalis staff worked tirelessly to ensure a seamless migration, providing workshops and training to our staff, and maintaining a professional presence at all times.”

Call to radically revamp 999 services for smartphone technology: Radical changes should be made to the emergency 999 call service to reflect the ‘digital age’, where more people are communicating by text or social media, a new report has said. Launched by the Institution of Engineering and Technology (IET), the study argues that in a world where smartphones, text and social media are becoming the norm, creating a new cross-platform, data-based emergency service with a standard interface for consumers should be a priority, reported National Health Executive. Professor Will Stewart, chair of the IET’s Communications Policy Panel, said that communications has changed drastically since the 999 service was designed in 1937 – “so there is a critical need to update the service”. It was suggested that a data-based emergency service would allow people to text alerts via any appropriate app on a chosen easy-to-remember special number, such as 999 – and these alerts would then be passed to the human emergency operator. Prof Stewart added: “Much of the technology we need to update our emergency service is available today. But we need a shared, cross-party strategy to create a common and user-friendly interface for all service providers to connect to – and one that the general public will be happy to use.”



The four Budget must-knows to transforming care
On budget day, NHS Confederation CEO Rob Webster wrote in Health Service Journal about some of the urgent financial questions associated with the biggest challenge of changing care.

In the last of four questions, Webster asks what does £8bn extra, as outlined in the NHS’ Five Year Forward View, actually buy?: “The NHS must not be seen to be always asking for more money. It’s a natural response from a service that is continually being asked to treat more people.

“The forward view outlines a balance between the government finding £8bn in funding and the NHS making almost three times as much in efficiency savings, to fill a £30bn funding gap. 

“There’s a risk the funding gap will be bigger than this because of the impact of social care. Similarly, the NHS might struggle to save £22bn without the right conditions.

“If these big risks materialise, it’s a problem for both the government and the NHS. It’s not simply about the former finding more money, rather tough choices will be needed to protect the NHS and patients we serve.

“Answering all these questions allow us to get on with the real work of transforming care, which will take skill and significant political will to succeed unencumbered by constant discussions about money.” 

On the cusp of an innovation revolution
The co-founder, of the NHS Innovation Accelerator programme, Dr Mahiben Maruthappu, looks at the transitions facing healthcare.

“Technology continues to disrupt the world we live in. In healthcare, the revolution is only just beginning. Almost every industrialised country stands on the cusp of three fundamental shifts in modern medicine. The question is, will we in the NHS embrace them?

“The first is genomics and personalised medicine. It’s been a decade and a half since we launched of the Human Genome Project and we’re still in the early days of finding out what collecting and decoding complete sets of people’s genes will enable us to learn about specific conditions.

“The second is data and digital health. Going digital benefits all – from offering citizens the chance to access their records online to enabling doctors to record vital signs and monitor observations remotely using tablets.

“Third, hardware and wearables. Fitbits, ECG’s and ophthalmoscopes that attach to your phone, Applewatch – each allow us to provide interconnected care, monitoring, predicting and treating in concert. 3D printing, the ability to print plastic or metal bones and limbs, to receive the blueprint for a medical device via the internet and print it on-demand, and when combined with regenerative medicine, the capacity to print cells, tissues and organs will revolutionise treatment, transplantation and manufacturing of devices.

“The NHS needs to embrace and harness these revolutions – sink or swim; either we surf the innovation wave or let it wash over us.”

A messy unpredictable future?
Traditional NHS managers are organisationally centric, something which will no longer work in 2015, writes Anne Cooper, in a personal blog this week.

She says that NHS managers seek to deal with problems through organisational structures with clear and logical relationships, and that they seek to be successful at an organisational level as that means survival of their organisation – they are organisationally centric.

“I was trained and educated like this but I believe that in 2015 and beyond it will no longer work,” she writes. “Over the last few years I am starting to see that the complex adaptive system that is the health and care system can’t survive if we behave like this and yet I still see these old styles of thinking. We often say the right things but we don’t walk the walk.

“In the new world working across communities, which is what we need to do, means giving up power and sometimes resources for the greater good. If we are going to change the way we deliver care it means some organisations will have to change and give up some of their share. It takes good managers to make this happen but it takes guts to lead it.

“Change in the way that we need it means messiness. It means small may be beautiful, that solutions delivered in local communities may be messy, unpredictable and probably don’t look like corporate solutions managers know best.

“Systems think they know best for people. I hear people talking this way all the time, assuming that all the expertise is in the ‘system’ and implying that there is none beyond. I do not believe this is true. Citizens, patients if you prefer, or even service users, may also have other ideas about what is the right thing to do and choose differently.

“We need to find the energy where it smoulders, in communities, in people, in hearts and let it burst into flame.”



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