News in brief

NHS to get £4bn in drive for ‘paperless’ health service: The government has launched its latest attempt to improve the use of technology in the NHS in England, reported the BBC. The aim is to create a paperless service that would be more convenient for patients, and help doctors to provide faster diagnoses. More than £4bn has been set aside for areas such as electronic records and online appointments, prescriptions and consultations. Full details of the funding are being agreed between the Department of Health and NHS England, but are expected to include: £1.8bn to create a paper-free NHS and remove outdated technology like fax machines and £1bn on cyber security and data consent. Health secretary, Jeremy Hunt said doctors found filling out paperwork and bureaucracy “so frustrating”. “We know that proper investment in IT – it’s not without its pitfalls – can save time for doctors and nurses and means they can spend more time with patients,” he told the BBC’s Andrew Marr Show. The aim is to allow patients to book services and order prescriptions online, access apps and digital tools and choose to speak to their doctor online or via a video link. Through the funding, everyone will have access to their own electronic health record, which will be shared between professionals so patients will no longer have to repeat their medical history.

We will fight contract imposition, says BMA: Junior doctor leaders have promised to fight on after the government in England announced it will impose a new contract on the profession, reported the BBC. The British Medical Association (BMA) said it was “considering all options” as the dispute threatens to escalate further. It comes after health secretary, Jeremy Hunt said he had been left with no choice but to act – just hours after the latest doctor strike ended. The union refused to accept a “take-it-or-leave-it” offer on Wednesday. BMA junior doctor leader Dr Johann Malawana said the contract was “flawed” and they had put forward a “fair and affordable” alternative. “The government’s shambolic handling of this process from start to finish has totally alienated a generation of junior doctors – the hospital doctors and GPs of the future, and there is a real risk that some will vote with their feet. Our message to the government is clear – junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and we will consider all options open to us.” The stance raises the prospect of more strikes, while behind the scenes there has been talk of legal action, mass resignations and doctors refusing to sign contracts. Ministers took the decision to impose the contract after their chief negotiator Sir David Dalton had advised them to do “whatever necessary” to end the deadlock. He said the final offer, which was made on Tuesday, on the eve of the strike, and rejected on Wednesday, when the walk-out was in full swing, was fair.

Review of information technology in NHS: IT expert Professor Bob Wachter has launched a review of computer systems across the NHS, reported Gov.UK. The review, “Making IT work: harnessing the power of health IT to improve care in England”, will look at places where IT has worked well and those areas that need improving. It will also look at different ways to implement IT in healthcare as the NHS works towards being paperless by 2020. Professor Wachter said: “The NHS is one of the world’s largest health and healthcare systems, and one of its largest employers. It’s essential that information technology across the NHS works well and can perform the tasks needed to deliver high quality, safe and efficient care.” Professor Wachter will make his recommendations to the National Information Board later this year. Health secretary Jeremy Hunt said: “Improving the standard of care patients receive even further means embracing technology and moving towards a fully digital and paperless NHS. NHS staff do incredible work every day and we must give them and patients the most up-to-date technology – this review will tell us where we need to go further.” The review will consider the experiences of clinicians and trust leaders as well as the current capacity and capability of trusts’ IT systems, as set out in the terms of reference. It will be formed of an advisory committee, the National Advisory Group on Health Information Technology in England, members include experts and patient representatives from England, Scotland, Denmark and the US.

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DigitalHealth.London to work with SMEs: A programme launched in London this week aims to bring together clinicians with healthcare providers, entrepreneurs and industry to speed up the adoption and commercialisation of digital health technologies, reported Launched by life sciences minister George Freeman, DigitalHealth.London aims to give companies a clearer route to market based on the needs of patients and the NHS. Its first major project is a Digital Health Accelerator programme to support emerging companies working in the digital healthcare sector. The accelerator will work with 30 small digital health businesses each year over an initial three year period and will hold its first open day for small and medium-sized enterprises (SMEs) on 7 March. DigitalHealth.London is a collaboration between MedCity, the Mayor of London’s life sciences promotional agency for the greater south east, the Greater London Authority, and the capital’s three academic health science networks – the Health Innovation Network, Imperial College Health Partners and UCLPartners. A statement on the programme launch said: “The use of digital health technologies is being slowed by challenges including the lack of a clear procurement route in the NHS, and difficulty in gaining access to clinicians and patients who can help shape products and explain needs and constraints at an early stage.” DigitalHealth.London wants to grow a network of relationships between industry, entrepreneurs, clinicians, patients and healthcare professionals.

Productivity in NHS hospitals falls for third year: Productivity in NHS hospitals has fallen for the third year running, according to official data that will intensify the debate over whether the service can survive in its current form without more funding. The research, carried out for the Financial Times by the Health Foundation, highlights the lengths to which the health service must go to reach its target of saving £22bn a year by 2020 – even as it enjoys one of the few inflation-protected budgets in Whitehall. Productivity is the ratio of “outputs” – for example, the number of hip replacements performed or patients treated in accident and emergency departments – compared to the “inputs” used to produce the care, such as staff numbers and the amount and type of drugs administered. The fall in productivity revealed by the Health Foundation reflects heavy government pressure to raise staffing levels, as ministers reacted to devastating revelations about substandard and inhumane care in a Staffordshire hospital in the mid-2000s. Anita Charlesworth, the Foundation’s chief economist, said: “It’s clear that in 2014-15 hospitals went backwards rather than forwards in improving their productivity, which makes the task of finding £22bn even harder, and it was a huge, Herculean task in the first place.”

Beverley Bryant gives details on £1.8bn paperless NHS funding: NHS England’s director of digital technology, Beverley Bryant, has shared more details about the £1.8bn promised for “a paperless NHS”. Bryant told the audience at a Westminster Health Forum on electronic patient records that the £1.8bn being spent on paperless will be split between £900m in capital investment, available to frontline NHS, and £400m in revenue funding to support the running costs of the investment. Bryant said the £400m revenue funding has been ring-fenced from the newly established Sustainability and Transformation Fund, which was announced in January 2016, reported Computer Weekly. Although the exact details of the funding won’t be revealed until April 2016, Bryant said “some capital funding” will be available in the next financial year, while the revenue funding “will be back-ended”. She also confirmed that both capital and revenue funding would be available for every year of the programme. Previously, NHS trusts have applied for funding through NHS England’s technology funds, but this will not be the case with the new money. Allocations from this latest fund will be based on local sustainability and transformation plans, which health and care organisations must complete by June 2016.

SNP pledge 500 more nurses and £27m health funding boost: Nicola Sturgeon announced a £27m boost to train more doctors, nurses and midwives as she admitted Scotland faces “real challenges” in recruiting GPs over the next decade, reported The Scotsman. The first minister set out measures to boost access for students to the medical professions as it emerged 53 GP practices have been forced to bring in restrictions on patient numbers. The funding would cover £3m for 500 extra specialist nurses as well as £23m to create 50 new medical school places while widening access for disadvantaged students. Sturgeon also made a commitment to retain student nurse bursaries and introduce a £1m safety net for the poorest candidates. In a speech at Queen Margaret University in Musselburgh, East Lothian, Sturgeon said: “We need to make sure that we are training the right numbers of professionals – in and across different specialisms – with the skills they need for the health service of the future. That’s why this additional funding of £27m is so crucial in ensuring the NHS in Scotland remains robust, resilient and ready for the challenges of the 21st century.”

Record rise in NHS dissatisfaction levels – survey says: The biggest ever rise in public dissatisfaction with the NHS was recorded last year, according to a long-running survey, reported the BBC. The British Social Attitudes Survey has been tracking satisfaction since 1983. The 2015 poll of nearly 2,200 people have shown satisfaction with the NHS at 60% – down from a peak of 70% in 2010. Some 23% said they were actively dissatisfied – a rise of eight percentage points on the year before and the biggest single jump in a year. The findings come amid growing pressure on waiting times for cancer care, A&E and routine operations, such as knee and hip operations. Patients reported highest satisfaction rates for GP services and lowest for social care, which is run by local authorities and covers home help for tasks such as washing and dressing, and care homes. Chris Ham, chief executive of the King’s Fund think-tank, said that while overall satisfaction levels were still high by historical standards, the findings should act as a “real wakeup call”. “What’s gone wrong is the public’s perception of the NHS under growing pressure. Money is tight, waiting times are getting longer, people are concerned that when they need the NHS it might not be there for them.” A spokesman for the Department of Health in England said: “There is pressure on the NHS as our population ages, and that’s why the government is investing record amounts to transform care.”

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A&E waiting time over 12 hours for more than 100,000 in England: More than 100,000 patients spent at least 12 hours in A&E departments in England last year, data seen by the BBC’s 5 live Investigates showed. The figures from the Health and Social Care Information Centre (HSCIC) also showed the number of people waiting that long has been rising. There were 124,000 such events (1% of attendances) in the first 10 months of 2015 against 68,000 in all of 2013. NHS England said the proportion of extended waits was extremely small. However, it added that even one 12-hour wait by a patient was too many. The NHS target is for 95% of patients to be discharged, transferred or admitted into hospital for treatment within four hours. All nations currently report performance against this target publically but England is the only nation which does not report 12-hour waits from arrival in A&E. Dr Adrian Boyle, chair of the Quality Emergency Care Committee at the Royal College of Emergency Medicine (RCEM), said: “It’s not just about tedious waits for patients. Studies have repeatedly shown that there is an increased mortality in people who spend a long time in emergency departments, so crowding kills patients.” The data includes all patients still in A&E after 12 hours but does not say why they were there so long. Dr Boyle said: “These are almost always people who need admission to hospital, so these are the most vulnerable and the most seriously ill patients.” 

Massive health IT framework coming soon: A massive new framework tender for electronic patient records (EPR), hosting, portals, mobile working and many other digital solutions will be published at the end of this month, reported Potentially worth hundreds of millions of pounds, the tender for a new Clinical Digital Information Systems Framework is a refresh of the framework contract created by the ‘2015 consortium’ of 38 community and mental health trusts in London and the South that needed to buy new systems and support before the end of their national contracts last October. The new framework will be available to acute trusts, GPs, clinical commissioning groups, social care bodies in local government, charitable organisations and private sector healthcare providers. It will also be available to trusts in the North, Midlands and East. Some in the region already used the former framework to procure systems before the end of their national contracts this July. NHS London Procurement Partnership said the framework will be published at the end of February at the request of the London NHS chief information officers’ council, and the ‘2015 Consortium’. A statement from the LPP said the new framework will: “Combine the benefits of an EPR system with the integration and interoperable digital tools which will give care professionals and carers access to all the data, information and knowledge they need, where and when they need it. This will be real-time digital information on an individual’s health and care, made available by 2020 to all NHS-funded services. It will also provide comprehensive data on the outcomes and value of services provided, which in turn will support improvement and sustainability.”

Carter: NHS to adopt ‘meaningful use’: NHS Improvement should create “meaningful use” standards for clinical IT systems and use incentives to drive better adoption of technology, Lord Carter’s review of hospital productivity recommended. Carter also said that the new national body that is being set up to take on the work of Monitor and the Trust Development Authority should create a set of national and local dashboards to allow real-time comparison of performance in all clinical specialities, reported The peer’s report makes 15 recommendations, including putting a “meaningful use” clause into provider contracts to encourage uptake of digital technologies. The report said trusts need to make better use of their existing systems and/or invest in new modern systems to improve the access and accuracy of data they need to manage their performance. At a minimum, it recommended trusts should have the key systems for: e-rostering; e-prescribing; patient level costing and accounting; e-catalogue and inventory management; RFID systems where appropriate; and electronic health records. “But we know the NHS does not have a good track-record in implementing such systems, so we are recommending NHS Improvement take the lead by setting the standards for ‘meaningful use’ of such systems and incentivising trusts to achieve them,” it said. Carter’s long-awaited report highlighted that data and information is critical for managing quality and efficiency performance across the care pathway: “To truly performance manage quality and efficiency on a regular basis, seamless real-time data is needed, which in turn requires investment in inter-operable information technology.”

NHS England ‘tightly in control of the purse strings’ for devo Manc: NHS England will remain responsible for many of the budgets being delegated to Greater Manchester under the devolution programme as it is employing the region’s new chief officer. Extensive details of the devolution arrangements for 2016-17 have been published, with the key changes affecting specialised services. Ian Williamson, chief officer for the devolution programme, told Health Service Journal (subscription required) the arrangements were “consistent with what we set out to do by this point”. However, a policy expert has said the plans are “not keeping pace with the ambition”. A report to the region’s strategic partnership board said several national budgets will be delegated to a newly appointed Greater Manchester chief officer from April, including for some specialised services, public health, pharmacy and secondary dental services. The officer will be employed by NHS England. The paper explains the “delegation” model as: “Local [clinical commissioning groups] involved in discussions with NHS England budget holders but accountability and responsibility remains within NHS England.” NHS England is currently recruiting the chief officer, with the application process closing on 15 February. The officer will have legal responsibility for the region’s £450m transformation fund, although “operational responsibility” will rest with local leaders.

E-discharge uptake revealed by DMI: Around two thirds of NHS trusts are sharing discharge summaries electronically with GPs and one fifth are prescribing electronically, early findings from digital maturity self-assessments showed. NHS England’s director of digital technology Beverley Bryant revealed some of the initial findings of the new “digital maturity index” to, but stressed that they are yet to be audited. NHS England wrote to trusts in November asking them to fill out a digital maturity assessment, which will feed into a national index, due to be published next month. Bryant said 264 invitations were sent out and 248 organisations have completed their assessment. Deloitte is now auditing the responses to ensure that what is reported by organisations is really reflected on the ground. Bryant said she felt that the overarching picture presented by the results so far “might be right”, but the data needed to be validated before details can be released. The initial findings of the Digital Maturity Index are the first indication of whether a national target for all discharge summaries to be sent electronically is being achieved. The requirement to send them electronically became part of the secondary care provider contract last October. However, it has not been requirement for GPs to be able to receive electronic discharge summaries. This will change as of April when it is included in the new General Medical Services contract. The focus of the new digital maturity assessments is on the ‘meaningful use’ of IT systems, rather than whether a system is deployed.

Four in 10 people would be willing to receive GP advice through apps, study finds: Nearly four in 10 people would be willing to receive advice from a “virtual” GP through an app, while six in ten would even be prepared to see a GP in a shop, a new study has found. The survey, carried out by PwC, of 2,000 UK consumers, patients and clinicians has revealed that a trend is growing where “IT-savvy consumers” are willing to have their care delivered outside traditional GP practices, reported Pulse. The study found that 38% of those surveyed would be willing to have a GP consultation through an app on their smartphones and tablets, 60% would be prepared to see a GP in a retail store during their shopping trips and 55% would even take a urine test in a shop. At the same time, 80% of 18-34 year-olds said they would be happy to receive treatment in a high street store or pharmacy. Alan Milburn, chair of the health industries oversight board at PwC, said: “The old relationship between patients and clinicians is giving way to a new one. New entrants from outside the traditional health sector are moving onto the pitch and disrupting the old rules of the game, often with ground-breaking ideas. This is a revolution that can only pick up speed in the years to come.” The healthcare apps and wearables sectors are expected to be worth £460m and £375m respectively by 2020, compared to £100m and £125m in 2015, PwC predicted.

System C buys Careflow Connect Ltd: System C has acquired Careflow Connect Ltd, developer of the Careflow secure mobile communications system for clinicians and care professionals, reported Careflow is a Slack-like collaborative unified clinical messaging and workflow platform. Use of the platform is said to reduce reliance on pagers, phone calls and unsecure services such as SMS messaging and instant messaging apps. Dr Ian Denley, chief executive of System C, described Careflow as a transformational technology that will completely change the way clinical teams work together. “It’s a bit like Slack for clinicians, and offers a fully mobile cloud-based solution.” Denley added: “Our plan is to integrate with the Graphnet shared record, System C Medway electronic patient record, and even with Liquidlogic in social care.” Dr Paul Stevens, medical director at East Kent Hospitals said: “The Careflow system provides an easy way to get everyone together to make quick clinical decisions. This has fantastic potential for improving patient safety and ensuring the correct accountability.”

Former NHS chief calls for four hour mental health target: A new four hour waiting time target for acute adult mental health patients should be established by the government from October 2017, according to an independent commission led by former NHS chief executive Lord Crisp, reported Health Service Journal (subscription required). The commission on acute adult psychiatric care has also called on ministers to end the controversial practice of sending adult and child patients hundreds of miles to find a bed. The commission’s report said: “Access to acute care for severely ill adult mental health patients is inadequate nationally and, in some cases, potentially dangerous. There are major problems both in admissions to psychiatric wards and in providing alternative care and treatment in the community. These two sets of problems are intimately connected and need to be tackled together.” By October 2017 the commission wants the government to introduce a maximum waiting time of four hours for adult patients to be admitted to acute psychiatric wards or be accepted for home treatment after an assessment. Lord Crisp said: “It is time to end the difference in standards between mental and physical illnesses. People with severe mental illnesses need to be able to find care just as quickly as people suffering from physical illnesses – and they shouldn’t have to travel long distances to do so.”



Reasons for being (dis)satisfied with the NHS
John Appleby, chief economist, policy at The King’s Fund looks at the data we get from the British Social Attitudes survey and asks how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?

“The results for this question show a 5 percentage point fall in satisfaction in 2015 compared to a year earlier. This is a statistically significant drop, although at 60 per cent satisfaction is still relatively high in historical terms. The survey also shows dissatisfaction rising by 8 points to 23 per cent. Think about how you would answer the question; it is clear that there are many factors that could influence your answer. Your recent personal experience of the NHS or your feelings about the NHS as an institution. You may have formed a general impression of the NHS from what you’ve read, seen or heard from the media. Maybe there was a high-profile event (a hospital scandal or a major policy change for the NHS) that occurred at the time of the survey and stuck in your mind.

“To explore some of the underlying drivers of opinion we added additional questions to the 2015 survey asking respondents why they had expressed either satisfaction or dissatisfaction. The options for the final survey were derived from a pilot and were designed to capture the majority of reasons that people gave.

“Figure 7 from the report shows the reasons the public gave for being very or quite satisfied with the NHS. The results suggest four or five key reasons for being satisfied with the NHS. Three relate broadly to the performance of the NHS: quality of care; attitudes and behaviour of staff; and acceptable waiting times. Two concern the nature and founding principles of the NHS itself: that it is free at the point of use and that it provides a wide range of services.

“Those who said they were very or quite dissatisfied gave their top reasons as: long waiting times; staff shortages; underfunding; financial inefficiency; and quality of care. There is more to explore within these results. For example, are there differences between age groups or political affiliation in the reasons cited for satisfaction and dissatisfaction? We will analyse this in more detail in the final report of the BSA survey results, which will be published later this year by NatCen.”

Another view: of funding GP workload
In this week, Neil Paul provides his take on reviewing the funding formula for GPs, using data to form some interesting analysis.

“There is this myth that GPs have had a huge pay rise. This dates back to 2004, when yes we got a decent pay rise. For most of the last ten years we have had below inflationary income rises so, effectively, pay cut after pay cut.”

Paul describes the Carr-Hill formula GP practices use to provide a weighted list in order to work out capacity and funding levels, but this formula needs revising. “Well, our local GP federation has been working with Edenbridge Healthcare to develop a BI dashboard for primary care. It’s starting to show some interesting figures. Perhaps we haven’t yet done the statistical analysis that the previously mentioned groups have done [GPRD general practice research database and QResearch database], but the early data is making me concerned.

“The dashboard is aimed at practices that want to look at their capacity, their activity and their demand, to help them plan better and understand what it is they are all doing. However, we have already pulled some interesting data from the past ten years – that is, from just after the last review of Carr-Hill – and it shows things are going up faster and faster and not just in a straight line. 

“Locally, our collective list size has gone up quite a bit; reflecting a growing population. This in itself shouldn’t be a problem the formulas use list size. However, at the same time, the average age of the population has gone up to new record highs. With this, the number of co-morbidities has also gone up. So it’s therefore not surprising that the rate at which patients present has also increased.

“So, in short, from the data I have, I’m not convinced the [Carr-Hill] formula takes into account the real ageing effect on demand for primary health care. I’m also worried that our negotiators have let our income fall behind our workload”.


Guest blogs: reactions to £4bn NHS tech investment

The Paperless NHS investment should focus on people, not products, writes Shane Tickell, CEO, IMS MAXIMS in response to the government plan to supply £4bn funding for healthcare IT.

The £4bn technology move will unleash confidence in UK companies, writes Patientrack director Donald Kennedy, who argues that UK SMEs can now invest more in helping the NHS, meaning less reliance on global software giants.

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