News in brief

More than 20 NHS hospitals on ‘black alert’ amid reports of patients left in ambulances: Overcrowding in NHS hospitals has become so severe that last week more than 20 trusts issued ‘black alerts’, meaning they are unable to guarantee life-saving emergency care, reported the Independent. The top-level alert, considered a “serious incident” by NHS England, can result in scheduled operations being cancelled and patients being diverted to other hospitals as overflowing A&E departments struggle to cope. At least 23 hospital trusts in England declared they were unable to manage demand last week, reported The Guardian. In Leicester, patients were made to wait in ambulances until A&E staff were able to see them, according to the newspaper. And bed shortages at Royal Surrey hospital in Guildford at one point are said to have left 27 patients in need of a bed with nowhere to go. Around a third of NHS trusts said they were facing intense pressures in December, according to the Nuffield Trust, which found 50 hospitals had declared alerts at the two highest escalation levels on an official scale last month. Most of the 23 trusts The Guardian spoke to said they had reached the most severe of the four levels, with some describing the pressures they were facing in terms of a “serious internal incident”. A Nuffield Trust spokesperson told the Independent if more than 20 of these alerts were at Opel 4, the top of the alert level system, that would mean an “unbelievably high” number of hospitals were failing to cope with demand.

May vows to address nation’s hidden mental health problems:  Prime minister Theresa May has promised to tackle the “hidden injustice” of mental illness, particularly among young people, by providing more training for teachers and companies in England, reported Public Finance. In a speech to the Charity Commission, May announced a range of measures including offering mental health first aid training to secondary schools, and training for employers and organisations to support staff who need to take time off. May said: “For too long mental illness has been something of a hidden injustice in our country, shrouded in a completely unacceptable stigma and dangerously disregarded as a secondary issue to physical health.” True parity for mental and physical health must be achieved, she said, and promised “to employ the power of government as a force for good to transform the way we deal with mental health problems right across society”. According to the government, one in four people have a mental health disorder at any given time, at a cost to the state of £105bn every year, with young people disproportionately affected. Speaking on the BBC’s Today programme, health secretary Jeremy Hunt, admitted there was a “black spot” in the area of mental health provision for children and young people. Former care minister, MP Norman Lamb, said he would grill the government in Parliament over what he called a roadblock to the improvement of mental health services, reported the Independent. Lamb said: “This is a puny response to a burning injustice and an attempt to cover up for this government’s failure to deliver on promised investment for children’s mental health. I welcome the fact the prime minister is addressing the issue of mental health and the focus on schools and employment is right.”

NHS England chief contradicts May over spending: The chief executive of NHS England has contradicted government claims that the health service is getting more funding than it asked for. Simon Stevens told MPs this was “stretching it” and there were “clearly substantial funding pressures”. And, in clashes with Labour leader Jeremy Corbyn, the PM called claims of a “humanitarian crisis” in the NHS “irresponsible” and “overblown”, reported the BBC. However Corbyn said Theresa May was “in denial” over the situation. There have been several warnings in recent days about the pressure on the health service in England. The Royal College of Nursing said its members were reporting the worst conditions they had experienced. In a separate move, 50 leading doctors have warned the prime minster in a letter that lives are being put at risk because of mounting pressures on the NHS – and charities working with elderly people said long-term solutions were needed, with a similar call from a group of Conservative, Labour and Lib Dem MPs. Health officials said they were investing more in care. The fresh calls for government action came a day after documents leaked to the BBC showed record numbers of patients were facing long waits in A&Es in England. The document compiled by regulator NHS Improvement showed this winter is proving to be the most difficult for more than a decade, with nearly a quarter of patients waiting longer than four hours in A&E last week.

GPs drafted in to send hospital patients home as patients asked to take on ‘daunting’ care duties: GPs are being drafted in to help send patients home and free up hospitals in midst of what has been called the worst ever accident and emergency crisis, reported The Telegraph. Families are being asked to take on “daunting” duties looking after patients who are being sent home early. Health officials are drawing up emergency measures amid widespread pressures across the health service, with hospitals urging patients to stay away from A&E unless in great need. Doctors said the moves were driven by “panic” and took no account of desperate shortages of GPs. In NHS North Lincolnshire, family doctors are being called in to review patients at Scunthorpe General Hospital amid “unprecedented demand” on services with patients experiencing “extremely long A&E waits.” Local doctors said the request was “outrageous” stating they had never seen such requests in 20 years. The area is struggling with a major shortfall of GPs, and is currently recruiting doctors from Lithuania, Poland and Greece in a bid to plug gaps. Dr Andrew Green, chairman of the British Medical Association’s GP committee clinical and prescribing subcommittee, said the request was “incredible”.

Hunt suggests scrapping four-hour A&E target for ‘non-urgent’ patients: The health secretary has sparked controversy by saying that the four-hour target for patient treatment shouldn’t apply to people who present to A&E with minor illnesses in a bid to ease pressure on ailing emergency departments, reported National Health Executive. Jeremy Hunt made the comments in an emergency statement in the House of Commons as A&E departments flounder over the winter period, with a third of England’s hospital trusts warning that high patient numbers were affecting care and stories of patients being increasingly diverted to other hospitals due to a lack of capacity. A&E doctors have admitted that many departments are struggling to achieve the four-hour target, with 40% of English hospitals registered with the Royal College of Emergency Medicine’s (RCEM’s) winter flow programme reporting performance under 75% of that standard. However, the RCEM, which represents A&E doctors, has said that Hunt’s suggestion to caveat the four-hour standard is misguided, warning that decisions must be made to deliver quality patient care rather than to simply improve statistics, reported National Health Executive. “We welcome the health secretary’s recognition of the current problems and he is correct in saying that emergency departments should be for emergencies only,” said Dr Taj Hassan, RCEM president. “However, it is exactly those patients who present as emergencies that pose the greatest challenges as a substantial proportion of these spend long periods of time in the emergency department, waiting for a bed. Seeking to target patients with minor illnesses should not be the priority.”

A&E departments failing to hit four-hour waiting time targets: A&E departments have once again failed to hit their waiting time targets, new NHS England figures revealed. The statistics showed the proportion of people seen within four hours in November was 88.4%, against a 95% target, reported ITV News. That is a 2.9% fall compared to the same time in 2015 and represents a seven-month low.  Additionally, only 11 out of 138 NHS trusts with major A&E departments fulfilled their waiting time aim. The data highlighted acute problems with delayed discharges – where patients are medically fit to leave hospital but are stuck in beds due to problems arranging care in the community. This impacts on A&E as hospitals struggle to find beds for incoming patients. The Telegraph reported that bed-blocking had risen more than 40% in a year as hospitals continued to be overwhelmed with people needing care. The research for England highlighted acute problems with delayed discharges – where patients are medically fit to leave hospital but are stuck in beds due to problems arranging care in the community. It followed calls from the head of the NHS for extra funding for social care.

Welsh LGA: Social care costs may force councils to merge after all: The rising cost of social care could eventually force Welsh councils to merge despite these plans being dropped just last October, the Welsh Local Government Association (WLGA) has said. The WLGA’s chief executive, Steve Thomas, warned that the costs Welsh councils will face for social care will double over the next 15 years from £1.3bn to £2.6bn, with “no suggestion” of how councils will fund the rise, reported Public Sector Executive. Thomas suggested that the answer to the crisis may have to come in the form of funding given by Westminster rather than in the Welsh government budget, describing social care as “the elephant in the room” for future councillors. “There are huge pressures, not least of all on health and social care. Social care costs will double in the next 15 years,” Thomas told BBC Radio Wales. “Active consideration of either mergers of authorities or at least merger of services will be commonplace in the next period as the situation is becoming serious,” added Thomas. “We’ve got problems with residential care homes. We’ve got problems with huge demographic challenges.” With elections due to be held in all of Wales’ local authorities this May, Thomas said that social care is “certainly … the biggest issue” that new councillors will have to address.

Stevens: FYFV update due in spring as NHS faces ‘very real’ pressures: NHS England chief executive, Simon Stevens has said that the NHS faces “very real” pressures that are only likely to become more trying as funding becomes more “constrained” over the next three years, saying that the NHS got “less [money] than it asked for” from the government, reported National Health Executive. Stevens made his comments under questioning by the Public Accounts Committee (PAC) on the financial sustainability of the NHS alongside Jim Mackey, the chief executive of NHS Improvement, and two representatives from the Department of Health, David Williams and Chris Wormald. Stevens said that the NHS was “fortunate” to get front-loaded funding increases this year after Meg Hillier, chair of the PAC, picked up on comments made by NHS Providers leader, Chris Hopson, that the NHS can no longer deliver what is being asked of it under its current financial pressures. “We heard from Mr Hopson very clearly that there’s not enough money in the system and the NHS can no longer deliver what’s being asked of it, but the government is repeatedly telling us that the NHS is getting more money than it asks for. What is your view?” Hillier asked. “It’s right that by 2020 NHS England will be getting an extra £10bn over the course of six years. I don’t think that’s the same as saying we’re getting more than we asked for over five years as it’s the Five Year Forward View, not six years,” Stevens replied. “I said to the select committee back in October that like probably every part of the public service we got less than we asked for in that process, so I think it would be stretching it to say that we got more than we asked for.” He added that NHS England will look to refresh its Five Year Forward View considering what needs to be done in the NHS over the next two years, with the update to be produced by the end of March 2017.

£107m funding for health and social care integration: The Scottish government is to invest an extra £107m to ensure more people are able to be cared for safely in their own homes and avoid preventable admissions to hospital, reported Scottish Housing News. The money will be invested into health and social care partnerships which bring together NHS and local council care services for patients, in particular the elderly, and reduce the need for them to go into hospital for treatment. The new investment means NHS spending on social care and investment will increase to almost half a billion pounds in the coming year, and will go towards delivering our living wage commitment to adult social care workers. First minister Nicola Sturgeon discussed the investment during a visit to Midlothian Community Hospital in Bonnyrigg, which she opened in 2011. Sturgeon said: “Integration is one of the most ambitious programmes of work this government has ever undertaken and one which we believe will deliver health and social care services that work more efficiently, putting people at the very heart of treatment decisions. That is why this £107m additional funding across Scotland is so important. Not only does it ensure that patients can receive more treatment in their communities where we know they are more comfortable, but it also reduces demand for acute hospital usage by reducing avoidable admissions, lengths of stay and delayed discharges.”

Five Year Forward View for Mental Health response shows support for digital services: The UK government has now published its response to the Five Year Forward View (FYFV) for Mental Health, accepting the recommendations set to improve the provision of digital mental health services, reported Health IT Central. The news came after Theresa May’s announcement on Monday that £67.7m will be invested to expand the digital infrastructure of mental health services; the newest report published by the government supports the new set of reforms. Speaking in front the House of Commons, health secretary Jeremy Hunt recognised that the NHS was still far away from providing the right online tools that patients need, calling Theresa May’s plan ‘an ambitious expansion of digital mental health provision’. The plans revealed included the publication of a ‘green paper’ that will contain new recommendations ‘to improve services across the system’, set to be published later this year, and a pilot programme that will match patients with ‘well-trained’ mentors with the help of online resources. The Mental Health Taskforce, chaired by Paul Farmer, chief executive of mental health charity Mind, released the FYFV for Mental Health in February last year. The response showed the government had accepted the recommendation to publish a ten-year strategy report for mental health research in order to make the UK ‘a world leader in the development and application of new mental health research’ and it is due to be released in spring 2017.

Prime minister launches review of care and integration policy: The prime minister has begun a review of policy on social care funding, delivery and integration with health, amid huge concern about failure in the sector, Health Service Journal (subscription required) has learned. The project was initiated by Theresa May before Christmas and work is now under way. Several senior officials have been seconded to a team at the Cabinet Office for the review. They include Department for Education director general for children’s services, Paul Kissak; Care Quality Commission deputy chief inspector for social care, Sally Warren; and Charlotte Buckley, currently a deputy director at the business department, who until recently worked on social care at the Department of Health. It is not known how long the review will run, but it is expected to produce an internal report on options for next steps by March. The team has begun visiting areas that have well developed links between health and social care, such as Manchester and Nottinghamshire, and talking to experts on care and integration. Several well-placed sources said the work was focused on medium and long term change, rather than short term improvements, and was examining a large range of issues. These include the funding model, approaches to bringing health and care together, commissioning, delivery, and the role of intermediate care.

Leicester’s Hospitals  switches to new electronic workflow and patient information system in their ED: Leicester’s Hospitals has successfully deployed a new electronic patient record to manage the flow of patients through their Emergency Department (ED), reported Health Technology Newspaper. Developed in partnership with Nervecentre Software, the new solution, known as Nervecentre WISE, was chosen to provide a faster and more efficient patient information system to support an ever increasing and demanding hospital environment. The switch from the previous ED system was achieved over two days with the Minor Injuries Unit going live the first day, followed by majors, resus, paediatrics and eye casualty the next day. John Clarke, chief information officer at Leicester’s Hospitals, said: “With up to 600 patients each day through our ED, switching to a new electronic workflow and patient information system in the department was a big step up for us, one that we successfully achieved through great team-work between ICT teams, clinical staff and Nervecentre.” Paul Volkaerts, CEO, Nervecentre Software said: “Swapping out a platform in continuous use without slippage or clinical impact is challenging and I’m very proud of the close teamwork that achieved that. Our venture into ED is driven by our belief that our mobile workflow approach can radically improve efficiency within the ED; and I’m excited to see what we can achieve together over the coming months as Leicester’s Hospitals’ ED turn on the mobile workflow features inherent in our product.”

Former Surrey NHS IT chief and supplier both jailed for corruption: A former NHS IT chief has been sentenced to three-and-a-half years imprisonment after accepting more than £80,000 in bribes from an IT supplier for awarding him a contract with Royal Surrey County Hospital NHS Foundation Trust, reported, Computer Weekly. The trust’s former informatics director, Peter Lewis, was given more than £80,000 by Richard Moxon, the director of an IT company, in return for awarding him a contract worth nearly £1m in its first year. Guildford Crown Court sentenced Lewis to three-and-a-half years in jail, while Moxon was given a 14-month sentence. The head of proactive crime for Surrey Police, detective superintendent Karen Mizzi, said Lewis had “sought to greedily divert money from the NHS into his own pockets”. The sentencing was the result of an investigation into Lewis’s activities as the trust’s director of informatics. In November 2016, he admitted to taking the bribe and Surrey Police is now seeking a confiscation order to seize any available assets he may have.

Review shows limited progress in digitising NHS records: Health scientists at the University of York have shown that in the 25 years since the NHS was tasked with digitising patient records there had been limited progress made, reported Medical Xpress. The first of a kind review showed that limited guidance on IT implementation and underestimating the level of change to the working lives of staff members, were some of the reasons why little progress had been made towards becoming a fully digitised NHS. Researchers argued that the high number of challenges highlighted the scale of the complexity in implementing technology in healthcare systems. Dr Arabella Scantlebury, research fellow at the University’s Department of Health Sciences, said: “It is difficult for those outside of the NHS system to visualise the scale of this project; there are hundreds of departments and healthcare organisations, using different IT systems, trying to share important information about a patient.” The team reviewed policy documents and evaluations of policy to explore the extent of progress that had been made and to try and understand whether common mistakes were being repeated. The review showed that progress was limited to the introduction of IT infrastructure, such as NHS Spine, which provides network support for electronic records, allowing information to be shared across the many different systems used by NHS departments.

Intelligent healthcare tech design will benefit from patient input: Patients with dementia and Parkinson’s will be involved in the design of an intelligent healthcare technology developed at City University of London, Neil Maiden, professor of digital creativity at Cass Business School and lead of the SCAMPI project, has told Health IT Central. The team gathered by Maiden at the university will start working in March on the development of a computerised toolkit that will allow patients living at home, their relatives and healthcare professionals to manage their care while collecting data in real time about the ‘quality of life with a condition. SCAMPI is one of the projects that has recently received funding from the Engineering and Physical Sciences Research Council for the design of intelligent healthcare technologies. “In order to relieve pressure on an increasingly overstretched NHS, there is an ever-growing need to deliver more efficient, effective, patient-centric care in the community. New intelligent healthcare technologies have the potential to deliver this care to relieve the pressure, in the form of simple-to-use digital technologies in people’s home that support self-care and reduce the need for routine interventions from healthcare professionals,” Maiden added. Patients using SCAMPI will be able to interact with the toolkit through ‘a new form of intelligent visual care plan’ entitled VIZ-CARE which they will be able to share by using ‘web technologies’.

Hospital trust to implement API for clinical mobile apps: A London hospital trust is planning to implement new technology for mobile clinical apps, including an API for secure information exchange, as part of a partnership with London based digital specialist DeepMind, reported UKAuthority. Imperial College Healthcare NHS Trust said it is planning to use the API to support the exchange of data between its existing electronic patient record system and new apps for patient care, and to use the company’s Streams clinical app. It has become the second NHS body to team up with the company, following a similar arrangement with the Royal Free London NHS Foundation Trust announced last November. Imperial contributed to the development of Streams in some of the early product development and a pilot for an app named Hark, which in turn was taken over by DeepMind early in 2016. The trust said that over the past two years it has moved from paper to electronic patient records, and that it regards the use of apps as the next step in the use of digital tech in healthcare. The API is intended to support different apps in working together while ensuring that patient data is secured and consistent. Dr Sanjay Gautama, Caldicott guardian and chief clinical information officer for the trust, said: “For apps to be useful and safe they cannot operate in isolation – they need to be securely linked to the core electronic patient record system. By working with DeepMind we are embracing the opportunities that technology brings to improve patient care, using their expertise to help us deploy a system that allows us to maximise future innovations in mobile technology for healthcare for the benefit of our patients.”

Big trust overhauls info strategy to meet cyber threat: The growing threat of cybercrime is driving an information technology strategic overhaul at one country’s largest trusts, reported DigitalHealth.net. Sheffield Teaching Hospitals NHS Foundation Trust published its latest “ambitious” 2017-2020 information technology strategy in response to significant changes in “the global, NHS and trust contexts for information and technology”. Published in the trust’s December board papers, the draft document said cyber-attacks were the trust’s most significant digital threat. The strategy said: “The significance of cyber security in the modern world cannot be overestimated. In a healthcare setting, the effects resulting from a cyber-attack can be devastating. The average cost of a security breach is £600,000 to £1.5m and the rise in ransomware attacks on the NHS was of particular concern. The infection can come from anywhere, sometimes even a trusted source, and therefore we need to be extra vigilant as a cyber-attack could be a case of life or death.” Sheffield Teaching has already been targeted, unsuccessfully, by ransomware attacks, the strategy said. Many trusts had been re-evaluating the cyber security in the wake of the damaging ransomware attack on Northern Lincolnshire and Goole NHS Foundation Trust in October last year.

New NHS Confederation chief executive revealed: Niall Dickson, former chief of the General Medical Council, has been appointed as chief executive of NHS Confederation, reported Health Service Journal (subscription required). Dickson announced he would be leaving his role at the GMC last January and left at the end of 2016. He had led the organisation since 2010. Previously he had been chief executive of The King’s Fund, from 2004 to 2009, and during his career as a journalist worked for the BBC and Nursing Times.

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Opinions

May weaponising NHS all by herself
The Prime Minister’s refusal to acknowledge that social and health care needs more immediate funding and, in the long run, broader reform, is giving political ammunition to Labour, writes Sky’s senior political correspondent, Beth Rigby.

“Remember the 2015 election, when Ed Miliband reportedly wanted to “weaponise the NHS” to win votes? David Cameron was furious over his rival’s “disgusting” attempt to use the health service as a “political football”.

“Two years on, Theresa May is in a full-blown NHS crisis and she can’t blame Labour for weaponising the health service.

Rigby says ongoing rows over how much cash the Government was really putting into the NHS has gathered pace over recent months: “Theresa May insists it’s £10bn; Sarah Wollaston, former GP and chair of the health select committee, said the real figure was more like £4.5bn.

“Feeding into this, the full-blown crisis in social care brought on by years of spending cuts: 400,000 elderly people are now without any social care support in their local communities, forced into A&E when they need support.

“Bed blocking is up a quarter in two years and running at three times the levels of other countries.

“The more Theresa May denies, sidesteps and dodges the charge, the more she weaponises the health service for Labour. She’d do better to engage with the issue and have a proper debate with the public about how the NHS can be put on a sustainable footing instead of lurching from one winter crisis to the next.

“But we need to have an honest conversation about its shortcomings and how we safeguard its future. Proper funding involves asking, and answering, hard questions: should the public pay more tax to fund healthcare; should inheritance tax be used to pay for people’s social care; should we move to a hybrid service where more people rely on private health insurance; should the costs of an ageing society be paid for by wealthy older people or the working population?”

Time to dodge the hard choices on NHS sustainability has run out
We can no longer put our heads in the sand about the immense pressures on the provider sector, writes Chris Hopson in Health Service Journal (subscription required).

Hopson, the chief executive of NHS Providers says: “Trusts are working flat out, treating more patients than ever before but slipping further behind performance targets. Wherever we look there are pressing priorities: managing the finances, dealing with spiralling emergency demand and completing the sustainability and transformation planning process.

“In the midst of these pressures, it’s important to look at the big picture and ask the top level questions that often get lost in the day to day hurly burly.

“We currently seem stuck in a fruitless and sterile argument about whether the government has fully funded the NHS’s own plan.

“First, can we all now agree there is a clear gap between what the NHS is expected to deliver and the funding available?

“Most people, including many senior leaders across the NHS, recognise the service can no longer deliver all its current priorities and performance standards within current funding. But we can’t properly plan for and meet this gap until we all agree that it exists.”

Dr Chris Mimnagh: Telemedicine should be as simple as Alexa
We have a habit of making things difficult in the NHS. Ideally, if we can make it difficult and expensive it’s even better writes Dr Chris Mimnagh in GP Online.

“A perfect example is superglue. We pay a fortune for sterile blue coloured superglue because we’re using medical grade stuff. It’s the same as the clear stuff from the DIY store, but it’s guaranteed sterile and for the NHS.

“I think telemedicine is a similar sticky mess.

“I bought my parents a small, voice-operated box for £50 which now controls their heating, light and has the potential to monitor house security too.

“They say hello to Alexa (the voice of the box) every morning, wish her good night, ask her to play music, read books. They could, if they wanted, ask her to do the shopping too. 

“All this needs no training, is not saved for emergencies but is rapidly becoming part of life for a pair of closer-to-80-than-70-year-olds.

“All that has to happen now is for the NHS to add a new ‘skill’ to the options list, which includes voice ordering of prescriptions, booking appointments, or even messaging family members if nobody says hello by 9am or if doors are opened after midnight.

“I know that we won’t, we can’t make it that simple, cheap or consumer friendly.”


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