News in brief

PMQs: Jeremy Corbyn and Theresa May social care ‘crisis’ clash: Elderly people are being left isolated because of a “crisis made in Downing Street” over social care funding, Jeremy Corbyn has claimed. The Labour leader urged Theresa May to replace a corporation tax cut with cash to cover social care costs as they clashed in Prime Ministers Questions (PMQs), reported the BBC. It came with councils set to be offered extra tax rises to bring forward planned social care investment. May promised a “long-term, sustainable system”. She also said Labour had done nothing to tackle the problem during its 13 years in government between 1997 and 2010. Campaigners have been calling for investment to tackle what they say is a funding crisis in services for the elderly and disabled. The government was criticised after funding for adult social care was not mentioned in last month’s Autumn Statement, and local authorities have complained about cuts to the funding they receive from Whitehall. Just before the start of PMQs in the Commons, it emerged the government would offer councils an increase in the extra council tax they can impose to cover social care costs. Corbyn said a 2% increase was a “nonsense”, saying changes to council tax would raise more in wealthy areas. He said government funding for social care was cut by £4.6bn in the last Parliament, accusing ministers of a “con” in transferring the burden to local authorities. In response, May said the government was investing in social care through its Better Care Fund, as well as allowing councils to raise extra funds. A Local Government Association source said the funding change would be insufficient for councils already facing significant pressure.

Hunt to force trusts to publish avoidable deaths data: Health secretary Jeremy Hunt will bring in new regulations on NHS trusts to force them to collect, estimate and publish data about their number of preventable deaths, reported the Nursing Times (subscription required). Hunt made the announcement in the House of Commons following the publication of the Care Quality Commission review into learning from deaths that occur in the NHS. Mr Hunt said he was “accepting all their recommendations”. He told MPs that he would lay new regulations in parliament which will require trusts, from 31 March 2017, to collect a “range of specified information” on potentially avoidable deaths and serious incidents. Each trust will have to estimate how many deaths could have been prevented and provide an “assessment of why this might vary positively or negatively from the national average”.  Hunt’s plan for local estimates of avoidable deaths was previously labelled as “meaningless” by Professor Nick Black, from the London School of Hygiene and Tropical Medicine. In parliament, Hunt announced he was backing down on some aspects of his plan saying he accepted it would not be “valid” to compare data between hospitals nor would he be setting “any target for reducing reported avoidable deaths”.

Health secretary launches campaign to help parents spot sepsis: Jeremy Hunt has launched a nationwide campaign to help parents spot the signs of sepsis, reported the Guardian. The health secretary is hoping to raise awareness of the “devastating” condition, which causes about 37,000 deaths each year in England. Hunt said: “We need to get far better at spotting it across the NHS. By raising awareness and improving clinical practice we will save lives in the fight against this horrible illness.” The campaign, delivered by Public Health England and the UK Sepsis Trust, is part of measures by the NHS to tackle the condition, which arises as a complication of an infection. It is aimed at parents and carers of newborns to four-year-old children. Millions of leaflets urging parents to take their child to A&E or call 999 if their child is displaying symptoms will be delivered to GP surgeries and hospitals across the country. Sir Bruce Keogh, the national medical director for NHS England, said: “This campaign is an important addition to our ongoing work – we will never treat sepsis in time unless everyone ‘thinks sepsis’.”

Scottish budget cuts ‘will increase delayed discharges from hospital’: The number of patients kept in hospital after they are medically fit to go home will only grow if further cuts are made to public spending, opposition parties have warned. A census carried out in October found 1,576 people were delayed in their discharge, up from 1,524 in September, reported STV News. Over the course of October, patients spent 43,919 days in hospital as a result of delayed discharge. Most delays were caused by health and social care challenges, such as an absence of care home places or social care support at home. Health secretary Shona Robison said: “One unnecessary delay is one too many and I’ve made clear my ambition and expectation that our new integrated health and social care partnerships will successfully address this. We’re working with boards to prepare for winter and recently announced £3m in November to support them. This is in addition to the £30m a year allocated to health and social care partnerships to help them tackle delayed discharges.”

NHS accused of spending ‘more time on cover ups than saving lives’: The NHS stands accused of “covering up” failings behind patient deaths in a landmark report which warns that not a single hospital is properly probing deaths which warrant investigation, reported the Telegraph. The Care Quality Commission (CQC) said too many families who sought the truth about the deaths of their loved ones were given a “toxic drip feed” of information in their search for justice. The CQC review, which was ordered by the health secretary, following a scandal at Southern Health trust, carried out in-depth examinations of 27 NHS investigations into deaths. In just three cases, there was evidence that those carrying out probes had taken account of the perspectives of the families involved, the study found. Families who wanted to find out how loved ones had come to die in the care of the NHS were left feeling that they themselves were under investigation, the report said. They said they were left with the impression that the NHS spent more time on cover ups than on saving lives. In total, 83% of those who took part in investigations said they felt the process had made “no difference” to preventing future fatalities. And nine in 10 families said they were not treated with care or respect.

NHS Wales must speed up electronic prescribing, says auditor general: Welsh NHS bodies are working well together to improve the way medicines are prescribed and managed, but medicines management needs a greater internal push, the auditor general for Wales has concluded. The auditor general published a report which found that NHS Wales can take further steps to improve quality and costs in primary care prescribing, such as improving the storage of medicine, reducing gaps in information about medicines and finally introducing a national electronic prescribing system, reported National Health Executive. With the demand for medicines growing in Wales – the country has seen a 46% increase in dispensed items over the last decade –  the report concludes that strong medicines management is vital for bodies to ensure good patient outcomes and value for money. The auditor general for Wales, Huw Vaughan Thomas, said: “With over £800m spent on medicines and over 79.5 million different medicines dispensed in the community per year, it is vitally important that the use of medicines is optimised so that patients receive the best possible outcomes.” A spokesman for the Welsh government added that since last year, the government had made good progress on a number of earlier recommendations by the auditor general and it would respond to the report shortly. However, Nick Ramsay, chairman of the assembly’s public accounts committee, said there was “still much to do to ensure the safe and cost effective use of medicines in Wales”.

Raise taxes to increase NHS funding, says GP MP: The government needs to raise more money for the NHS from the public, House of Commons Health Committee chair and former GP Dr Sarah Wollaston has said. The Tory MP told the House of Lord’s committee on NHS sustainability that politicians had to decide whether that would be via income tax or through national insurance, reported Pulse. Dr Wollaston, who has previously critcisied the government for “misleading” the public on the funding increase it is promising the NHS, also criticised the government for failing to make “politically difficult” decisions that would protect NHS finances by keeping people healthier. She said: “I think you need to have a mechanism to bring more money into the system as a whole. It is not for me to tell you what is the right mechanism but I think there needs to be a cross-party consensus about how we achieve that in the long term.”

Stevens: NHS bouncing ‘between feast and famine, sugar-highs and starvation’: The NHS will need additional funding this parliament to help it become more efficient in the long term, Simon Stevens has said. The chief executive of NHS England told the House of Lords NHS Sustainability Committee that he thought there was no evidence that support for a taxpayer-funded health service was “in any way diminishing”, reported National Health Executive. Stephen Dalton, interim chief executive of the NHS Confederation, said recently that private companies should not be seen as “bogeymen” in the NHS as it struggles to cope with a growing financial crisis, with £22bn in efficiency savings needed by 2020. However, Stevens argued in the inquiry that the NHS was currently bouncing “between feast and famine, sugar-highs and starvation” because its funding rates are dependent on the state of the wider economy, ultimately leading to poorer care and inefficient use of resources. “I think the main question will be whether at some point during this parliament it is possible to liberate more capital expenditure for the NHS, which would help invest in some of the new service models that we can see are part of what the future needs to look like,” Stevens said.

Billion-pound framework released for Health IT: A billion-pound framework aimed at improving health IT has gone live, with a score of trusts lining up to procure new kit, reported The Clinical and Digital Information Systems (CDIS) Framework covers an estimated £800m to £1.3bn of IT work in London and the South. However, the framework is also available to health and local authorities across the United Kingdom. Developed by London Procurement Partnership, it is a refresh of the framework contract created by the ‘2015 consortium’ of 38 community and mental health trusts that needed to buy new systems and support before the end of their national contracts last October. Overall, 68 suppliers have made it on to the frameworks, covering the full range of IT solutions focused of delivering the ‘paperless 2020’ vision across health and social care. These were narrowed down from the 198 suppliers that responded to the tender, and include most of the big suppliers in the market, such as Cerner, Emis Health, Orion Health, System C, and CSC. The framework includes: electronic patient records (EPRs), specialist clinical systems, data hosting, informatics, integration, networks, telehealth, and patient facing applications, among other products. These products are divided into four lots; EPRs, hosting, ‘enabling systems supporting EPR & digital 2020’, and ‘specialised digital solutions & professional services’. The focus and mix of the products was designed to put single EPRs under pressure but provide a greater range of interoperability and innovative products. Pushing choice to patients has also big a big motivator, it is understood.

Summary Care Record now used in 50% of community pharmacies: 50% of community pharmacies are now using the Summary Care Record (SCR) to access key clinical information about patients, reported Digital Health Age. This marks a major milestone, with nearly 6,000 pharmacies using the functionality. NHS Digital released the SCR to community pharmacists and pharmacy technicians one year ago. Almost 90% of community pharmacies have participated in briefing sessions to support their implementation of the SCR and more than 20,000 pharmacy professionals have completed online SCR training. Pharmacists can use the SCR to benefit from improved clinical decision making, reduced patient waiting times and fewer calls to GP surgeries. It can also help free up resources within general practice and A&E by helping pharmacy become the first port of call for minor ailments. Mohammed Hussain, programme head for Integrated Pharmacy at NHS Digital, said: “It is really encouraging that half of community pharmacies now have access to the SCR, allowing them to support patients with better informed and tailored care. From April 2017, accessing the SCR will also become a NHS England measure under the Quality Payments Scheme for community pharmacy, helping to drive up quality of care in this setting.”

Telephone GP consultations show promise – report: Introducing telephone GP consultations has proved effective but video has shown less tangible benefits, an NHS England report has said, reported Evaluating the £50m Prime Minister’s GP Access Fund, the review found interoperability and IT provider limitations were key barriers to implementing technology. Set up in 2013, this report evaluates the money provided between April 2014 and March 2015 across 20 pilot sites covering 1,100 practices. However, this evaluation was only released in October. The money was intended to provide additional hours of GP appointment time, improve patient and staff satisfaction with access to general practice and increase the ways GPs can be contacted. Financially, return on investment for telephone consultations was described as an “encouraging outcome to date”. This tentative appraisal was repeated in the report’s conclusions where the growing evidence suggests that investment in telephone consultations could be “cost effective due to the GP time savings that are being achieved”. However, central bodies remain keen on using the technology, with Skype being a particular pet project of the health secretary, Jeremy Hunt.

Surrey trust seeks patients for £5m tech study: NHS England and Surrey and Borders Partnership NHS Foundation Trust are looking for patients to take part in a £5m ground-breaking technology study that aims to change health outcomes for people with long-term conditions in collaboration with Innovate UK and other industry partners, reported Health IT Central. The Technology Integrated Health Management (TIHM) study is intended to assist clinicians with the remote monitoring of patients with dementia so that they could intervene quicker to help avoid crises and reduce the number of hospital admissions in the area. Dr Ramin Nilforooshan, dementia specialist at the trust said: “The technology is designed to alert us to any changes in behaviour or any changes in wellbeing that could signal someone is becoming unwell or that they are in trouble.” Patients from Surrey and North East Hampshire that have been diagnosed with mild or moderate dementia and have a carer are asked to get involved in the study which is organised in partnership with the University of Surrey, the Kent Surrey Sussex Academic Health Science Network, six other local clinical commissioning groups, the Royal Holloway University of London and nine technology innovators. Half of the people selected to take part in the trial will have their homes equipped with ‘sensors, apps and tracers’ attached to fridges or beds that will connect to each other to analyse information about a patient’s condition and behaviour.

Gloucestershire deploys new EPR: Gloucestershire Hospitals NHS Foundation Trust has gone live with the first phase of a new electronic patient record (EPR) system rollout following major delays, reported Health IT Central. The technology, TrakCare, from InterSystems, is said to be facilitating the transition between paper-based and paperless processes, creating a new EPR that enables remote access to information for clinicians directly at the point of care. Representatives from the trust revealed that TrakCare will be deployed gradually over the next year to ensure that services will not be disrupted, with full implementation expected to be delivered by late 2017. “Whilst we have worked hard to minimise the impact of this implementation, a change of this magnitude will inevitably cause some delays for patients and we would ask them to bear with us while our staff get used to the new way of working,” said the Gloucestershire NHS Foundation Trust chief executive, Deborah Lee. The digital platform is expected to improve patient safety by helping clinicians respond quicker in case a patient is at risk of becoming severely ill; furthermore, the platform is developed taking into account interoperability standards, enabling easier interaction with future applications. “The implementation of TrakCare represents a significant investment in technology and has the potential to transform the way we deliver care. It is about putting our patients and their safety first, using the best of digital technology to improve the experience and outcomes for our patients. There is no doubt that this is a big chance for our staff, adjusting their working practices and getting used to new systems, while at the same time delivering high quality care,” added Lee.

University Hospital Limerick upgrades digital emergency department system: University Hospital Limerick has gone live with an emergency department (ED) patient management system, aiming to improve patient care, reported Computer Weekly. The hospital, which runs one of the busiest EDs in Ireland, has deployed the system from IMS MAXIMS to better collect real-time data and track a patient’s journey throughout their stay. Colette Cowan, CEO of UL Hospitals Group, which manages six hospitals including Limerick, said the system was a “fantastic achievement”. “The new software enables clinicians to have a shared view of their patients’ conditions, and offers the tools to quickly and accurately treat or discharge them. It also readies the hospital for further digital transformation,” she said. “We are making great advancements in digital health, and I look forward to seeing the continued benefits to staff and patients in Limerick.” The system includes modules such as clinical triage, recorded outcomes, recording attendance and tracking for each patient presenting to the ED. The hospital is also opening up a new ED in May 2017, and the system is fully integrated into the hospital’s other systems, designed to fit the layout of the new department.

Pathology framework worth up £250m out to tender: A multi-million pound pathology framework tender has been issued by NHS organisations in the north of England, reported The framework agreement has an estimated value of £20m to £250m and is being run by the North of England Commercial Procurement Collaborative (NOE CPC), hosted by the Leeds and York Partnership Foundation Trust. The procurement is for pathology analysers or analytical systems that produce pathology results. The four-year contract is split into two lots. The first covers analysers, analytical systems and associated products and services while the second covers pathology managed service contracts. The NOE CPC covers about 80 NHS bodies including clinical commissioning groups, ambulance trusts, hospital trusts, care trusts and mental health trusts. Trusts covered by the framework include Leeds Teaching Hospitals NHS Trust. Last month, Cancer Research UK published a report that said investment in digital pathology and data collection will be essential if diagnostic services are to be able to cope in the future. The nine recommendations include funding the infrastructure required for digital pathology and investing in technology so data can be sent to the Cancer Outcomes and Services Dataset. However, Suzy Lishman, president of the Royal College of Pathologists, said digital pathology is still in its early stages and “there is not yet sufficient evidence to support its wholesale adoption”.

Nearly 45% of UK prefers traditional NHS channels, says survey: Research shows UK citizens are reluctant to use digital platforms offered by the NHS due to data sharing concerns, reported Health IT Central. Only 33% of participants would rather see the system fully digitised, a survey on the public sector digital experience conducted by Loudhouse has revealed. The research was published in a new Riverbed report, showing that approximately 45% of the respondents did not find it easy to book an appointment with the NHS on the digital platforms that it is currently offering, while 34% had to use it “more than once” to carry out a basic task. Data sharing is cited as one of the main reasons why citizens prefer the traditional healthcare delivery model as 20% of interviewees said they would not be “happy” if the government went paperless by 2020. “The likelihood is that citizens are worried about data safety with health and the personal cost of it being lost.  This transformation to digital is already underway but it comes with a renewed need for security, as well as controlled access, application performance, and visibility across the multitude of services and applications across different public services in the UK,” added John Street, UK & Ireland Riverbed Technology regional director for government and defence.

GP tests out connected stethoscope, cleared for NHS use: A digitally connected stethoscope from Eko Devices is now available in the UK and promises to change patient-doctor interaction. The stethoscope has just received its CE certificate, making it the first and only digital stethoscope to wirelessly pair with a mobile device, allowing clinicians to securely record, save, annotate and share sounds with experts for a second opinion, reported Computer Weekly. Connor Landgraf, CEO and co-founder of Eko Devices, said: “Given the 7 million heart disease patients in the UK, this has tremendous potential to help clinicians who are less specialised in cardiovascular to detect and manage heart problems, saving significant NHS resources.” Dr Keith Grimes, a GP and “digital healthcare innovator”, based in Eastbourne, has trialled the device. He said he had begun using the device alongside his traditional stethoscope. This has two advantages for healthcare professionals, said Grimes: “It facilitates remote care and can also be shared with patients to transform their understanding of what is going on.” Eko is also developing a way to analyse the audio, enabling clinicians to understand what they are listening to. Grimes also said: “The Eko device enables remote clinical examination in any location, from a patient in their own home, to a paramedic in an ambulance, or a care worker in a residential setting – the possibilities for a digital stethoscope are endless.”

Snapchat spectacles worn by UK surgeon while operating: UK teaching surgeon Dr Shafi Ahmed has livestreamed an operation using Snapchat spectacles, which are sunglasses with one small camera integrated, allowing the wearer to record what they are seeing. The routine hernia repair procedure took place at the London Independent Hospital. Clips from it were posted to Snapchat. Stepping out of a clinic to speak to the BBC, Dr Ahmed said the spectacles presented a unique opportunity because of the platform they offered for teaching. “I’m always looking for ways to develop my teaching, especially using wearable technology. When I saw the Snap spectacles, I asked friends in New York to buy some and send them to me immediately. We have inequalities in medical education in different countries – I’m looking for ways we can use cutting-edge technology in relatively low-cost gadgets to teach people everywhere,” he said. The operation was initially viewed by about 200 medical students and trainees. It has now had thousands of views on YouTube. Dr Ahmed’s colleague then posted the clips to Snapchat. The challenge of the Snap spectacles was the tinted lenses because they are designed to be used as sunglasses. With plans to use the spectacles for teaching, the lenses are set to be replaced with clear glass by a US company. Dr Ahmed said: “In terms of teaching and learning the spectacles have enormous value. The feedback has already been good – students understand what we are doing here.”

1970s printers replaced with e-prescribing in Ireland: GPs in Ireland will finally replace printers as old as the first Star Wars film, with the first rolling out a new national e-prescribing service before Christmas, reported The first few GP practices are expected to dump their 1970s-era Matrix printers on 23 December, replacing them with a parallel laser printer and electronic system. eHealth Ireland chief executive Richard Corbridge said the system should be rolled out to all “digital practices” by the end of the year. “GPs want to get rid of these old printers and the pharmacists are enthused about the removal of manual entry.” The system is collaboration between GP suppliers, such as Clanwilliam Health, and the government agency eHealth Ireland. Currently patients take a print out of their prescription to their chosen pharmacist, who then enter the information into their own electronic system and files the prescription. Under the new system, electronic information will be sent automatically from the GP’s system to the pharmacist’s system, which should have the prescription ready by the time the patient comes to pick it up. The information will be sent securely over Healthlink, a national health IT data and messaging infrastructure akin to the NHS Spine. In addition, a paper element will be retained, with patients given a laser printed prescription with unique barcode to be used to pick up their prescription at the pharmacy

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The doctor on your Xbox? The NHS needs more digital ambition
Patients and staff use a wide range of new technologies, from smart watches to virtual gaming. Let’s see how the NHS can use it, writes CommonTime’s Roger Booth on the Guardian.

Booth, CommonTime’s chief technology officer, says: “Imagine a world where doctors and nurses glance at their watch to see patient updates, where virtual reality headsets are used to consult on medical procedures, or where patients could interact with their doctor through their television or media console.

“All of this, and a great deal more, is achievable with the technology we have today, but both the NHS and its technology suppliers are yet to embrace what’s possible and make these scenarios happen.

“The health secretary, Jeremy Hunt, has called for an “NHS for the smartphone age”, but mobile and digital means and offers healthcare so much more; something technology consumers are very aware of.

“Large touchscreen devices, smart watches, other wearables, smart TVs, virtual reality displays and even games consoles are just a few of the digital devices available to consumers. But mobile health (mHealth), both in the UK and many other parts of the world, still largely falls far short of embracing the potential range of devices.

“Meanwhile, clinical staff qualifying today in their 20s and 30s have grown up with mobile technology. They have smartphones, consoles, tablets and wearables. They use FitBits, health apps and messaging platforms.

“A lot of frustration can be found among those professionals who want to use this technology in their working environments to improve care.”

Technology, not contract change, to modernise the NHS
The NHS is under immense pressure and its workforce is beginning to crumble, writes Chris McCullough in an article for Digital Health Age.

The CEO and co-founder of staff scheduling company RotaGeek, comments on the staffing issues that are currently crippling NHS.

He says: “Overall the NHS is servicing more people today than ever before. But the circumstances under which it works are unsustainable, as a recent report by the General Medical Council showed.

“The report revealed that over a quarter of F2 doctors (those finishing their initial postgraduate training and moving on to specialist or general practice training) plan on taking a break following their two-year Foundation Programme. Almost 90% of these breaks are due work-life balance, out of which 47% attribute it to “burning out”.

“However modified salaries will not rectify run down staff. In fact, this will only help to further perpetuate the problem; tweaked compensation will become an inappropriate apology for flawed staffing and scheduling. Imposing a rigid scheduling process that results in doctors comprising their personal commitments, and even personal wellbeing, to fit their lives around inflexible and impersonal shift patterns is not a long-term solution.

“Eventually, doctors will seek to work elsewhere, for example in medical agencies. The NHS needs to empower doctors and this is not a matter of contract change. It is a matter of how certain processes, namely staff scheduling, are carried out.

“The NHS needs to modernise, starting with the foundations, in order to fit demand without stretching its resources to breaking point. Earlier this year, the Estates and Technology Transformation Fund set out to invest millions to accelerate the adoption of technology and improve operations. But modernising staff scheduling has been neglected – even though its people are the heart of the organisation. 

“At the moment, running on outdated processes is costing the NHS time, energy and above all its very best resource – NHS staff.”

Progress on integrated care
A ‘person-centred’ health service became an international movement this year, writes Don Redding, director of policy at National Voices, the coalition of health and care charities, on National Health Executive.

He says: “In England there is additional cause for concern. The ever-changing goals of health reform, churn of leadership, and loss of institutional memory have already begun to dilute the strength of purpose that existed only three years ago.

 “At NHS England, following a change at the top, the FYFV (Five Year Forward View) was launched and is now the single compelling force driving ‘transformation’. The pioneers were quickly eclipsed by (or cannily morphed into) the vanguards, 50 local sites prototyping new models of care. Here we start to cross our fingers somewhat nervously. Let’s be clear: National Voices helped shape the Forward View, especially its ambition to work in new ways with people and communities. 

“To judge whether the key elements of the FYFV succeed, we will need new outcomes: focused on overall health and wellbeing; reflecting ‘what matters most’ to people; and consensually covering the combined efforts of the formal health and social care systems and the voluntary and community sector.  

“But the governing metrics for so-called transformation and integration are those for secondary care resource use: admissions, readmissions, lengths of stay, delayed discharge. On any given day these easily trump such measly indicators as the quality of life and death, or being supported to self manage effectively.

“Has the historical moment for the primacy of ‘people-centred integrated health services’ arrived just too late? 

“As ever, National Voices, the People and Communities Board and the VCSE sector more widely are working to ensure the answer to these questions is no.”


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