News in brief

Hospitals need to get to grips with IT Nuffield report: NHS hospital boards need to get to grips with the potential benefits and pitfalls of implementing information technology, a new report from the Nuffield Trust urged. Delivering the Benefits of Digital Healthcare identifies seven areas in which the think tank argues that there are systems available that could deliver “huge scope from major improvements in quality and productivity”. However it also warns that “without careful implementation” such technologies can “create inefficiencies, staff frustration, and even threaten quality of care”, reported DigitalHealth.net. The report identifies “seven conditions for success” that start by noting that “you need a transformation programme supported by technology, not the other way around” and that clinical leadership is vital. Candace Imison, the Nuffield Trust’s director of healthcare systems, hopes the report will do two things: “The first is that this is how healthcare is going to be delivered in the future, the second is that there are lessons to take on board, including the alignment of technology and workflow. That is no mean feat, because you have extremely complex IT systems and a really complex healthcare system, and that makes this hard.” The report says all boards now need to “deepen their understanding of the new capabilities that technology gives them and, most importantly, to align their technology and transformation programmes”, and to invest in clinical IT leadership.

NHS trusts may hit £2.3bn deficit, report warns: NHS trusts in England are on course to be £2.3bn in the red by the end of the financial year, according to a leading health think tank, reported the BBC. Based on data from about one in three trusts, The King’s Fund said the financial position was getting worse and performance was deteriorating. It said this year was shaping up to be “make or break” for the NHS in England. Three months ago, The King’s Fund thought the overspend for trusts in this financial year in England could top £2bn. Now it is forecasting a net deficit of £2.3bn by the end of March. The findings suggest two-thirds of trusts expect to overspend by the end of the year, including 89% of acute hospital trusts. Commenting on the findings, The King’s Fund’s chief economist, Professor John Appleby, said they showed the NHS faced a huge financial challenge. “Even with the additional funding recently provided by the Treasury and a big switch from capital to revenue spending, it is touch and go whether the Department of Health will be able to balance its budget at the end of the year. At the same time, performance is deteriorating with key targets being missed with increasing regularity and increasing concerns being raised about the quality of patient care. This is shaping up to be a make-or-break year for the NHS.” Health minister Alistair Burt said: “There should never be a choice between providing safe care and balancing the books, which is why we’re investing £10bn to fund the NHS’s own plan for the future, including nearly £4bn next year.”

Nation must focus on mental health – PM: David Cameron has called for the nation to focus on mental health after a review revealed inadequate, underfunded care, leading to “thousands of tragic and unnecessary deaths”. The report – by a taskforce set up by NHS England – said around three-quarters of people with mental health problems received no help at all. Ministers agreed more needs to be done, committing £1bn extra a year by 2020, reported the BBC. The government says this will help treat a million more people a year. The funds are to come out of the £8.4bn the government has promised to the health service during this Parliament and comes on top of extra money already announced for children’s services. Prime minister, David Cameron said: “We should be frank. We have not done enough to end the stigma of mental health. We have focused a lot on physical health and we haven’t as a country focused enough on mental health.”

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SNP unveils blueprint for healthcare to tackle inequalities: Bold proposals to deliver more healthcare from home and create networks of specialist doctors have been unveiled to tackle “unacceptable” levels of health inequality in Scotland, reported The Scotsman. Scottish health secretary Shona Robison outlined plans to shift the burden of care away from acute hospitals, as part of the new National Clinical Strategy, by supporting smaller hospitals, creating teams of nurses, GPs and pharmacists to treat people in a community setting, and using new technology. The plans are aimed at targeting staffing shortages by allowing specialist doctors to work across several hospitals, as health boards have struggled to recruit highly-skilled staff in some specialties, forcing patients to wait for treatment or travel elsewhere. This could lead to fewer specialist inpatient units with specialist services centralised instead, but with follow-up care delivered locally, the report said. More recovery and rehabilitation will also take place at home under the plans. Announcing the strategy, Robison said: “People will get most of their health and social care services provided in their own homes and we want to prevent people going to hospital as far as we can. I think people understand that if it is a once-in-a-lifetime procedure then they may have to travel further to a specialist centre where outcomes will be better. We will make sure people get most of the care they need in their local hospitals.”

Seven-day NHS may not cut death rates, say Hunt’s own officials: Jeremy Hunt’s key argument in his demands for a seven-day service in NHS hospitals has been called into question by his own department, in a leaked report which says it is not able to prove that fuller staffing would lower the numbers of weekend-admitted patients dying. The report also admits it will be “challenging” to meet the government’s promise to recruit 5,000 more GPs by 2020, a Conservative pledge during the election campaign, and that 11,000 new staff will be needed to run a seven-day service in hospitals. The increased numbers of deaths among patients admitted at weekends has been the cornerstone for Hunt’s argument in favour of a seven-day health service, with the health secretary citing 15 international studies since 2010, including one co-authored by the NHS’s top doctor Professor Sir Bruce Keogh, which indicated an increase of deaths in hospitals at the weekend. However, an internal Department of Health draft report, leaked to the Guardian, said the department “cannot evidence the mechanism by which increased consultant presence and diagnostic tests at weekends will translate into lower mortality and reduced length of stay”. Critics have long argued Hunt’s figures are skewed and that patients who attend hospital at weekends are far likely to be sicker or unable to access alternative palliative care services.

Large “jump in deaths” expert warns: England and Wales have seen the biggest jump in the number of deaths a year for a whole generation, a public health expert suggests. Professor Dominic Harrison said this must act as a “strong warning light” and suggested cuts to local authority social care budgets could be partly to blame, reported the BBC. Public Health England said it is monitoring the provisional data. And its officials say a particularly bad strain of flu and an ineffective vaccine may be behind the rise. Professor Harrison’s own analysis backs up figures in the Health Service Journal which suggest there have been 5.6% more deaths in England and Wales in 2015 than in the previous year – the biggest increase in the national death rate since the 1960s. Though the final figures – which take changes in population size into account – will not be released by the Office for National Statistics until the summer, experts say more needs to be done to understand the reasons behind the spike and urge public health experts to focus on wider factors. Professor Harrison, director of public health in Blackburn and Darwen and adviser to Public Health England, also pointed to a separate report by Public Health England which reveals a large number of local authorities showed a fall in life expectancy at age 85 in 2014. Taken together he says the figures suggest “something is making the population more vulnerable to death.” And he said the findings are unlikely to be fully explained by winter infections or a rise in the elderly population. Professor Harrison said reductions in local authority social care budgets in England have particularly affected preventative care services that would normally provide daily one-to-one contact for elderly people.

NHS Spine 2 managed entirely in-house: The new open source NHS Spine service is being run entirely in-house by the Health and Social Care Information Centre (HSCIC) working with small and medium-size enterprises. HSCIC chief operating officer Rob Shaw said the insourcing of Spine 2 was completed over the first weekend in February when the Data Transfer Service was moved in-house and is now called Mesh (Messaging Exchange for Social Care and Health). The insourcing process started when Spine 2 went live over the August bank holiday weekend in 2014. “That exits fully our relationship with BT, we are now working purely with SMEs,” Shaw told DigitalHealth.net. He said the HSCIC has ensured it does not become reliant on a single supplier because it does not want to be tied down going forwards. It is working with Maztech, Redcentric and local Leeds firms BJSS and Infinity Works. Spine 2 has been built using open source components including the Riak open source database. Shaw said the HSCIC still has a contract with the database supplier Basho in case anything goes wrong: “because Spine outages hurt the NHS so much, we have to make sure security resilience and sustainability are at the forefront of all design work.” There are 400 million transactions via the Spine a month and that number is growing exponentially as it is used for more things by more people. Shaw said the in-house team is now responding to user demand to drive the priorities for changes and improvements.

Minister to give keynote at digital health summit: Life sciences minister George Freeman and National Information Board interim chair John Newton are amongst the keynote speakers at a Digital Health Leadership Summit this month, reported DigitalHealth.net. The new two-day summit, held in Warwickshire on 25-26 February, will bring together senior NHS executives and digital health leaders from local and national organisations to share lessons on the case for strategic digital investments and measuring benefits. IMS MAXIMS and Microsoft are sponsoring the inaugural summit organised by Digital Health in partnership with the Health and Social Care Information Centre. Three NHS trust chief executives from Taunton and Somerset, Northumberland Tyne and Wear and University Hospital Southampton NHS foundation trusts will also present as part of the summit. Shane Tickell, CEO of IMS MAXIMS said: “The profile of digital technology as an enabler for transformational change has never been higher. By supporting the summit, we are reinforcing our commitment as a company, and a team, to developing new ways of information sharing and shaping service redesign to deliver efficient and quality healthcare.” Jon Hoeksma, editor of Digital Health, added: “Leadership is critical to realising the promise of a digitally-enabled health and care system. The new summit builds on the many brilliant leaders within the CCIO and Health CIO networks to help them make the case for strategic digitally-led transformation to further NHS senior executives. IMS MAXIMS are emerging as a key disruptor in the market and their commitment and support, both as a sponsor of the CCIO Network and for the summit has been magnificent.” 

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Department of Health plans NHS “transparency league table”: The Department of Health (DH) is developing a “learning organisation league table” to rate NHS trusts on how well they report and respond to information, Health Service Journal (HSJ, subscription required) has learnt. HSJ has been told by several well-placed sources, who asked to remain anonymous, that the department is working on a composite indicator to compare providers on the openness and honesty of their reporting, and how effectively they make changes after incidents. According to the sources, the rating, which is being referred to as a “learning organisation league table”, is supposed to address the slowness with which NHS organisations frequently investigate incidents, implement recommendations and learn from each other. HSJ understands the league table will build on measures added to the MyNHS website that rate trusts on their “reporting culture”. It is also likely to draw on indicators in the NHS staff survey about responsiveness, some of which were added in the 2015 survey, whose results are due to be published this month. One of the sources said the aim was to give a “further nudge” to trusts to help “support local systems to become more open and honest”. The source added that the league table was as much about improving the willingness of NHS staff to come forward with concerns as it was about improving things for patients.

Hunt urged to re-enter contract talks as deal ‘was within reach’ – ATDG: An agreement on junior doctors’ pay and working hours was “within reach” and the government should resume negotiations, the Academy of Medical Royal Colleges’ Trainee Doctors’ Group (ATDG) has said in a letter to the prime minister. The letter, urges health secretary Jeremy Hunt MP to withdraw the imposed contracts on junior doctors announced last week, reported National Health Executive. It adds that the negotiations over Hunt’s controversial efforts to introduce longer working hours on weekdays and additional hours on weekends for junior doctors had already been successful in gaining changes, such as safeguards on the number of hours junior doctors work. The letter warns that consequences of the imposed contract could affect training, recruitment and patient safety and lead to an exodus of junior doctors from England, particularly affecting sectors that already face staffing shortages such as emergency medicine and psychiatry. It states: “The determination to deliver immediate reform has meant that the final part of those negotiations concerning Saturday working, have been curtailed prematurely. This is particularly distressing as we felt a fully negotiated settlement was within reach. The decision to unilaterally impose a contract in opposition to a significant proportion of the total medical workforce has further damaged the morale of an essential part of a profession that already feels undermined and under-valued. We once again urge your secretary of state for health to withdraw the imposed contract and complete a negotiated settlement that will provide for the long-term future of healthcare in this country.”

Members flock to Ireland’s CCIO council: Ireland’s Council of Clinical Information Officers (CCIO) has 145 members from 35 disciplines and is pushing to formalise the role across the country, reported DigitalHealth.net. eHealth Ireland’s chief clinical information officer Yvonne Goff said that since eHealth Ireland was created a year ago, it has had a strong focus on clinical engagement; adding that the need for this was one of the big lessons learned from England’s work to digitise its health system. While the role of chief clinical information officer has been established elsewhere in the UK, Goff said it remains a new concept in Ireland and she is the only person who officially holds this position. Getting more people appointed into CCIO roles is a top priority and she would also like to see a more formal clinical group advising on national ICT projects. Goff said the interest of healthcare professionals in the potential of technology is shown by the large and diverse membership of Ireland’s CCIO council. “I’m only one person, one opinion, so we built a council of clinicians. In some respects it’s like pushing an open door because all of these people are so passionate and want to be involved,” Goff said. The council meets four times a year. It previously had a more ‘top-down approach’ whereby experts would speak to members about what is happening in other places, but from March this year, council members will set the agendas, she added.

NHS ‘never events’ a disgrace, says Patients Association: More than 1,000 NHS patients in England in the past four years have suffered from medical mistakes so serious they should never happen, according to analysis by the Press Association. The so-called never events included the case of a woman who’s fallopian tubes were taken out instead of her appendix, reported the BBC. NHS England insisted such events were rare, but the Patients Association said they were a “disgrace”. Other “never events” included the wrong legs, eyes or knees being operated on and hundreds of cases of foreign objects such as scalpels being left inside bodies after operations. The Press Association analysis also found that patients’ lives were put in danger when feeding tubes were put into their lungs instead of their stomachs. Katherine Murphy, chief executive of the Patients Association, said: “It is a disgrace that such supposed ‘never’ incidents are still so prevalent. How are such basic, avoidable mistakes still happening? There is clearly a lack of learning in the NHS. It is especially unforgivable to operate on the wrong organ, and many such mistakes can never be rectified.” NHS England insisted never events were rare – affecting one in every 20,000 procedures – and that the majority of the 4.6 million hospital operations each year were safe.

Free NHS England sessions teach GP practices to “release capacity”: NHS England is hosting a series of roadshows around the country for GPs to learn how to “release capacity” in their practices, reported Pulse. The free workshops, which are being run during this month and next, provide an opportunity for GPs to “hear about successful innovations” in other practices and see how they may themselves implement these, NHS England suggested. It said it would also be an opportunity for GPs to meet their local NHS England representatives and “learn about the national programme to release pressure”. NHS England, which is cooperating with the British Medical Association on the roadshows, said: “Attendees will leave with new understanding of the evidence about bureaucracy and potentially avoidable demand, insights into solutions being implemented around the country, and a practical plan for action.”

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Opinion

Why a long-term strategy is critical to ensuring the NHS avoids the perils of ‘digital by default’
Tony Pickering, professional services director, Ricoh UK writes: Jeremy Hunt has announced yet another £4bn digital transformation plan for the NHS, but throwing money at technology can’t fix the NHS alone. 

“The UK government announced yet another bid to improve the level and use of technology in the NHS across England. More than £4bn is expected to be set aside for areas such as electronic records and online appointments, prescriptions and consultations. While these proposals will be welcomed from most patients, doctors and healthcare workers alike, it is critical that they’re implemented with a long-term strategy in mind. After all, investing in large scale technological reform is only worthwhile if an organisation’s employees are properly taught how to use the equipment and why it is in place.

“So what steps must health trusts take in order to equip their staff for a digital tomorrow?

“Envision a real paperless strategy: before even thinking about technology that could support staff, decision-makers need to take a step back and map out each entire process from start to finish, how it interacts with other processes and finally where improvements can be made.

“Audit the paper trail: the NHS faces a number of challenges on its journey towards a digital future. Firstly, the sheer volume of information and physical documentation it maintains on a daily basis requires an audit as to exactly what will be kept and what will be lost during the changeover.

“Ensure the secure delivery of data: trusts must be prepared for a host of possible threats in every process throughout the lifecycle of electronic and hardcopy documents as they are generated, processed, stored, archived, and disposed – without hindering ease of use of the technology. With the threat of sanctions from the Information Commissioner, a vital solution is to ensure that users authenticate themselves at the device so that the document can be released securely and confidentially while the person is there to collect it.

“Lead with a vision: large-scale national programmes are an attractive proposition for any new government wanting to make its mark, but leaders must beware of the significant money that has already been wasted on these types of policies in the past.

“With this focused investment, today’s NHS can harness digital technology to enhance patient care and improve services all round.”

The story behind the figures
Joni Jabbal, researcher at The Kings Fund discusses what NHS finance directors are telling us.

“Our quarterly monitoring report (QMR) provides a thorough review of NHS performance figures along with insight from an accompanying survey of trust finance directors and clinical commissioning group finance leads. Over the past couple of years I’ve often wondered when and if our QMR survey respondents would become more optimistic in their outlook. Not yet, would seem to be the answer. 

“Our latest survey of trust finance directors – carried out after the Spending Review announcement and planning guidance was published – shows that 67% expect to overspend by the end of this year – including 89% of acute trusts. Despite the aim of the planning guidance to contain overspending to £1.8bn, we estimate an overall deficit of around £2.3bn by March this year after various in-year loans and other financial support.

“Our respondents spell out what this really means for their organisations – overwhelming pressure would probably sum it up. One trust finance director described how the organisation’s deficit meant that it would need a ‘£37m cash loan in February to be able to pay staff and suppliers in the last two months of the year.’ Another finance director explained how the trust had revised its original planned deficit of £5 million due to ‘very significant operational service pressures and huge increases in demand for beds since August 2015’.

“While there is no doubt that the health system is under pressure, there were also signs of optimism. One respondent told us about their experience with developing place-based systems of care and the positive effect this has had on quality of care, attributing this to ‘some genuine joint working among commissioners that is feeding through to providers, so that we can contribute to genuine joint win-win situations’. With the introduction of sustainability and transformation plans and the development of ‘transformation footprints’ perhaps more of this optimism will be evident in future surveys.”

Approach mental health like cancer care: prevention is key
For decades cancer strategy has focused on early prevention and diagnosis. Now we must do the same with mental health, writes Jenny Edwards, chief executive of the Mental Health Foundation on the Guardian’s healthcare network.

“It’s not only in funding that mental health lags behind, it’s also in approach. As efforts to improve cancer survival rates show, care and treatment in physical health has for decades focused on preventing and diagnosing physical problems early. This approach must be mirrored in mental health.

“Beyond the economic cost of £105bn a year, poor mental health is destroying lives

“However, the focus of the debate on mental health is mostly on acute care, as was seen last week when Lord Crisp published his independent commission report. This is understandable: it is a real problem that needs to be resolved. But the lack of access to acute mental health services is a symptom of the mental health crisis, not its cause. The cause is the failure to prevent, where possible, mental health problems from developing in the first place.”

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