News in brief

NHS England makes slight improvement: The number of people treated within four hours at A&E departments recovered in the second week of January, reported the BBC.  But while performance has improved since the first week in January, it remains way below its target of 95%. Leaked data covering last week puts the national figure at 82.4% with only five hospitals meeting the 95% standard. NHS England said they were doing “everything [they] can to ensure the best care possible is being delivered.” While the national figure remained low, it did show an improvement on the first week in January, which is usually the health service’s hardest week. An earlier exclusive report by BBC News had revealed that, in that first week, 79.6% of patients were seen within four hours and only one hospital met the 95% target. The new analysis by NHS Improvement, which oversees foundation and NHS trusts, revealed a general pattern of gradual improvement since the low of January 3, when the daily A&E rate reached a low of 75.8%. Over this weekend, the service managed to see more than 85% of patients inside the four-hour waiting target.  A spokesman for NHS Improvement said: “In the past few days, we’ve seen a real improvement in how quickly patients are being seen and discharged from accident and emergency departments – including to social care. But we know the pressures facing our hospitals will continue over the remaining weeks of winter and we’re working hard to ensure they have the support they need to offer patients quick, safe, quality care.”

More than 7,000 nurses could face axe under secret NHS plans: More than 7,000 nurse posts could be axed from NHS hospitals across the country despite a mounting A&E crisis, new plans revealed. Every area has been ordered to draw up measures to save £22bn and reorganise health services in order to meet rising demand from an ageing population, reported The Telegraph. However new documents suggested that the proposals could result in the loss of more than 17,000 staff by 2020 – including 7,300 nurses and midwives. Senior nurses said the implications for safety were “truly frightening” with widespread shortages of staff already in overstretched hospitals. The forecasts, seen by Health Service Journal, also revealed that the plans rely on a dramatic reversal in trends which have seen casualty units under unprecedented pressure. While A&E attendances across England have risen by 4.5% and emergency admissions by 3.5% in the past 12 months, the plans rely on a 4.2% fall in attendances, and a 0.8% drop in admissions. While forecasts set out plans to boost GP numbers, the time taken to train such staff mean a time lag between cuts to hospital staff, and any significant increase in family doctors. The documents also set out plans to increase the number of GP “support staff.” Health officials said this might include some nurses.

Delay in patient discharges down by 4% across Scottish hospitals: The number of patients kept in hospital when they were clinically ready to leave has fallen 4% in a month, latest ISD Scotland figures show. A census carried out for November found 1,509 people were delayed in hospital, down from 1,576 in October – a reduction of 4.3%, reported The Herald Scotland. The total number of days lost to so-called bed blocking also decreased over the same period, from 48,104 in October to 45,639 in November – a drop of 5.1%. More than two-thirds (68%) of the people delayed were aged 75 and over. The majority of delays were due to health and social care reasons, such as waiting for care home places or for social care support. Health secretary Shona Robison said: “It is encouraging to see a reduction in the number of bed days lost to delayed discharge in November. However, one unnecessary delay is one too many and I have repeated my ambition and expectation that our new integrated health and social care partnerships will address this. The draft budget announced an additional £107m to transfer from the NHS to health and social care partnerships to support sustainability in the care sector, bringing the NHS contribution to enhancing social care to around £500m next year, and that funding will be used to further improve social care provisions.”

OBR: NHS needs £88bn extra by 2067 to cope with rising costs: The Office of Budget Responsibility (OBR) has said that the NHS budget will need to increase by at least £88bn by 2067, ruling out chancellor Phillip Hammond’s chances of balancing the Treasury’s budget in the next Parliament, reported National Health Executive. The rising costs of healthcare due to an ageing population with chronic long-term conditions and non-demographic factors such as slow growth and technological advances risk putting public finances on an “unsustainable” path unless the government increases taxes or cuts spending in other areas, said the UK’s independent fiscal watchdog in its fiscal sustainability report. Overall, the government is expected to have to increase health spending from an expected 6.9% of GDP in 2020-21 to 12.6% by 2066-67, an overall budget of £228bn. “Evidence from the UK and other countries suggests that health spending will grow faster than the economy over time, thanks in part to the ageing population, but more importantly to non-demographic factors, such as technological advances and relatively low productivity growth,” the OBR said. “The fiscal challenge from rising healthcare costs – assuming that future governments spend more to accommodate them – is substantial over the longer term, but they would also make the current chancellor’s nearer-term goal of balancing the budget in the next Parliament harder to achieve.” The information casted doubt on the government’s short-term spending plans as their average annual NHS budget increase of 1% a year since 2010 have been half as much as the average rise of 2% that the OBR predicted will be required. Richard Murray, director of policy at The King’s Fund, welcomed the OBR’s acceptance of a long-term increase in GDP spending on health as a “welcome dose of realism” while warning that it illustrated the pressures currently facing the NHS.

Scotland’s NHS ‘at breaking point’ warns BMA chairman: The NHS in Scotland is stretched pretty much to breaking point and needs more staff in all posts, a leading doctor has warned. Dr Peter Bennie, chairman of the British Medical Association Scotland, said figures claiming that doctor numbers were at a record high were not relevant when there were vacancies across the country, reported The Scotsman. He told BBC Sunday Politics Scotland that consultants, doctors and nurses were having to take on more work “just to keep things running”. During the First Minister’s Questions, Nicola Sturgeon suggested struggling accident-and-emergency units in England should look to Scotland but came under attack from the Tories and Labour over the SNP’s stewardship of the NHS north of the border. Dr Bennie told Sunday Politics Scotland: “We’re running vacancies right across the country – urban, rural, hospital, GP. And we’re just fed up with a mantra that says from the government we have more doctors than ever before. The point is we need more again in order to be able to provide the service that people require. The relevant question is do we have enough doctors, do we have enough nurses, do we have enough staff outside the health service to provide the care that people need? And at present, we don’t.” He added: “We’re stretched pretty much to breaking point, just trying to keep things going.”

Welsh NHS patients still waiting longer than in England: Waiting times in the Welsh NHS continue to lag behind the health service in England in most key categories for treatment and diagnosis, according to the latest statistics. Directly comparable figures showed the biggest gap was in the wait for hip operations, up by a fifth in 2015-16, reported the BBC. The average wait for hip operations in England was 76 days while in Wales it was 226 days. However, waiting times in Wales for heart by-pass surgery fell significantly. In 2014-15 the average wait in Wales was 111 days. It fell to 43 days in 2015-16. Overall, there were significantly longer waits in Wales in seven out of the 11 main indicators measured in Wales compared to the same indicators measured in England. Tim Havard, a director of the Royal College of Surgeons in Wales, said it was “disappointing” that Wales lagged behind England but Wales’ population was on average sicker and older than England’s. “There continues to be a need to prevent ill-health, especially through tackling the higher rates of obesity in Wales,” he said. “Many of the causes of longer waiting times are complex and will not be solved overnight, but this shows that when focus is given to reducing waiting times the NHS can improve access to care.”

STPs could be put in charge of collecting patient data: Accountable care organisations and sustainability and transformation plan (STP) footprints could be given responsibility for collecting patient data, according to a proposal being drafted for consultation by NHS England. Data could be collected at regional level and then fed into a national “data lake”, the document said. The dataset would provide a “near real time” supply of identifiable and pseudonymised patient data for patients, industry, clinicians, NHS England, the Care Quality Commission and NHS Improvement, reported Health Service Journal (subscription required). By making the data collection regional rather than national, it is hoped there might be less “pushback” from the public. – the previous flagship programme to join up patients’ data across the health and care system – was criticised by privacy campaigners and patient groups before it ended last year. The concept of the “data lake” is described in Target Architecture, a draft summary of a summit of national and international health IT experts in November. The document has an introduction by Will Smart, chief information officer for health and social care in England. According to the proposal, self-organising regions such as STP footprints or accountable care systems would become the public face of the “data lake”. This would effectively distance the project from NHS Digital and the National Information Board and present the project as a local initiative. Each regional team would be responsible for 2-5 million people. The summary said that in other countries, smaller regions have been able to ”enact laws and regulations over health data sharing without major pushback”. Patients would play an active role in generating and using data as well as controlling how heath and care providers use their data, the document said.

A&E departments to benefit from £4.3m innovation tech funding: NHS England has backed a £4.3m investment on five new technologies that may help ease pressure on A&E departments, reported National Health Executive. The organisation has said that each of the five innovations, which could reduce A&E admissions through the likes of wireless monitoring, self-help apps and point of care diagnostic testing, will receive up to £1m in financial backing so that they can be taken to the next stage of development and the money will be donated by Small Business Research Initiative (SBRI) Healthcare. Richard Phillips, chair of SBRI Board and director of the Association of British Healthcare Industries, said: “As demands and pressure on the urgent and emergency care system increase, we need to find new ways to bring high value innovation into the NHS. The announcement will bring new and creative solutions into this space that will improve care for patients and efficiency for the NHS.” Five  companies were selected from a shortlist of 14 which received six months’ ‘feasibility funding’ in March last year and will be supported and fully funded to continue with the development and testing of their products. The successful companies (and supporting AHSNs) are: Preventing & Reducing Admissions: Healthera (Eastern AHSN) and Microbiosensor (Greater Manchester AHSN), Coordinating & Managing Resources: Biovici (Wales), Planning for Flow & Discharge: 365Response (Yorkshire & Humber AHSN) and snap40 (Scotland).

Nearly 200 GP practices closed in 2016 alone, NHS data suggest: Data on GP practice populations released by NHS Digital this month listed just 7,532 GP practices – down 181 from the total a year earlier in January 2016, reported GPOnline. Part of the drop in GP practice numbers in the NHS Digital data is likely to be driven by mergers, which could mean that some of the practice locations no longer listed in official figures remained open, but under the wing of a larger group. However, BMA leaders have warned that closures were at ‘record levels’ and the latest figures suggested that the trend was not slowing down as GPs waited for government pledges of investment through the GP Forward View to take effect. Health minister David Mowat pledged in November that 1,000 practices would receive support in the current financial year from a £16m tranche of the GP resilience fund that clinical commissioning groups must spend by the end of March. But since the GP Forward View was launched in April 2016, GPs have repeatedly warned that support was not coming through fast enough. Responding to the latest figures, General Practice Committee deputy chair Dr Richard Vautrey said: “This is yet more evidence of the crisis facing general practice right around the country and is a direct result of unsustainable and unsafe workload pressures, and failures to attract enough doctors in to general practice so that it’s increasingly hard for practices to replace retiring GPs. Every closure will impact on groups of patients who will worry about the loss of the relationship they had with their GP. There is now all the more urgency to invest in general practice and deal with unsafe workload levels.”

STPs could cost £15m in management consultancy fees, Unite warns: The NHS could spend up to £15m on management consultants for advice as it draws up its sustainability and transformation plans (STPs), the country’s largest trade union has warned. Unite has urged health secretary, Jeremy Hunt, to make clear the true cost of the expenditure on management consultants surrounding the 44 STPs currently being drawn up in England, in a major reconfiguration which the union already worried would see closures or relocations of hospitals, reported National Health Executive. The union calculated the £15m figure after a report in the Coventry Telegraph revealed that NHS leaders responsible for Coventry and Warwickshire’s STP paid £343,000 to PricewaterhouseCoopers (PwC) for advice on how to save money in their STP. Unite’s national officer for health, Sarah Carpenter said: “It is very disturbing news from Coventry and Warwickshire that the management consultants are again scooping up loads of taxpayers’ cash to proffer advice on the local STP. Any such funds would be much better spent on frontline services, such as under pressure A&E departments, rather than on jargon-filled reports.” The news came as the NHS is gripped in a winter crisis with A&Es overcrowding to the point that patient safety and care has started to be compromised.

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Trojan malware blamed for Barts cyber-attack: Barts Health NHS Trust has said that Trojan malware, not ransomware, was to blame for the cyber-attack that forced the trust to shut down some IT systems for four days, reported The trust told staff on Friday 13th January that it had shut down some of its IT systems to deal with “ransomware virus attack issues”. The trust later clarified in a statement issued the following Monday that the attack was Trojan malware, and not ransomware. Trojan attacks usually rely on tricking a user into installing the malicious software, which can then be used to copy, block, delete or modify a user’s data. The statement added: “The virus has been quarantined, and all major clinical systems are now up and running.  No patient data was affected, there was no unauthorised access to medical records, and our anti-virus protection has now been updated to prevent any recurrence. In addition to the trust’s core clinical system Cerner Millennium, radiology and imaging from X-rays and scans continue to be used. The computerised pathology results service is now back online and processing requests as normal – it may take a day or so to deal with the backlog that built up during the short period when we processed requests manually.”

Plymouth Hospitals applies barcodes to medical products: Plymouth Hospitals NHS Trust has created a barcoding system for the management and location of medical products as part of the national Scan4Safety programme to use the technology in the health service, reported UK Authority. In a project with NHS Shared Business Services (NHS SBS) and healthcare tech company Global Healthcare Exchange, it has barcoded the relevant products as part of streamlining the identification and payment process for suppliers. NHS SBS said this will enable the trust to reduce waste across the purchase to pay process by providing up-to-date catalogue information managed by the suppliers. In turn, suppliers will know exactly which products they are expected to deliver to the trusts. Plymouth Hospitals is one of the six demonstrator sites in the Scan4Safety programme, which is aimed at saving an average of £3m a year for every NHS hospital in England. It is using GS1 standards for the barcodes – set by the global, non-profit organisation of the same name – and those within the Pan European Public Procurement On-Line (PEPPOL) framework. Ann James, the trust’s chief executive and a member of the Scan4Safety programme board, said: “Thanks to collaborating with our workforce and suppliers, and other trusts on the Scan4Safety programme, we now have a platform that can help the NHS ensure that every product used in hospital is assigned to the right location, to the right patient, and is backed up by the right purchase orders and invoices. This will benefit Plymouth and the wider NHS as it looks to deliver efficiencies that will help enhance the quality of care we can provide.”

30% of NHS trusts were victims of ransomware attacks: A Freedom of information (FoI) study by endpoint security company SentinelOne has revealed that 30% of NHS trusts have suffered a ransomware attack, placing patient data and potential lives at risk, reported Information Age. SentinelOne made FoI requests to 129 NHS trusts, of which 94 responded. Three of these refused to answer, claiming that their response could damage their commercial interests. Alarmingly, the FoI revealed that all but two NHS trusts – Surrey and Sussex, and University College London Hospitals had invested in AV security software on their endpoint devices to protect them from malware. Leeds Teaching Hospital had suffered five attacks in the past year, despite installing a McAfee solution. In a more extreme case Imperial College Healthcare NHS Trust admitted to being attacked 19 times in just 12 months. “These results are far from surprising,” said Tony Rowan, chief security consultant at SentinelOne. “Public sector organisations make a soft target for fraudsters because budget and resource shortages frequently leave hospitals short-changed when it comes to security basics like regular software patching. The results highlight the fact that old school AV technology is powerless to halt virulent, mutating forms of malware like ransomware and a new more dynamic approach to endpoint protection is needed.”

Obama: Health IT interoperability ‘harder than expected’ During an interview on Obamacare with news services Vox, President Obama said achieving progress on healthcare interoperability had been frustratingly slow during his presidency, reported Obama said the US$27bn (£23bn) his government had spent on Meaningful Use since 2009, a programme designed to accelerate digitalisation of the US healthcare system, had delivered mixed success. “We put a big slug of money to encouraging everyone to digitalise and catch up with the rest of the world here,” Obama said. “It’s proven to be harder than we expected, partly because everyone has different systems, they don’t all talk to each other, it requires retraining people in how to use them effectively, and I’m optimistic that over time it’s inevitable it’s going to get better because in every other part of our lives, it’s become paperless.” National Coordinator for Health Information Technology Office figures showed that more than 90% of US hospitals have some type of electronic medical record (EMR) system, a higher prevalence than in NHS hospitals. However, US hospitals did less well when it came to interoperability and sharing patient data, with only 38% saying they can use or integrate data from another hospital into their own EMR. In his review of a digital NHS IT released last year, US-based Dr Bob Wachter said while the UK could learn from United States’ digital health successes it could also benefit from its shortcomings, particularly poor interoperability. Speaking to Vox, Obama acknowledged digitalising health had taken longer than expected. “Some of it has to do with the fact that it’s decentralised and everyone has different systems. Other barriers included perverse economic incentives that meant service providers had an incentive not to share records,” he said.

NHS SBS launches new IT hardware framework: NHS Shared Business Services (NHS SBS) has refreshed its procurement framework for IT hardware and services, taking in 61 individual contracts over 10 lots, reported UKAuthority. The joint venture between the Department of Health and Sopra Steria that manages aggregated procurement for the NHS went live with the arrangement in mid-December, although the contract award notice has just been published in the EU Journal. The deal covers a range of products and services, including desktops, laptops, tablets, healthcare IT (such as mobile carts and clinical assistant devices), clinical monitors, green IT, printers and scanners, deployment services, third party warranty and one stop shop. A spokesperson told UKAuthority that the new arrangement was identical in structure to the IT framework it replaced, but that the suppliers list had been refreshed to include a mixture of original equipment manufacturers and resellers. The estimated value is £500m and the framework is set to run for two years with two possible extensions of a year each. The framework is open to public sector bodies outside the NHS: the organisation said that approximately 30 had signed up to access its predecessor.

West Middlesex University Hospital trials wireless monitoring system: West Middlesex University Hospital is now piloting a wireless monitoring system that offers clinicians real-time access to information about a patient’s general condition, reported Health IT Central. The technology reportedly sends information regarding a ‘patient’s heart rate, respiration rate and underarm temperature’ so that healthcare professionals receive an alert whenever someone is at risk of deterioration. “This is an innovative project addressing key NHS challenges: early detection of patient deterioration and sepsis prevention,” said Dr Lawrence Petalidis, head of innovation and impact for the CW+ charity, which funded the trial. “It is such projects combining trust strategic priorities, disruptive innovation and significant patient benefit potential that we are keen to be part of,” he added. Alex Honour, European clinical services manager, revealed the hospital wanted to expand the implementation of the system on different sites. “We’re only at our pilot stage currently but our aim for 2017 is to get this technology on all relevant wards and have doctors and nurses familiar with the devices because we believe in the future this will save lives,” Honour concluded.

Global digital health VC funding hit £4.2b in 2016: Global health IT and digital health venture capital funding topped £4.2bn ($5bn) for the first time in 2016, reported According to the US technology market intelligence company Mercom Capital Group, venture capital funding for Healthcare IT, including private equity and corporate venture capital, raised £4.25bn (US$5.1bn) in 622 deals in 2016. This was up from £3.8bn ($4.6bn) raised in 574 deals in 2015. Mercom Capital disclosed the figures in its annual report on funding, mergers and acquisition activity for the healthcare IT and digital health sector consumer-focused digital health companies accounted for the largest share of investment, bringing in about £2.9m ($3.5bn) in 437 deals in 2016, up from £2.6bn ($3.1bn) in 403 deals in 2015. The top funded areas in 2016 included – mobile apps, with £1.1bn ($1.3bn) and wearable sensors with £493m ($592m). The majority of digital health VC funding rounds in 2016 were for US companies. However, the two largest deals were for Chinese companies; a medical service app Ping An Good Doctor with a £416m ($500m) and video consultations app Chunyu Yisheng, which raised £152m ($183m) round. In addition, Flatiron Health’s raised £146m ($175m), Jawbone raised £137.5m ($165m), and Meet You raised £126m ($151m).


Hunt needs to fix the NHS, not blame its staff
Nursing Times editor Jenni Middleton comes to the defence of GPs following accusations from the health secretary that limited practice hours are part of the winter pressure problem.

Middleton writes: “The NHS, across the board, is under immense pressure. Hospitals are bulging at the seams, their corridors filled with patients waiting hours to be seen. A&E targets are being breached, and staff are at breaking point, unable to provide the care they want to because the system is broken.

 “Staff across the NHS have said it and now Simon Stevens has publicly said it.

 “So what is health secretary Jeremy Hunt’s response? It is to claim GPs are at least partly to blame because they don’t open their practices for long enough, leaving people with no choice but to head to their local A&E if they have a health issue.

 “I won’t pretend that patients making inappropriate visits to their local emergency departments aren’t causing some of the current pressures. And Mr Hunt is right that the problems in hospitals are not entirely the result of what is going on inside those bricks and mortar establishments – he is correct to look beyond that, but I fear he is looking in the wrong direction.”

Addressing Mr Hunt directly, Middleton adds: “Your government’s continued cuts have caused this pressure. And the situation isn’t going to get better without your government changing how it runs and funds the NHS. You can point fingers and play the blame game. You can even stop requiring hospitals to meet the four-hour A&E target, but ultimately, that won’t improve patient care. Only one thing will. More money – in both health and social care.”

Could imaging be a goldmine for NHS artificial intelligence?
Unused archives of millions of diagnostic images could become one of the most powerful datasets in the NHS and help diagnose illnesses, writes Jane Rendall in HSJ.

“There might be a future for the NHS where teaching machines new tricks with our data could result in huge benefits for transforming diagnostic capacity and the very nature of how our professionals identify serious illnesses.

“There is one specific area where machine learning could unleash one of the NHS’ biggest un-tapped resources – a huge archive of diagnostic imaging.

“In radiology alone, millions of X-rays, CT scans, MRIs and a plethora of other diagnostic imaging have been stored digitally for many years, for the most part sitting in departmental archives undisturbed. This vast data source is only set to grow as other ‘ologies’ look to invest in extensive digitisation programmes.

“If this access can be opened to machine learning, the role of the archive will change from just being a big bucket that is occasionally accessed for retrieving data, to becoming a central component of the NHS enterprise, where data can be re-processed and re-analysed continuously to add clinical decision support for precision and personalized medicine based on population comparisons.

“Machines can act as a powerful decision support system, but more than that they could be programmed to proactively suggest other conditions that they have been taught to recognise.

“The opportunity from machine learning is too great to ignore, and we must lay the technological groundwork so that we have the capacity to make this reality in the future.”

Can we crowd-source the future of the NHS?
The wisdom of the crowd can guide us, some argue. Can the same be said for the future of health and social care? Katie Mantell, deputy director of communications and information at The King’s Fund, reflects on some of the ideas put forward under the umbrella of the think tank’s ‘The NHS if…’ competition, which invited essays exploring hypothetical scenarios for the future of health and care.

Initial submissions were from selected experts whose essays “challenged us to consider scenarios such as a carbon-neutral NHS, an NHS in a world in which antibiotics stopped working and a society in which obesity were eradicated, among others”.

“Then, aware that we might be constrained by our own particular world view and lists of contacts, we decided to throw the net wider and invite anyone – patients, carers, students, those working in health and care – to share their vision of a hypothetical future for health and care, in the Fund’s first-ever essay competition.

“And over the Christmas holidays, the essays piled in. This past week I’ve had the privilege of reading all 94 essays we received. As you’d probably expect, they covered a wide range of subjects – from an NHS with no immigration to an NHS dominated by artificial intelligence – and reflected different writing styles and author experiences.

“Nevertheless, there were some recurring themes. A large number of essays focused on what I’d describe as a more holistic, non-medicalised vision of health. These essays imagine a world in which we’ve broken down the divisions between mental and physical health; a world in which promoting healthy living is a cornerstone of all government and NHS policies; a world in which doctors prescribe healthy activities as readily as they prescribe drugs. None of these ideas are new, but the fact that such a range of people were able to take a leap of faith and imagine what might need to happen to achieve these hypothetical scenarios gave me a real sense of what might be possible.

“With so many thoughtful essays, covering such a range of issues, from such a diversity of perspectives, it won’t be easy to choose a winner. The judging panel meets next week and I’m expecting we’ll have some lively debate before coming to a decision. Keep an eye out for the publication of our winning essay and runner-up next month.”

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