News in brief 

Patients ‘could suffer’ as NHS trusts bust budgets: Patient care could start to suffer after hospitals and other NHS trusts in England overspent by a record £2.45bn last year, experts are warning, reported the BBC. The unprecedented deficit for 2015-16 – triple what was recorded the year before – is largely a result of hospitals busting their budgets. They will now need to use extra money they are being given this year to bail themselves out. Hospital chiefs warned that may lead to longer waiting times and poorer care. Chris Hopson, chief executive of NHS Providers, which represents trusts, said the situation was “simply not sustainable”. He said: “We have to rapidly regain control of NHS finances, otherwise we risk lengthening waiting times for patients, limiting their access to wider services and other reductions in the quality of patient care.” The NHS in England is already missing a series of key waiting time targets, including in A&E, cancer care and the ambulance service. Anita Charlesworth, of the Health Foundation think tank, said the mood in the NHS “could not be bleaker”. She said: “The level of deficits in terms of scale and how many hospitals are in deficit is unprecedented. It puts organisations under stress, which makes them fragile and risky.” The figures have been released by the regulator NHS Improvement and cover ambulance, mental health and community trusts as well as hospitals. Overall 65% of the 240 trusts are in deficit with nearly all hospitals ending the year in the red.

Junior doctors dispute: BMA and government reach deal: The government and the British Medical Association (BMA) have reached a deal in resolving the dispute over new junior doctors’ contracts, following 10 days of talks at the conciliation service Acas, reported ITV News. The deal is subject to BMA junior doctor members approving the new contract in a vote. Under the deal, doctors will be paid a normal rate for Saturdays and Sundays between the hours of 9am and 9pm. It also includes a basic pay rise of between 10% and 11%, whilst any shifts which start at or after 8pm and lasts longer than eight hours, and which finishes at or by 10am the following day, will result in an enhanced 37% pay rate for all the hours worked. Doctors will receive a percentage of their salary for working more than six weekends a year – this will range from 3% for working one weekend in seven, and up to 10% if working one weekend in two. If approved, Acas expects the new deal to be finalised in the next two weeks, with elements of the new contract coming into force from August. All junior doctors will then move onto the new terms between October and August 2017. No further industrial action will be called while the vote is underway. The Guardian presented reactions to the announcement with Dr Will Rook, a junior doctor in general medicine, saying the new deal was worse than its predecessor, which the BMA rejected in February. “It hasn’t addressed a lot of the concerns I had in the first place around trying to spread a five-day service over seven days without having extra people to do the job. It also appears to further devalue our work-life balance. A 10% supplement for working one in two weekends a month is a joke. The disruption it causes is immense”, Rook said. Dr Johann Malawana, the chair of the BMA’s junior doctors committee, also commented: “Following intense but constructive talks, we are pleased to have reached agreement. Junior doctors have always wanted to agree a safe and fair contract, one that recognises and values the contribution junior doctors make to the NHS, addresses the recruitment and retention crisis in parts of the NHS and provides the basis for delivering a world-class health service.”

TTIP: Government caves in to cross-party alliance of Eurosceptic MPs demanding NHS is protected from controversial deal: The government has caved in to an unholy alliance of Labour and Tory Eurosceptic MPs who united to demand guarantees from ministers to protect the NHS from the controversial TTIP (Transatlantic Trade and Investment Partnership) trade deal, reported the Independent. Jeremy Corbyn told his MPs to support an amendment to the Queen’s Speech that ‘regretted’ the government did not intend to legislate to “protect the National Health Service from the Transatlantic Trade and Investment Partnership”. More than two dozen Tory MPs, who are backing a vote to leave the EU, also pledged to support the amendment along with the SNP and Greens. Downing Street said it would accept the amendment. “As we’ve said all along there is no threat to the NHS from TTIP. So if the amendment is selected we will accept it,” said a government spokesman.

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NHS FDs believe patient care is deteriorating, The King’s Fund finds: Nearly two-thirds of NHS trust finance directors and more than half of clinical commissioning groups finance leads think their local quality of patient care has deteriorated over the past year, according to The King’s Fund, reported Public Finance. Findings from the think-tank’s latest quarterly monitoring report also revealed that more than 80% of trusts doubt they can meet NHS control totals for the current year. Responses also showed that 70% of NHS providers ended 2015-16 in deficit, including 90% of acute trusts. More than half of finance directors expected their trust to end this year in deficit once again. Detailed findings showed 38% of trusts and 61% of CCGs were concerned about meeting cost improvement targets in 2016-17, while 82% of trusts were unsure whether they could meet new control totals set by NHS regulators to reduce spending. The report also found that 8% of patients, equivalent to more than 1.85 million people, spent longer than four hours in accident and emergency departments, the worst performance since 2003-04. The King’s Fund chief economist John Appleby said: “2016/17 is a watershed year for the NHS in which it has been tasked with eradicating deficits and improving performance. Despite significant additional funding and a huge effort to contain deficits, it is clear that this is going to be a Herculean challenge.” NHS Confederation acting chief executive Stephen Dalton said: “Today’s report outlines the alarming reality that ongoing financial strain on the NHS is impacting our members’ efforts to deliver high quality care.”

‘Train NHS staff’ to plug doctor gaps, bosses say: Nurses, paramedics and pharmacists should be trained to fill in for doctors and help the NHS in England cope with demand, bosses said, reported the BBC. Management body NHS Employers has given the plan the green light after advisers said there was a range of extra tasks they could do with more training. A Nuffield Trust review found examples of nurses filling in for hospital doctors and pharmacists for GPs. The report said as well as helping cover for doctor shortages, such moves made sense because of the changing nature of care, with much more stress on looking after people with long-term conditions such as diabetes and heart disease rather than curing them. It said that as doctors only made up about one in 10 of the workforce much more was needed from other health staff, but the Nuffield Trust admitted money would need to be set aside to ensure it happened. But unions warned against using it as a quick fix for problems in the NHS. It has been well documented that there are gaps in junior doctor rotas, while GPs are struggling to cope with the rising number of patients coming through their doors. NHS Employers asked the Nuffield Trust to look at ways the 1.3 million-strong workforce could be reshaped to help. Report author Candace Imison said there were “huge opportunities” in reshaping the workforce. But British Medical Association leader Dr Mark Porter said while he supported increasing the skills of the workforce, this should not be done “at the expense of good quality training for doctors or indeed doctors themselves”.

GPs must be central to integrated health and social care: The Royal College of GPs (RCGP) said in its latest report that GPs need to become the expert medical generalists at the centre of integrated, concurrent treatment by a number of different health and social care disciplines as larger than ever numbers of people are living with multimorbidity, reported OnMedica. It called for the health service to move away from the management of single disease conditions and towards an understanding of how multimorbidity impacts on patients’ health. In ‘The Future of GP Collaborative Working’, the college gave several examples of how some GPs have already taken the initiative to work alongside secondary care physicians and the wider health and social care system, in order to successfully redesign services to better meet their patients’ needs. But the college argued that for others to be incentivised to take similar opportunities, several challenges will have to be overcome – for example, getting ‘buy in’ from commissioners, providers and health authorities, and lack of funds and staffing. RCGP chair Dr Maureen Baker said one of the NHS’s greatest challenges is responding to patients’ increasingly complex needs. She said the college would work with NHS England and others to ensure that good ideas such as those in the report are more widely adopted. She said: “Our patients’ health outcomes are best when we treat them as people, not diseases, and this holistic approach can only be achieved when doctors from across the health service work together – but we need to do this more, and better.”

Mass resignation is an ‘impending reality’, says GPC chair at LMCs Conference: Mass resignation is not just a threat, but an impending reality, GPC chair Dr Chaand Nagpaul has said, reported Pulse. In a passionate speech, the GPC chair also called for local area teams to be held to account for every one of their practices that closes. He also said that seven-day services were ‘immoral’, and praised NHS England for not focusing on weekend opening in its General Practice Forward View. Dr Nagpaul said: “With government figures stating 38% of GPs intend to quit in the next five years, mass resignation is not a threat – it’s an impending reality. The government must ensure we retain the current workforce, in particular tackling the perverse factors driving older GPs to leave early.” Dr Nagpaul also focused on the issue of practice closures, referring to the £40m ‘resilience programme’ announced in the forward view. But he said that NHS England local area teams must be held accountable for practices closing. He said: “It should be a significant untoward incident and a failing of the local NHS if any practice needlessly closes. This creates disruption and displacement of essential family doctor services to patients, and the domino effect of instability on neighbouring practices, not least wasted costs to the taxpayer of re-providing the service. I therefore call upon NHS England to use the forward view’s practice resilience programme to make it an explicit KPI (key performance indicator) for all area teams to ensure there’s not a single unnecessary or avoidable practice closure now or in the future.”

Framework launched to encourage nurses, midwives and care staff to lead change: Nurses, midwives and care staff should play a key role in building a more effective and sustainable NHS and care system, the chief nursing officer for England has said, reported National Health Executive. Launching the ‘Leading Change, Adding Value’ framework, Professor Jane Cummings said it is vital for increasing the role of nurses, midwives and care staff in delivering changes to the NHS such as the Five Year Forward View. She said: “The role that nursing, midwifery and care staff play should not be underestimated – we are on hospital wards caring for people, out in the community, care homes, academia, sitting on boards, developing policy, and in the private sector. The framework – which can be used across all the sectors, whatever the setting – will support staff to demonstrate how they can use their expertise to drive change. The leadership potential in our workforce to manage the challenges of today and shape the future is boundless. From addressing differences in the incidence of pressure ulcers, to changing pathways of care and support in diagnosing diabetes – nursing, midwifery and care staff are ideally placed to be leading that change and demonstrating their value.”

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NHS develops first of its kind app for mental health patients: Decades of global stigma over electro-convulsive therapy (ECT), a potentially life-saving treatment that helps thousands of patients with illnesses like severe depression, could soon be overcome as a result of a first of its kind mobile app developed within the NHS, reported Leicestershire Health Informatics Service (LHIS), which is hosted within Leicestershire Partnership NHS Trust, was able to create the ECT app through a platform called mDesign. The platform has allowed the trust to rapidly build its own internal mobile development skills in collaboration with mobile technology company CommonTime. The app has now been made freely available on the App Store and Google Play and is the first in a new programme of mobile app development activity for the trust. The ECT tool is believed to be the first ever mobile app to provide such a detailed, accurate and engaging source of trusted information on ECT and also allows patients to access key contact information for specialists. Dr Girish Kunigiri, consultant psychiatrist at Leicestershire Partnership NHS Trust and project clinical lead, said: “Electro-convulsive therapy can be life-saving for patients suffering from severe psychiatric conditions. But despite high success rates in helping patients, stigma still exists.” Steve Carvell, head of healthcare at CommonTime added: “Mobile technology has enormous potential in the NHS and in helping to change perceptions around mental health and associated treatments. Apps, like the ECT tool, are extremely valuable in placing reliable, trusted and engaging information into the hands of patients and their support network. The staff at Leicestershire have been determined to quickly develop their ability to produce useful technology that can provide potentially life-saving information to people in the way that they need it.”

Up to 1.5m opt out of, new data suggests: Up to 1.5 million people have registered to opt out of the controversial programme, requesting their records do not leave their GP practices except for direct care or in “exceptional circumstances”, Health Service Journal (subscription required) reported. According to the publication, Health and Social Care Information Centre (HSCIC) data revealed there were “1,461,877 instances of type 1 opt out codes”, in GP records as of April 2016 across England’s circa 7,400 practices. A type 1 opt out, one of two opt out options, prevents a person’s record being shared outside the practice for purposes other than direct care, except for in certain exceptional circumstances. The HSCIC said the number of people opting out could not be known exactly from the number of codes recorded in records, because a single person could potentially have several records across different GP practices.

New digital healthcare service to help people battling depression: Health specialist Inhealthcare, which works with NHS organisations across the UK to digitise care, is expanding its services into mental healthcare, reported The Yorkshire Post. The Harrogate-based company is developing digital services to help people suffering from low-level depression and anxiety. Inhealthcare is working in partnership with not-for-profit company My Possible Self and a globally renowned academic institute. Patient data will be hosted safely and securely by Inhealthcare within the NHS private network, N3. My Possible Self, founded by Joanne Wilkinson in 2009, has provided emotional health and wellbeing services to thousands of patients, including those who might not otherwise be able to afford them. Ms Wilkinson said: “By combining the unique technology Inhealthcare has created, with my approach and the proven content of a leading academic research institute, I will be able to achieve a lifetime’s goal of providing immediate assistance to hundreds of thousands patients throughout the UK.” The new service will teach people how to use simple self-help strategies to manage problems and improve resilience. One in four people will experience a mental health problem such as depression or anxiety in any given year.

Cambridgeshire trusts could merge by 2017: Peterborough and Stamford Hospitals Foundation Trust and Hinchingbrooke Health Care Trust will consider a merger of the trusts by 2017, the two providers have announced, reported Health Service Journal (subscription required). The recommendation was set out in an outline business case by executives from both trusts published on Wednesday morning. It will be discussed by the trust’s boards in separate public meetings next week. A joint statement from the trusts said the business case “shows £9m of savings a year, primarily in back office services” which could be delivered by merging the organisations. They added: “The [outline business case] concludes with a recommendation that in order to sustain and improve services for patients and the taxpayer in Huntingdonshire, Greater Peterborough and south Lincolnshire, both trusts would benefit from working as one organisation and merge on 1 April 2017.” The move is likely to provoke opposition from Huntingdon MP Jonathan Djanogly, who has been campaigning against Peterborough taking over Hinchingbrooke. He said the move would result in Hinchingbrooke losing key services such as its accident and emergency department. If the boards approve the recommended option, the next step will be to produce a full business case by September to set out how the merger will be put into operation.

Role of wearable tech data to inform healthcare growing according to Forrester report: Capturing the data from wearables is proving increasingly vital for those working in healthcare and pharma marketing, in order to inform how they improve the experiences of those seeking a better standard of service overall, reported The Drum. Having recently reported that consumers expected a similar level of service when it came to healthcare provision as they received from major service-providers such as Amazon, Forrester’s newest document examined the role of the Internet of Things in order to improve the potential experience concurred with those findings. The report claimed that self-diagnosis was ‘notoriously inaccurate’ but found that the evolution of wearable technology, including health and fitness apps, provided an opportunity to data capture to better understand a patient’s condition and engage with them to improve their own health and wellness outlook. The report cited technology from companies such as Apple, with HealthKit; Google, with Google Fit; and Microsoft, with Microsoft Health and Health Vault, as established devices with cloud ecosystems while tech such as Fitbit and Garmin have their own proprietary cloud data stores. All of these upload and store data which is available to be stored within an electronic health record or a patient record. As a result of storing such data over a length of time, predictive analytics can be built to offer a long-term view of that person’s prognoses in the future. 

Sandwell and West Birmingham picks Cerner as IT partner: Sandwell and West Birmingham Hospitals NHS Trust has chosen Cerner for a major investment in IT that will see it overhaul its infrastructure, implement an electronic patient record, interface with local GP systems, and create a new patient portal, reported The investment will require approval by NHS Improvement (the new regulator that combines Monitor and the Trust Development Authority), but the trust is hopeful that implementation will start in August this year and be complete by November 2017. In a statement announcing the development, Dr Pete Davies, the trust’s chief clinical information officer, said: “This is going to represent a quantum leap in our capacity to provide safer care, to reduce unnecessary variation, and to improve patient experience.” Geoff Segal, vice president and general manager for Cerner UK and Ireland said it was “delighted” with the trust’s decision. “Together, we will focus on improving outcomes and delivering the best possible care to the local community,” he said.

Bradford NHS Trust adds 1.7 million images to new VNA: Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) has completed its second stage to migrate all of its imaging data into one place, reported Health IT Central. Last year, the BTHFT completed its first stage of the project, sending over 126 million images where they had been held under a digital imaging contract. As part of its wider data management strategy, the trust embarked on the second phase of the project with a number of objectives in mind. The first was to ensure that its cardiology data was part of a comprehensive and robust data protection environment, and secondly, to centrally store its cardiology data, using open standards, so that it would be accessible and available to those that need it including other trusts from across the country. Geraldine Metcalfe, head of department for cardiology at BTHFT, commented: “We were delighted that cardiology was selected for the next stage of the data management project as our legacy GE archive was ageing and needed replacing. BridgeHead was an ideal partner as they were able to complete the migration in a matter of weeks – what could have been an arduous task was made relatively pain free due to BridgeHead’s experienced and dedicated team.” Cindy Fedell, director of informatics at BTHFT, explained: “This cardiology project was the next step in our evolution as we move ever closer to realising our vision of a true electronic patient record.”

How a smartphone could help spot disease

A new smartphone technique can significantly increase the speed of tests for biomarkers, BBC Click has reported. The programme explained that many diseases leave biomarkers in the blood, but that detecting them can be an involved and slow process, involving a laboratory analysis process which can take hours or days. Now a technique which makes use of a smartphone could change this by providing results in minutes.



The Carter review is not motoring, it is stuck in the garage
Health Service Journal (subscription required) editor Alistair McLellan reacts to the Health Committee questioning of health secretary Jeremy Hunt and Simon Stevens, chief executive of NHS England as part of its inquiry into the impact of the Spending Review on health and social care.

“HSJ makes no apology for returning to the question of how the NHS is expected to deliver the punishing efficiency targets it has been handed for this parliament. There is no greater challenge and failure to deliver poses no greater threat for the health service. Last week we voiced concern that there was complacency in parts of the national leadership about the work needed to deliver Lord Carter’s recommendations on NHS productivity. That concern was promptly validated when Jeremy Hunt told MPs that the Carter programme was “really motoring”. The Carter programme is not motoring, for reasons HSJ has already outlined. It’s in the garage.  

“The need for action on efficiency was driven home last week by an NHS England briefing that breaks down how the £22bn savings required over coming years are expected to be spread across the health service. It shows that £8.6bn is expected from provider productivity, £6.7bn from “national” action including pay restraint and cuts to community pharmacy, £1bn from clinical commissioning group running costs and non-NHS providers, and the rest from demand management initiatives such as RightCare. If the national leadership truly believes the Carter programme can provide savings of the magnitude required of NHS providers, it needs to take concerted national action now to get it moving. 

“As part of this, it needs to ensure providers are having a single conversation with national bodies. How sensible is it that while NHS Improvement is charged with leading the Carter work and holding trusts to their financial targets, work on estates rationalisation – a key strand of the Carter recommendations – is being driven from the Department of Health? There are many similar examples of this fragmentation. 

“On the other hand, if national leaders do not in fact believe the Carter programme can deliver – and instead regard the programme as useful window dressing – let us find that out sooner rather than later. Because the savings challenge is not getting any smaller.” 

The time for telehealth is now!
James Norman, UK public sector CIO, EMC argues the benefits of telehealth and explains how it can help both the patient and healthcare organisations.

“Not to state the obvious, but telehealth involves using technology to enable healthcare professionals to remotely monitor data on certain aspects of a patient’s health. At its core, it is essentially the remote monitoring of patient health data, wherever they might be. A few years ago, research was undertaken by the UK Department of Health, which revealed that adding telehealth to standard care increased costs by about 10% (including costs of the intervention and additional healthcare services) for only a very minimal gain in quality of life. This led the researchers to conclude that telehealth was simply not a cost-effective addition for these patients and didn’t offer any benefits of improving care.

“In the past, telehealth wasn’t able to link with devices and therefore health data wasn’t able to be captured. But times have changed. With the introduction of wearable and Internet of Things devices, all of this is now possible. There are now apps and wearable fitness trackers that can link data together and information can be shared with healthcare providers directly. People can also have consultations via their smart phones based on health symptoms that are captured on mobile devices, something that will become extremely beneficial in light of David Cameron’s recently-announced “seven day NHS”.

“Now is the time for healthcare organisations to come together and take a new look at why now might be the right time for telehealth. Over the past year or so, telehealth has been mostly embraced by the public – citizens who wish to capture their own health data and analyse their lifestyles or monitor their loved ones, for example – but more needs to be done to drive telehealth among health providers, insurance companies and other healthcare organisations.

“The benefits of this are obvious. Not only can the public get immediate medical attention, breaking down barriers to receiving care, but the benefit for healthcare providers is significant. Not only is there a reduced amount of documentation and paperwork through using an online portal, but it is also more cost-effective, due to helping to reduce A&E attendance and hospital admissions.

“While this is the case, trust is still a key issue that we need to overcome. However, these concerns can be alleviated through legal, technical and administrative security measures and through proper patient education.” 

Listening and communication are key skills for chief executives
People who won’t put their head above the parapet to take on a chief executive role are missing the potential of an amazing career, writes Catherine Beardshaw, former chief executive officer of Aintree University Hospitals NHS Foundation Trust.

In a blog on The King’s Fund website, Beardshaw, who started her career as a radiographer, says: I loved being a chief executive and consider myself very privileged to have led two super trusts with great people. I can’t think of another job that provides the variety, the intellectual challenge and the opportunity to work with so many interesting people and teams. Walking around the hospital and talking to staff was a pleasure and this helped the development of stronger communication channels, trust and common purpose as well as keeping me sane.

The dark times were difficult. You don’t want to start a spiral down throughout the organisation but you do need to be clear about the challenges that face the hospital and to support teams in doing what needs to be done. At first when dealing with difficult situations, I underestimated the impact my facial expressions and body language had on staff – you have to watch this all the time so you don’t send the wrong messages out.

“Overall, I don’t think you should aspire to be a chief executive unless you are happy working with people. There will be others in your team that can do the other stuff but an organisation needs a leader who can communicate and develop relationships.

“One of the most important relationships to be developed and fostered is that with the chair of the board of directors. I’ve worked with three really good chairs, all different but all with experience and strengths that complemented mine. This relationship is vital: you need someone to share things and chew the cud with, and you can’t always do this with members of the executive team.

“I have heard the phrase ‘won’t put my head above the parapet’ in relation to taking a chief executive role more times than I would like – that is a real shame as people are missing the potential of having an amazing career. I really hope that more clinicians ‘put their head above the parapet’.”

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