News in brief

NHS finance chiefs call for urgent £8bn injection: Almost all NHS finance directors (FDs) say a promised £8bn funding injection for the health service must be given within the next 18 months to cope with the pressures on the service, according to a survey by the Healthcare Financial Management Association. The findings come amid tough negotiations over the settlement for the NHS in the spending round, reported The Financial Times (subscription required). Simon Stevens, NHS England chief executive, last week signalled that agreement on a “workable” budget allocation for the service was still some way off. The vast majority of survey respondents lacked confidence that a plan for the future of the service set out by health leaders a year ago was achievable. More than eight out of 10 of the 200-plus FDs canvassed said they lacked sufficient resources to implement the plan without extra support and almost nine out of 10 expressed doubts that their organisation could deliver the 2% to 3% a year productivity gains needed to close the expected £22bn NHS funding gap. A large minority of more than 40% questioned whether the NHS could continue to maintain quality standards within the levels of increased funding currently promised. The extent of financial pressures in the service were underlined in the survey, with every acute trust finance director that responded predicting a year-end deficit, compared with 77% four months ago.

Junior doctors row: 98% vote in favour of strikes: Junior doctors in England have overwhelmingly voted in favour of going on strike in their dispute with ministers over a new contract, reported the BBC. Some 98% voted in favour of a full strike and 99% in favour of action just short of a full strike. The first walk-out will start on 1 December with another two dates earmarked for later in the month. The British Medical Association (BMA) said it was “inevitable” disruption would be caused to patients. BMA leaders said they regretted this, but added ministers had left them no choice because the contract was “unsafe”. The union has asked the Advisory, Conciliation and Arbitration Service (Acas) to get involved to offer independent arbitration – something the Academy of Medical Royal Colleges, which normally stays out of politics, has said it supports. The dates for industrial action are: 08:00 GMT 1 December to 08:00 GMT 2 December (junior doctors to staff emergency care), 08:00 GMT to 17:00 8 December (full strike), 08:00 GMT to 17:00 16 December (full strike). The BMA balloted just over 37,700 members – over two-thirds of the workforce – and 76% took part in the ballot.

IT productivity plan an “educated guess”: NHS England’s plan to spend billions on technology to drive efficiencies in healthcare provision is based on an “educated guess”, according to an academic in health information. Dr Philip Scott, a senior lecturer at the University of Portsmouth’s Centre for Healthcare Modelling and Informatics, told that the “evidence summary” for the McKinsey report, which is driving NHS England’s digital health agenda, doesn’t provide any genuine evidence for its recommendations. “One of the objectives says it is to provide an evidence base, but it’s not evidence at all, it’s an educated guess. There’s nothing wrong with educated guesswork but that’s what it should be called.” The full McKinsey report is unavailable to the public, although an evidence summary was sent to by pressure group Spinwatch, which obtained it via a Freedom of Information Act request. It recommends that the NHS needs to spend an additional £7.2bn to £8.3bn on digital technology over the next five years in order to achieve savings of between £8.3bn and £13.7bn. The latter figures were discussed publicly by NHS England’s director of patients and information, Tim Kelsey, during a meeting of National Information Board earlier this year, while the investment recommendations appear to form the basis for NHS England’s bid of between £3.3bn and £5.6bn to the government’s spending review, which is due to report later this month. Scott said that the suggestion that investment in technology could save up to £13.7 billion is “an unfounded claim”. “It’s not based on anybody actually having done it; it’s based on what we think it ought to do. And, as we know from the National Programme [for IT] and other initiatives, there is often a gap between expectations and reality.”

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NHS chiefs spend £1.2m on publicity drive to expand use of personal health budgets: NHS managers are spending more than £1m on the drive to get clinical commissioning groups (CCGs) to offer more people personal health budgets (PHBs) despite ongoing concerns about how they will affect the health service, Pulse has learned. NHS England’s PHB delivery plan for this year – obtained through a request under the Freedom of Information Act – detailed spends, totalling £1.18m, on various initiatives that included a round of workshops for CCGs and a pilot for developing business cases at 12 sites. GP leaders questioned why managers were spending this figure on rolling out PHBs at a time when the NHS is running a huge deficit – and warned the government’s long-term agenda was to use PHBs to cut services. The delivery plan is part of NHS England’s drive to widen access to the budgets under its Five Year Forward View, which outlined that CCGs should “lead a major expansion” of PHBs in 2015/16 and “include clear goals on expanding PHBs” as part of their strategy. CCGs have been expected to offer PHBs to patients receiving NHS Continuing Healthcare since last October, while NHS England also set out a commitment to extend the offer to anyone with a long-term condition who can benefit, from April this year. In addition, this year more than 10,000 “high-need” patients are being given a combined personal budget, covering both their health and social care services. NHS England boss Simon Stevens has said more than five million people could be using such budgets for their NHS care by 2018.

NHS 24 abandons ‘challenging’ IT system: Scotland’s health advice service, NHS 24, has had to withdraw a new, £117m computer and phone system over patient safety fears as winter pressures approach, reported In a statement, NHS 24 said that despite a “huge amount of planning, system testing and staff training, the performance of the service since it launched has proved extremely challenging.” The organisation’s chief executive Ian Crichton said the decision to move back to NHS 24’s legacy system was influenced by the expected high demand for the service during the winter period. The decision to abandon the Future Programme comes just weeks after the new system crashed on go-live and forced call handlers to use pen and paper to take patient details before the service switched back to its old system. Scotland’s health secretary Shona Robison said: “While disappointing, patient safety must always be the number one priority and its right that NHS 24 take the time necessary to understand and fix any outstanding problems completely.”

End of NPfIT in London and the South: The National Programme for IT (NPfIT) has come to an end in London and the South with the exit of the final trust to deploy Cerner Millennium from the BT data centre. All of the trusts that received Cerner’s electronic patient record (EPR) system have switched to individual supplier contracts with the company or with new providers. Seventeen trusts that received Millennium from BT as part of NPfIT had to exit the BT data centre and move to individual contracts before 31 October. A contract extension had to be enacted for North Bristol NHS Trust after it failed to exit on time, but it went live with its Lorenzo EPR from CSC on 15 November. Barnet and Chase Farm Hospitals NHS Trust also had a fractionally late exit on 1 November. The Health and Social Care Centre’s (HSCIC) director of provider support for London and the South, Dermot Ryan, told that the Department of Health (DH) viewed patient care as paramount, and so made provision within the existing contract for transitional assistance if a trust could not manage to exit before November 2015. “It’s no trivial matter replacing an EPR in an acute trust, so this is a culmination of several years’ of effort on the part of the DH, HSCIC, trusts and suppliers,” he said. Ryan added that lessons learned from the end of NPfIT in London and the South will be used to help ensure a smooth process in the North Midlands and East of England, where national contracts expire next July. Thirteen of the 17 acute trusts, including all of those in London, stuck with their Cerner system; using a framework contract negotiated for the capital or individual procurements. One each switched to System C, IMS MAXIMS and CSC’s Lorenzo.

Precarious CCG finances could threaten new models of care: A report on health service finances highlighted NHS England data showing that clinical commissioning groups (CCGs) are forecasting a combined underspend for 2015/16 of just £2m, compared with a £151m underspend in 2014/15. CCGs plan to spend £71.8bn in 2015/16, around £400m of which has been drawn down from previous years’ surpluses, the latest Healthcare Financial Management Association’s (HFMA) NHS financial temperature check report said. Without this extra cash, “the CCG sector would report an in-year deficit”, it added. HFMA policy director Paul Briddock told GPOnline that CCGs were now spending right up to their “financial limits”. The report found that 48% of CCG finance directors said their 2015/16 spending plans would eat into brought-forward surpluses from previous years. A total of 56% of CCG finance directors said their organisation’s year-end financial position would be worse for 2015/16 than it was in 2014/15. Nearly four out of five said acute sector contracts had cost more than expected, 60% said prescribing costs had exceeded forecasts and just over half said they had underachieved on savings plans. More than 80% of CCG finance directors said organisations in their area did not have sufficient funding available to implement NHS England’s Five Year Forward View plans, and more than 85% were not very or not at all confident that their organisation could deliver the 2% to 3% efficiency savings required to save £22bn across the NHS by 2020. Briddock called for the government to use the spending review next week to “front-load” an extra £8bn in health service funding demanded by NHS England.

Axed patient feedback service cost £1.2m: NHS England’s abandoned patient feedback service Care Connect cost on average £1,600 for every patient query resolved during the pilot phase. A freedom of Information (FoI) request by revealed that the total cost of the scheme between 2013 -15 was £1.25m. Pioneered by NHS England’s national director for patients and information Tim Kelsey, it allowed patients to go online, ring a telephone number, text or use social media to log concerns, ask a question or provide feedback on their experiences. Twenty-two trusts in London and the North of England piloted the service between July 2013 and February 2014. Care Connect case handlers completed 760 cases and dealt with another 220 “miscellaneous questions” via text, the FoI response revealed. Inspired by the 311 hotline service in the US, Care Connect was due to be rolled out across England by February 2014. However, the multi-channel service has been quietly abandoned and NHS England confirmed to that there were no plans for a national roll-out. The plan was that the service would become part of the new NHS Choices, now rebranded as It was key to NHS England’s aim to: “ensure that all NHS funded patients will have the opportunity to leave feedback in real time on any service by 2015”, as outlined in the document, Everyone Counts: Planning for Patients 2013/14.

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Irish hospital to offer patient access to records by November 2016: Galway Clinic in Ireland is aiming to offer patients full access to their medical records by November 2016. The private 146-bed hospital plans to go live with the latest version of the Meditech electronic medical record (EMR) system, including a patient portal. Giving patients access to records is hugely important and empowers them to take control of their own health and care, Galway CIO, Raphael Jaffrezic told Computer Weekly. Through a patient portal, a module of the Meditech v.6.1 EMR, patients will be given full access to their medical records, test results and notes. “We want them to be able to have a patient portal to access their medical records, and use the portal as a communication tool with the clinic,” Jaffrezic said. If a patient is due in to have surgery, the hospital can give the patient information on what to expect through the patient portal. When the patient is then discharged, they can look in the patient portal for information on the recovery process and the different medications they are given. Jaffrezic is a staunch believer in giving patients access to their medical records. “If a patient sends a letter saying they want access to their records now, under the Data Protection Act they are entitled to see the full record, so why shouldn’t it be the same electronically”, he said.

Up-to-date capacity stats could help CCGs and GPs spread the patient load: Clinical commissioning groups (CCGs) and GPs could gain access to up-to-date capacity information to direct patients to “emptier” providers at the point of referral, NHS England has revealed. NHS England will work with CCGs to develop more sustainable approaches to proactively managing demand and increase patient choice, reported National Health Executive. The organisation has also put in place a dedicated project team tasked with identifying and matching spare capacity – including in the private sector – to help NHS deliver contracted volumes of activity for 2015-16, as well as ensure all available capacity is fully utilised. The push for shorter waiting times and smarter patient take-up builds on the latest figures indicating the state service is failing in several areas. Concerning cancer patients, for example, providers missed the 62-day treatment standard in August. A significant factor in delivering this target successfully is the availability of diagnostic tests, particularly endoscopy tests. However NHS England has assured that it has established a programme management office to facilitate the transfer of at least 9,000 patients to providers with available endoscopy capacity by the end of March 2016.

NHS England doubles funding for GP practice pharmacist pilot: NHS England has announced that it is doubling the size of the pilot that will see pharmacists employed directly in GP practices following an “overwhelmingly positive response” from surgeries, reported The Pharmaceutical Journal. The budget for the three-year initiative is being increased from £15m to £31m, which will pay for 403 pharmacists and involve 698 practices, it said. “By testing these new ways of working across professional boundaries we are taking another step forward to relieving some of the pressure that GPs are clearly under and ensuring patients see the health professional that best suits their needs,” NHS England’s chief executive Simon Stevens said. The announcement, made this week, was described as “fantastic news” by the chair of the Royal Pharmaceutical Society’s English Pharmacy Board Sandra Gidley. “It’s a real vote of confidence in the pharmacy profession and a huge step towards the integration of pharmacists into primary care. More patients will see first-hand the difference a practice pharmacist can make to their health and more GPs will come to regard them as an essential part of the multidisciplinary team in their practice.”

Fewer than one in 10 hospitals meet their own nurse staffing targets: More than nine out of 10 acute hospitals in England are failing to meet their own targets for the numbers of nurses working on wards, reported Health Service Journal (HSJ, subscription required). According to safe staffing data reported by 225 acute hospital sites in England, 207, or 92%, did not achieve their planned staffing levels for qualified nurses working during the day. The data, collected by HSJ last month, shows the average staffing levels across the 225 sites in August and reveals a worse position for nurse staffing compared to data for January. The deterioration in performance may reflect trusts increasing their planned levels for registered nurses on wards following safe staffing guidance from the National Institute for Health and Care Excellence published last year. The NHS is struggling to recruit nurses due to a national shortage, while providers are also forecasting a collective deficit of £2bn this financial year. NHS Providers chief executive Chris Hopson said it was clear acute trusts were under “significant pressure around the recruitment of permanent staff. One of the biggest issues facing the NHS is how we balance the pressure around finance and the demand around staffing levels.” Cheryl Etches, chief nurse at The Royal Wolverhampton Trust, said her trust was planning to recruit 200 nurses from overseas in addition to local graduates. She said “if you want better quality care, better length of stay, better efficiency, less harm, less complications and errors, you don’t want to be reducing your nursing staff.”

Healthcare innovators to open Edinburgh chapter: An international community of healthcare professionals will open their Edinburgh facility in December, reported The Scotsman. Those involved in the healthcare industry in Scotland will finally have their own Scottish chapter when Health 2.0 opens. Health 2.0, an international organisation dedicated to the creation and demonstration of new health technologies will commence operations on December 3. Members of the organisation will hold conferences, conduct market research and host developer competitions to create international solutions to some of the world’s biggest healthcare issues. Chapter leader Diwakar Thakore, said: “The chapter was founded in February to serve the healthcare innovation and technology ecosystem of Scotland. We need to build a community here in Scotland that becomes a bridge between healthcare innovators, society, patient groups, doctors and nurses to help build a truly world class health innovation cluster, keeping the tradition of being a great medical research city.”



Don’t let an identity crisis stand in the way of health and care integration
Connecting Care programme director, Andy Kinnear says challenges in identifying patients and connecting their activity across multiple health and social care organisations cannot remain a barrier to integration.

“Integration has been spoken about for decades. Now it has a chance in reality, which is good news, as achieving this is absolutely essential for the sustainability and even the very survival of the NHS.

“From October 1, NHS and adult social care organisations across the country have had an obligation to use the NHS number. Under new rules, health and adult social care bodies are expected to share information with each other when they are working together to provide direct care and treatment to a patient. Integration must happen with speed if health and care services are to cope with growing pressures. We cannot afford to wait years for this to happen, it must happen now. 

“True realisation of an integrated digital care record, an underpinning element of making integrated care a reality, means the ability to draw together and accurately identify care episodes that are recorded by social workers, local government, mental health organisations, community providers and many others – for all patients, whatever their age or location and whatever services they receive. We need to be able to match records, however they have been recorded. 

“We need to account for issues and anomalies associated with the use of national identifiers, such as duplicate records, or potential instances where a number is being used by more than one patient. We must be able to cope with errors that can occur in assigning an incorrect NHS number due to false assumptions over similarity in names, addresses and other demographic data. And we need to bridge the gap where current technologies, such as patient administration systems, for example, might not be presently able to communicate using the NHS number.

“Effective and comprehensive records on individuals are now being built, with secure user based access allowing hundreds of care professionals to make and execute more informed care decisions. Wider adoption throughout the country of such an approach could have a significant impact on the ability to create accurate integrated care records, an important development both for clinicians and in empowering patients themselves.”

Investing in the NHS and neglecting social care doesn’t add up
A good NHS cog is useless in a broken health and care machine, write Rob Webster and Ray James on the Guardian’s Healthcare Network this week.

Webster, the chief executive of the NHS Confederation and James, the president of Adass, argue that we must build on the ambitions of pioneers and vanguards to better meet patient needs and transform together.

“The government’s spending review is about to conclude. No promise of funding or reform for the social care system has been made yet – although everyone understands its importance. 87% of NHS leaders told the NHS Confederation they want a five-year financial commitment from the government on both health and social care in the review.

“The Association of Directors of Adult Social Services (Adass), the NHS Confederation and other organisations have called for urgent action from the government. Together we make a clear case for investment for local transformation.

“We have been arguing, on behalf of patients and people receiving social care that the system risks creating a future where the NHS is supported and social care is left behind. This would lead to failure – a good NHS cog is useless in a broken health and care machine.

“A failure by the spending review to address this need would be incredibly disappointing, not least because there is genuine enthusiasm to use this parliament to implement major service change.”

Another view: returns to IT for GP federations
GP Neil Paul has been asked to advise an IT company on the changing face of general practice and its IT requirements. He has a lot of ideas; and wants to find a way of seeing more of them implemented faster.

“In almost all cases, we have hit the boundaries of current technology fairly quickly. So here are a few of the things that we will be telling the IT company.

“Workforce brings up several issues. First, an increasingly part time workforce, working in bigger teams, means we need very robust ways of coping when people aren’t in. Getting everyone at a meeting to discuss things can be difficult. So never mind the adoption of Skype for doctor-patient interactions, let’s have video-conferencing for doctor-doctor interactions (and other staff interactions, for that matter). Let’s have video conference rooms or video calling from the desktop or even video calling from home. That way, all the doctors working across the multiple sites covered by a single federation could attend training/updates without wasting time on commuting.

“Care plans also need a real overhaul. The current consultation model of recording what we are doing is getting old fashioned. We need better tools to manage groups of patients to Starfield principals. Actually, we need better tools just to manage care, instead of reacting to requests for appointments. Drop in pathways/Gant chart-like flow diagrams/other ideas? They all need to be experimented with.

“Big suppliers tend to have their own road map for developing their products. They think in terms of something they can sell to 1,000 or more surgeries; not just to ten, and certainly not to the one with a hunch.

“You shouldn’t have to convince the system supplier to add it to their roadmap, for release at some unspecified date. You should be able to hire a developer and get it done; in the way that I can for most web-tools.”

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