News in brief
Junior doctors’ strike: Two walkouts in a week as war of words continues:
The junior doctors’ strike has dominated headlines this week – here is our roundup.
- Almost 13,000 operations and more than 110,000 outpatient appointments were cancelled this week as junior doctors staged their first all-out strike in the near 70-year history of the National Health Service. The government criticised and said it had done “all it could” to resolve the dispute, which this week saw many of England’s junior doctors withdraw services including emergency cover from 8am to 5pm on Tuesday and Wednesday. David Cameron told the Financial Times (subscription required): “We have done all we could to avoid these strikes. It is ultimately a decision by the junior doctors to go ahead. This is about how we put in place what we need to deliver a seven-day NHS. It was a clear commitment.”
- Government sources said both the Department of Health and Number 10 had made it clear any escalation in strike action would not stop imposition of the contract from this summer, the BBC reported.
- The Financial Times (subscription required) reported, Jeremy Hunt, the health secretary, as saying that doctors were “crossing a line”, and questioned whether the action was “proportionate or appropriate to withdraw emergency care from vulnerable patients”. He said the dispute, following 75 meetings over three years of negotiations, boiled down to one issue of substance: the premium rates paid to England’s 55,000 junior doctors on Saturdays.
- In a letter from junior doctors’ leader to the health secretary published on the BMA website, Dr Johann Malawana said the dispute was not about a single issue, but included protection against working excessive hours, acknowledgement of the impact and definition of work patterns and rotas, and pay for all work done.
- Polling for the BBC by Ipsos Mori suggested public support for the junior doctors remained high, as reported in The Independent. About 58% of adults in England backed the medics, much higher than the 44% who said they would support them in January if they withdrew emergency care. However, the proportion blaming both the government and the doctors for the disruption had also almost doubled since February.
NHS warned of financial crisis over ‘out-of-control’ specialised care spend: Specialised services spending is out of control and poses a threat to the financial stability of the NHS, a new report from National Audit Office (NAO) warned, reported National Health Executive. Responsibility for commissioning specialised services, transferred from primary care trusts, who worked together in groups to commission services, to NHS England in April 2013 under the Health and Social Care Act 2012. The report found that since then, the budget for specialised services has increased from £13bn to £14.6bn or 6.3% a year, compared to a 3.5% increase for the NHS as a whole. It is set to increase by 7% this year, compared to 3.4% for the rest of the NHS. Amyas Morse, head of the NAO, said: “Against a backdrop of increasing pressure on NHS finances, NHS England has not controlled the rising cost of specialised services. If specialised services continue to swallow up an increasing proportion of the NHS budget, other services will lose out.” The report urges NHS England to gain control of specialised services by developing an “overarching strategy” and integrating it in the Five Year Forward View, and finalising its governance arrangements for specialised commissioning. An NHS England spokesperson said: “For the first time in three years, specialised commissioning has successfully balanced its budget this year but the NAO rightly points to the pressure we’re having to manage from rapidly rising demand for extremely expensive new treatments.”
Southern Health criticised for putting ‘patients at risk’: The NHS mental health trust which ran a care unit where a teenager drowned in a bath is “continuing to put patients at risk”, inspectors have said, reported the BBC. Southern Health failed to adopt safe bathing guidelines for two-and-a-half years after Connor Sparrowhawk died following an epileptic seizure in 2013. His unsupervised death led to a report into hundreds of unexplained deaths. Trust chairman Mike Petter resigned on Thursday ahead of the publication of the Care Quality Commission’s (CQC) report. He said he was stepping down “to allow new board leadership to take forward the improvements”. The CQC’s inspection in January was ordered after an investigation looked at all deaths at the trust between April 2011 and March 2015 and found hundreds had not been investigated properly. Now the watchdog has said the trust has still not done enough to reduce “environmental risks” and condemned a low roof at a Winchester site that patients could climb onto and ligature points across its sites. The report revealed there had been eight occasions where patients had climbed onto the roof between 2010 and 2015, as well as two in February – one of which involved a patient leaving the ward and then leaving the country. Dr Paul Lelliott, deputy chief inspector of hospitals, said that, despite staff efforts, risks to patients were “not driving the senior leadership or board agenda”. He said: “It is clear that the trust had still missed opportunities to learn from adverse incidents and to take action to reduce the chance of similar events happening in the future.”
Primary care workforce should be government’s “priority”: The training, development and retention of GPs and wider multi-disciplinary teams (MDTs) should be a key priority for the government, the Health Select Committee urged in its report on primary care, reported Primary Care Today. The committee’s inquiry report outlines the challenges facing primary care and looks at some long-term solutions which can improve access to services and patient care outcomes. Introducing the report, committee chair Dr Sarah Wollaston MP, said: “if we are going to provide the best possible care for people living with increasingly complex long-term conditions, then primary care needs to be able to change. We need to allow for longer appointments and for people to be cared for by a wider range of professionals.” In 2015, the Primary Care Workforce Commission (PCWC) was tasked in by Health Education England to come up with models of primary care that would meet the needs of a future NHS. The PCWC’s final report put federations and MDTs at the forefront of the movement towards a more sustainable health system, adding that primary care will be “based around the GP practice” with a stronger population focus and an expanded workforce. While the vision for a new model of primary care workforce has been introduced, the Health Committee argued that the real challenge is for the government and NHS England to overcome the barriers to building these new teams. The committee urged “basic” reforms such as widening the responsibilities of nurses, self-referral to physiotherapy and the incorporation of pharmacists into general practice to be enabled and accelerated.
HSCIC actions 1.2m patient opt-outs: More than 1.2m people will have their objection to having their identifiable health data shared for purposes other than direct care actioned by the Health and Social Care Information Centre (HSCIC) this week, wrote DigitalHealth.net. This means that 2.2% of England’s population of 56 million patients have opted out of having their confidential data shared for secondary purposes such as research. This could impact research institutions that use patient identifiable data sets for their activity, and questions have been raised about whether people were adequately informed about the opt-out when it was offered more than two years ago. The objections will now come into force on 29 April. The HSCIC had previously estimated the number of opt-outs at around 700,000 based on data from GP clinical suppliers, but the real figure has been revealed to be much higher. Patients were offered the option of a ‘type-2’ objection to their identifiable data being shared as part of the launch of the controversial care.data programme in February 2014. However, the programme was paused the month it was launched and no data has been extracted. The HSCIC was later given the task of dealing with any type 2 objections that were already registered with a GP. Now, HSCIC has signed an undertaking to comply with the Data Protection Act, reported Computing.
NHS Alpha is moving to beta: The NHS Alpha project plans to have moved a significant portion of NHS Choices pages to an interactive NHS.uk service within a year, reported DigitalHealth.net. The NHS Alpha team was set up last September to progress plans for a new “digital hub” by developing NHS.uk to connect patients with digital services. It is one of the key National Information Board workstreams and pulls together staff from NHS England, NHS Digital and the Department of Health. Testing of six redesigned NHS Choices pages for topics such as cancer, diabetes, asthma and COPD will take place this financial year, with plans for a public beta version of NHS.uk to be live by next March and a full launch of the new site in autumn 2017. NHS Alpha strategy lead Dan Sheldon said the current offering on NHS.uk – NHS Choices – focuses on providing information, while the new pages will provide tools to encourage online interaction with the NHS. The six long-term condition pages have been redesigned by the Alpha team, following interviews with more than 100 patients, as well as several user research sessions and labs at GP practices over the past six months. They focus on providing a more limited set of content that is relevant to patients and pointing them towards online tools, such as booking a GP appointment.
Nearly two million patients to receive person-centred support to manage their own care: People with long-term conditions will be supported to better manage their own health and care needs, thanks to the roll-out of an evidence-based tool over the next five years, NHS England has announced. NHS England said it had agreed a deal which will grant nearly two million people access to more person-centred care as part of its developing Self Care programme. Local NHS organisations and their partners are being invited to apply for free access to patient activation licences, which will help them assess and build their patients’ knowledge, skills and confidence, empowering people to make decisions about their own health and care. The Patient Activation Measure (PAM) is a validated tool which captures the extent to which people feel engaged and confident in taking care of their health and wellbeing. Locally, it is expected that measuring and improving patient activation will lead to patients enjoying better experiences of care and outcomes, making more positive choices about their health and wellbeing, and experiencing fewer unplanned hospital admissions. Dr Alf Collins, NHS England national clinical advisor, said: “Truly empowering patients to keep themselves well, manage their conditions and stay out of hospitals requires health professionals to understand the needs, the skills, and the confidence of the individual patient they are working with. The Patient Activation Measure shows real promise as a tool to achieve this.”
Nurses warn of rationing patient care as ward staffing levels worsen: An annual nursing survey has found widespread discontent across the profession, with nurses warning they lack enough staff to deliver an adequate standard of care, reported National Health Executive. The survey, ‘Pushing the Call Button on Unsafe Staffing: Who Will Come to our Aid?’, conducted by trade union Unison, found that 63% of respondents felt there were inadequate numbers of staff on the wards to ensure safe, dignified and compassionate care, an increase from 45% in the previous year’s survey. Many felt this led to too few nurses looking after too many patients, with 56% of staff reporting they had eight or more patients to look after, an increase from 42% in 2015. This number grew to 71% working evening shifts. They said this meant they couldn’t spend enough time on each patient (70%) or had no time to comfort or talk to patients (75%). Christina McAnea, Unison’s head of health, said: “Nurses and midwives should not have to ration their time and make the difficult choice as to which patients receive care and which miss out. Even working through their breaks and staying late or coming in early isn’t enough. It’s unfair for staff to be in this position and it puts patients at risk. Increasing demands on the NHS show no sign of letting up, and despite all ministers’ talk of protecting the NHS, the desperate situation painted here by health professionals across the UK looks set to continue.”
GP numbers decline by nearly 2% in a year: GP numbers are in decline, according to new figures from the Health and Social Care Information Centre (HSCIC), reported National Health Executive. The figures show that there were 34,055 full-time equivalent GPs, excluding locums, working in England as of 30 September 2015. This represents a decrease of 1.9% from the 34,712 recorded in 2014. The figures come as the British Medical Association (BMA) have launched a campaign, ‘Urgent Prescription for General Practice’, to address the growing crisis in GP care. The BMA’s figures revealed that approximately 37.3% of practices say doctors are planning to retire in the next five years, whilst 10.4% described their practices as financially unsustainable. NHS England recently published its General Practice Forward View, promising a £2.4bn funding injection and a 3,250 GP recruitment target to end the shortfall in GPs.
Nokia buys e-health startup Withings to become your digital doctor: Legacy mobile phone brand Nokia has announced plans to buy Withings, a digital health company that makes connected weighing scales, thermometers and blood pressure monitors, reported The Telegraph. “We have said consistently that digital health was an area of strategic interest to Nokia, and we are now taking concrete action to tap the opportunity in this large and important market,” said Rajeev Suri, CEO of Nokia. Nokia Technologies, the company’s R&D arm, will acquire the French startup for £132m in cash. Nokia exited the consumer retail space two years ago this week, when it sold its mobile business to Microsoft. Since then it has been beefing up the technical and enterprise side of the business. Its plan is to expand in the “Internet of Things” or connected devices space, with the digital health market growing at 31% every year. “We will be building up our product portfolio so it fits seamlessly into everyday life,” Withings CEO Cedric Hutchings said. Two new products have recently been announced, including a simple activity tracker and a medical-grade thermometer. “We have connected people all over the world in developed and emerging markets. Now we can connect them to health and wellbeing,” said Ramzi Haidamus, CEO of Nokia Technologies.
Government overhauls IT services procurement framework to improve Whitehall’s digital transformation: Small and medium-sized businesses (SMBs) should find it easier to compete for government digital contracts following the introduction of a new Digital Marketplace framework, reported Computing. Designed to change how businesses sell IT services to Whitehall and the wider public sector, the Digital Outcomes and Specialist framework replaces the Digital Services 2 framework. Rather, it has been designed to allow suppliers to talk directly to government buyers in order to better understand the projects they work on and their digital services requirements. The new framework enables suppliers to bid for contracts, which the Government Digital Service (GDS) said will make it “easier than ever” to work with a wide range of companies, including new firms. It is claimed that 50% of companies on the framework are new to the Digital Marketplace. A total of 1,261 suppliers are said to be on the framework, 92% of which are SMBs. This would seem to indicate that the GDS is looking to create a procurement structure that allows departments to move away from large monolithic contracts with only a few major suppliers, and instead set up smaller, more agile agreements with a wider range of suppliers, especially SMBs. Pioneering open source EPR provider, IMS MAXIMS, has been awarded a place on the new framework under two categories, reported eHealthNews.
Launch of crisis-hit NHS 24 IT system delayed again by ‘fresh technical difficulties’: The launch of a new IT system at NHS 24 has been delayed again after running into fresh technical difficulties, The Herald reported. The multi-million pound system for handling calls from sick and worried patients was due to go live in June but a new problem which was causing computer screens to appear blank has reportedly forced a delay to the planned roll-out date of June 14. Concern among staff about being equipped to use the new system in time was also said to be behind the postponement. No new launch date has yet been announced although in a statement NHS 24 said it was still planning to put the system into service this summer. The statement said: “NHS 24 has been planning to put its new technology system into service during the summer of 2016 and that plan remains the same. Our board recently considered proposals to launch the system in June, but this was dependent on full technical assurance as well as an assessment of staff readiness. A technical issue, which was very recently highlighted by suppliers, combined with staff feedback, means we must take the appropriate time to get this right.”
A future without desktops – addressing real clinical needs in a mobile NHS
Investing in the in-house mobile capabilities of the NHS can place vital information into the hands of clinicians, writes Matthew Kybert, systems development & integration manager at The Hillingdon Hospitals NHS Foundation Trust.
Kybert, writing on OnMedica, describes how the trust has developed its own mobile care record, in which mobile access to Co-ordinate My Care alerts has been just one of a number of clinical benefits.
“At the start of this journey, the trust did not have the toolset needed to develop secure mobile applications so we needed to find a way to develop our internal capabilities to quickly replace paper and desktop processes with mobile solutions.
“The trust was looking for more than a standard, off-the-shelf mobile system. So, we built the Hillingdon Care Record app by working in collaboration with our mobile partner CommonTime, utilising a mobile application platform called mDesign. The mDesign platform has been pivotal to the HCR app project that allows us to build sophisticated applications quickly and responsively to the trust’s needs.
“Throughout the process of building the mobile HCR app, Hillingdon developers have continued to gain new mobile skills and can now confidently make future developments in-house through the platform. This has placed the trust in a strong position moving forward to swiftly respond to changing clinical priorities.
“We are already providing mobile access to the trust’s PAS, as well as our discharge system, radiology information system, pathology results, clinical documents, GP information, palliative care records and more, so that information which has been joined together by our integration engine can now be made genuinely useful.
“But as we continue to engage clinical staff to steer our informatics projects and to understand where we need to refine our mobile offerings to the frontline, the trust is now in a stronger position than ever before to achieve this, in a responsive, timely and self-sufficient manner.
“Investing in more than solutions, the in-house capability of trusts can be a powerful mechanism to meet real clinical needs.”
Open for business
Dr Mahiben Maruthappu, the co-founder of NHS Innovation Accelerator (NIA), blogs for NHS England on how technology is transforming the world and says the NHS, although thought by some to be slow at adopting innovation, is seeing progress.
“Innovation is hard. The NHS is under pressure, be it efficiency demands, financial supply, or operational performance. Add to this the common challenges healthcare innovators are facing; from system fragmentation to stakeholder navigation, complex procurement to prolonged regulation; it’s hardly surprising that some may be turned off. This combination of barriers is what causes healthcare globally to lag behind other sectors when it comes to disruptive technology.
“Are disruptive solutions present in health? Yes, but they have not been widely adopted. For example, agency staff cost the health service over £3 billion a year, with a hefty sum going to the healthy wallets of agency companies. The issue is that most of them are outmoded.
“When I practice as a doctor, I receive sporadic text messages and phone calls, asking me whether I’m available to do a hospital temp-shift three days before it’s due. Hardly an efficient consumer experience. Start-ups are now automating and digitalising the process, using on-demand Uber-like apps to match nurses and doctors to available staffing shifts at a fraction of the overhead. However, only a fraction of our providers are using them.
“The health service cannot afford to turn off innovators with these types of solutions anymore.
“To try to address this, we designed the NHS Innovation Accelerator (NIA) last year. Like many ideas it was taken from another sector. Accelerators aim to support the growth and spread of technologies, in the past developing solutions such as AirBnB and Dropbox. Microsoft, IBM and MIT all have accelerators, and now we do too. Its ambition is to work with innovators to drive the spread of their innovations, unblocking system barriers that they face.”
Enter the CCG: on Patient Online
Dr John Lockley, clinical lead for informatics at Bedfordshire Clinical Commissioning Group, writes about how he is worried about the Patient Online programme – and just how much work making the full GP record available to patients could entail; at a time when practices are under enormous pressure.
“There are many occasions when the ‘obvious’, ‘intuitive’ answer to a problem is totally wrong, when only by the careful application of data, knowledge and logic does the truth becomes apparent.
“This has just become all too relevant for the GPs in our clinical commissioning group; indeed, for every practice in England. The problem is Patient Online, the government’s scheme to allow individual patients to interact electronically with their surgery’s computer. There are two parts to Patient Online: the interactive aspect, which allows patients to order repeat prescriptions and make or change appointments online. The other part of Patient Online is about enabling patients to view their own electronic GP record. Allowing patients to see their records is intended to create greater openness.
“Now for the downside. Patients have to be individually registered for Patient Online services. Before any patient can be allowed to view their record the practice has to check that it contains nothing that might cause problems. That means: no inappropriate references to third parties; no unanticipated diagnoses which might cause distress. In addition, will anything in the record put staff at risk because the patient is likely to become upset by what they have written.
“All healthcare organisations now agree that before any individual patient’s record is viewable online it should be checked thoroughly for entries such as the above, with consideration given to the need to redact parts of the record from the patient’s view. This will take time.
“The average GP record now has many letters attached (often of three or more pages each). So every practice would have a huge job on its hands to check that each record is safe for detailed viewing — and all future entries will also have to be rigorously checked for the same things at the time they are made.
“Fortunately NHS England has begun to acknowledge the logistical problems Patient Online presents, and now accepts that it is reasonable for practices to limit the uptake and checking of records for access to a rate they can manage, depending on their resources.”
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