Jeremy NettleGuest blog

Oracle’s healthcare expert and Highland Marketing’s industry advisor Jeremy Nettle outlines the lessons that UK healthcare should learn from European examples of person-centred integrated care.

News in brief

Thousands of NHS nursing and doctor posts lie vacant: More than two-thirds of trusts and health boards in the UK are actively trying to recruit from abroad as they struggle to cope with a shortage of qualified staff, figures reveal, reported the BBC. Health unions blame poor workforce planning, but officials say the NHS has more staff than ever before. Data from a BBC Freedom of Information request shows that on 1st December 2015, the NHS in England, Wales and Northern Ireland had more than 23,443 nursing vacancies – equivalent to 9% of the workforce. One solution to the staff shortage adopted by many trusts is employing doctors and nurses from overseas. The figures show more than two-thirds – 69% – of all NHS trusts and health boards are seeking staff overseas. And in just England and Wales, the figure is nearly three-quarters of all trusts and health boards – 74%. Some are travelling from as far afield as India and the Philippines. A spokesman for the doctor’s union the BMA – which is currently locked in a dispute with the government in England over a new contract for junior doctors – said: “Poor workforce planning means we aren’t producing enough doctors and sending them to the right areas.”

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NHS to help create ‘healthy new towns’: Ten new housing developments in England are to be built with healthy living in mind under an NHS scheme, reported the BBC. Clinicians, designers and technology experts will work together to create the “healthy new towns”. Plans include homes with virtual access to GP services, safe green spaces to play, and fast-food-free zones around schools. The money to build the developments will come from council budgets and private partners rather than the NHS. The places earmarked to test the ideas include existing villages in the South West, London and the North West, and two new developments in Cambridgeshire and Darlington. Some of the developments are already being built, but others will not be completed until 2030. Simon Stevens, the head of NHS England, said a much-needed push to kick-start affordable housing across England had created a “golden opportunity” for the NHS to help town planners promote health and keep people living independently. “As these new neighbourhoods and towns are built, we’ll kick ourselves if in 10 years’ time we look back having missed the opportunity to ‘design out’ the obesogenic environment, and ‘design in’ health and wellbeing,” he said. “We want children to have places where they want to play with friends and can safely walk or cycle to school – rather than just exercising their fingers on video games.”

‘Stars are aligned’ for health IT – Freeman: Health ministers are “completely behind” the digitisation of health and social care because “it is urgent for personal care, it is urgent for safe care, and it is urgent for research”, life sciences minister George Freeman has said, reported DigitalHealth.net. In a video recorded for the first Digital Health Leadership Summit, Freeman said ministers were also committed to learning the lessons of “two decades” of attempts to do this; which had delivered only “patchy” results. He argued that the job of government was to provide leadership and to develop the “railway lines” on which projects could run; for example by developing a “protocol for interoperability” and sorting out information governance. Freeman said: “There is £4.2 billion despite wariness about IT projects that goes very deep in government, and despite the general financial problems. [That is because] ministers really do get this; that digital is safer and more efficient, that the centre’s role is to build platforms, and that this is not about technology but about what it can do.” Similarly, Andy Williams, the chief executive of the Health and Social Care Information Centre, said the “stars are in alignment” for healthcare IT.

One in ten GP practices ‘at risk of closure’, warns BMA: More than 800 GP practices in England said they are at risk of having to close due to being “financially unsustainable”, a major BMA survey has shown, reported Pulse. The survey of 2,830 practices found that 294 practices (10%) regarded themselves as financially unsustainable within the next year. It also showed that almost half of practices in England (46%) said they had at least one GP planning to retire, or leave UK general practice, in the next 12 months. The General Practitioners Committee (GPC) said it had conducted the survey to supply evidence of the “state of emergency” general practice was in, and the results follow the Special LMC Conference in January, which called on the GPC to consider canvassing the profession on potential mass resignation in six months. The chair of the GPC said that this demonstrated the “dire situation” GPs face, and that thousands of patients will be left without a practice unless the government implemented a rescue package. GPC chair Dr Chaand Nagpaul said: “With hundreds of GP practices facing financial uncertainty… we need the government to act urgently to deliver a comprehensive rescue package that safeguards GP services for patients. We cannot have a situation where thousands of patients are left without a local GP practice that can deliver the care they deserve.” 

Care homes ‘could solve NHS bed-blocking’: A report suggests the NHS in England should pay care homes to look after patients trapped in hospitals because of the delayed discharges problem, reported the BBC. Think Tank Respublica said it would free up hospital beds if care homes took them in, bringing in vital investment into the care sector. The patients would be cared for temporarily in the care homes until permanent arrangements could be made. Respublica director Phillip Blond said: “The bed blocking crisis in the NHS is only getting worse – clogging up wards and leaving newly arrived patients on trolleys in hospital corridors.” He added the extra money could also help care homes stay afloat. A Department of Health spokesman said attempts to get the health and care sectors to “work better together” would be aided by the Better Care Fund.

Trust has 1,000 patients waiting over a year for treatment: More than 1,000 patients waited more than a year for treatment at a single hospital trust – more than the rest of the English NHS put together, reported Health Service Journal (HSJ subscription required). Barking, Havering and Redbridge University Hospitals Trust has not reported waiting times data to NHS England since February 2014, but a trust document obtained by HSJ shows it had 1,015 patients waiting more than a year for elective treatment at the start of February.  The number of one year waiters at the east London trust dwarfs the reported national total. The latest NHS England data on elective waiting times showed 748 patients waiting more than a year for treatment as of December. The revelation could expose Barking to a £5 million fine from its commissioners. Trust chief executive Matthew Hopkins said: “It is crucial that patients are seen as quickly as possible and we are sorry that a lot of patients are waiting too long for treatment. We are taking urgent action, working with our local partners and stakeholders, to ensure high quality, accessible care for our patients. Those patients who have been waiting a significant amount of time have been contacted and we are booking in their appointments for the coming weeks. We have put in place a robust recovery plan, with support from the NHS Trust Development Authority and NHS England.”

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Extra funding announced for Scottish health boards: Health Secretary Shona Robison has announced extra funding for Scottish health boards’ 2016-17 budgets, reported the BBC. She said the additional money totalling more than £500 million would take the Scottish government’s spending on health to a record level of almost £13 billion. The funding will support the new Edinburgh Royal Hospital for Sick Children and the replacement of Balfour Hospital in Orkney. Extra money will also go towards the National Blood Transfusion Centre. About £250 million has been allocated to ease the integration of health and social care services. Among the health boards to receive more funds are NHS Highland and Tayside. Audit Scotland raised concerns about the health boards’ finances last year. She said: “People in Scotland should get the care and support they need in the right place, at the right time, which is why we are transforming our health and social care system to make sure it keeps pace with Scotland’s changing needs. This funding will allow people to be supported to maintain their independence for as long as possible, in their own homes and communities and mean that fewer people need to go to hospital to receive care.”

Fujitsu, NHS IT contract dispute set to drag on for another two years: The dispute between Fujitsu and the UK government over the cancellation of a NHS IT contract could drag on for a further two years, reported Computer Business Review. The NHS handed out a number of contracts in efforts to digitise records, but cancelled its contract with Fujitsu in 2008 citing poor performance. According to media reports from 2014, a legal fight between the two parties ended with arbitrators siding with Fujitsu, with the Japanese technology group set to recieve millions in compensation. Reuters reported that Duncan Tait, Fujitsu’s head of Europe, Middle East, India and Africa, said: “Talks on a contract settlement continued. We are still in the arbitration process, we would hope that would conclude within the next two years or so.” The Public Accounts Committee (PAC), which conducted an investigation into the incident, revealed that as much as £31.5 million was spent by the health department in legal costs, while trying to fight with Fujitsu. The initial contract was part of a £11 billion programme by the UK Department of Health to modernise its computer systems and to create a digital health record for every patient. Tory MP Richard Bacon, a member of the PAC, told officials who appeared before the committee last year: “The contracts were let [awarded] in an enormous hurry, in total secrecy, bound up with huge confidentiality clauses and it was only after they were all signed – quite rapidly after – that people became aware that the contracts would not deliver what was required.”

Electronic early warning system introduced by NHS Fife cuts cardiac arrests by up to two-thirds: Cardiac arrests have fallen by up to two thirds after NHS Fife became the first health board in Scotland to deploy an electronic early warning system, reported Holyrood. The Patientrack technology was rolled out at Victoria Hospital in Kirkcaldy six months ago, alerting doctors and nurses when patients’ vital signs deteriorate. Early findings from the deployment of the early warning system – the first of its kind north of the border – were revealed earlier this week at Holyrood Connect’s annual eHealth conference in Clydebank. Dr Gavin Simpson, consultant in critical care and anaesthetics at NHS Fife, who led the clinical deployment of Patientrack at NHS Fife, said: “Any clinician can now instantly see the profiles of the sickest patients in the hospital. Patientrack has helped us introduce some of the biggest and most immediate changes in clinical practice I have ever seen.” Patientrack allows nurses to capture vital signs on handheld tablet devices at the bedside, with the technology then calculating the patient’s early warning score and automatically calling doctors to intervene when there are signs of deterioration. Dr Rob Cargill, associate medical director for NHS Fife, said: “It is enormously powerful to be able to view a live summary of where the sickest patients in our hospital are so we can respond appropriately.” Donald Kennedy, managing director of Patientrack, added: “This is a fantastic move for better, safer care in Scotland and we look forward to spreading the benefits across the country.” 

Skype increases support for diabetes patients: The introduction of Skype appointments for diabetes appointments in Newham has slashed non-attendance rates in the borough and patients feel more supported to self-care, reported DigitalHealth.net. The pilot scheme, Diabetes Appointments via Webcam in Newham (DAWN), was launched by the diabetes team at Newham University Hospital in 2011 with funding from a SHINE award from the Health Foundation. Skype is already widely used by Newham residents, so it was relatively straightforward to roll out. Patients could send a message to the specialist nurse or doctor between fixed appointments, to see when they would be available for a Skype call. The reduction in non-attendance rates was not the only benefit. Desiree Campbell-Richards, a research nurse at Newham University Hospital said: “[Patients] said the interaction with the clinician was a more honest interaction, because they felt that the clinician’s focus was very much on them. The nurse felt the same – she said patients felt at ease to discuss a lot of things, because a lot of them would be Skyping from home. So the nurse felt the shift in dynamics was quite a powerful thing.” The success of the diabetes scheme has led to the creation of the Vocal project, which as well as continuing to offer Skype-based appointments to diabetes patients, extends the service to patients with other conditions, including those who have experienced cancer surgery.  

Scotland launches tablet framework tender: The Scottish government has issued a tender for a £50 million single supplier framework to provide tablet client devices and other associated services as part of a wider series of technology procurements, reported Government Computing. “The scope of the framework is for the provision of tablet client devices, accessories and all services associated with the deployment of these devices,” said the tender document. The exercise is part of the National Client Device (NCD) strategy, with the government earlier this month announcing that it had awarded HP a £90 million framework agreement to provide desktop client devices and related services. The framework tenders fall under the Scottish government’s Digital Public Services Strategy, which is designed to offer public sector organisations with high quality end point devices to help meet environmental and energy efficiency goals.

App helps 100,000 people contribute to Parkinson’s research: 100 for Parkinson’s is a global project asking 100,000 people to track their health for 100 days, using an app, to help understand the impact of Parkinson’s and provide new research, reported Digital Health Age. It is led by UK digital health startup uMotif, and supported by organisations such as The Cure Parkinson’s Trust, Parkinson’s UK, Nesta and the Cabinet Office. A survey by The Cure Parkinson’s Trust revealed that 90% of people with Parkinson’s were interested in using technology to understand their symptoms. Through 100 for Parkinson’s, patients can use smartphone technology through the uMotif app to track their symptoms. The app will enable people to track sleep quality, mood, exercise, diet and stress levels, areas that are commonly affected by the disease.. Bruce Hellman, chief executive of uMotif said: “100 for Parkinson’s will find out how smartphone platforms can help people with Parkinson’s, and everyone else, to understand their own bodies. Patients with Parkinson’s often only visit a doctor twice a year, so knowing more about their health will help them to bridge the gap between health visits and better understand their symptoms.” Anyone can take part in the project and the donated data will contribute to academic research approved by a committee led by The Cure Parkinson’s Trust and Parkinson’s UK, helping to unlock new discoveries in Parkinson’s. Those interested in taking part should go to the 100 for Parkinson’s website.

Councils urged to adopt NHS information governance assessment toolkit to aid health and social care collaboration: The representative body for local government ICT professionals said councils need to ensure their information governance matches the levels adopted over the past decade in the health sector, reported PublicTechnology.net. In November, chancellor George Osborne announced that every part of the country will be required to produce a plan for integration between social care and the NHS by 2017, to be implemented by 2020. A statement from Socitm said councils “need to demonstrate that staff know how to safeguard information, how to share data legally and sensitively, and understand when it is relevant to keep data it locked away behind encryption, and when it is not”. The body says local authorities should adopt the IG Toolkit, which allows NHS bodies to assess themselves against information governance standards. It also said councils need to take a single, standard approach to the issue across all departments. “As well as being more efficient, such an approach engenders trust by health organisations of the council as whole, rather than having to rely on individuals within that organisation,” it said. Socitm said that further work remains to be done within the IG Toolkit to provide cyber security information and support to health and care sectors. It called for a review of the toolkit for large, complex organisations, including local government “so that it can become an enabling vehicle to support information sharing across the care system”, along with better training.

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Opinion

The five principles behind the world’s most efficient health systems
Mark Britnell draws on his experience of working across 60 different countries to assess the relationship between health expenditure and health outcomes. Two of his five principles behind the successful management of a health system mention the significance of technology.  They are:

  1. Integrated care
    “One of the best systems I have seen to balance the two seemingly opposed forces of competition and collaboration is in Israel. Healthcare there is divided into four health maintenance organisations (HMOs), which both pay for care and operate their own pharmacies, primary care clinics and hospitals. That creates a strong incentive to keep patients well and out of hospitals by getting providers across the pathway to work together.“At the same time, the HMOs are constantly improving their services to attract more members. This is the foundation for a truly tech-savvy, primary care-led service that is always innovating, and which enjoys an average life expectancy of over 82 years for just 7.2% of GDP.”
  1. Standardise and simplify
    “From a provider’s perspective, a common three-step process can be found behind many of the world’s most efficient hospital systems. Whether it is India’s ultra-lean chains such as Narayana and Apollo, or world-leading centres of excellence like Geisinger in the US, a common thread shows how high-quality, low-cost care can be achieved.“The first step is to standardise clinical workflows by defining best practice, developing explicit guidelines and making sure these are consistently adhered to. The second is to develop IT systems that cement these practices into the everyday work of staff – making best practice the default choice. And the third step is to change the skill mix so that highly skilled professionals are only used for their expertise, and other workers take the strain of routine care and patient management.”

For the full list visit the Guardian Healthcare Network. 

Wachter Review must take Carter’s analysis into the modern era
“The Carter Review promises good things for a digital NHS”, writes Guy Wood-Gush, former neurosurgeon, ophthalmic surgeon and current CEO of Deontics.

“Now the NHS and its Wachter Review need to reject its language of efficiency, and take a more open approach to see how technology can achieve the quality aspirations that should drive the future NHS.

Lord “Carter has tried to set the foundations for a greater use of health technology. But there is the risk that this will end up delivering more of the same. Awareness of what health technology can offer is low.

“Telling a clinical workforce that variation is unwarranted is a red rag to a bull; their imperative is to treat the patient in front of them to the best of their knowledge and ability to ensure the best possible outcome. Never mind efficiency; these are people’s lives.

 “A system that is looking to drive efficiency should be looking at new generation clinical decision support systems (CDSS) (that) are vital in combining good practice with the needs of an individual patient, and ensuring the delivery of cost-efficient, quality care.

“Unfortunately, because of a lack of understanding of what is possible with new generation CDSS, in both the UK and the US, CDSS are some way off being seen as an essential part of the drive for quality and efficiency. They are seen as if they might be important but are not well understood. So if a trust is choosing an EPR, choosing one that ‘delivers decision support’ is a desirable but not an essential feature.

“New generation CDSS can apply the most up to date guidance for an individual patient’s condition and present that to the clinician at the point of care. They can learn and adapt so that personalised care with its multiplicity of variations can be delivered with confidence and at scale. They can monitor variations in clinical practice and compliance with the evidence base in real time, allowing both clinicians and patients to choose the appropriate care in line with best practice.

“It is now up to the Wachter Review to show that it has its eyes open to the potential for health technology that can be perceived as empowering clinical staff to deliver quality, rather than forcing them to prioritise efficiency.”

Communities and charities hold the answer to a more equal NHS
Many people still don’t receive equal care – but voluntary groups can change this, writes Samir Jeraj on the Guardian’s voluntary sector network. 

“Community organisations are often on the frontline of helping marginalised people and are formed from the very communities they work for,” he writes. “This means they are not only trusted by these groups of people but also understand what they need from health services.

“The organisation Friends, Families and Travellers is a good example – it has long supported Gypsy and Traveller communities’ access healthcare and worked to ensure the NHS and other services meet the needs of these groups. In fact, many of these voluntary sector groups, just like the REF, started because public services like the NHS were simply not working for some people in society and their voices were not being heard.

“Yet there are areas where NHS trusts are already working with communities by creating novel ways to receive feedback. The North West ambulance service has developed a novel way to reach out to its local community by creating a patient experience board game with the theme. Players move round the board, hopping from different healthcare issues, and are allocated points depending on the feedback and views they give. The feedback is then passed on to the ambulance service. The game is a simple way for people to give their opinions on health services without filling out a form – making it accessible for people with poor literacy skills.

“But to really achieve equality, NHS organisations need to make long-term commitments to communities.”

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