News in brief

Health spending devolved in Greater Manchester: Greater Manchester has become the first English region to gain control of its health spending, reported the BBC. From 1 April, the £6bn health and social care budget will be managed by councils and health groups as part of an extension of devolved powers. The Greater Manchester Strategic Partnership has now been formed comprising 37 organisations including hospital trusts, NHS England, the 10 borough councils and GP commissioners. Lord Peter Smith is chairing the group. The move will see local political leaders and NHS chiefs making decisions on how budgets are allocated and targeted at specific health issues, instead of decisions being made in Whitehall. The government hopes integrating health and social care services will ease pressure on hospitals and help to improve home care services for patients who need it. Lord Smith, who is leader of Wigan Council, said: “The big vision is about people and getting people’s health in Greater Manchester better. We spend £6bn on health and social care but life expectancy in Greater Manchester is not as good as it should be. Lots of people suffer from long-term illness and we’ve got great ambition to do something about their health. But it’s wider than health we want to do something for the economy.” Jon Rouse, currently director general at the Department of Health has been appointed to head up Greater Manchester’s devolved healthcare system, reported Manchester Evening News. He will become the region’s first chief health officer on £142,000 a year – making him one of the two people ultimately accountable to NHS England for the £6bn system. He was appointed after an interview process last week and replaces the interim chief, Ian Williamson, who returns to his role at Central Manchester Clinical Commissioning Group.

Leaving the EU would put the NHS at risk, Jeremy Hunt says: Leaving the European Union would starve the NHS of investment and could lead to an exodus of foreign national clinicians, the health secretary has warned, reported The Independent. Jeremy Hunt said voting to leave the bloc would “truly undermine the public finances”, leaving less money for the health service. “Those who want to leave need to explain how they could protect the NHS from this economic shock,” he said. “No savings can compensate for the economic volatility that would follow a vote to leave.” Hunt added that the NHS relied on 100,000 EU national citizens in its workforce and that they could be at risk amid “uncertainties” over work permit and visa statuses in the wake of Brexit. Matthew Elliott, chief executive of the Vote Leave campaign, said that leaving the EU would in fact make more money available for the NHS. He added: “Under Jeremy Hunt’s stewardship, the NHS has plummeted into a financial crisis. If we vote to leave we can stop wasting money on EU bureaucrats and instead spend our money on our priorities like the NHS.”

Ministers “letting down mentally ill people” by not collecting data: Ministers have been accused of letting down mentally ill people by failing to collect basic data about waiting times, suicides and deaths, which would allow them to secure more funding to tackle the crisis in mental health, reported The Guardian. Luciana Berger, the shadow mental health minister, has accused the government of “negligence” after having more than 50 freedom of information requests dismissed with the response that the data is “not collected centrally”. Berger said: “The number of questions ministers cannot answer is staggering. It is absolutely appalling that ministers have no idea how many new mums have taken their own lives because of mental health problems, how many people diagnosed with mental illness go to prison, or how many children have died in NHS mental health units.” The prime minister delivered a speech last month promising to lead a “revolution in mental health treatment in Britain”. Jeremy Hunt, the health secretary, has said he wants to spur a “transparency revolution”, which he argued was crucial to driving up standards. Berger said ministers were “at best negligent” and “at worst making a wilful choice” to treat the mentally ill in an inferior way. Lib Dem MP Norman Lamb said the lack of data was a “total frustration” while he was in government, and meant that mental health inevitably secured less funding. The minister for mental health, Alistair Burt, said that the government will publish a five-year plan for mental health data by the end of this year.

£55m moneypot to fund switch to digital referrals: NHS England has set aside £55m to reward GPs and hospitals that switch to making referrals digitally by 2018. Currently only around 50% of patients are referred for hospital appointments electronically. It is intended this will increase rapidly to 60% by September this year, 80% by 2017 and 100% by 2018. NHS England and NHS Improvement also plan to consult on a proposal that by 2018 NHS commissioners and providers will no longer be paid for referrals made by paper, reported Building Better Healthcare. NHS England’s director of digital technology, Beverley Bryant, said: “For a long time our first-class healthcare system has been let down by outmoded systems, where patients are referred to hospital by second-class post. We have a duty of care that extends beyond providing effective treatments. We must also provide an effective patient experience that ensures patients feel reassured at a time when they are most vulnerable.” This incentive aims to encourage clinical commissioning groups (CCGs) to support GPs and hospitals to adopt the practice of electronic referrals. NHS England will release up to £55m of funding through the 2016-7 Quality Premium, a scheme designed to reward CCGs for improvements in the quality of services. There will be further payments for hospitals to adopt the practice of processing electronic referrals next year through a 2017-18 Commissioning for Quality and Innovation (CQUIN), which recognises excellence and improvement in providers.

Around the clock care for dying “not good enough”: A national review of end-of-life care has found most hospitals are failing to provide face-to-face palliative care specialists around the clock, reported the BBC. The review shows only 16 of 142 hospital sites in England offer specialists on site 24/7. NHS experts acknowledge steady improvements in the last two years, but warn there is still work to do. In 18% of more than 9,000 patient notes researchers examined, there was no written evidence to suggest that do-not-resuscitate decisions had been discussed with relatives or friends. And in around 3,000 notes there was no evidence that the patient’s ability to eat and drink had been assessed on the last day of life. However the researchers’ main concern was that many patients and doctors did not have full access to on-site palliative care specialists at evenings and weekends. The majority of hospitals did offer a specialist telephone helpline at all times and 53 of 142 hospital sites offered face-to-face palliative care on Monday to Sunday between 9am to 5pm. But for 26 trusts there was no record of face-to-face specialist palliative care involving doctors at any time. Study-lead Dr Sam Ahmedzai said: “We know that most front-line doctors and nurses giving end-of-life care do it to a very good standard. But the problem happens when things start to go wrong and often they go wrong out-of-hours in the middle of the night and at weekends. Then doctors and nurses who may be inexperienced need to be able to access specialists in palliative care.”

SBRI streams £1.4m into new solutions for A&E: SBRI Healthcare, an NHS England funded scheme to develop innovative products that address unmet health needs, is awarding £1.4m to companies developing innovative new technologies that reduce pressures on A&E. Fourteen companies have been chosen to share the cash pot, with an average award of £98,000 each, to underpin development of novel approaches to preventing admissions, co-ordinating admissions, and resource planning, reported Pharma Times. The successful projects, which have been chosen for their potential value to the health service and improved outcomes to patients, will be supported and fully funded to demonstrate the technical feasibility of their proposed concept. Those businesses demonstrating best value and greatest technical feasibility in phase one will progress through to phase two to be further supported and funded to take their technologies through to commercialisation, SBRI said. Phase two contracts for prototype development are worth up to £1m over one year. Phase three contracts are intended to accelerate product adoption, with up to a further £1m over 12 months, providing the opportunity for validation in NHS settings.

Millions of patients across England given greater say in their local community healthcare: More than six million people across England will be given a greater say over the way healthcare services are provided in their local communities after Monitor awarded foundation trust status to two new NHS trusts. Birmingham Community Healthcare NHS Trust and Sussex Community NHS Trust have been authorised as foundation trusts by Monitor, effective from 1 April 2016. These decisions mean there are now 155 NHS foundation trusts in total, more than 60% of all trusts in England’s NHS, reported Gov.UK. The trusts will now be able to give patients, staff and the public the chance to become members or governors with a formal say over how their trusts are run. The trusts will also have more freedom to shape services to match the needs of local people. Miranda Carter, executive director of provider appraisal at Monitor said: “I’m delighted to announce the creation of these two new foundation trusts. It is a true testament to the hard work and dedication of every member of their staff. As foundation trusts, these two organisations now have the freedom to develop services more tailored to the needs of the populations they serve.”

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A&E strike should be suspended, say medical leaders: Medical leaders say the planned all-out strike by junior doctors in England at the end of April over a contract dispute could be damaging to patients and should be suspended. And they say ministers should hold off imposing the controversial contract, reported the BBC. They are asking both sides to “step back from the brink” and re-enter negotiations. “We believe that this is essential if the current impasse is to be broken and progress made in resolving this extremely damaging stand-off for the benefit of all NHS stakeholders, particularly our patients and trainees,” says the Academy of Medical Royal Colleges. Meanwhile, more than 1,000 medics have signed a letter asking the prime minister to intervene and stop the new junior doctor contract from going ahead. The letter warns that if the dispute continues “many more doctors will follow the current trend and leave the country to work abroad as they feel disillusioned and unhappy with how they are being treated by your government.” There are two further periods of planned strikes. The first will begin at 8am on 6 April for 48 hours when junior doctors will refuse to offer routine care but will provide emergency cover – similar to a Christmas Day service. All-out stoppages are then planned to take place from 8am to 5pm on 26 and 27 April. This would be the first time doctors have removed cover from areas such as A&E and intensive care. The British Medical Association (BMA) has launched a judicial review to challenge the health secretary’s imposition of junior doctor contracts, reported ITV News. It will challenge the lawfulness of Hunt’s decision to impose the newly published junior doctor contract, the BMA said.

Patient-facing integrations with GP systems run late: The April 2016 target for getting third-party suppliers of patient facing services integrated with the principal GP systems will not be met. The first of these integrations will now likely go-live in late spring. When a new GP Systems of Choice contract (GPSoC) was signed in March 2014, it specified that principal system suppliers [Emis, TPP, INPS and Microtest] must provide interface mechanisms to allow the suppliers of subsidiary services to integrate with them. A “pairing process” was developed by the Health and Social Care Information Centre to manage the integrations. NHS England’s senior responsible owner for GPSoC, Tracey Watson, said last October that she expected the interface mechanisms (IM) to be ready by the end of 2015. The first of the integrations were expected to be live by April 2016. However, only two integrations have been awarded full roll-out approval – Total Billing Solutions and My RightCare – neither of which are patient facing. Three patient-facing services suppliers – PAERS, Wiggly-Amps and iPlato – told they are close to being assured, but none will achieve the April target. Watson confirmed this month that TPP was the first company to offer the necessary interface mechanism and Emis is “part way there”. INPS offered part of its IM last year and Microtest is due to deliver in April. “I’m being assured that it’s not going to take much longer. I’m expecting there to be activity, in terms of go-lives, in late spring,” she said.

£1.3bn clinical and digital health systems tender launched: The NHS London Procurement Partnership has issued a framework tender valued at up to £1.3bn to supply healthcare providers and charitable organisations with applications including electronic patient record (EPR) systems, data centre hosting and multi-functional devices. The proposed Clinical and Digital Information Systems Framework (CDIS) aims to support trusts and other care providers to meet the key aims of the National Information Board (NIB) “Personalised Health and Care 2020” paper, which focuses on how patient data and technology can better inform treatment. Intended to go live by August this year, the framework will be divided into four separate lots designed by the partnership to try and bring together “key clinical and administrative data” in a single place over the four year lifespan of the agreement, reported Government Computing. According to the procurement partnership, the framework will bring together the benefits associated with an EPR system with integration services and interoperable digital tools to ensure health providers can access all data they require when and where it is needed. “This will be real-time digital information on an individual’s health and care, made available by 2020 to all NHS-funded services,” said the organisation in a statement. It will also provide comprehensive data on the outcomes and value of services provided, which in turn will support improvement and sustainability.

NHS trust bosses slam £600m hospital fines over patient targets: Hospitals are being fined £600m a year for missing key NHS patient treatment, reported The Guardian. NHS Providers, which represents hospital trusts, says that the fines levied by GP groups are nonsensical, given that about 90% of trusts are in deficit and the sector is due to end the financial year later this week an estimated £2.8bn in the red. “NHS trust chief executives tell us they are intensely frustrated by these fines and see them as shortsighted, counterproductive and reflecting a sense of denial about how serious the problems facing hospital, community, mental health and ambulance services really are,” said Chris Hopson, chief executive of NHS Providers. Penalties are being imposed on trusts across England for failing to treat patients waiting for A&E, cancer and non-urgent care quickly enough, even though almost all hospitals are struggling to meet the growing demand from patients. Barts Health NHS Trust was fined nearly £53m last year. A trust is fined £120 every time its failure to treat an A&E patient within four hours leads to it breaching the duty to deal with 95% of such cases within four hours. There is a £300 fine every time staff fail to treat a patient on the non-urgent referral-to-treatment waiting list within 18 weeks, and the trust then cannot attend to 92% of such cases within the required timescale. The fines are levied by clinical commissioning groups, the GP-led local NHS bodies that pay hospitals to treat patients, and NHS England. Trust chiefs claim the charges hinder their ability to hire staff, set up specialist teams and take other steps to tackle the underlying problems that have led to them breaching targets in the first place.

Lincolnshire Health and Care Selects InterSystems HealthShare to transform patient care for the region: InterSystems, a global leader in health information technology, has announced a partnership with Lincolnshire Health and Care (LHAC) that will help LHAC achieve its ambitious goal to transform health and social care services in the county, potentially saving up to £4m every year, reported Hospital Healthcare Europe. Patients and clinicians in Lincolnshire will soon experience the benefits of an integrated care record through InterSystems HealthShare. Delivered on a health informatics platform, the system will allow multiple health and care providers to securely share essential patient information – improving patient outcomes as a result. LHAC brings together 13 health and social care organisations in the county, including clinical commissioning groups (CCGs), acute trusts, and the local authority. Gary James, accountable officer at East Lincolnshire CCG, said: “All Lincolnshire Health and Care organisations have joined forces to develop the portal, which will allow care professionals, with the patient’s permission, to see all the information relevant to that patient’s care. This will improve the quality and safety of care and will also save staff time by providing fingertip access to the information they need to manage that patient’s care.”

South East London record sharing project reaches GPs: GPs and acute trusts in Southwark and Lambeth are sharing patient records using an in-house developed portal and the Medical Interoperability Gateway, reported The Local Care Record allows healthcare professionals at Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS foundation trusts and local GP practices to view each other’s patient records. More than 50 practices have enabled viewing of their records within the King’s Health Partners portal and 21 are able to view the King’s portal so far. Ninety-one have signed data sharing agreements and are registered to become users. In the first month of use, GPs have already viewed the records 2,000 times and full roll-out is expected to be complete by the summer. GPs have agreed to share their records with the acute providers via Healthcare Gateway’s MIG. Nine views of primary care data are available to hospital clinicians, including the patient problem list, medications, diagnoses and procedures. Dr Adrian McLachlan, chair of NHS Lambeth Clinical Commissioning Group and GP partner at the Hetherington Group Practice, said: “The Local Care Record is something my GP colleagues and I have been really excited about and it is already adding clinical value. We have a clearer picture of the people we are caring for and their different health needs.” Dr Cormac Breen, chief clinical information officer at Guy’s and St Thomas’ described the Local Care Record as a “major step forward in how the local NHS shares information to improve care for local people”.

North Middlesex starts 1m note scanning project: North Middlesex University Hospital has gone live with the Unity electronic document management system as part of its strategy to be fully digital in 2017 at the earliest, reported The solution, from Fortrus, is available as a standalone or through the trust’s home-grown portal enabling clinicians to view not just the scanned record but also any other clinical system through a single interface. Musadiq Subar, IT programme manager, said: “We built our portal in 2013 and have any number of systems linked to it but our clinicians were held back by the physical notes. So now we are making them electronic.” The project was part paid for by NHS technology fund money, and has involved setting up an in-house scanning bureau to scan 100,000 sets of live notes over the next 18 months – an estimated one million documents. Clinicians can annotate the record and complete electronic forms within the portal. Subar said clinicians had reacted “positively” to the new system and having clinical notes available on-line anywhere in the organisation viewable either through the Unity app or through the portal. Over the next year, the trust plans to make electronic notes available to patients’ GPs enabling them to see “the whole picture” of the patient, including test results.

Another 33 ‘sustainability and transformation’ leaders confirmed: NHS England has revealed another 33 “sustainability and transformation plan” (STP) leaders have been confirmed. Nominating a single leader to oversee and co-ordinate the STP process, to “get a sense” of the scale of the challenges existent in local areas, was part of key pre-Easter targets to ensure trusts can get access to NHS England’s £1.8bn bailout fund, reported National Health Executive. Although three areas are still undecided, NHS England guaranteed that “conversations are ongoing”. When eight of the 44 leaders were announced, there was a definite balance between their backgrounds: two were council CEOs, three were clinical commissioning group officers and three came from foundation trusts. Two of the eight were women. This balance between local government and NHS has mostly changed, with just three of the 41 leaders announced hailing from councils. Around one-third of them are women. As before, there are some major names amongst the list of 33 nominated leaders, including the outgoing NHS Confederation chief executive, Rob Webster. The remit of these leaders vary greatly, with populations ranging from the hundreds of thousands to the millions.



How are NHS financial pressures affecting patient care?

The NHS is experiencing increasing financial pressure, but what does this mean for patients, asks Ruth Robertson, fellow in health and policy at The King’s Fund.

Writing in a blog, Robertson says this is a difficult question to answer with information on the impact on patients remaining scarce for a number of reasons.

“First, across the country patient care varies for many reasons beyond the size of the local NHS budget: decisions about the care available to individuals are influenced by national bodies, local commissioners and providers, and clinicians at the bedside. Second, when budgets are cut or (more likely) do not grow in line with patient demand, some providers go into deficit. By overspending, providers may be protecting patients from the worst effects of funding pressures, meaning data on financial performance does not tell us anything about the impact on patients. Third, there is extensive evidence of overtreatment in health services, so when referral rates go down or access to services changes, we should not always view this negatively.

“Finally, tightening budgets can motivate providers to improve productivity. There are many examples of innovations that both improve the quality of patient care and cut costs, delivering better value. Although the impact of financial pressures can be difficult to identify, it can and does affect patient care.

“To explore this further, over the next nine months we are researching the impact of the slowdown in NHS funding since 2010 on patient care by looking in detail at four services. We hope to get closer to answering the difficult (but crucial) question of what the financial pressures in the NHS mean for patients.”

A 15 Year Forward View can lead to transformation in the NHS

A Fifteen Year Forward View needs to be in place to move from crisis intervention to preventative models, writes Jessica Studdert on Health Service Journal (subscription required).

Studdert, the deputy director of New Local Government Network, says that short term political and operational pressures presently prevent a focus on transformation at the scale needed. She argues that a Fifteen Year Forward View would address that.

“This would bring together currently separate institutions that work in a fragmented way.

“The Five Year Forward View was an effective rallying cry for NHS sustainability to 2020, and continues to provide a frame through which policy is focussed. Now it is becoming increasingly urgent to lift the horizons of the system beyond the end of the decade, to a longer period over which payoffs for investment in prevention made now will be realised.

“A Fifteen Year Forward View would recognise that the NHS cannot be expected to solve the demographic and modern lifestyle-related health challenges it faces in isolation. The process would engage a wider range of stakeholders including local government, housing providers, employers and beyond to build a vision for a system that better supports health and wellbeing.

“This would bring together currently separate institutions that work in a fragmented way but can all contribute to supporting wider determinants of individual health outcomes.”

Integrated systems is first step on the long road to paperless NHS

George Thaw, managing director of Advanced Health & Care, discusses the Department of Health’s recent announcement about an upcoming review of how best to implement IT in healthcare to achieve a paper-free health and care system.

“Creating a paperless, digital NHS remains top of the Government agenda, with the Department of Health (DH) recently announcing a review of computer systems across the organisation. The review will look at different ways to implement IT in healthcare to achieve a paper-free health and care system by 2020.

“The notion of a paper-free NHS has been a hot topic for a while now, and is an area that the Government continues to invest in. Last month, the DH revealed how it intends to allocate the £4.2bn it has earmarked for creating an integrated, digital NHS. The biggest chunk of this spend, £1.8 bn, is committed to creating a paper-free NHS with health information systems working closer together.

“This vision is the ultimate goal, but to reach it the NHS will need to find innovative ways of delivering paperless working, but crucially without compromising quality of care or data security.

“Although many staff working in healthcare, and the DH, recognise the importance of digitisation, the road to achieving a paperless NHS remains a long and, more than likely, bumpy one. Replacing paper-based records and processes with integrated, intuitive systems designed specifically for healthcare providers should be the first step on this road.

“This is absolutely fundamental to improving communication and collaboration across the organisation and enabling mobilisation, which, in turn, will generate the efficiencies every department is under pressure to achieve.”


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