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Can healthcare events save the day?
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News in brief

RCP warns of patient safety risk with NHS ‘slash-and-burn savings tactics’: A new programme of strict financial controls on NHS providers could put patient safety at risk, Alex Callaghan, the deputy head of strategy and policy at the Royal College of Physicians (RCP), has said. National Health Executive reported that the measures, announced by NHS England and NHS Improvement last month, include new financial and performance targets for trusts and CCGs, with penalties for failing to meet them. It comes at a time of unprecedented financial pressure for the NHS, with a recent Health Select Committee report warning that it is not on track to address its £22bn deficit by 2020. Callaghan said in her blog post: “Special measures regimes raise an additional risk to doctor staffing levels, by deepening damage to morale and by increasing difficulties in recruitment and retention within organisations that are frequently already struggling to ensure adequate numbers of doctors.” She said that trusts are already struggling to fill gaps in rotas because of the shortage of NHS staff and that the new financial measures could make this worse. Callaghan added that the serious care failings at the now-dissolved Mid Staffordshire trust were “a warning of the consequences of cost-cutting taking precedence over safe patient care”. She said that RCP is concerned that the financial measures are short-term “slash-and-burn savings tactics”. She warned that similar measures in the past have left the NHS needing “years of reinvestment” to restore staffing and services at the level required to address patient need. Callaghan noted that a whole-system approach to health, including promoting health and wellbeing in order to reduce the demand on services, is the only way to balance NHS finances.

Jeremy Hunt asks pay review body to examine salaried GP model: Health secretary Jeremy Hunt has asked the doctors and dentists pay review body (DDRB) to consider the salaried GP model in its next report, reported GPOnline. Hunt reportedly asked the DDRB for its observations on the factors affecting “recruitment, retention and motivation” of salaried GPs. “The review body’s last report noted that there has been an expansion of the salaried model in general practice and that understanding this trend would be important,” Hunt said in a letter. He also reportedly said that “pay restraint in the public sector” would continue to be a part of government plans. Hunt was said to have told the DDRB that the Department of Health would provide it with better measures to assess recruitment and retention issues and to consider whether there was a case for targeting pay awards.

Keogh: GPs “undervalued by the NHS at a time we need them the most”: GPs have been “undervalued” by the NHS at the time when they are most needed, NHS England’s national medical director has said, reported Pulse. In a lengthy statement in NHS England’s board meeting, Sir Bruce Keogh painted a picture of how GP funding and income has declined while responsibilities have increased and are continuing to pile on further. At the same meeting, NHS England chief executive Simon Stevens admitted primary care professionals have suffered financially as a “direct effect” of secondary care providers running deficits. Referencing the GP Forward View, Sir Bruce said that “by focusing on general practice and primary care we bring benefits to our patients” and that this was the “end game in all of this”. “The reality is that the best way of looking after our patients in the community, is by looking after our GPs and our primary care. And that is true both for our current patients and for our future patients,” said Sir Bruce. In his statement, he acknowledged a number of points including GPs dealing with an increase in demand from both patients and policy makers while tackling rising levels of bureaucracy and staff shortages. Sir Bruce said: “As patients have been moved out of hospital to be treated in the community, we have seen a commensurate requirement for the professionalism of GPs who have increasingly become the general physicians, the consultant community physicians of the day. That is a very important change in my view. Yet at the same time, I think there is evidence that our GPs have been undervalued by the NHS at the time when we need them most and when we are asking for them to do more.”

NHS issues plan for two-year payment tariff: National NHS bodies have proposed creating a two-year payment tariff in the health service in a bid to increase certainty across the sector following the announcement of a financial reset, reported Public Finance. Publishing the first stage of a consultation on the national payment tariff, NHS England and NHS Improvement said that this was in response to feedback from across the sector calling for greater certainty and stability from the NHS payment system. A two-year tariff for 2017/18 and 2018/19 would match the planning round announced by the national NHS bodies, which is intended to cut the 2015-16 NHS deficit of £2.45bn to £250m in 2016-17 and to begin 2017-18 in “run rate” balance. In a statement, a spokesman for NHS Improvement and NHS England, said: “Moving to a multi-year tariff will give providers and commissioners critical financial information earlier than ever before. This greater certainty will help providers and commissioners make robust investment decisions, and support their joint plans on how best they can deliver services to patients. A two-year tariff is a first for the NHS, and we believe answers the call for greater stability from the payment system. We see this change as a continuation of work on strengthening the payment system, so that it does more for patients, and promotes better financial management amongst NHS organisations.” NHS Confederation chief executive Stephen Dalton said he was pleased that the case for a multi-year tariff had been recognised. If implemented well, it could contribute to stabilising planning during a difficult period for the NHS, he added.

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Selling into the NHS; it’s not about luck, it’s about having the right approach

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NHS England offers trusts funds to set up global digital excellence centres: A total of 26 of the most digitally advanced trusts have been invited by NHS England to apply for more than £100m of funding and drive forward better use of technology in health, reported HealthITCentral. In a bid to win up to £10m each to invest in digital infrastructure and specialist training, the 26 acute trusts will need to show their potential to become world leaders in health informatics. From there, between 10 to 16 trusts will be selected to become centres of global digital excellence. Once established, the centres will lead the way for the entire system to move more quickly in getting better IT on the ground, delivering benefits for patients and sharing learning with other local organisations through networking. The successful centres will be announced at the NHS Health and Care Innovation Expo event in September where “digital doctor” Professor Bob Wachter will outline recommendations to enhance use of technology in the NHS following a review of how IT is working across the health service. Professor Keith McNeil, chief clinical information officer at NHS England, said: “It is evident the benefits of investing in and optimising use of digital technology to improve efficiency and enhance care is more widely understood but we are not yet realising these benefits at scale or sufficiently quickly. We need to move faster in getting clinicians real-time access to accurate information and joining up healthcare systems to improve outcomes for patients and reduce workload for doctors, nurses and other NHS staff.” To be selected, trusts need to show they will deliver comprehensive use of electronic patient records information sharing across the local health and care system and robust data security.

NHS England extends deadline for innovation and technology tariff: NHS England has extended the deadline for a new tariff designed to make it easier to fund innovative healthcare technology by two weeks, reported National Health Executive. The innovation and technology tariff, first announced by NHS England CEO Simon Stevens at the NHS Confederation conference in June, allows NHS England to “bulk buy” innovations nationally instead of locally and guarantee automatic reimbursement when an approved innovation is used. Developers now have until 16 August to apply for the scheme, which will be judged and administered by the NHS Innovation Accelerator Programme. Matthew Swindells, national director for operations and information, said: “The NHS has a proud track record in medical innovation but has sometimes stumbled on getting ground-breaking and practical new technologies into the hands of NHS patients, nurses and doctors as quickly as possible. The new national funding route will help cut the hassle experienced by clinicians and innovators in getting uptake and spread across the NHS. At a time when the NHS is under pressure, we want to make it as easy as possible to fast track innovations that enhance patient outcomes and improve efficiency in NHS care.” Examples of innovative technologies which could be routinely commissioned under the reforms include AliveCor, a mobile heart monitor that detects heart arrhythmias, MyCOPD, an app to self-manage Chronic Obstructive Pulmonary Disorder.

Campaigners fear plans still live: Parts of the controversial programme could live on but with fewer options for patients to opt-out, MedConfidential has warned, reported Last month the government “closed” the national data collection and sharing programme. The decision was made public on the same day the National Data Guardian, Dame Fiona Caldicott’s report on data security, consent and opt-outs was released. But Phil Booth, co-founder of privacy campaign group MedConfidential, said many recommendations in the report would see the programme continue in another guise; with the extraction of a new GP dataset set to go ahead. Furthermore, the report recommended that patients should no longer be given the ability to object to their GP records being shared with the Health and Social Care Information Centre (now NHS Digital). This would mean an end to what is currently known as a “type 1” objection, Booth said. In announcing the closure of last month, then life sciences minister George Freeman said: “The government and the health and care system remain absolutely committed to realising the benefits of sharing information, as an essential part of improving outcomes for patients.”

Southend University Hospital FT rated requires improvement over staffing concerns: Southend University Hospitals NHS Foundation Trust has received a ‘requires improvement’ rating from the Care Quality Commission (CQC) after the regulator found the hospital lacked safe staffing levels and was cancelling operations, reported the National Health Executive. A CQC inspection in January this year found that the trust lacked sufficient and appropriate staffing levels in some areas, particularly end of life and palliative care. There was also a high level of cancelled operations, sometimes without clinical input, and there was a back log of patients waiting for follow up appointments in ophthalmology and respiratory services. Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said: “Staffing numbers were not adequate to meet patients’ needs. The identified shortfalls compromised patient safety. However, the trust responded promptly when we identified the concern.” Professor Richards said that the high number of cancelled operations was due to congestion within the hospital. The hospital had taken the decision to open escalation beds, which increased bed capacity but put more pressure on services. New NHS England statistics, show that rates of bed occupancy and cancelled operations have increased in the past year. The NHS as a whole is also facing a 5.9% clinical staffing shortage. Overall, Southend was rated ‘requires improvement’ for being safe, responsive and well-led and ‘good’ for being effective and caring. The leadership in urgent and emergency services, however, received an ‘outstanding’ rating.

Practices given tens of millions of pounds to support them in federating: Clinical Commissioning Groups (CCGs) around England have already spent tens of millions on helping practices form larger organisations, a Pulse investigation has revealed. Across the 92 CCGs that responded to a Pulse media enquiry, almost £15m has been spent on helping GP practices to federate to work in networks or clusters. The news came after NHS England said in April’s General Practice Forward View that it will ask CCGs to provide £17m of “practice transformational support… to stimulate development of at-scale providers”. If Pulse’s figures are extrapolated across England’s 209 CCGs, this could mean commissioners have already spent some £30m or more in total. According to the publication, not all CCGs felt comfortable with direct funding of member practices’ federation efforts, expressing concerns over conflicts of interest. A spokesperson for NHS Aylesbury Vale CCG, which has not provided direct funding, said: “As a CCG we would be uncomfortable with taking a lead in the facilitation and direction of a federation and also with the ideas of financial support. We would be guilty of funding and shaping a provider to whom we then contracted.”

British company to implement electronic medical records for Qatar: TPP Middle East, the subsidiary of UK based technology software company, The Phoenix Partnership Leeds Ltd (TPP), has signed a major collaboration agreement with Integrated Intelligence Services (IIS) to deliver SystmOne to the private healthcare sector across Qatar, reported the Department of Health. The project is valued at £21m over five years. TPP’s integrated electronic medical record system will be implemented in approximately 300 primary care sites across Qatar. It supports Qatar’s vision to establish a more advanced healthcare system. By allowing medical records to be shared across the country, patients’ data will be standardised and collected routinely. TPP’s integrated patient record will be a cornerstone of IIS’s strategy to work with partners to create a network of high quality healthcare services. The two companies will start to work with clinics in the private sector over the next few months, with the first clinics due to be using SystmOne by the end of the year. Deborah Kobewka, managing director of Healthcare UK said: “I’d like to congratulate TPP and IIS Holdings on signing this significant contract for an electronic record in some 300 of Qatar’s private primary care centres. It is an excellent example of healthcare collaboration, facilitated by the Department for International Trade team in Qatar who have supported TPP over several years to achieve this great outcome for both parties and for the people of Qatar on their healthcare transformation journey.”

GPs to make “nearly all” prescriptions electronically under NHS plans: The NHS is pushing for GPs to make “nearly all” prescriptions electronically as part of a drive to expand use of the Electronic Prescription Service (EPS), which will also look at electronically prescribing controlled drugs, reported Pulse. A pilot set to launch across 16 GP practices will test whether prescriptions can be electronically signed and sent by GPs using the EPS, without a patient having to first “nominate” a pharmacist to collect it from. The EPS is live in more than 80% of surgeries and about 43% of prescriptions since June have been made through the service. The new model would just require a barcoded paper “token” – matched to the GP’s electronic prescription – which the patient will use for collecting medications, in a move intended to “streamline” the process. A bulletin for GPs by the newly rebranded NHS Digital added: “Separately, EPS will also be testing a way of allowing controlled drugs to be prescribed and dispensed using the system.” This could launch in 2017. The new features could be used by GPs and consultants to quickly discuss referrals or other clinical issues with parties able to mark when they’re available at their desk or busy.

New innovative partnership to improve care in Hammersmith and Fulham: Four NHS organisations across south-west London have set up a joint initiative to develop a vastly improved way of providing care for almost 200,000 people living in Hammersmith and Fulham, reported Health IT Central. The Hammersmith and Fulham Integrated Care Programme has three key goals to improve care through the borough. Working in partnership with patients and local residents, they want to design a practical accountable care approach, which will entail collectively looking after the holistic care needs of local people. The programme also wants to identify improvements to join up care, working on that through two pilot schemes. One of these will focus on patients who frequently use A&E and the other to boost child health. Finally, building strong foundations for forming or becoming part of a formal accountable care partnership is vital moving forward. Dominic Conlin, director of strategy at Chelsea and Westminster Hospital NHS Foundation Trust, said: “To meet changing needs, we have to make the shift from care being reactive and crisis-driven to being proactive and health-focused. It’s also essential that, regardless of provider, patients feel their care is joined-up, consistent and tailored to their individual needs.”

First patient facing app to get GP system approval: The first patient facing app is expected to get approval to integrate with a GP primary system this week, after years of development, reported PAERs is one of three patient facing subsidiary suppliers, along with iPlato and Wiggly Amp, that has been going through the long process of pairing with primary systems. Brian Fisher, co-director of PAERs, said the company’s iPatient product (a patient facing record system, that allows patients to view their health records and test results, book appointments, use secure messaging, and request repeat prescriptions) was being piloted in five GP practices using the EMIS Health primary system and he expects to get approval for full roll-out across every EMIS GP site in the country imminently. “It has taken an unbelievably long time but we think what we have to offer is going to change how we do health care,” he said. Matt Murphy, EMIS Health managing director of primary and community care, said the road to approval for PAERs and other patient facings subsidiary supplier seeking approval had been “really difficult” and raised questions about whether a central approval process was the best approach. The ‘pairing process’ between primary and subsidiary systems was developed by the Health and Social Care Information Centre (now NHS Digital) to manage the integrations. A NHS Digital spokeswoman said last week that iPatient was still in the pilot phase with EMIS with “full rollout approval still to be granted”.

NHS providers must now make information accessible for disabled people: Information at all organisations providing health and social care must be made accessible to disabled people under the new Accessible Information Standard, reported National Health Executive. Under the Accessible Information Standard, which the NHS has been developing for two years, NHS organisations, including trusts and GP practices, must ask patients if they have information or communication needs and find out how to meet them. They must then clearly record those needs, ‘flag’ them on the patient’s file, and share them with other providers, with the patient’s permission. Anu Singh, director of patient and public participation at NHS England, said: “Good quality, accessible health and care information is essential, particularly for patients with the greatest needs. We must strive for equality across the health service and this new framework will help patients with disabilities receive improved standards of care and be more involved in how that care is delivered.” The support needed could include giving information in large print or Braille for patients with visual disabilities or providing a British Sign Language interpreter for patients with hearing problems. The NHS also recently announced that it is introducing a Quality Checkers Programme so that patients with learning disabilities can assess services to see how they address their needs. Paul Breckell, chief executive of the charity Action on Hearing Loss, which helped develop the standard, said: “We hope that health and social care professionals will see that far from being a box-ticking exercise, this is a real opportunity to provide better care and better outcomes for patients who have previously faced barriers when accessing health and social care.”

Top digital job for Kelsey in Australia: Former NHS England digital head Tim Kelsey has been appointed to the top digital health job in Australia, reported Australian minister for health, Sussan Ley, announced that Kelsey has been appointed chief executive at the Australian Digital Health Agency. The role will once again put Kelsey in charge of a nation’s digital health service and system “with a focus on engagement, innovation and clinical quality and safety”. Ley said Kelsey was regarded internationally as “a leader in digital health, in both the private and public sectors, and has a proven track record in delivery of digital health services”. Kelsey is best known in the UK as NHS England’s national director for patients and information, which gave him a wide remit over Health IT strategy and commissioning. He was also chairman of the National Health Board. During his tenure at NHS England he oversaw most of the biggest, and sometimes most controversial, health IT projects in recent years. In 2013, he oversaw a big overhaul of the NHS Choices website, introducing more information for patients, particularly about the performance of hospitals and individual medical teams. Kelsey will start at the Australian agency not long after the launch of a nationwide My Health Record, which provides an online health summary that patients can view and share with clinicians. He will start in his new role later this month.

Patients could receive health checks at local post offices: Post offices in Ireland are working with a number of multinational companies and third-level institutions to develop technology for eHealth services which could be rolled-out in local branches, reported the Irish Examiner. The strategy is part of a number of initiatives being looked at to help the country’s 1,100 post offices, many of which are struggling to survive. Under the scheme those living in isolated areas could avoid long journeys to hospital for check-ups and could also access GP and nursing services in their nearest post office. The remote health service and eHealth system would allow GPs and consultants to examine the patient remotely through a digital video conferencing system which would be developed. Irish Postmasters Union general secretary Ned O’Hara said: “You could have a virtual examination. I know when people are sick they have to go to their consultant and the consultant may look at them for a few minutes and are told to come back in a month. They may have to come from the top of Donegal or they may have to come from Longford and get a taxi 40 or 50 miles away or they may have to get a bus. They are down there all day in the hospital, all for five minutes in front of a consultant. Some of that, not all of it, but some of it, could be done remotely and technology could be used for that”. A number of major companies that have bases in Ireland as well as research institutes have come forward to lend their expertise and support to develop the system under a “shared value initiative.” Post offices would be paid some commission for facilitating the remote health system.



Pressure intensifies on squeezed NHS
There have been yet more reminders this week about the intense pressures on the NHS, the BBC’s health editor Hugh Pym writes this week.

In a news analysis piece, covering demand for new drugs, treatments, the burden of chronic disease and the financial squeeze, Pym says: “All this adds up to a financial squeeze on the NHS in England and there have been new warnings about the impact of that in the next few years.

“The debate over the HIV prevention drug PrEP focused partly on how to meet rising patient expectations with a constrained budget.”

He continues to describe the implications of a new report from NHS England, that “laid bare” the financial consequences of diabetes. And in other financial considerations he comments:

“Author Sally Gainsbury returns to the thorny issue of the £22bn of annual efficiency savings that have to be made in England by 2020. She argues that even if hospitals and other trusts manage efficiency improvements of 2% per year there will still be a £6bn gap in 2020.

“Further scepticism about the £22bn of efficiency savings has emerged with a survey of health professionals who have signed up to attend the UK Health Show in September.

“Of the 400 who responded, 85% said they were not confident the savings could be delivered in full. Only 10% were confident that the £5bn of hospital cost savings identified by the government adviser Lord Carter could be achieved.”

What can the UK learn from New York’s approach to mental health?
The UK should take notice of New York’s prevention and recovery focussed mental health programme, writes Paul Burstow on the Guardian.

In an article on the publication’s healthcare network, Burstow, a former UK health minister, explains how impressed he is at New York mayor Bill de Blasio’s new programme, entitled Thrive.

“Over the next four years, the mayor has committed $853m (£650m) to deliver the roadmap. Some of its objectives include training 250,000 people in mental health first aid; screening and treating all pregnant mothers with depression; setting up a 400-strong mental health corps to work in primary care and substance misuse; recruiting 100 mental health consultants (social workers and psychologists) to work in schools; and scaling up community-based parent coaching and social and emotional education. There are 54 initiatives in total and many have a strong emphasis on data collection and evaluation.

“So what can the UK learn from New York’s approach? Last summer one in four people responding to a consultation by NHS England said that prevention of mental illness should be a priority. Prevention does feature in the NHS England Mental Health Taskforce’s February report. However, the focus is more on improving access and choice of treatments. The treatment gap in mental health in the UK and globally is admittedly huge, but the taskforce recommendations would not close this gap even if implemented in full. So what should we do?

“Like New York, we have to pursue a twin approach: upscaling and improving access to treatment while helping to prevent mental illness in the population. Both are necessary; one is not sufficient without the other.”

Burstow also emphasises the need to look beyond mental health services for the answers.

“Collaboration and common purpose were evident in New York. The mayor is looking beyond mental illness services for solutions that foster resilience and support recovery. So should we.”

Can technology save the NHS?
Bob Hudson, professor in the Centre for Public Policy and Health, University of Durham, explains how bottom-up technology initiatives, backed by a robust strategy, can help tackle many of the challenges facing our health service and can offer huge rewards.

“The NHS is buckling: the scale of the funding challenge is colossal, the service is under unprecedented strain and it is struggling to keep pace with relentlessly rising demand. Can technology be a big part of the solution to this situation?

“What about initiatives that utilise the vast array of digital health products now available? From low-level gadgets through to traditional telecare/telehealth and on to emerging digital technology. All of these make possible the maintenance of independence at home for longer, keeping people out of hospital for longer, discharging them from hospital more quickly, and all at less cost.

“This is precisely the aim of the ‘Test Bed’ programmes in seven localities announced earlier this year by NHS England CEO, Simon Stevens. There is good reason to think that building up successful interventions in this way can be highly successful. Reviews and studies suggest that technology-enabled services can indeed improve the quality of life of older people and their carers, reduce social isolation, increase perceived health status and security, and allow carers to balance care and work.

“Currently there are tensions of many kinds – between innovation and tradition, between enthusiasm and digital Luddism, and between policy aspiration and achievement. What can be done to address this? A robust strategy will have three strands: Structure: a stronger central push, Knowledge: a stronger evidence push, Culture: a stronger behavioural push.

“There is the need to face up to the enormity of the digital revolution. The rapid growth of Information and Communication Technologies and innovation in digital systems represent a revolution that has fundamentally changed the way people think, behave, communicate, work and earn their livelihood. There is every reason to think this will apply just as much to the way health and care is delivered in the future, yet it tends to be perceived as an optional bolt-on to ‘normal business’. The challenge is complex and messy; the rewards potentially huge.”

Our problem is your problem – social care and the NHS
Paul Carey-Kent, health and integration policy manager at CIPFA, the Chartered Institute of Public Finance and Accountancy, reflects on the increasing melt-down in the social care sector and what it means for the NHS.

“The pressures the (social care) sector are under also represent a significant threat to the just-as-cash-strapped NHS. Health and social care are intertwined, as the government’s encouragement of their integration recognises, and a good proportion of the impact of problems in social care services will fall on health. So, if social care looks close to breaking point, what will this mean for the NHS?

“Approximately 40% of hospital ‘bed blockers’ are now staying longer than they need to because their social care needs aren’t being met. This is compared to 25% in 2010. This can mean using a bed costing the NHS £2,000-£3,000 a week for the want of social care more likely to cost £500 per week. Delayed transfers for older people alone costs £820m a year, according to the National Audit Office. 

“With the NHS under pressure to save £22bn by 2020, it is unclear how things will improve. Health and social care need to be working together to reform the whole system, yet their budgetary positions appear designed to encourage them to retreat into desperate measures to protect their own bottom lines. This is at the expense of the collaborative investment and transformation that is desperately needed for the longer term.  

“Can the new prime minister solve the problem? CIPFA has proposed in its More Medicine Needed report that the whole health and social care system needs to be funded on a more secure and less politically exposed basis. Theresa May should call for a commission to assess the appropriate proportion of GDP to be spent on health and social care and to recommend the measures likely to be needed to make that a reality. Only radical fiscal action will save the sector from melt-down and so far this sort of approach is not looking likely.”

Mark-DaviesGuest blog

Dame Fiona Caldicott’s report is a powerful call for the introduction of more democracy in our clinical records, writes Dr Mark Davies, medical director at MedeAnalytics, in this week’s Highland Marketing guest blog.

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The arrival of the novel coronavirus has been shocking and is impacting on all sorts of unexpected areas, including the use of technology in the NHS. Health tech vendors are naturally scrambling to respond. But…

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