Healthcare Roundup – 7th April 2017

News in brief

NHS Scotland misses A&E waiting times target for seventh month: NHS Scotland has failed to meet its A&E waiting times target for the seventh month in a row, reported STV. The health service is tasked by the Scottish government with making sure no more than 5% of patients wait longer than four hours to be admitted, transferred or discharged from A&E departments. On average over the past 12 months, 5.9% of patients waited more than four hours. In February, NHS Scotland again failed to meet the 5% target, with 7.5% of patients waiting longer than the four-hour limit. A Scottish government spokesperson said: “It’s welcome that A&E performance has improved again this week thanks to the efforts of NHS staff, and that we have seen an improvement in the monthly times too. For at least 23 consecutive months, Scotland’s core A&Es have been the best performing in the UK, over 13 percentage points better than England on the latest comparable statistics – that’s the largest gap in the six and half years of data which has been available.” A spokesman for the Scottish Greens said: “Evidently there has been a small improvement, compared to last month, but once again waiting time targets have been missed. We need to see a greater effort in recruitment and retention of staff, not just in A&E but in our GP surgeries and in social care to minimise the need to visit and stay in hospital where possible.”

Naylor Review: £10bn needed now to fully finance STP reforms: A total of £10bn is required to properly fund England sustainability and transformation partnerships (STPs) and maintain health facilities in the future, an independent report written for the Department of Health has revealed. The report, drawn up by Sir Robert Naylor, former CEO of University College London Hospitals NHS Foundation Trust, warned that without actual new investment in the NHS estate, there is little chance that STPs will be delivered, as facilities would remain as unfit for purpose, reported National Health Executive. Sir Robert’s review follows NHS England’s long-awaited Five Year Forward View (FYFV) progress update last week, which revealed that STPs will be given a raft of new flexibilities in exchange for robust governance arrangements. The update also announced that accountable care systems would now be considered an ‘evolved’ version of an STP working as a locally integrated health system. However, this week’s report warned: “The general consensus is that the current NHS capital investment is insufficient to fund transformation and maintain the current estate. We estimate that STP capital requirements might total around £10bn, with a conservative estimate of backlog maintenance at £5bn and a similar sum likely to be required to deliver the FYFV. This could be funded through property disposals, private capital (for primary care) and from the Treasury. However, the NHS needs to develop a robust capital strategy to determine the final investment requirements through the STP plans.”

Sharp rise in A&Es turning away ambulances: Figures compiled by the Nuffield Trust have revealed overcrowded hospitals in England were forced to close their doors nearly 500 times to ambulances this winter, reported the BBC. The number of diverts was nearly double the level in the previous three winters and has prompted warnings about the pressures facing the health service. Hospitals said closures were a last resort but had to be done to maintain safety in A&E. However, paramedics warned it had the knock-on effect of slowing their ability to get to the sick and injured quickly. Ambulance crews have failed to hit any of their response time targets since May 2015, with latest figures showing that a third of the most critically ill patients wait longer than eight minutes for a 999 response. Richard Webber, from the Royal College of Paramedics, said that while he was “sympathetic” to the problems hospitals were facing, the diverts were a significant cause of delays in reaching “seriously ill and injured patients”. “There is a double whammy in that not only do crews have to drive further away once a divert is implemented – [but] once that’s happened, an ambulance crew will then also need to travel further to get back to their own area to respond to the next call,” he said. 

Alex Neil puts forward ‘health tax’ proposal to improve NHS: Scotland should introduce a new health tax to fund fresh spending in the NHS as it struggles to make the “significant improvements” needed in performance, former health secretary Alex Neil has said. The senior SNP figure also laid bare the massive waste in bureaucracy and drug spending in Scotland’s health service in a hard-hitting report published this week setting out the need for change, reported The Scotsman. Entitled “A Stimulus for a National Debate on the NHS”, published by the Options for Scotland think tank, the report includes a series of recommendations such as a crackdown on well-off consultants and GPs who retire in their mid-50s – then return as highly paid locums. It also contains recommendations to introduce a separate tax specifically targeted at the health service to bring the NHS in line with other “more advanced” European countries. “The whole British system is in stress and while efficiency savings are needed, they will not be enough, which is why I float the idea of a separate health tax, although deeply controversial but cannot be ignored,” he said. “We haven’t caught up with more advanced European partners and I think at a UK level we have to try and do that, otherwise we are going to face a crisis right across the UK. It’s already happened south of the Border and it will get a lot worse everywhere if we don’t put additional resources in.”

Biggest ever NHS tender launched as £6bn contract put on market: Manchester health leaders have kicked off the search for a single provider for all “out of hospital” health and care services across the city under a contract worth nearly £6bn – the largest ever NHS services tender, reported Health Service Journal (subscription required). A tender document, published by NHS Shared Business Services, sets out for the first time the contract value and other details of the ambitious plan to set up a “local care organisation (LCO)” to provide all non-acute services through a single 10 year contract to a population of around 600,000 across the city. The contract will be let by Manchester Health and Care Commissioning, a partnership between the city council and a newly formed single clinical commissioning group. The notice, which calls for expressions of interest by the end of April, said: “Commissioners seek responses from interested providers who wish to deliver… a local care organisation for the population of Manchester with the aim of bringing together a range of health, social care and public health services to be delivered in the community. The LCO is envisaged [to have] an emphasis upon: local population health and prevention of ill health; connecting to community assets and building upon people’s strengths and self-management skills; and targeted care to support people’s needs particularly as needs change and become more complex. The estimated total contract value for the 10 year contract term is £5.9bn.”

STPs to be told how to make integrated care savings: All 44 sustainability and transformation partnerships (STPs) will be sent a tailored report on how to integrate physical and mental health in their region and what savings the changes can make, reported Health Service Journal (subscription required). NHS England has commissioned Midlands and Lancashire Commissioning Support Unit (CSU) to provide a bespoke report to each STP by the end of April. Data packs will set out how each area can improve patient care through closer integration of physical and mental healthcare services, and will model any financial savings that can be made including reducing pressure on acute care. NHS England said the data packs and accompanying analysis will also support STPs and commissioners to develop investment cases for key priorities in the Five Year Forward View for Mental Health. The contract also commissions the CSU to provide analysis at clinical commissioning group level, which NHS England hopes will help implement STPs’ priorities. The packs will contain data on, for example, life expectancy of people using specialist mental health services and levels of acute hospital use for different cohorts of people using specialist mental health services and data on the scale of potential savings to be generated for acute care by achieving better levels of integration between mental and physical healthcare. The CSU will also produce a national report for NHS England.

New £2bn training supplier framework created for NHS: NHS Shared Business Services (SBS) is creating a new framework for suppliers of apprenticeship training with a potential market value of £2bn by 2021. The framework will be available free of charge to NHS providers to allow them to source suppliers easily, reported Health Service Journal (subscription required). As of the 6th April, trusts will be required to pay a new apprentice levy worth 0.5% of their pay bill as part of a government drive to fund more than 3 million apprentices nationally. The NHS is expected to raise £200m towards training new apprentices through the levy, with the government expecting the policy to raise £3bn overall. The framework tender process for suppliers is open now and the framework is expected to be up and running by May. It is open to any supplier that is approved by the Skills Funding Agency and named on the Register of Apprenticeship Training Providers. Suppliers will be awarded a place on the framework after being assessed against predetermined requirements, which means the NHS will be able to get a consistent standard of training. The framework will be in place until April 2021 and NHS SBS has estimated it is worth between £1bn and £2bn, as public sector organisations invest in more apprenticeship schemes. The Department of Health has set a target for the NHS to create 100,000 apprenticeships by 2020.

Government should make technology uptake an NHS “priority”, says House of Lords committee: The House of Lords Select Committee report on the long-term sustainability of the NHS has said the government should “make it clear” the adoption of technology is a ‘priority’ for the NHS, reported the British Journal of Healthcare Computing. The report emphasised the uptake of digital innovation is “slow” across the NHS, with some arguing during evidence sessions this is a result of “inadequate levels of funding” or “persistent cultures of complacency”. The committee also highlighted there is “disagreement” in regards to savings that could be generated through adoptions of technologies, suggesting that a viable option would be to design a system that would “appraise” digital innovations and decide what should then be implemented, although it is “unclear” who should be in charge of this. Data is considered another issue of “critical importance” as the “continued failure” to use information effectively has so far resulted in “unacceptable levels of variations in patient outcomes”. The committee stated the NHS should remain a “tax-funded” and “free-at-the-point-of-use”, asking the government to “initiate cross-party talks” to have a “national conversation” in regards to further development. It also mentioned that funding should increase at the same speed as the growth of the GDP for at least ten years starting from 2020, while “failure” to train staff accordingly is considered the “biggest internal threat” to the future of the NHS. The report also recommended that NHS England and NHS Improvement “merge” to form a new body that would have “simplified regulatory functions” and “strong local government representation”.

NHS Digital targets late September online identity launch: NHS Digital aims to begin offering a single secure identity assurance function by October. This will allow the public to access online health and care services with the existing GOV.UK Verify and GP-focused Patient Online service being considered among potential solutions, reported Government Computing. According to a recent board paper outlining ambitions for its Personalised Health and Care 2020 programmes strategy, NHS Digital intends to agree a solution for citizen identity that will go live for “selected” functions relating to health and care services by 30th September. Work is ongoing to assess the preferred method for implementing an identity assurance solution that can be used by the NHS and local authorities, yet no timeline has been provided by the organisation for when it will formally decide how to manage secure access to services. “We are exploring a number of strategic options for authentication and identity verification for digital health services, including consideration of existing services such as Patient Online and GOV.UK Verify,” said NHS Digital in a statement. “We are taking an incremental approach and we will be publishing updates as we progress through this work.” Online identity is among a number of key aims for the Personalised Health and Care 2020 programmes that also intends to tackle the need for tackling digital exclusion among patients, as well as launching the NHS.UK domain to the public, ensuring patient access to personal health records and delivering Wi-Fi to GP surgeries.

Dorset Care Record project signs £7.8m deal with Orion: People in Dorset are set to benefit from shared health and care records, after a £7.8m five-year framework contract was awarded to Orion Health. The Dorset Care Record (DCR) project is being led by Dorset County Council, working in partnership with local NHS organisations and borough councils. Each will contribute to the overall cost of the project, which is estimated at £20m over 10 years. The new DCR will bring together information from hospitals, GPs, community teams and local councils, enabling summary details of a person’s medical or care history to be accessed in one place. Benefits should include improved coordination of care and communication between different health and care agencies, improving treatments and reducing delays. Patients will be able to access and contribute to their records online. Eventually, the DCR will bring together a range of patient and client information including: health problems and diagnoses; prescribed drugs; blood tests; pathology and x-ray results; next of kin, carer and care provider; hospital discharge letters; and care plans agreed between people and professionals. The platform for the development of the DCR will be supplied by Orion Health. Implementation will begin in autumn 2017. Andy Hadley, head of IT development at NHS Dorset Clinical Commissioning Group, told DigitalHealth.net: “We are aiming to be live by September for first data, including access to GP records in A&E, then social care and then ambulance, and within 18-months and we should have a pretty rich record.”

NHS trust using predictive technology to improve patient care: An NHS trust is to use video calling, wearable devices and predictive technology to improve how it cares for patients, reported Health IT Central. In a joint initiative between Microsoft and IT healthcare firms System C and Graphnet, University Hospitals Bristol NHS Foundation Trust will use three Microsoft solutions. Analytics from HealthVault Insights will be used to bring together patient data from a range of sources, including wearables, so medical professionals can spot trends in people’s health. Azure machine learning will use that data from wearables to help patients and System C and Graphnet’s myCareCentric Epilespsy app will look at sleep patterns, exercise, heart rate and temperature and aim to “learn” when epilepsy patients are about to have a seizure. Skype for Business will give clinicians the option to hold meetings and calls with each other and patients in a secure environment. Calls can also be recorded and added to clinical records. “The ability to apply machine learning innovation in healthcare is key to alleviating some of the pressures on health and social care services worldwide,” said Heather Jordan Cartwright, group program manager, artificial intelligence and research at Microsoft.

ICO launches new resources to help prevent data breaches: The Information Commissioner’s Office (ICO) has responded to concerning health data audits with a new set of specific tools for staff in NHS and other health organisations, reported DigitalHealth.net. The newly created resources include posters, tool-kits, training videos, infographics and a webinar. The ICO found that there were more than 200 self-reported incidents of data being posted or faxed to the incorrect recipient in the last financial year in the health sector. During the same period, there were more than 200 self-reported breaches of paperwork lost or stolen. ICO’s good practice group manager, Leanne Doherty, said in a statement that “unfortunately our audits showed a worrying trend of health organisations failing to properly manage the records they held. The people we speak to want to get this right”. The ICO’s audits also found that 33% of health organisations had no information asset register or nominated information asset owners, and 22% of health bodies had issues with logging, tracking, movement or security of paper records. Doherty added the resources are meant to offer health professionals “practical support and give them the tools to improve people’s approach to records management in their organisations”.

Sir Bruce Keogh to leave NHS England: Professor Sir Bruce Keogh has announced he will be stepping down as NHS England’s national medical director at the end of 2017, reported Health Service Journal (subscription required). He will take up his new role of chair of Birmingham Women’s and Children’s Foundation Trust once his term at NHS England ends. Sir Bruce Keogh has been NHS England’s national medical director since the body was formed in 2013 and for five years prior to 2013, he was medical director of the NHS in England. Sir Bruce authored NHS England’s urgent and emergency care review in 2013, which set out plans to reclassify the NHS’s 185 emergency departments in a major shakeup of services designed to concentrate specialist services in larger units. It said it envisaged between 40 and 70 A&Es would become “major emergency centres” and the rest would become “emergency centres”. But to date, the flurry of A&E reclassifications has not materialised. NHS England will be responsible for finding his successor.

Opinions

LDRs: a critical part of STPs and sharing cross-border learning
Dr Masood Nazir, national clinical lead – digital transformation of general practice at NHS England and information lead & senior information risk owner at NHS Birmingham CrossCity CCG, discusses the opportunities for sustainability and transformation plans (STPs) to adopt shared approaches across regions, in National Health Executive.

“Following the Five Year Forward View, local health and care systems were asked to set out, through Local Digital Roadmaps (LDRs), how they would achieve the ambition of ‘paper-free at the point of care’ by 2020.  In total, 73 LDR footprints were submitted in June 2016, but in the autumn, this was reduced to 65 as some combined to align more closely with the 44 STPs. 

“LDRs preceded STPs. The challenge has been trying to align them. The key reason for them is that you weren’t going to achieve the paperless agenda unless you collaborated in a group. One of the key things STPs have to do is deliver efficiencies and a key thing to efficiency is making some of the processes paperless.  

“It is all good and well me saying I want a paperless practice, when everyone around me is still using paper. There is a lot more investment needed to make hospitals paperless and paper light, at least, but we need to bring everybody on the journey together. If we don’t recognise what the challenges in primary care are, then what will happen is we will make paper light hospitals with primary care still sending paper into hospitals. That is why we need to have them working together. 

“Investment, although challenged, will come into STPs. So, it’s really important that organisations work together and really look at what the local health economy needs and make the best use of that investment.”

People power in health technology
Anne Cooper, deputy clinical director and chief nurse at NHS Digital, discusses the importance of clinical involvement in health digitisation in National Health Executive in an article that also reveals NHS Digital plans for a new digital transformation team that will offer health and care organisations practical advice on using existing products and getting the most out of technology.

“True digitisation of the NHS will not be delivered through technology alone,” she says. “We have great developers and designers who can deliver big tech, but what we need is to win hearts and minds. We will do this by co-producing solutions which act as an enabler to great care.

“We need to put things in place that make the lives of patients better, improve their experience of care, make the work of the NHS smoother, more efficient and improve outcomes. Our systems need to be intuitive, fast and really add value if we are going to encourage usage and deliver real benefit.

“To make a real difference, digital tools need to be part of a wider business and cultural change.

“Change can be difficult, so we are developing new ways of working that support organisations to be able to make the right technology choices for themselves, but with access to excellent help and support to guide them through that process and to embed new ways of working so that patients and staff get access to the best technology solutions that are on offer.”

Brexit business has become real – the NHS must keep watch
With Article 50 now triggered and Brexit negotiations to begin in fervour, the head of the NHS European Office, Elisabetta Zanon, considers what lies ahead for the NHS and social care over the next two years and beyond.

“After nine months of gestation, the Article 50 Brexit notification has finally seen the light of the day.

“It is important to make clear that during the next two years the UK will remain a full member of the EU and all the rights and obligations linked to our membership continue to apply. This does not mean, however, that nothing will change for the NHS for two years. On the contrary, some issues have already started to emerge from an NHS perspective. 

“The appetite to engage UK organisations in collaborative EU-funded health projects has already declined, with our EU counterparts preferring to build partnerships with colleagues in other EU countries for new EU projects, due to the uncertainty that emerged in the aftermath of the referendum. 

“Furthermore, currency fluctuations have resulted in price increases for NHS purchasers of drugs and other supplies from across the EU, at a time when the NHS is facing unprecedented budget pressure.

“More important still, nurses and other health and social care workers across EU countries now see the UK as a less attractive country to migrate to. The weaker exchange rate and the UK government’s aim to reduce future net migration from the EU to the tens of thousands have discouraged some overseas health professionals from applying for jobs in the UK. 

“As negotiations progress and a new relationship with the EU is forged, other important issues for the NHS will materialise. This will include the relocation of the European Medicines Agency (EMA) from London and the UK leaving the EMA centralised system for the approval of new medicines.  

“With these important issues in mind, as the Brexit negotiations now begin in fervour, our office will follow the discussion from our privileged position in Brussels, with close proximity to the decision-makers involved. We’ll be providing helpful, factual analysis to support the NHS during this time of uncertainty and helping to prepare for the changes ahead.”

Highland Marketing news 

This week we welcome experienced healthcare journalist Lyn Whitfield to the Highland Marketing team as strategy and content director.

Highland Marketing blog

Next Steps – what it means for the NHS and its IT 
NHS England has published an update on the “Five Year Forward View”, outlining what it describes as “a series of practical and realistic steps for the NHS.” In this Q&A, Lyn Whitfield, Highland Marketing’s new content and strategy director, explains why the “Next Steps” document matters, and what it has to say about healthcare IT.

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