Healthcare Roundup – 11th July 2014

News in brief

NHS waiting lists highest for six years: The number of patients waiting for NHS treatment has risen above 3m, the highest total for six years, according to figures released this week. The announcement that a further 75,000 joined the queue for treatment in May comes after an analysis of data by the Nuffield Trust suggested the health service could be facing a funding crisis before the general election as demand for hospital care outstrips resources, reported The Financial Times (subscription required). In a statement responding to the figures, the health department appeared to pave the way for more bad news on the NHS in the coming months. It pointed out that in May 2014, the most recent month for which figures were available, the target that 90% of people should be referred for treatment within 18 weeks had been met. However, it acknowledged that the waiting list had reached almost 3.1m, despite five trusts not submitting data. The department said: “We know we are going to have a tough few months as hospitals get through the backlog, and the standard [for admissions] may be failed in the next few months. But we have put plans in place and announced additional support to help hospitals cope and we are confident the NHS will get back on track quickly.” However, Andy Burnham, shadow health secretary, said David Cameron had said that the length of NHS waiting lists would be the test of his running of the NHS. The news that the waiting figures had reached a six-year high highlighted “the growing gap between his spin at the despatch box and the painful reality for patients”, he said. Burnham said people were “being forced to choose between suffering in silence or paying to go private – the age-old Tory choice in the NHS. People who can see the NHS going backwards will today be justified in wondering why David Cameron threw the NHS into the chaos of a reorganisation when nobody voted for it.”

Frail need joint health and care budget, says NHS boss: Vulnerable patients should be offered their own personal health and care budgets, the NHS England boss says. Simon Stevens wants to see the frail elderly, people with disabilities and those with serious mental health problems given joint pots from the NHS and council-run social care services, reported the BBC. The hope is that five million people will be offered them by 2018. The plans represent an extension of a policy – known as personal budgets – that has started to be rolled out. The idea is to give patients a nominal budget – probably at least £1,000 – which they can then decide to spend on whatever care and services they want, as part of a drive to give patients more power. GP and emergency care is not included, and they can use these the same as anyone else. These budgets have been used in social care for a number of years – nearly 650,000 people have them currently. However, they have just started to be used in the NHS, with less than 2,500 patients thought to be getting them. In a speech to the Local Government Association’s annual conference in Bournemouth, Stevens said: “Patients, service users and carers have the biggest interest in getting things right, but they can only do so if we give them real power to shape their own care. We need to stop treating people as a collection of health problems or treatments. We need to treat them as individuals whose needs and preferences should be seen in the round and whose choices shape services, not the other way round.”

Future of NHS funding needs national debate, say health professionals: A host of health experts have penned a letter to the Times urging a national debate on the future of NHS funding in England, reports Commissioning GP. While celebrating the rise in life expectancy, the letter warned that the next 50 years will see a growth of at least two-and-a-half times the number of people suffering from multiple problems. If nothing is done, an additional £30bn of funding will be required to maintain current service provision by 2020. The status quo is not an option and there are already signs that the system is “creaking at the seams”, according to the letter. Furthermore, if health productivity continues to grow at a meagre 1% per year, the Office for Budget Responsibility calculates that public debt will skyrocket to 211% of GDP by 2062-63. The letter calls for a cross-party approach to lead a “national conversation” on the scope, and funding of health and social care. Addressing the prospective funding squeeze for the NHS, head of public policy at the Institute of Economic Affairs Ryan Bourne, wrote in City AM: “We could move to co-payments, whereby NHS funding is reduced from full cost absorption to 95%. Subject to an income-related annual cap, this would see patients pay the remaining 5% of the cost of every medical service they receive. Full-cost reimbursement could remain for the very poor and for preventative care. But for everything else, co-payments would encourage patients to ask whether the treatment recommended represents value for money, whether they could see a nurse in a walk-in clinic rather than a doctor, or whether the drug they are prescribed is more cost effective than a generic one.”

Monday deadline for tech fund two bids: NHS trusts in England are at varying stages of readiness for the £240m second round of NHS England’s technology fund, with the deadline for applications closing next week. Applications for Tech Fund two, officially re-named the Integrated Digital Care Fund, close on July 14. Trusts were given exactly two months to get their bids in for the fund, after the first round of the tech fund was criticised for running against very tight deadlines. Unlike the previous round, trusts can only submit one bid, though they can also submit a joint bid with social care or local authority organisations. Several trusts told eHealth Insider they will not be placing bids for the second round, instead putting their energy into the implementation of successful first round bids or planning for the second round of the nursing technology fund.

Government toughens up Better Care Fund scrutiny: The government is creating a cross-department scrutiny team to supervise the Better Care Fund, NHS England (NHSE) has revealed. Early assessment of plans for using the Better Care Fund suggested that they “lacked rigour and granularity” and could place clinical commissioning groups at “significant financial risk”, NHSE confirmed. NHSE´s 2014-15 commissioning round update – released among board papers – said it had initiated a tougher series of checks to mitigate the risks of planned savings not being realised through the £3.8 bn Better Care Fund initiatives, reported The Commissioning Review. The update, by Dame Barbara Hakin, national director of commissioning operations at NHSE, said the cross-government team that is being created will report to a Ministerial Programme Board. A dedicated senior programme director will be appointed and a joint team across the Department for Communities and local government, the Department of Health and NHS England will also be created to oversee use of the fund. Arrangements for the performance element of the fund are also being strengthened to ensure that the costs of any activity which results from planned reductions not being realised can be covered, she said. “Because the Better Care Fund is not new money, much of it will have to be reinvested from existing NHS services. The Fund will support the development of social care and community health services, which prevent unnecessary emergency admissions to hospital, reduce admissions to care homes, support discharge from hospital, and allow people to live more independently in the community. NHS commissioners will bear a significant financial risk if the local changes are not successful in reducing demand for hospital care,” she said.

Scotland aims for £10m telehealth fund: The Scottish health secretary has announced its ambition to seed a £10m telehealth fund to benefit 300,000 households over the next three years. eHealth Insider has reported that the national health and social care innovation fund, which was launched by the Scottish health secretary Alex Neil at NHS Scotland’s annual conference, will be used to develop “original and pioneering” treatments for patients. The fund will start with an initial £100,000, just 1% of the £10m target. It is hoped that this will act as a catalyst to help secure further funds from other sources. The new fund will be specifically targeted at supporting projects that turn innovative ideas into services, and will not be used for mainstream services or research already being funded. Speaking on the launch of the fund, Neil said: “This dedicated fund is about giving those innovators the support they need to turn their excellent ideas into world-leading health services for the people of Scotland. Scotland is already leading the way on harvesting the innovations in our NHS. We have also made significant progress on developing and expanding new technologies fit for our twenty-first century healthcare service.” The Golden Jubilee National Hospital in Glasgow will work on behalf of the Scottish NHS to raise money from a number of further sources for the fund. Jill Young, chief executive at the hospital described Golden Jubilee as Scotland’s “flagship hospital” it is dedicated to leading research and innovation for the country. “We are very excited about the possibilities and potential that the future holds as we move onto our next chapter as a national resource for the NHS in Scotland,” she said. NHS Scotland said the fund is part of a wider programme to improve efficiency and quality in the NHS.

Alzheimer’s research in ‘major step’ towards blood test: British scientists have made a “major step forward” in developing a blood test to predict the onset of Alzheimer’s disease, BBC Health News has revealed. Research in more than 1,000 people has identified a set of proteins in the blood that can predict the start of the dementia with 87% accuracy. The findings, published in the journal Alzheimer’s & Dementia, will be used to improve trials for new dementia drugs. Experts warned that the test was not yet ready for doctors’ surgeries. Research into treatments for Alzheimer’s disease has been plagued by failure. Between 2002 and 2012, 99.6% of trials aimed at preventing or reversing the disease flopped. Doctors believe the failure is down to treating patients when it is already too late, since symptoms appear around a decade after the start of the disease. Identifying patients earlier is one of the priorities for dementia research. Dr Eric Karran, director of research at Alzheimer’s Research UK, described the study as a “technical tour de force”. However, he warned the current accuracy levels risked telling healthy people they were on course to develop Alzheimer’s, which may lead to anxiety and depression. It is unlikely that the test would be used in isolation if it eventually makes its way into clinics. A positive result could be backed up by brain scans or testing spinal fluid for signs of Alzheimer’s.

CCGs could co-commission specialised services: Clinical commissioning groups (CCGs) could be handed a role in commissioning a significant chunk of the £14bn specialised services budget, Health Service Journal (HSJ, subscription required) has learned. The move is being considered by a working group established by NHS England’s specialised commissioning task force. NHS England currently commissions the services. While discussions are at an early stage, HSJ understands that NHS England could ditch sole responsibility for up to half of the 143 services it commissions either through co-commissioning or the wholesale transfer of responsibilities. The commissioning of services such as renal dialysis and chemotherapy – collectively worth £1.7bn – could be transferred to CCGs. Steve Kell, co-chair of NHS Clinical Commissioners leadership group, has been involved in the discussions with NHS England. He told HSJ that CCGs would commission or co-commission specialised services where it made sense for patients, but only if they were given the means to do so. “We need the resources to shift with the responsibility. What would be wrong was if CCGs are handed the bits that are too hard,” he said.

GPs to be charged for sending text messages through email in ‘short-sighted’ DH move: Practices are set to be charged for sending text messages to patients’ phones reminding them of appointments and notifying them of test results under proposals that IT experts have warned will affect hard-to-reach patients. NHS England and the Department of Health have developed a business case for the development of the NHSmail 2 system to replace the current NHSmail, which they say will enhance the existing system, improve security and allow providers to customise their email addresses among other benefits, according to Pulse. However, the business case also highlights that central funding for the widely used email-to-SMS text messaging function will be halted in March 2015, despite many practices relying on this to contact patients effectively. GP leaders said that the current system is essential for promoting inclusion and outreach with hard to reach populations – which the government has promoted as a major aim – and that cutting it would be ‘short sighted’. A letter from the Health and Social Care Information Centre informed NHS trusts in June that practices will have to fund their own alternatives to the NHS SMS service if they wish to continue it beyond March 2015. The same letter explained that NHS England will be leading the investigation on the service’s future in primary care and would notify GPs in the immediate future.

NHS ‘falling short on complaints handling’: The NHS still has a long way to go to improve the way it handles complaints, although there are signs of improvement, a survey suggests. The NHS has been heavily criticised over its complaints system in the wake of the Stafford Hospital scandal, reported the BBC. The poll of 4,000 people in the UK by Populus for consumer group Which, found just a quarter were happy with the way their complaint had been handled. However, this was a rise from 16% two years ago. The survey showed more than half felt their complaint had been ignored – more than in other parts of the public sector – and 43% were “dissatisfied” with the outcome. But four in 10 who have had a problem reported not even complaining – although this was again a slight improvement on the picture two years ago. Improving complaints handling was one of the central themes of the public inquiry into the poor care at Stafford Hospital. A government-commissioned inquiry into complaints last year – led by Labour MP Ann Clwyd – said too many patients found the current approach unresponsive and confusing. In response, hospitals were ordered to publish regular updates on complaints and make it clearer to patients what they had to do when they were unhappy with their care. While these measures applied to England only, ministers in Scotland and Wales are also making improvements.

London trust seeks £289m transformation: Central London Community Healthcare NHS Trust has gone out to tender for a strategic partner to manage its transformation project in a contract worth up to £289m of which £21m will go on its IT strategy. The trust has told eHealth Insider (EHI) that it wants a partner to work on its five-year transformation project in order to simplify, streamline and automate internal processes. The strategic partner may be required to manage the trust’s capital investment of £21.38m on IT and the contract is worth between £85m and £289m over five years. Ian Millar, director of finance and corporate resources at the trust, told EHI that the programme will enable the trust to become more responsive and competitive “by developing new models of care, through making greater use of technology and by reducing our operating costs.” Some traditional ways of delivering care have now become outdated and inefficient, creating the risk of a poorer patient experience and wasted resources,” he said. The core requirements set out in the tender includes IM&T delivery management; infrastructure; software development, user application support and development, business systems training; service desk; and application and data processing services. The trust told EHI that the trust has a number of “relatively small scale outsourced contracts” at the moment, but that this piece of work represents a “new and exciting future for the organisation”.

Allscripts buys PAS specialist Oasis: US clinical software supplier Allscripts has purchased patient administration systems (PAS) supplier Oasis Medical Solutions, according to eHealth Insider. The acquisition of the UK company means that Allscripts will be able to offer integrated PAS and clinicals and significantly grow its client base in both mid-tier NHS hospital trusts and private health providers. The company says the acquisition will enable it to provide a single-source offering for an “advanced and innovative” EPR. The terms of the acquisition were not disclosed. Allscripts recently opened its European headquarters in Manchester as it aims to win more UK clients, building on successful wins and implementations at Liverpool Heart and Chest and Salford Royal NHS Foundation Trust. Richard Berner, president at Allscripts international said that the UK is an “important growth market” for the company. “A strong clinical offering combined with a highly regarded PAS provides a complete and proven solution to meet the critical longs-term needs of the NHS trusts,” he said. “By acquiring Oasis, we believe we have optimised our position in the market and expect to drive significant value from this combination for our clients.”

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Eight and half years ago Jane Eccles had an emergency c-section and gave birth to a son, George. Whilst in hospital she fell ill contracting Necrotising Fasciitis (NF), more commonly known as the flesh-eating superbug. She was given two hours to live as once NF gets ahold there can be no stopping it. Jane was in Intensive Care and had numerous surgeries in a short space of time. Surviving against all odds, Jane was told that she would most probably never be able to walk again, let alone return to her role as a teacher. In the same defiant form that helped her survive, Jane spent the next few months in a wheelchair focusing on learning to walk.

Incredibly Jane and her husband Graeme are now on the road cycling over 1000 miles in 14 days, with no backup support, raising money for the Lee Spark NF Foundation. The foundation helps medical professionals become more aware of the NF disease, symptoms and treatments. It’s a huge challenge for Jane, especially as she could not even lift her leg over a crossbar two years ago.

To find out more about the charity cycle visit Jane’s website. To sponsor Jane visit her Virgin Money Giving page. Many thanks for your support!

Opinion

Open innovation: big opportunities and a few challenges

Open innovation has big opportunities and a few challenges, says David Rhodes, head of business development for Public Health England.

Open innovation has become one of the most popular business “buzzword” terms of the 21st century. The terminology and the academic focus may be new, but the approach has probably been applied since Neanderthals first got together to work out how to stop water seeping into their cave.

“What has changed in recent years, however, is that commercial entities and public bodies such as Public Health England have really woken up to the opportunities that open innovation presents. The old days of the traditional corporate R&D laboratory or the government research establishment working in isolation are well and truly over. Scientists, software developers and managers working in such institutions are much more likely to be involved in international networks, hosting visitors and secondees from around the world, and running pilot projects with key customers than they are to be tinkering with their secret inventions late at night in lonely laboratories.

“Open innovation can encompass a broad range of approaches and techniques, including opportunities to improve open-source software, challenge-led innovation competitions, crowdsourcing, involvement of customers in design development and product pilots, and idea portals where inventive individuals can approach companies in a user-friendly way.

“For an organisation like Public Health England, open innovation offers exciting opportunities to develop better solutions to public health problems, faster, and at lower cost to the taxpayer, and offers new routes to have our own innovations widely adopted.

“Of course open innovation is not without its challenges. Intellectual property rights have to be respected: innovations can be of great value and it is important that inventors and development partners are fairly rewarded. Innovations involving multiple participants can be complex to manage and can be expensive in terms of legal costs, for example.”

Better Care Fund, better read the small print?

Richard Humphries, the assistant director at The King’s Fund, blogs about the Better Care Fund, sharing resources across the NHS and the consequences of the re-think.

“It is surprising that anyone was surprised that many of the local plans submitted on 4th April didn’t pass muster. What began as a well-intentioned agreement between the Department of Health, NHS England and the Local Government Association is fast becoming a Faustian pact – the devil truly will be in the detail of the revised guidance that we haven’t yet had sight of.

“The key change is that £1 bn of next year’s fund will be allocated through a local ‘performance pot’ for each health and wellbeing board – and the money each board receives will depend on its performance in reducing hospital admissions. The remaining money will be used to commission NHS services. This will offer some small cheer to hard-pressed acute trusts – it means the NHS will avoid paying twice for emergency admissions (once through the fund, and again for the admission that wasn’t avoided). But the price of this very modest amelioration for the NHS is a substantial shift of risk back to local authorities that can’t be sure they will receive the grant for services that have to be funded up-front.

“As Simon Stevens, Chief Executive of NHS England, pointed out recently, merging two leaky buckets does not create a watertight solution. What is needed is a genuine health and social care transformation fund with new money to meet the double-running and transition costs of changing how and where care is provided. […] The consequences of not acting are serious – sticking plaster solutions will not deal with the significant challenges facing social care, nor will they address the growing funding pressures facing the NHS.”

Power to the people on the sharing economy

Paul Hodgkin, founder and chair of Patient Opinion, explains how the economies of sharing, especially through communication, could have significant financial benefits for the health and social care industry.

In eHealth Insider he writes: “Clearly, much health care is high tech or governed by stringent safety and governance issues. So let’s set aside any idea that the sharing economy could somehow do hernia repairs or run neonatal units.

“But carers and patients already share an enormous amount. They support each other through patient organisations and via generic platforms like HealthUnlocked. They give their thoughts and suggestions freely via Patient Opinion and donate their time as research subjects on sites like PatientsLikeMe.

“Most importantly of all those informal carers provide services worth £119 bn for free each year – rather more than the cost of all the professionally-led health services that we spend so much time talking about.

“Could the web provide tools that increase the size of the informal caring economy or make it more efficient? Well it looks like it. For example there are several start-ups that make it easier to link informal carers together.

Howz (as in Howz Pete?) is a spin off from work done by NHS Trafford Primary Care Lunch and enables those who visit Pete – and Pete himself – to share the fact that a visit has taken place and to pass on messages about what happened.

“This includes professionals – GPs and district nurses are able to upload their notes to Pete’s Emis or SystmOne record if they wish.”

Highland Marketing blog

In this week’s blog, Myriam McLoughlin welcomes the recent news around the debate for NHS funding and looks at recent initiatives that have already proven that prevention is better than cure.

Stabilising the NHS – it’s going to take a lot more than AI
Get it right, but get it done
Guest interview: Dr Jane Brightman
Getting it right – Positioning
Getting it right – The “Full-Stack” Marketer