The healthmatters blog; commentary, observation and review
The national disability charity Sense has repeated its call for urgent government investment into social care. The action follows today’s report from the National Audit Office (NAO), which revealed that the ‘Better Care Fund’, designed to incentivise the integration of health and social care and deliver better outcomes or patients and service users, has failed to meet its first year targets 2015/16.
The NAO report shows that demand for health and social care services has grown faster than resources can manage. There was an increase of 87,000 emergency hospital admissions (2014/15 – 2015/16) and an increase in delayed transfers of care of 185,000 over the same timeframe, despite plans in the Better Care Fund to reduce them.
The report also highlights that NHS England has failed to properly assess how pressure in social care can impact the NHS.
Richard Kramer, Deputy Chief Executive at Sense, said:
“Since 2012, spending on the NHS has increased 11%, while expenditure on social care by councils has decreased 10%. Cutting social care means that more demand is placed on the NHS, and it is patients, and older and disabled people that suffer.
The situation unfortunately looks set to get worse, with our social care system chronically underfunded, the deficit predicted to grow to at least £2 billion by 2020, unless action is taken.
The consequences of doing nothing are clear; without long-term integrated planning and significant new funding into social care; more and more people will be left without the essential services that they need to live independently and in their communities.”
Social prescribing is missing an opportunity to help people with long-term health conditions into meaningful work, Work Foundation report finds. The new report from the Work Foundation – part of Lancaster University – promotes this in supporting clients with long-term health conditions back into meaningful work, arguing that the services need to play a far greater part in achieving this goal.
Social Prescribing: A Pathway to Work? found that employability and work-related outcomes need to become a core aim of social prescribing services, with greater recognition required for the important role that work plays as a social determinant of health and wellbeing.
Social prescribing is a means of enabling healthcare professionals to refer patients to a non-clinical service, who will work with them to co-design “non-healthcare interventions” to improve their health and wellbeing. There is growing evidence that social prescribing, where patients are linked into a variety of community activities, improves self-confidence, self-efficacy, and reduces social isolation. As this report shows, this can also support people onto the pathway back to work.
The report includes a survey of members of the Social Prescribing Network, ascertaining their views on how well employment is currently being championed within this context. The majority (70 per cent) of respondents agreed that employability and work-related outcomes should be included in the specifications of social prescribing services. Overall, respondents believed there was real potential for social prescribing to better help clients achieve work. However, the majority also felt that work was not currently optimised within the system as employment was seen as low priority goal for social prescribing services, and limited formal recognition or support available to achieve it.
Authors also looked in detail at four social prescribing organisations, showing how they are supporting people to find and prosper in work, and how they can be supported to do more.
Karen Steadman, Research and Policy Manager at the Work Foundation, said: “Social prescribing services should more directly recognise getting clients who want to work, back to work, as a key aim – whether this is in the short or long-term. More emphasis must be placedon the role of meaningful work in sustainably reducing social isolation, improving self-confidence, and self-esteem, and improving health and wellbeing.
“However, we must show caution before tying such an approach too closely to the welfare system: in order to help those who most need it, we must listen to what they want, and support them on their pathways.”
New data – announced in February by Nuance Communications – has revealed that nearly half of NHS Trusts (43%) are investing in artificial intelligence ( AI ) enabling patients to ‘self-help’ when accessing services. The Trusts are harnessing technology such as virtual assistants, speech recognition technology and chat-bots to ease the pressure on healthcare workers across their organisations.
This new insight – obtained from a Freedom of Information (FoI) request issued to 45 NHS Trusts, with 30 responding – also found that the vast majority of NHS workers are still reliant in some way on pen and paper to build patient records, with 93 per cent admitting staff still hand writing reports in their Trusts and also 93 per cent of Trusts (28) depend on traditional word processing tools for staff to type up electronic patient records (EPRs).
Research commissioned by Nuance in 2015 into the impact of clinical documentation in NHS acute care trusts revealed that clinicians spent over 50% of their work day on clinical documentation. In a more recent Nuance study of UK GP Practices over 90% reported that patient documentation was a considerable burden for their practice and that in 49% of the practices over half their patient documentation is paper versus electronic format or the use of AI.
However, by deploying technology – such as speech recognition and AI – clinicians are enabled to process clinical documents quickly and accurately, without the need to outsource transcriptions or hire additional secretarial support. Technology has proven to free up vital resources to focus on patient care and reduce the burden of administration for clinicians.
Alongside investing in technology to improve efficiencies inside the hospital, allowing staff to work flexibly can also play a key role in driving up productivity. Encouragingly, the FoI request also found that nearly half (47%) of trusts now allow staff to use mobile devices to develop patient records, saving those working in the community valuable travel time and expense.
60 per cent of the eighteen responding trusts also stated that at least some staff have access to the use of speech recognition technologies to build diagnostic reports and update patient records.
Commenting on these latest findings, Frederik Brabant, MD, Chief Medical Information Officer at Nuance, said:
“Deploying technology such as AI to enable patients to self-help is an important step forward to providing the best possible care – ensuring employees can manage the more complex ailments directly with patients, while giving easy access to information for everyone.
“With staff across the NHS already under enormous pressure to deliver first-class services – typically exacerbated in the winter with disease-levels peaking – access to supporting technology to ease this pressure will be key.
“Yet many clinicians are still forced to spend half of their time documenting patient care. While it is encouraging that some departments within Trusts are using tools like speech recognition, with nearly all of them still reliant on pen and paper in some form, there is a significant opportunity to drive up this usage across the board.
Our goal is to bridge the gap between clinicians and technology, freeing them to focus on their patients”.
As the NHS battles to cope with a target to switch to electronic patient records by 2020 it may be time to ask whether the deadline itself is unhealthy. In a world where the amount of data is exploding and demand for the health service is soaring it’s easy to see why the government has been so anxious to modernise the way we keep records. After all, few people – whether patients or clinicians – truly believe paper-based systems are the best choice to survive and flourish in a digital age.
In reality, however, hospitals continue to rely on the old ways despite successive government campaigns to modernise their systems. Large technology programmes such as the NHS National Programme for IT (NPfIT) and “Care.data” have certainly not inspired confidence, with both being cancelled despite a lot of effort and money spent on them.
Now the government wants the electronic patient records that once targeted for 2007 in place within four years. Can it happen? Well, anecdotal evidence suggests a lot people in the NHS take the attitude ‘we’ll believe it when we see it’.
The first hurdle is simply getting the buy-in of key users. Many consultants and GPs remain unconvinced – patient records may be two inches thick but it is still possible to thumb through them and find what you want. An electronic record, with 200 images, is a bigger challenge.
In an ideal world, people would instantly choose the more modern and efficient electronic patient record option. In the real world of resource limitations and legacy patient records – not to mention ingrained working practices – a simple switch over is not going to happen.
So, the diagnosis is clear, the symptoms are obvious – but we really need a different course of treatment. A sensible diet of good habits and localised but coordinated change including local stakeholders is more likely to succeed than major surgery. There is no single big bang technology fix available – certainly not one that is affordable – and back-file scanning of old paperwork is unlikely to be cost effective. In that light, recognising that legacy systems and processes will be around for longer than most people would like is the key.
Joining the paper and digital worlds together is not impossible – in fact it is absolutely essential to ease the transition to fully digital patient care. Eventually doctors can be augmented by intelligent systems which will bring a whole new set of processes and cultural challenges to healthcare worldwide – not just in the NHS. But before we get there we need to rework the NHS and all the types of information it currently uses.
Will we be paperless by 2020? It’s highly unlikely. So it’s time to live in the real world and make paper and digital work seamlessly together. Here are ten top tips on the long road to a paperless NHS:
- The first priority should be to examine the options of “digital first”. Is it possible to combine paper and digital in the short term to future-proof data in healthcare but without making a painful impact on service?
- Consider implications of the forthcoming EU General Data Protection Regulation. This regulation provides extra rights for European citizens to ask to see their data and to ask for it to be edited. So one of the biggest hurdles we face is how to make data shareable and searchable.
- Utilise new systems to link consultants’ diaries to accessible patient records.
- Convert as many physical records into digital records as possible but beware of assuming that scanning all records is the answer. This is an expensive option and, as it does not often undergo OCR/ICR (text recognition), a scan is not always searchable. Without careful indexing and metadata being added (often a costly exercise) this provides significant problems.
- Consider storing records offsite, releasing space back for core activity. Outsource the management of onsite records to an expert.
- Analyse where digital can be most easily and effectively utilised to cope with modern demands and improve the standard of healthcare.
- When a patient appointment is made it can kick off a process to recall the necessary paperwork. Rather than being delivered on paper this could be scanned and made available at the necessary time. Over time only the most recent electronic records would be needed but for now a hybrid approach in some areas should not be discounted.
- Utilise systems to link physical and digital records.
- Think about future technology and how it might affect record keeping in years to come. Health-tracking apps and web resources offer huge potential to the health of the population. As do smart buildings and wearables with sensors built into our living environment. New systems need to be able to cope with these innovations.
- Put systems in place to prevent data breaches.
Trusts probably won’t admit they lose records, but they do. Not in the sense that they are left on the streets or on the Tube – most are lost somewhere inside a hospital. Many NHS employees don’t see this as ‘lost’ or a as a data breach – but patients and the regulators may think differently.
John Culkin, Director of Information Management, Crown Records Management
Breast cancer patients and prostate cancer patients talk very differently about their cancer online and receive significantly different levels of online support, according to social listening research* commissioned by Teva Pharmaceuticals Europe and published ahead of World Cancer Day on Saturday, 4th February. Based on this research, Teva has launched an online cancer portal called My Day (MyDay.eu.com) that aims to help cancer patients and their caregivers learn about their condition, connect with their online support community, and have productive discussions with their physicians. The website, named ‘My Day’ to reflect the unique journey each cancer patient experiences, is guided by an independent, medical advisory board to ensure the portal provides content of value to cancer patients and their physicians.
- Research identified over 20,000 online cancer conversations over the past 3 years
- Analysis shows prostate cancer patients focus on ‘technical details’ while breast cancer patients make greater use of ‘emotional’ language – pointing to differences in progression, diagnosis and treatment of these two cancers
- Research also reveals women with breast cancer receive significantly less online support than men with prostate cancer
- Teva launches ‘My Day’ online cancer portal to support patients in their online cancer conversations
These differences between breast and prostate cancer conversations may partly be attributed to differences in the progression, diagnosis and treatments of these two types of cancer. Prostate cancer is typically treated with a watch-and-wait approach, delaying time to prostatectomy to preserve quality of life for as long as possible without risking the cancer metastasizing to other parts of the body.
Furthermore, prostate cancer patients often have access to a urologist as well as an oncologist to further ‘crowd-source’ their knowledge and ideas about the best treatment path forward. Based on the social listening research, prostate cancer patients appeared to trust themselves to collate this ‘crowd-sourced’ information from their peers and medical specialists and to partner with their physician to make the right treatment decision. Also, unlike with other types of cancer, prostate cancer patients have relatively concrete assessment tools – such as Gleason scores and the Prostate-Specific Antigen (PSA) test – that help men recognise the points at which it’s time to make a treatment decision. These concrete tools also provide prostate cancer patients with common ‘data points’ they can refer to in sharing their stories online with fellow patients.
However, for breast cancer patients, the complexity of tumour types and the lack of relatively simple assessment tools may make it more difficult for women to share ‘technical details’ of their cancer online. Women with breast cancer often reported they were not told by their healthcare professionals the path forward and that they were surprised by secondary treatments prescribed without forewarning. The breast cancer discussions indicated physicians frequently recommended unilateral mastectomies followed by hormone treatment or chemotherapy. Breast cancer patients did also go online to crowd-source potential treatment decisions when a physician did not seem clear enough or said something that sounded ‘off’, and expressed a desire to use that information to partner with their physicians. If breast cancer patients gave voice to fears or anger within their online community, they warned peers that they’re going to speak in negative terms. By contrast, they frequently reminded peers to ‘stay positive’.
Patients and their caregivers are playing a more direct role in managing their health, with social listening conversations and discussions happening more and more online. Connecting with fellow patients and caregivers in virtual online communities can be a source of comfort – but it can also impact discussions with physicians, when online peers advocate unfounded treatments. Understanding the types of cancer conversations happening online is key to helping healthcare professionals have productive, face-to-face conversations with their patients.”
The European cancer portal MyDay was launched in late 2016 with local language versions of the portal being launched in individual European countries during the course of 2017.
A positive and established practice used to treat those with mild to moderate dementia called Cognitive Stimulation Therapy (CST) is being spearheaded by Dr Aimee Spector, a Clinical Psychologist and senior academic at University College London, who joins SweetTree Home Care Services as a senior consultant from April.
Cognitive Stimulation Therapy has so far achieved positive outcomes for those with mild to moderate dementia. The results of Dr Spector’s findings were presented at a prestigious meeting of general practitioners in London on 17th January 2017. The event, sponsored by SweetTree and The Priory Group, took place at the Royal College of General Practitioners and was organised by The Independent Doctors Federation. Those who attended heard Dr Aimee Spector, founder of CST who is based at University College London, explain the practice surrounding the therapy. Dr Spector also spoke about the recent evidence and research surrounding the therapy and how to access this service.
The therapy has already been recommended by the National Institute for Health and Care Excellence (NICE) as the only effective non-drug treatment for cognition in dementia. CST provides mental stimulation to enhance cognitive skills within a seven-week group programme. Tasks include categorisation, word tasks, discussion of current affairs and multi-sensory stimulation. The therapy is flexible enough to suit a variety of capabilities and interests. Participants are encouraged to speak and open questions are asked so that conversations are based on opinions, rather than on factual information they may be unable to retain.
Following clinical trials, objective tests have shown significant improvements in cognitive functioning and self-reported quality of life following CST. SweetTree has already piloted a seven-week programme to existing clients living with dementia with very positive results and is launching the CST service in full in summer 2017. CST is normally conducted in a group setting, but SweetTree will also be offering ICST to its clients – Individual Cognitive Stimulation Therapy – a one-to-one individual service.
‘We’ve spent a great deal of time and effort testing the principles and methods of Cognitive Stimulation Therapy and I’m delighted to be working with SweetTree to offer the service to those with mild to moderate dementia. We are confident that this positive and established therapy will prove beneficial, helping people engage, making them feel valued and improving their confidence and self-esteem, all of which will help them maintain a better quality of life,’ says Dr Aimee Spector.
“The social care shortfall is edging ever closer to a full blown crisis” – commentary from Nick Sanderson, CEO, Audley Retirement Villages
Nick Sanderson, CEO, Audley Retirement Villages said:
“The social care shortfall is edging ever closer to a full blown crisis and we now find ourselves in a situation where underfunding is at such a critical point, the quality of care itself is falling. It is right that we discuss the issues and focus on solutions that look at prevention as well as cure. Clearly people prefer to be at home as they age, rather than in a nursing or care home, no matter what their age or care needs. But despite David Mowat MP’s laudable aims, it is unrealistic to expect families, many of whom live far from their parents, to take on full support for aging relatives.
“There may be no ‘final answer’ on how we deal with the rising costs, but we do know that high quality housing options with flexible care available is a model that works. If there were more options which allowed older people to continue to live in their own homes, but bring in support where needed, it would go a long way to improving quality of life and delaying hospital visits in the first place.Making those decisions and moving early enough has the dual purpose of reassuring families, and taking pressure off the state system. In the long-run, meeting the increasing demand for this kind of housing this will undoubtedly reduce costly intervention.”
Nearly half of UK workers “are too busy to exercise” – It’s time for employers to step in and make a difference
Survey reveals that 46% of UK workers can’t fit exercise into their daily schedules.
This is a particularly big problem for those aged between 25 and 34, with 52% claiming they do not have the time.
The results are reflective of a wider problem of inactivity and sedentary living in the UK.
Only 5% of Britons said their employer organises physical activity during working hours.
Businesses can be doing more to encourage employees to get active – new guide explains how.
A new survey from office furniture providers DBI Furniture Solutions has revealed that 46% of the working UK public say they do not have enough time for daily exercise.
The survey aimed to find out when and how people are scheduling in their quota of exercise each day, and the results showed that almost half of us are too busy to workout.
It’s a particularly big issue for women, with 48% claiming that they struggle to fit exercise into their busy schedules, compared with 43% of men.
Also, it appears that young professionals are the least likely to factor exercise into their routines, with 52% stating that there simply aren’t enough hours in the day.
Those who do workout are most likely to hit the gym, participate in a sport or go for a run after work (26%), whereas 17% get their quota of exercise in at the very start of the day.
Interestingly, a mere 6% said they use their lunch break in order to get active, while 5% told us that their employer regularly organises “team energisers” during the working day so that everybody has an opportunity to squeeze in a workout.
The Department of Health recommends that adults partake in at least 150 minutes of moderate-intensity aerobic activity each week, but many of us are falling woefully short of this.
The total cost of inactivity in England amounts to £8.2 billion a year, so it’s vital that changes are made.
Latest statistics published by the Chartered Institute of Personnel & Development (CIPD) showed that the average level of worker absence stands at 6.3 days a year per employee in the UK – costing companies a median £522 for each member of staff on an annual basis.
It’s imperative that more businesses take a proactive approach to ensuring their staff stay active. It’s worth their while in the long run, as fit, healthy staff are far less likely to take time off sick.
Nick Pollitt, Managing Director, at the company commented on the results of the survey:
“It’s worrying, but perhaps unsurprising, that such a high percentage of the British working public struggle to fit exercise into their day. Maintaining a healthy social life alongside work commitments is difficult enough, and by the end of the day rigorous exercise is the last thing on our minds.
“On the other hand, it’s clear that businesses could be doing more to promote exercise in the workplace. When it comes to encouraging exercise, it’s the little changes that make a difference. From bringing fitness experts into the office for quick sessions, to installing a fresh water cooler, you can easily encourage healthier life choices for your team.
“It will ultimately save businesses money in the long term.”
Charity Welcomes National Study that Could Show How to Protect Everyone from MenB Meningitis and Septicaemia
- Meningococcal B infection has for decades been the largest cause of life-threatening meningitisin the UK
- Teenagers carry the infection more than any other age group
- Introducing the MenB vaccine for babies was a major step forward, but only about one quarter of all cases occur in the under ones
- Government has now called for researchers to carry out a new study it is funding to find out whether vaccinating teenagers against MenB could prevent spread of the infection to others, thus potentially protecting the whole population
The Department of Health (DH) has announced a call for researchers to conduct a national study to evaluate the effect of the MenB vaccine in preventing adolescents from carrying the meningococcal B bacteria.
The public health minister committed to funding this study in April 2016 following a major public petition and campaign. Although the commitment was made, the £1.3 million fund for the teenage evaluation has only now been announced and a confirmed mechanism set out so that the study can take place.
In the UK, teenagers are more likely to carry the meningococcal bacteria in the back of their nose and throat than any other age group and they can spread it to others.
Meningococcal B infection has for decades been the single largest cause of life-threatening meningitis in the UK.
Introducing the MenB vaccine for babies in 2015 was a major step forward and evidence shows that it is doing an excellent job of reducing MenB cases in the under-ones. However, only about one quarter of all cases occur in the under ones, leaving older age groups unprotected from this deadly disease. Vaccinating babies will have no impact on MenB infection in older age groups because babies do not carry the bacteria.
The new government funded national study will evaluate whether vaccinating teenagers against MenB could prevent them carrying and spreading the infection to others, thus potentially protecting the whole population.
The lessons learned from this research will show whether an adolescent MenB vaccination should be introduced into the national immunisation programme.
A study at the University of Bristol, funded by MRF, is almost completed, investigating new sampling techniques and providing key evidence to enable effective design of the government’s large-scale study.
Vinny Smith, Chief Executive of MRF said, “Meningitis and septicaemia are deadly diseases that can kill or disable people in just a few hours. We’re delighted that this study has been given the go ahead. Our research and campaigning contributed to the adoption of the MenB vaccine in the UK for babies and the government commitment to backing this study. We hope that the findings from this study will mean that the wider population can also finally be protected from MenB.
“Another commitment made by ministers in April 2016 was to publish a report on the methodology for assessing vaccine cost-effectiveness. At the moment, vaccines that prevent rare but severe illness in children are at a disadvantage. A draft report was produced in May, but MRF is still waiting for the public consultation on the findings from this report to help create fair rules.”
New partnership helps fulfill goal of a cooperative approach to cancer advocacy and prevention
The Union for International Cancer Control (UICC) today welcomed the Movember Foundation as a Visionary Partner of World Cancer Day, a global movement that unites the world to reduce the global cancer burden under the one banner.
This partnership displays a working example of fulfilling the goals set out by World Cancer Day to ‘develop unprecedented global networks and alliances’ and a new cooperative approach to cancer advocacy and prevention. It also further demonstrates the Movember Foundation’s commitment to supporting the fight against cancer.
“We are very proud to announce the Movember Foundation as a Visionary Partner of World Cancer Day,” said Cary Adams, UICC’s Chief Executive Officer. “This new partnership represents an exciting opportunity to bring World Cancer Day to an even wider audience, to ensure the Day achieves maximum impact in the fight against cancer. With our core objective of getting as many people as possible to see, read and hear about World Cancer Day, we recognise the power of the Mo community to amplify the Day’s theme of ‘We can. I can.’
This new alliance recognises the potential to use the collective power of UICC and Movember’s global communities to bring the world’s focus to the Day. Concretely, with World Cancer Day, on 4 February, falling on a weekend in 2017 and 2018, the partnership aims to harness the power of sport, with the support of Movember’s deeply embedded alignment with sport across the world.
“World Cancer Day and the Movember Foundation are both truly global movements, and it makes perfect sense for us to extend our fight against cancer to include this brilliant campaign,” said Owen Sharp, Movember’s Chief Executive Officer. “Movember is excited and honoured to be named a Visionary Partner of World Cancer Day, and we’re looking forward to engaging with our community of Mo Bros and Sistas on February 4th to raise critical global awareness”.
Together, UICC and the Movember Foundation hope to deliver a campaign that puts the fight against all forms of cancer, firmly in the sights of the general public and key policy makers.