The healthmatters blog; commentary, observation and review
International leaders in patient experience measurement and data capture for healthcare improvement, umotif and the Picker Institute, have partnered to create an innovative new healthcare product. The digital platform supports patients to better manage their own care – used effectively it has the potential for reducing hospital readmissions rates and improving emergency services in the process.
The light-touch tool, has been designed for patients to use post-discharge, independently and with minimal clinician guidance or involvement.
Following a simple invite and registration process, patients are empowered to track their own care experience, including everything from symptoms, recommended treatments, medication schedules and even a photo and text led progress diary.
Having access to this library of data captured, supports patient confidence, and encourages people to ask more questions about their care journey. During follow-up treatment, it enables transparency and open communication between patients and healthcare staff. Preventing any confusion around medication instructions and enhancing the potential for shared-decision making.
In addition to the patient empowerment benefits, questions designed by the Picker Institute, who are leaders in feedback tool development and measurement, allow healthcare teams to specifically ask patient experience related questions. This data can then be downloaded and collated into digestible reports, and channelled into future service improvements.
Highlighting the value of the collaboration, Philip Stylianides, Group Director at the Picker Institute said; “If you consider that 41% of people were not told key medication side effects, when discharged*, you can begin to see why avoidable emergency hospital readmissions are costing the NHS an astounding £1.6 billion per year* and rising. Understanding someone’s patient experience is essential for teams’ to learn the strengths and weaknesses of the care they provide. umotif are leaders in healthcare data capture, who share our passion for improving care quality and we are delighted to be working with them on this opportunity.”
Speaking ahead of the launch Bruce Hellman, Chief Executive of umotif said; “Active, engaged patients are more likely to comply with their treatment plan and therefore less likely to be readmitted. Forward-looking healthcare organisations understand the value and importance of a data-driven approach to the measurement, delivery and improvement of services. Our tool allows staff and patients to truly understand and evaluate the care provided, and we are incredibly proud to be partners with the Picker Institute in such a necessary and innovative initiative.”
Trusts’ interested in using the tool, will receive a consultation, highlighting key features and ease of use, after which, the programme can then be tailored to the needs of individual organisations and services. Whether that be Oncology, Cardiology or Respiratory care, the features can be shaped to fit the cohort, need and condition measured. Delivering effective and useful data that can make a substantive difference to the quality of care and level of experience that a healthcare service can provide.
Alzheimer’s Research UK is calling for access to EU funding programmes to be made a priority in Brexit negotiations, as a poll of dementia scientists highlights fears that Britain’s exit from the EU will lead to a loss of funding for research. The survey, carried out by the UK’s leading dementia research charity, highlights a range of concerns about the impact of the EU referendum result – including a loss of funding, a drop in the UK’s standing as an international leader in research, and the impact on scientists’ ability to move between labs and collaborate.
The survey of 70 dementia researchers, carried out in August 2016, found that losing access to EU research funding is a leading worry among scientists, with 60% of people listing this as being ‘of great concern’. As Brexit negotiations get underway, Alzheimer’s Research UK is urging the government to ensure that access to vital EU funding programmes will continue for UK-based researchers, as one of a package of measures to protect the UK’s life sciences sector. The charity is also calling for continued mobility for UK and EU researchers, continued support for cross-border collaborations and for scientific representation during the government’s exit talks.
The poll shows that detrimental effects are already being felt in research as a result of the EU referendum outcome, with nearly half of respondents (47%) aware of opportunities for European partnerships being withdrawn or unsuccessful, while two in five (41%) were aware of researchers having been removed from grant proposals following the referendum result.
With a quarter of respondents (26%) coming from an EU member country and working in the UK, the survey highlights the collaborative and international nature of many dementia labs. But results from the poll also show difficulties with recruitment and retention of researchers in UK labs as a result of the referendum. Three quarters (76%) of scientists surveyed were aware of someone leaving the UK, or considering leaving, because of concerns about their future in the country, while half (51%) were aware of problems recruiting researchers or students from EU member countries.
Dr Matthew Norton, Director of Policy and Strategy at Alzheimer’s Research UK, said:
“It’s clear from our survey that dementia scientists are still very worried about the negative impacts of Brexit on UK science. UK government investment for dementia research has increased in recent years but EU research schemes are still an essential source of funding for dementia scientists in the UK. We are beginning to make real strides in the search for much-needed treatments for people with dementia, but if access to funding is lost there is a risk that progress could stall.
“We are deeply concerned that scientists may be discouraged from working in the UK: the ability to collaborate and move between labs is vital for research to thrive. Dementia research is still under-resourced in the UK, with just one scientist working on dementia for every six working on cancer – we must not allow Brexit to compound this problem. When our political leaders sit at the negotiating table it will be crucial that the scientific community is represented. There are 850,000 people living with dementia in the UK today and if we are to find new treatments that can make a difference to their lives, our research sector must be supported.”
Up to 59% of deaths from injury could potentially be prevented if public knew first aid, says British Red Cross. New research commissioned by the British Red Cross and conducted by the University of Manchester reveals over half of bystanders are failing to intervene in an emergency. eople are calling 999 then doing nothing. The British Red Cross is calling for everyone in UK to learn two simple first aid skills to help save lives.
Whilst 93% will call for an ambulance if they find someone with an injury, first aid intervention of any kind was infrequent. Around half did not attempt any first aid while waiting for the emergency medical services to arrive*. The research, which has studied data from coroners’ offices, was last carried out 22 years ago by Prof Anthony Redmond of the Humanitarian and Conflict Response Institute, who also led the new research which was conducted by Dr Govind Oliver from the Humanitarian and Conflict Response Institute.
The two first aid skills identified by British Red Cross as being the most essential in cases of accidental injury and trauma are:
If they are unresponsive and breathing: Open the person’s airway so they can continue to breathe by placing them on their side with their head tilted back.
If they are bleeding heavily: Stop them from bleeding to death by putting pressure on any heavily bleeding wounds
Joe Mulligan, British Red Cross Head of First Aid Education said “The good news is that most people are calling 999. But after calling 999 we want people to then do something in those crucial minutes before the ambulance arrives, every person needs to recognise that in an emergency, you are part of the ‘chain of survival.”
The British Red Cross is calling for everyone in the UK to learn two basic first aid skills that could help to prevent the number of people who die from injuries, such as those resulting from falls or road traffic accidents, before reaching hospital.
“Sadly in the majority of deaths we looked at, the simplest interventions could have helped keep someone alive until they got to hospital. For example something as simple as turning someone on their side and tilting their head back to keep their airway open – could be all it takes to make that difference between life and death in certain situations”.
The charity is also calling for more opportunities to learn first aid throughout one’s lifetime, starting at school, but also through the driving test and public health initiatives.
Find the report and more about the British Red Cross campaign online here
Barnsley Hospital is only the second in the country to implement the Perfect Ward app, an easy-to-use app which has a big impact on quality by simplifying ward assessments as part of hospital care. Perfect Ward is an app designed for nurses, which aims to improve organisation, precision and diligence and, ultimately, care of patients in their wards.
The app allows users to log checklists of jobs that need to be completed, as well as provide transparent feedback as part of the overall hospital care program. This allows doctors and nurses to roll the multitude of small but essential tasks they have to complete on a daily basis into one platform – a minimalist, easy-to-understand app. This data can be instantly collated, allowing management strategies to be tailored to statistics rather than through trial and error.
Before Perfect Ward was introduced at the Trust ward assessments were paper based which meant nursing staff had to take time to write up their findings. Using the Perfect Ward app greatly improves this process; the app is easily accessible for staff, the method of storing information is structured and easy to analyse. Users are able to add photos and comments where appropriate, there is no need to write up information as it is all stored on the app.
All photos and information are transferred immediately onto a secure server and are never saved on the user’s device, ensuring that it is a completely confidential system. For further details, see: (http://www.perfectward.com).
The BMA has confirmed that junior doctors in England will take further industrial action, from September.
Junior doctors will stage a full withdrawal of labour for five days, between the hours of 8am and 5pm from Monday 12 September – Friday 16 September inclusive, followed by further dates to be confirmed.
This follows a vote by junior doctors in July to reject the proposed contract, and repeated attempts by the BMA over the past two months to work constructively with the government to address the outstanding areas of concern. Despite this, the government is refusing to acknowledge junior doctors’ concerns and is continuing with plans to impose the contract in October.
Key concerns raised by junior doctors include the impact that the contract will have on those working less than full time, a majority of whom are women, and the impact it will have on junior doctors working the most weekends, typically in specialties where there is already a shortage of doctors.
The government has said that a new contract is needed to deliver more seven-day services when the department of health’s own documents show that the NHS does not have a plan as to how it will staff or fund further seven-day services.
This comes at a time when concerns have been raised about staff shortages across the NHS and hospitals in Chorley, Grantham and Stafford have been forced to close A&E departments or limit access because they don’t have enough staff to deliver safe care.
The BMA believes that progress was made during talks in May, and is calling for the government to lift the imposition and restart meaningful talks to agree a contract that is adequately funded, fit for purpose, delivers for patients and has the confidence of the profession.
The NHS 5 Year Forward View was based on an assumption that the NHS would need an additional £30bn of funding by 2020/21 and that £22bn of that would come through efficiency savings. In its spending review the government “promised” £8bn to fill the gap. It is time to revisit the figures and to look again at what the gap might be in 2020/21. (Some informed guesses are all that is provided.) What is attempted here is to cost what restoring the NHS and social care to a decent standard might involve.
Since the initial 5YFV we have more information. Recent figures for the growth in demand for services, despite a great many projects that are supposed to be reducing it, casts some doubt on whether the £30bn is realistic; let’s say its £32bn.
The promised additional £8bn pa funding for the NHS by 20/21 was part funded by cuts elsewhere in the overall health budget. Reversing this sleight of hand adds around £3bn. Costs for announced and worthwhile but unfunded improvements to mental health, GP funding (to allow for longer appointments) and for 24/7 working in hospitals adds around £3bn.
The improvements required in funding for Public Health, reversing the cuts of recent years adds a further £1bn (rising to £2bn) to fund the kind of programmes needed to restore longer term financial stability.
Turning to the proposed £22bn of efficiency savings, a far more realistic projection would be £10bn – with savings more in line with historic trends in efficiency gains; accepting that pay restraint has limits; there are few new ideas, transition funding has gone to pay off deficits, and easy wins have been used up. On the other hand moving away from the market model, bearing down on contracts like PFI, back office integration (NHS and Local Authorities), simplified funding and commissioning (via Sustainability and Transformation Plans – STPs) could save around £2bn.
To that has to be added funding for transformation and implementation of planned changes, like shifting to whole person care, a care system rather than an NHS service (or moving to the Berwick style Era 3 model for the NHS). However these are labelled, they represent big changes around integration, new models of care, service reconfiguration. In principle all these changes are necessary to establish long term sustainability; and they are all worthy enough in their own right, providing improvements in outcomes and/or experience of care. But the case for change is based on improving health care not reducing costs. And they are hard to do. To get such change implemented will entail some capital investment, major costs of programme governance and some years of double running costs; not to mention winning over a highly sceptical public.
These system changes can be addressed through the established STP architecture with funding made available on a programme basis. This is additional funding. Given the level of ambition such funding could be between £5bn and £10bn spread over the next 4 years to 2020/21.
Then equally vital is attention to social care. The additional cost of making social care free for all with needs assessed as moderate and above is around £12bn. There are reasonable expectations for other improvements in social care, such as making the other Dilnot changes; all these are also justified through helping integration and assisting savings in the NHS – then a further £2bn is necessary.
On this back of envelope basis the increased revenue funding for a modern care system (by 2020/21) is £34bn pa, over and above the spurious £8bn promised. Put another way, public spending on health and social care would rise to around 11.5% of GDP, bringing it in line with major developed EU countries. Plus up to £10bn over 4 years for the transition.
What would meeting the £34bn gap entail? One presumption is that improvements will mostly benefit older people who have arguably been shielded so far from the worst of austerity and so greater contributions from better off pensioners are justified. Also, for various well established reasons any form of hypothecation should be rejected – the common pool is fed by general taxation.
One possible set of ideas:-
A 1% rise in income tax would raise about £4bn. This would also be totemic – raising income tax to pay for a better NHS etc.
Increased charges in the NHS have very limited scope but could raise £1bn. Changes to pensioner benefits to remove universality, extending NI to pensioners’ income and modifying the triple lock (all unpopular!) could raise £3bn.
Increasing employee NI in a staged way, initially by 1% just for those over 40 but then increasing scope and level, might raise £3bn. Removal or reduction of benefits in tax treatment of private pension contributions could raise £6bn.
There is some scope for looking at the social support system and at benefits such as attendance allowance to see if pooling that funding might allow better allocation. A proper study is long overdue and this is very hard to put a value on, but maybe would provide a gain of £1bn.
Council tax can be raised in level (like the suggested 2% social care levy) and also by adding higher bands (mansion tax etc.). This might raise £3bn to put into combined care pot. There is some scope also for local authorities to raise other local charges and taxes specifically to fund care.
Changes to inheritance tax (death taxes) and/or other forms of wealth tax could raise £10bn. ‘Sin’ taxes related to things like sugar might be possible and desirable and could maybe raise £1bn.
The final £2bn should come from increasing taxes for higher income groups, better tax collection and from reducing all forms of tax avoidance.
Transition funding from the £10bn pot mentioned above would be allocated based on proper cost benefit analysis and so should be value for money and offer a reasonable payback in terms of extra efficiencies (or cost savings) over the term agreed.
The reaction to changes in benefits and taxes for older people will not be favourable but there is an inter-generational fairness argument to be won. Proper analysis would have to be done on wider economic consequences (better care good for growth) with taxes. And the impact on health inequalities would need to be examined and justified.
So do we want a modern effective sustainable care system of not? If we do here is the Bill.
A significant number of NHS Trusts in England have been hit by ransomware in the past year, according to data from a freedom of information (FOI) request. The FOI request was made by global risk mitigation and cyber security expert NCC Group. Sixty of 155 Trusts responded but 31 of these withheld information with many citing patient confidentialities. However, 28 confirmed they had indeed been a victim of ransomware.
Ransomware is a type of malware that restricts access to systems in some way, often by encrypting files and then demanding a ransom to obtain access. With NHS Trusts holding a range of sensitive data on patients and employees, an attack of this nature locking staff out of patient records could cause serious disruption to services and ultimately impact patient care. Many ransomware attacks are delivered via phishing emails. These are often well crafted and disguised to resemble something non-malicious to fool the recipient. Phishing emails often take the form of parcel delivery notifications, imaginary customer complaints or fake official letters.
Ollie Whitehouse, technical director at NCC Group said: “The damage that a successful ransomware attack can cause makes these findings not simply an issue for a Trust’s IT team, but for its board of directors too. Paying the ransom – which isn’t something we would advise – can cost significant sums of money, yet losing patient data would be a nightmare scenario for an NHS Trust. In the past the ransomware writers were sometimes quite careless and there was often a way to retrieve files. However, they have improved their capabilities and data retrieval is usually no longer an option. It makes preparation even more important.”
Responding to hostile media reports about local Sustainability and Transformation Plans (STPs), Stephen Dalton, Chief Executive, NHS Confederation, said:
“These local plans are being made when funding is very tight but they are not about cuts – they are about modernising services to match people’s changing care needs. It is inevitable during such important changes that some services will be moved, reduced or enhanced. It is too simplistic to focus only on what appears to be lost. It’s also important to look at what alternatives are being provided.
We are seeing an important shift in which local NHS leaders are starting to get beyond the anxiety of making tough decisions and are working closely with local government and others to reshape services, reflecting changes in public need. People will want more information and this is on the way. Leaders in the NHS and local government in each of these 44 areas will do their best to reflect local needs and will want the wider community to be involved in the conversation.”
News from Nowhere sympathises with Stephen Dalton’s view that the NHS is obsolescent and needs a redesign, but the secrecy round the STPs so far, the limited time for public involvement in the plans and the pressure from the NHS to develop them do make the whole enterprise look like a cover for short-falls in the NHS budget.
Nothing beats the feeling of spending a sunny afternoon exploring forest trails and hidden paths. Or not having to hit the gym in the evening because you’ve already commuted to and from work on your bike; your workout is done for the day! Whether you dust off your helmet every day or prefer to save it for family adventures out, have you ever wondered just how many like minded people love their cycling too?
By digging through some of the latest government statistics, Merlin Cycles has put together the Great British Map of Cycling. Here you can find which regions in the UK take their cycling seriously.
How does your area stack up?
According to the latest statistics on cycling in Northern Ireland, it is thought that 28% of adults cycle at least once a week.
That’s not all. The south east and south west of England reported that 10.6% and 10.3% of adults took to their bikes at least once a week.
A few other statistics…
For the East Midlands, almost one in 10 people (9.1%) hopped on their bikes once a week.
And finally the West Midlands reported an average of 7.9% of adults cycling on a weekly basis, as well as being the region in the UK that reported the lowest levels of anxiety in the country.
London loves to cycle
Whether you live one mile away from your office or eight, choosing to cycle instead of driving or taking the bus is a great way to get some exercise and cut your carbon footprint at the same time.
According to the most recent government figures, the capital city of London ranks 5th on the list of regions for cycling with at least 10% of adults saying they hop on their bike at least once a week. Transport for London even predicts that the number of people cycling on central roads in the city will soon overtake the number of car drivers.
Responding to the government’s disappointing childhood obesity strategy, Professor Parveen Kumar, BMA board of science chair, said:
“Given the UK has the highest level of obesity in Western Europe with one in three children overweight or obese by the time they leave primary school, the government should be doing everything in its power to tackle this problem. Instead it has rowed back on its promises by announcing a weak plan rather than the robust strategy it promised.
“Although the government proposes targets for food companies to reduce the level of sugar in their products, the fact that these are voluntary and not backed up by regulation, renders them pointless. Targets are also needed to reduce levels of saturated fat and salt in products – these must be backed up by regulation.
“Poor diet has become a feature of our children’s lives, with junk food more readily available, and food manufacturers bombarding children with their marketing every day for food and drinks that are extremely bad for their health. It is incredibly disappointing that the government has failed to include any plans for tighter controls on marketing and promotion.
“While the introduction of a sugar tax is an encouraging step forward, this on its own is not enough to solve the obesity problem facing our country. Poor diet is responsible for up to 70,000 deaths a year, and has a greater impact on the NHS budget than alcohol consumption, smoking or physical inactivity.
“The government must act now and take urgent action to address the ticking time-bomb that obesity poses to children and the NHS.”