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Belfast today, Home Counties tomorrow!


This health service funding business is easy, ask any Ulster politician. Recently all five Trusts in Northern Ireland consulted on proposals for significant cuts in services in order to meet their legal duty to stay within their 2017/18 budgets.  If implemented, the cuts would have potentially impacted severely on the health of people in Northern Ireland.  Fortunately the Department of Health (Northern Ireland), announced shortly after the consultation ended that the worst of the cuts would not go ahead, and that additional funding would be made available for both health and education. There are lessons here. First, health and social care are integrated in Ulster but the downside is that Trusts must stay in budget, like English local governments but unlike the English NHS. Second, money will be found when necessary – necessity in this case being the dependence of May’s government on Ulster MPs. So, logically, friends of the NHS should make the Conservative government pay handsomely to avert loss of seats. Did anyone say ‘Stuff Integration’ or ‘Progressive Alliance’?



Will the love-hate relationship between the NHS and information technology ever change? University Hospitals of Leicester Trust pulled out of the East Midlands Radiology consortium after meeting with radiologists, amid mounting concerns for patient safety and repeated system failures. The consortium was developed to link eight hospital trusts’ imaging systems to deliver savings and improve care, but it has been prone to breakdowns. The Health Service Journal (31st October 2017) reported that some consultants sent images on CDs via taxis for specialist review. This is bad news, because the IT story about imaging has been a positive paragraph in the wider and less optimistic tale about the NHS’ adoption of new technology. No more, it seems.


So how will the NHS adapt to Artificial Intelligence (AI)? Latest research suggests that AI could detect cancer in less than a second. A trial has found that AI systems were able to distinguish potentially dangerous bowel tumours from harmless growths with high levels of accuracy. In the trial the AI system was able to distinguish tumours in endoscopy images with 94 per cent accuracy (Laura Donnelly, Daily Telegraph, 29th October 2017).  But will NHS users prefer a friendly face to a silicon chip when it comes to using AI diagnostically? Information Management Company OpenText says yes! Its research suggests that that UK consumers, too, see the advantages of the technology: A quicker diagnosis was identified as the biggest benefit, with one in three (33%) UK consumers believing robots would reach a decision on their condition much faster; As well as faster diagnosis, one in four (25%) British consumers believe they would get a more accurate diagnosis from AI; A quarter of UK consumers (25%) said robot technology would mean they wouldn’t have to rely on booking an appointment with a GP, while 24% said the biggest benefit would be no longer having to take time off work to visit a doctor. So who would perform the endoscopy, ask News from Nowhere’s moles?


If AI is going to be a problem for the NHS, what about ‘customer journey management technology solutions’? Software company Qmatic (, thinking about numerous outpatient and GP appointments being missed, offers solutions. Healthcare facilities need to walk in the patient’s shoes by thinking about where the experience starts and deploying an approach that is connected throughout the entire patient journey. For example, implementing an online booking system enables healthcare facilities to reduce the number of failed appointments by delivering mobile reminders to patients who have upcoming appointments. This ensures patients are aware of their consultations and can cancel or reschedule these if necessary. It’s key that the online booking process is connected to staff profiles and availability. When connected, it can increase efficiency and deliver a great patient service by facilitating ease of booking, notifications and reminders and can be agile to patient changes.


Additionally, the system needs to be linked to the patient arrival. This is particularly important for outpatient clinics, which can be difficult to navigate, as there are numerous individual waiting areas. Self-service check-in kiosks, mobile applications or even robot helpers – all enabled with appointment scanning technology – can notify staff of the arrival of the patient and provide the patient with the information they need to put them at ease and assure them they are in the process. Healthcare providers will know exactly where their patients are at all times and why they are there, this reduces delays in providing a healthcare service. Connected solutions such as these are able to direct patients to the right service point at the right time and reduce the need for staff intervention, creating a smoother, efficient patient journey.


Ultimately, says Qmatic, great patient service is a journey that begins before the examination room and endures long afterward with a dedicated and personal follow-up, which a connected online booking system and arrival solution can enable. In fact, by implementing patient journey management technology solutions, clinics, hospitals, pharmacies and labs can create a seamless patient journey, improve the speed and quality of service, increase employee productivity, lower patient anxiety, and secure the bottom line.


Collectivization ahoy!


General practitioners are under increasing pressure to scale up, by making federations and super-practices, or by merging with Acute Hospital trusts. The Royal Wolverhampton Trust in the West Midlands is now running nearly a fifth of GP practices in its area, after incorporating its eighth practice as part of a vertical integration programme it began in 2016. The integration of the latest practice last week takes the trust’s population coverage with GP services from 41,327 to 52,862. This has happened despite Royal Wolverhampton trust not being one of NHS England’s national vanguard sites. Perhaps being unencumbered by NHS England’s anxious experimenters has advantages?


Not to be left out, Clinical Commissioning Groups are merging. For example, the six CCGs covering Staffordshire have appointed a single ‘accountable officer’. According to the Health Services Journal (November 3rd 2017), the Staffordshire and Stoke on Trent sustainability transformation partnership (STP), which the six CCGs are a part of, is in the national capped expenditure process and faces significant financial challenges. One CCG, East Staffordshire, is in very large contract dispute with Virgin Care. HSJ readers did not spare their words: “A basket-case of a health economy whose weak, disorganised commissioners were bullied for years by a monopolising, avaricious community trust and dysfunctional acute trusts”. Ooh er!


Mergers of CCGs have reduced their number from 211 in 2013 to 195 next year, and the HSJ (7th November 2017) is speculating about a total of around 150 (so back to primary care trusts), or even 50, or possibly just 20-30 regional managers. There’s never a dull moment in the modern NHS, and there could be no better time to choose a management career in it.





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