Hospitals should put waste before cash 30 June 2017 Just as sustainability and transformation plans (STPs) and new care models show signs of faltering, a clinician-focused approach to driving costs down and quality up could make a difference. Delegates at the BMA’s annual meeting have just voted for STPs to be abandoned. While some of the language around the vote was the usual conspiracy theory about it all being a plot to privatise the NHS, it was harder to argue with pleas for STP decisions to be based on robust, publicly-available evidence. STPs, or some evolution of them, are here to stay. Working as collaborative systems rather than isolated, competing organisations is the rational way forward. But there is a growing sense that STPs and the development of new care models are losing momentum, and risk being overwhelmed by financial pressures. Almost three years on, the principles in the Five Year Forward View have proved robust. Local development of new models of community-based, patient-centred care within a national framework is the right blueprint. There has been progress, such as substantial improvements in mental health services for children and young people. But despite many successes, there is a growing realisation that the development of new care models by the vanguards is proving far harder and taking far longer than almost anyone anticipated. Read the full article at the Guardian Healthcare Network __________________________________________________ NHS must face up to its workforce crisis 20 June 2017 The workforce crisis enveloping the NHS could soon eclipse funding as the most serious problem. There are tens of thousands of vacancies, far too few new staff are coming through; the pressure on those in post is relentless and morale is dangerously low. The number of clinicians in the NHS has risen by 26,000 since 2012, but this has been outstripped by the creation of 62,000 more posts – including many established in the wake of the Mid Staffordshire scandal – which means vacancy rates are climbing. The number of emergency medicine consultants has grown 32% in five years, yet demand for specialists to cope with rising A&E attendances means many hospitals are unable to fill their vacancies. Trust managers live in dread of being accused of running unsafe staffing levels, but there are The consequences of cuts have been severe. According to the National Audit Office, annual nurse training places were slashed by more than 3,000 (pdf) – 19% – in the decade up to 2014-15. The NHS has always struggled to match the supply of staff to its needs. In another effort to grip the problem, Health Education England (HEE) was set up in 2012 to oversee workforce planning. Many health service managers claim it is out of touch with the needs of hospitals and clinics, underestimates the size of the problem and lacks a sense of urgency. Read the full article at the Guardian Healthcare Network __________________________________________________ HSIB cannot shift safety culture alone 2 June 2017 The launch of the Healthcare Safety Investigation Branch (HSIB) marks an opportunity for substantial improvement in patient safety. But there may be fears that it will provide a veneer of progress, while the wider system still fails to tackle the root causes of safety problems. The HSIB, which began work in April, has an impressive pedigree; chief investigator Keith Conradi led the Air Accidents Investigation Branch on which the new organisation is modelled. Although its independence is not so far enshrined in legislation – it is hosted by NHS Improvement – there are strong signals that the expert advisory group will be fearless and forthright in identifying weaknesses in the system. But if all the HSIB achieves is providing faster and more effective inquiries into accidents, it will have failed. Its success will be judged by progress in shifting NHS culture from its current reactive approach – whereby something goes wrong, a patient dies, an inquiry is set up and recommendations are made – to what doctor, airline pilot and safety advisor Nick Toff described at the Cambridge Health Network as “a continuous cycle of learning and improvement”. At that point, the NHS will have moved from learning lessons to designing and refining safe systems. Read the full article at the Guardian Healthcare Network __________________________________________________ Parties reveal confusion and confession 21 May 2017 Labour’s election manifesto offers confused plans for the NHS, while the Conservatives have admitted there are serious problems with existing legislation. The Tory manifesto says that if the “current legislative landscape” – dominated by the government’s own health reforms – is hampering the Five Year Forward View or undermining local or national accountability they will fix it, as well as do what they can in the meantime to remove barriers to care integration. It identifies the internal market as the key problem, because it is too expensive to run and can fail to work in patients’ interests. This is a significant move. It had been assumed that Theresa May would avoid reopening the issue of NHS reform at the same time as navigating Brexit. But she has clearly been persuaded that the benefits of cutting running costs and making it easier to join up services outweigh the risks. One of the weaknesses in Labour’s proposals is muddled thinking about the organisational building blocks of the health service. It promises to repeal the Health and Social Care Act 2012, which imposed Andrew Lansley’s dysfunctional NHS reforms, and to “halt and review” sustainability and transformation plans (STPs). Read the full article at the Guardian Healthcare Network __________________________________________________ Prison creates the conditions for suicide 7 May 2017 Record levels of self-harm and suicide in our jails reveal a collapse in mental health support for vulnerable prisoners. Last year there were 40,161 recorded instances of prisoners harming themselves, almost 8,000 more than 2015. That is almost 800 a week. Suicides reached 119, the highest since records began in 1978. That means a prisoner kills themselves every three days. Labour’s Luciana Berger has described it as “the death penalty by the back door”. As well as coroners’ inquests and the findings of prison inspectors there have been at least 10 major reports investigating deaths in custody since 1991, including six in the last six years. Since 2010, according to Full Fact, the number of frontline prison officers has been cut from 19,900 to 14,700 full-time equivalents, as the prison population continues to climb. This week, parliament’s joint committee on human rights – with members drawn from both the Lords and Commons – rushed out a report on mental health and death in prisons before parliament was dissolved. They have been trying to understand why the deaths have continued despite the endless investigations and government promises to do something. It identifies a series of mutually reinforcing failures behind the mounting toll. Read the full article at the Guardian Healthcare Network __________________________________________________ Hearing the wisdom of frontline staff 5 May 2017 Personal stories from health and care professionals working in and around emergency departments reveal how staff dedicated to systems thinking, teamwork and leadership can deliver an outstanding service under pressure. The stories, captured in the IHM publication The Winter’s Tale, highlight the courage, stamina and self-belief required to turn around a struggling service. The report conveys the wisdom that comes from passionate staff working on the frontline. Among the many powerful messages was ensuring staff have the confidence to trust their own clinical judgment. Clinicians that feel overwhelmed, undermined and under threat become part of the problem they are trying to solve, by routinely admitting patients for ‘observations’ and other ill-defined reasons instead of sending them back out. A big step to achieving this is putting the most senior and experienced staff at the front door, so they can identify quickly who is and is not an emergency. Empowering professionals such as therapists, frailty teams and social workers transforms the performance of an emergency department. Frail patients who are not an emergency can be kept mobilised and supported to return to their own home quickly rather than being parked in a hospital bed to deteriorate. Discharge planning begins the moment they arrive. Read the full article at the Institute for Healthcare Management __________________________________________________ Unleashing power of the digital patient 4 May 2017 Digital technology has extraordinary potential to support patients in managing their own health. But making this a reality depends on the NHS rethinking its approach to both digital skills and the relationship between clinicians and patients, while the tech sector needs to develop a far deeper understanding of patients’ needs. The patients who stand to benefit most from the thousands of health apps coming onto the market of those with long-term conditions. While patients diagnosed with a long-term condition will be given guidance on how to manage it, each patient ultimately has to find out for themselves how their health and well-being responds to factors such as diet, and how to fit management of their condition into their everyday life. This can take years of trial and error. Jonathon Hope, who has lived with kidney failure since childhood, told the DigitalHealth.London Summit in February: “When I was diagnosed I was given 60 sheets of what I could and could not eat. There is no way I was going to be able to embed that in my care.” Artificial intelligence offers the prospect of cutting this learning cycle down to months or even weeks by linking information on a patient’s physical and mental state and learning which actions enhance or harm their quality of life. Read the full article at DigitalHealth.London __________________________________________________ The role of mental health in terrorism 27 April 2017 The shift in the terrorist threat from networks to lone attacks has put mental health and the protection of vulnerable people at the centre of the UK’s counterterrorism strategy. Metropolitan Police assistant commissioner Mark Rowley, the national lead on counterterrorism policing, tells The BMJ that the involvement of the NHS in Prevent—the part of the counterterrorism plan aimed at stopping people becoming terrorists—is “massively important, more important than it’s ever been.” He says, “We have wrestled with terrorism in the UK for at least 50 years, but for most of that time—whether it was the IRA or Al Qaeda—there were secret networks planning attacks, and the sort of people they recruited had to be highly trustworthy and reliable.” Now, terrorist groups try to incite people through propaganda on the internet and social media to carry out attacks: “Part of that has led them to—sometimes accidentally, sometimes very deliberately—trying to exploit vulnerable people.” Rowley claims that, of the people involved in the 13 attacks that the security services say they have foiled since 2013, “a disproportionate number of them do have mental health issues.” He would not specify a number. Rowley emphasises that any suggestion that mental illness causes terrorism is “complete nonsense.” Instead, the concern of the police is that people with vulnerable mental health are susceptible to being targeted: “If part of the terrorist methodology is to prey on the vulnerable and trying to exploit them and to radicalise them to commit acts of violence, then it stands to reason that there will be people with certain mental health conditions who will be . . . susceptible to that.” “Radicalising and inciting someone who is vulnerable to go and carry out some ghastly attack seems to be part of their tactics, and that has brought in a whole load of vulnerability issues, including mental health, that we now have to wrestle with.” Read the full article at the BMJ __________________________________________________ Mayors will be new breed of NHS leader 22 April 2017 While Labour will be desperate to push the NHS to the centre of the general election campaign, and the Liberal Democrats will be emphasising their commitment to mental health services, it is the six regional mayors being elected for the first time in May who could provide the biggest surprise when it comes to health policies. The exact powers of the six – covering Tees Valley, Greater Manchester, Liverpool city region, West Midlands, West of England and Cambridgeshire & Peterborough – vary depending on the deal each region reached with the government, but none of them will control the NHS. However, like any self-respecting local politician, the candidates are not allowing the limits of their formal powers to deter them from trying to influence such an important policy area. The manifesto of Andy Burnham, Labour’s candidate for mayor of Greater Manchester, typifies the influence mayors intend to wield. Burnham wants to cut waiting times for child and adolescent mental health services, manage the transition from child to adult mental health services more effectively, have a plan to get local people into NHS jobs, provide more incentives for services to shift from treatment to prevention, and “introduce in Greater Manchester the country’s first fully- integrated National Health and Care Service, building on the work that is already ongoing”. Read the full article on the Guardian Healthcare Network __________________________________________________