NHS faces high price for Stevens’ plan 31 March 2017 The NHS plan for the next two years represents a perceptible contraction of the health service’s offer to the public. The proposals in Next steps on the NHS Five Year Forward View, published on Friday, are shaped by shortages of money and staff. Simon Stevens, the NHS England chief executive, has burned through much of his political capital in disputing government claims about whether the NHS has been given all the money it asked for, so this was not an opportunity to push for further cash. So in the face of the unrelenting pressure of the government’s austerity programme and barely controlled hospital debt, he is gambling that politicians and the public will stomach longer waits for routine surgery if the health service can deliver better performance on cancer treatment, A&E waits, mental health services and GP appointments. In the wake of slipping cancer treatment times and the recent outcry over the death of a child waiting for urgent surgery, this is probably the right choice. But the price could be high. Read the full article on the Guardian Healthcare Network __________________________________________________ How technology can liberate patients 15 March 2017 Healthcare technology is liberating and empowering patients and redefining the role of the clinician. The leaders of this revolution are entrepreneurs who understand patients’ lives. The opportunities and risks this presents were at the heart of discussions at the annual summit for DigitalHealth.London – the collaboration between the capital’s Academic Health Science Networks, MedCity and NHS England, to accelerate the adoption of digital technology across health and care for the benefit of patients and populations. Health tech is moving from data crunching to artificial intelligence, with machines mimicking cognitive functions such as learning and problem solving. The current generation of decision-making aids will be replaced by systems that learn from the latest research and data and interrogate aspects of a condition that clinicians and patients will not have identified. Correct diagnosis will no longer depend on a skilled but fallible human. Ali Parsa, founder of digital healthcare service Babylon, told the summit that mobile technology coupled with automated diagnosis could deliver universally accessible and affordable healthcare. Read the full article on DigitalHealth.London __________________________________________________ Technology could redefine doctors’ role 11 March 2017 Advances in clinical uses of artificial intelligence (AI) could have two profound effects on the global medical workforce. AI, which mimics cognitive functions such as learning and problem-solving, is already making inroads into the NHS. In north London it is piloting use of an appaimed at users of the non-emergency 111 service, while the Royal Free London NHS foundation trust has teamed up with Google’s DeepMind AI arm to develop an app aimed at patients with signs of acute kidney injury. The hospital claims the project, which uses information from more than 1.6 million patients a year, could free up more than half a million hours annually spent on paperwork. AI raises the prospect of making affordable healthcare accessible to all. According to the World Health Organisation, 400 million people do not have access to even the most basic medical services. Hundreds of millions more, including many in the world’s most advanced countries, cannot afford it. A key factor driving this is the worldwide shortage of clinical staff, which is getting worse as populations grow. Read the full article on the Guardian Healthcare Network __________________________________________________ How to win hearts and minds for reform 10 March 2017 The NHS has always struggled to find the right relationship with patients and the public. Clinicians and managers know that listening to local communities and service users helps them to understand what matters and identify ways the system can be improved, but virtually all parts of the health service find it difficult to do. The need to get this relationship right is brought into sharp focus by the move to devolve control of health services to local areas. While Greater Manchester and other places are gaining additional powers over health through devolution deals signed between ministers and groups of councils, every part of the country has a greater decision-making role in the future of their local services through the sustainability and transformation plan (STP) process. Under this programme, the country has been divided up into 44 areas, each of which has delivered a proposal to NHS England on how it will make the local health economy clinically and financially sustainable. This means sorting out hospital deficits, and moving care from hospitals to the community to keep people with long term conditions living independently for longer at lower cost to the state. Read the full article on the Fabian Society website __________________________________________________ Labour can’t write its policy on a placard 25 February 2017 Labour’s attempt to terrify the voters of Copeland with talk of dead babies has failed. Now it needs to get serious about developing a credible health policy. In north Cumbria the NHS faces difficult choices on maternity care. It has been struggling to maintain the support services and staffing necessary for consultant-led maternity care of acceptable quality in both Whitehaven and Carlisle. This means Whitehaven may lose its maternity service. Both staff and public are anxious about the risks. Labour’s take during the Copeland byelection was “mothers will die, babies will die, babies will be brain-damaged”, and of course “only a vote for Labour will save our hospital”. Meanwhile, at prime minister’s questions this week, Theresa May easily swatted away Jeremy Corbyn’s latest riff on the theme of Tory NHS cuts. The manner of Labour’s defeat in Copeland is instructive. It took the most emotionally charged line possible, on an issue of great local sensitivity, on its signature issue of the National Health Service, and lost to the government. Read the full article on the Guardian Healthcare Network __________________________________________________ Tackling health problems in global cities 24 February 2017 The relentless growth of urban populations is driving city and national governments to increase access to healthcare while tackling the root causes of poor health. According to Oxford Economics, the world’s largest 750 cities will be home to 2.8 billion people by 2030 – more than a third of the global population. They will account for almost a third of the world’s jobs and more than half its consumer spending. More than a dozen cities will have populations greater than 20 million. Rapid, uncontrolled urbanisation strains many aspects of city life that determine health. Traffic, factories, generators and construction poison the air, meanwhile water supplies can become contaminated, poor housing harms the health of children, and food supply and quality can be compromised. Unplanned urban growth drives poverty. About 900 million people worldwide live in urban slums, where overcrowding encourages the spread of infectious diseases such as tuberculosis, dengue fever and cholera. The United Nations estimates that by 2030, roughly 60% of city inhabitants will be under the age of 18, which puts huge numbers of children at risk from illnesses such as diarrhoea and pneumonia, the leading causes of global childhood death. Read the full article on the Guardian Healthcare Network __________________________________________________ Integration is a well-intentioned mess 10 February 2017 As figures leaked to the BBC reveal the worst A&E performance figures in 13 years, a dissection by the National Audit Office of the stalled progress towards health and social integration lays bare government hubris and fictional promises of progress from within the NHS. Governments and the NHS have been firing off integration policies since the 1970s. Recent ones include the 2010 announcement that £2.7bn would be transferred from the NHS to local government to promote joined-up working; the 2013 spending review announcement of the Better Care Fund, which resulted in health and local government pooling £5.3bn to integrate services and reduce pressures on hospitals; the launch that year of the Integrated Care and Support Pioneers Programme to make joined-up and coordinated health and care the norm by 2018; and the Five Year Forward View in 2014. The NAO skewers the government on its failure to provide any evidence that integration delivers sustainable cuts in costs or hospital activity. An international study by the University of York in 2014 of 38 integration schemes in eight countries failed to find any robust evidence supporting claims of sustained cuts in admissions, yet ministers persist in creating the impression that integrating services will lead to costs falling out of the system. Read the full article on the Guardian Healthcare Network __________________________________________________ NHS risks losing sight of the human cost 27 January 2017 The revelation that thousands of people could be forced out of their homes into residential care raises serious questions about the judgment of clinical commissioning groups (CCGs). According to the Health Service Journal story, based on information gathered by campaign group Disability United, at least 37 CCGs have imposed restrictions on access to NHS continuing healthcare funding, which provides ongoing care for adults with a “primary health need”. Around £2.5bn a year is spent on NHS continuing healthcare, with about 60,000 people receiving support at any one time. A total of 19 CCGs have said they will not fund care in the person’s own home if it is more than 10% above an alternative – normally going into a care home. The remainder are imposing other restrictions. Up to 13,000 people could be affected among these CCGs; since 87 CCGs did not reply, the national figure could be around 22,000. Read the full article on the Guardian Healthcare Network __________________________________________________ What is really happening inside STPs? 20 January 2017 Behind the vision documents and targets, what is really going on inside the sustainability and transformation plan (STP) process? A clinical commissioner outside one meeting was overheard asking: “How are we going to shaft the acute?” But elsewhere there is a growing recognition that old-style NHS infighting is a big part of the problem. For there to be any chance of ensuring services have a viable future, local leaders are increasingly trying to understand what skills they need to run health and care as a system. To fathom how the people immersed in these tough negotiations are behaving, and what they need to do to think and act as leaders of the whole system, I interviewed 10 senior health and local government managers for the Institute of Healthcare Management. The resulting report, Swimming Together or Sinking Alone, reveals frank assessments of the difficulties they are encountering, alongside their insights about what needs to happen. Read the full article on the Guardian Healthcare Network __________________________________________________ More cash should be linked to reform 13 January 2017 The biggest crisis facing the NHS is that, no matter how high or low the funding, transformational change fails to happen. It is easy to justify why reform is so slow and patchy currently, but neither did it happen in the years following the NHS Plan in 2000, when the annual real funding increases were among the highest in NHS history. The same promises were made – risk stratified prevention, involving people in their own care, a digital revolution, a massive expansion of primary care. Waiting lists tumbled, A&E treatment times were slashed and there was huge capital investment, but the underlying shape of the service remained largely unchanged. That history is one reason why the Treasury is so resistant to injecting more cash. After the NHS England chief executive, Simon Stevens, appeared in front of the Commons public accounts committee this week former permanent secretary Nick Macpherson tweeted: “NHS bottomless pit. Money should be linked to reform.” Read the full article on the Guardian Healthcare Network __________________________________________________ Finding a way out of reform labyrinth 6 January 2017 The surprise in the health service is not how little collaboration there is across professional and organisational boundaries, but how so many people achieve so much in the face of overwhelming odds. Ministers and NHS leaders encourage and cajole staff to improve services, but even the most driven transformation zealots find themselves worn down by having to fight the system rather than be supported and encouraged by it. In the words of one GP: “There is a hell of a lot of bureaucracy that gets in the way. The whole thing around designing care is how straightforward it is as a concept, but the bureaucracy cannot disentangle itself from the engineering to allow simple things to happen. “Change can be virtually impossible because money flows will not allow it to happen, so you have teams of people wading through spreadsheets and legal issues. There are boards, frameworks and contracts which create a system that never moves, but people are crying out for a system that allows care to be integrated.” Read the full article on the Guardian Healthcare Network __________________________________________________