HSJ Live 19.03.2015: Trust sector forecasts £448m overall deficit

Hinchingbrooke Health Care Trust, which was placed in special measures in January, is “to return to traditional NHS trust legal and governance arrangements from 1 April”, according to a paper discussed at the TDA’s board meeting on 19 March.

4.24pm A striking gap between those following key official national and local NHS Twitter accounts and those of local Healthwatch organisations is revealed today in analysis from J B McCrea Ltd.

The analysis was presented at an event on March 19th 2015 for over 70 NHS Heads of Communication organised by the NHS Confederation.

The analysis was produced using a unique NHS social media data mining tool – “Find SoMeone in Health” -developed by J B McCrea Ltd and containing the details of over 500,000 Twitter accounts with the highest interest in the NHS and UK healthcare, including every Twitter follower of:

• @nhsengland
• @dhgovuk
• @nhscitizen
• @CareQualityCommission
• @healthwatchE (national Healthwatch)
• all local Healthwatch Twitter accounts
• sample of local NHS Trust main Twitter accounts

The analysis reveals:

• 60,000 people follow at least one local Healthwatch Twitter account - of these, 40,000 (75 per cent ) do not follow any of @NHSEngland, @dhgovuk, @CareQualityCommission, @HealthwatchE OR @NHSCitizen
• On average, less than 5 per cent of people follow BOTH their local NHS Trust Twitter account AND their local  Healthwatch Twitter account
• On average, 81 per cent of local Healthwatch Twitter followers do not follow their local Trust
• On average, 94 per cent of local Trust Twitter followers do not their local Healthwatch

Speaking at the event, managing director Joe McCrea said: “Our research is based on social media data never before available to the NHS.

“It suggests that there is currently a clear disconnect between those choosing to follow their local Healthwatch on social media and those choosing to follow key national NHS Twitter accounts or their local NHS Trust.

“This does not have to be seen too negatively. It could be simply that local Healthwatch has been particularly good at attracting local people to follow them.

Or it could be that local people value conversations about their local health services over and above national policy discussion and debate.

“Whatever the reason, it suggests that thousands of people get information and comment about the NHS direct from their local Healthwatch rather than through other NHS bodies, either nationally or direct from local Trusts.

“Closing this disconnect will be vital for the NHS in the coming period as it embarks on a massive programme of significant local health and care service changes and tries to change behaviour and attitudes in accessing and using local NHS and care services.

“There is also clearly a great opportunity for local NHS Trusts and their local Healthwatch to be working even more closely together to share messages, comments, insights and followers.”

Chief executive of Healthwatch England, Katherine Rake, said: “These findings highlight precisely why the Healthwatch network was set up, to reach out to new audiences and engage them in decision making about their local health and social care services.

“It’s really positive to see so many thousands of people following what their Healthwatch is up to and using social media to share their views and experiences of local hospitals and GPs.

“The key now is to ensure we join-up with local services on platforms like Twitter to ensure people’s online conversations can be used to influence real change.

“There is great opportunity for social media to make a positive difference to the way providers work with patients, all the system needs to do is listen.”

Chief executive officer of the NHS Confederation, Rob Webster, said: “The conversations we have on social media are a significant part of modern life.

“Social media is a potentially powerful tool for engaging populations. This will be essential as we work to improve healthcare and transform services in the future.

“This analysis challenges us to make sure we use all the routes available to make sure we engage people who use out services and let them have a say in the future of care.”

3.30pm Women who received a text message reminding them about their breast cancer screening appointment were 20 per cent more likely to attend than those who were not texted, according to a study published in the British Journal of Cancer today.

Researchers, funded by the Imperial College Healthcare Charity, trialled text message reminders for women aged 47-53 years old who were invited for their first appointment for breast cancer screening.

The team compared around 450 women who were sent a text with 435 women who were not texted. It found that 72 per cent of women who were sent a text message reminder attended their screening appointment, compared with 60 per cent who were not. 

Text message reminders had the biggest impact on women from the most deprived areas who were 28 per cent more likely to attend their first screening appointment if they were sent a text.

The research found that women were almost three times more likely to cancel their appointment in advance if they were sent a text message reminder.

Lead author, Robert Kerrison, at the Cancer Research UK health behaviour unit at University College London, said: “We all forget things now and then, and doctor’s appointments are no exception – in fact, forgetting is one of the most commonly cited reasons why women miss breast cancer screening appointments.

“Our research found that a cheap, simple text-message-reminder could boost the number of women – especially those from deprived areas – attending screening, or cancelling in advance. More trials are needed to confirm this, but texting could save valuable NHS resources.”

Ian Lush, chief executive of Imperial College Healthcare Charity, said: “The potential positive impact the study could have on the UK population’s health is huge and goes far beyond the borders of London where the text message service was originally trialled. Research outcomes like this confirm the need for the charity to continue funding such pioneering work which will continue to help improve the health of the population.”

Dr Julie Sharp, Cancer Research UK’s head of health information, said: “Research like this can help tackle practical barriers that sometimes stop women from attending screening appointments. Cancer screening can save lives, but it’s important to remember there are risks as well as benefits. People should also receive good quality information to help them decide whether to take up a screening invitation.”

2.00pm BBC Cumbria tweets:

A “major incident” has been declared at the Cumberland Infirmary because they have run out of beds. Please RT. pic.twitter.com/nxMmULVCYm

— BBC Cumbria (@BBC_Cumbria) March 19, 2015

1.30pm NHS trusts are forecast to end the year with an overall deficit of £448m, in the latest sign of the “continuing deterioration” in the health service’s finances.

According to board papers posted on the NHS Trust Development Authority’s website yesterday, based on figures to the end of last December the trust sector is projecting the £448m deficit for 2014-15 in spite of more than £1.3bn in forecast efficiencies.

The £448m shortfall is £140m worse than the £308m deficit which the TDA was forecasting for trusts two months ago.

The papers note that the “continuing deterioration in the financial position of NHS trusts” is “a consequence of the many pressures on providers and an issue of overriding concern”.

It adds that the challenges faced by trusts are “mirrored in the foundation trust sector” and that the early evidence is that “forecasts for 2015-16 will be more difficult still”.

12.03pm Writing in The Times, deputy prime minister Nick Clegg explains how placing therapists will help boost mental provision for young people. 

“If there were thousands of young people suffering from cancer or diabetes in Britain, but struggling to get the help they needed, it would be a national scandal,” he says.

“Yet that’s been the reality for generations of young people with mental health problems.

The Times carries an joint interview mental health minister Norman Lamb and his son Archie, about Archie’s own experience with obsessive compulsive disorder

The family of a man who died after a “do not resuscitate” order was placed on his hospital record without his knowledge have urged others to look over the medical notes of their loved ones, The Times also reports.

Michael Richardson died four day after being admitted to James Paget University Hospital. His family only learnt about his DNR order when they collected his death certificate.

11.38am New analysis of NHS waiting times by Specsavers reveals that patients in some parts of England can wait up to four months to be fitted with hearing aids, around three and a half times longer than the current national average of 4.7 weeks. In stark contrast, patients in other areas of the country are being fitted with their hearing aids within a week of being referred.

Specsavers analysed the waiting times of clinical commissioning groups across England which show glaring variations in the amount of time people are waiting for audiology treatment.

The analysis shows that patients in Yorkshire are particularly badly affected. CCGs in Leeds rank longest in the country for audiology services, with waiting periods of up to 16.8 weeks. In fact, almost 40 per cent of patients in Leeds are not seen within the 18-week NHS target for referral for treatment. Neighbouring areas of Bradford, Airedale, Warfedale and Craven also have some of the longest waiting times, ranging from 8.8 and 9.2 weeks. In contrast, patients in the Midlands are able to receive their hearing aids an average of one week after referral.

Under the NHS Constitution, patients in England should wait no longer than 18 weeks for treatment following referral by their GP. Community providers of audiology services such as Specsavers Hearing Centres must meet even shorter targets and are required to treat NHS patients free of charge within 16 days of referral. Not only do community providers reduce the time that patients have to wait for treatment, they provide quick and easy access to follow up care closer to where patients live. Greater use of community providers can also help reduce the strain on the NHS by taking people out of the traditional hospital setting.

Colin Campbell, director of professional services and NHS Hearing Centres at Specsavers, said: “Like the rest of the health service, NHS audiology departments are being tasked with managing a service in the face of severe budget cuts and increasing demand from an ageing population. In many cases, this is leading to longer waiting times which can put people off attending audiology appointments despite needing hearing aids.

“With community providers, people requiring hearing aids can be seen quicker, with a majority of hearing aid fittings carried out on the same day as the assessment. Furthermore, providing hearing care in the community gives people greater flexibility around where and when they receive treatment, helping to provide them with the hearing aids and support they need to live a full and independent life. Greater use of community providers for hearing care can play a vital role in reducing the pressures on hospital audiology departments by allowing patients to be treated free of charge on the NHS in a shorter time, and by giving them access to ongoing support closer to home.”

Going against the traditional North/South divide, the waiting times analysis shows that patients in the East and South East of England also face longer waits for treatment. CCGs in Ipswich and East Suffolk (12 weeks), Great Yarmouth and Waveney (11.7 weeks), Bexley (10.4 weeks) and Merton (9.5 weeks) show some of the longest waiting times in the country.

More than 10 million people in the UK – 1 in 6 of the population – suffer from some form of hearing loss, with age being the biggest single cause. Approximately 70 per cent of those over 70 year and 40 per cent of those over 50 years are affected by age-related hearing loss. Of the estimated six million people would benefit from hearing aids, only two million people in the UK currently have them, and only 1.4 million use their hearing aids regularly.

11.30am The Guardian reports that David Cameron’s proposal to make weight loss programmes compulsory for anyone who is obese and claiming benefits is “financially and ethically questionable”, according to medical experts.

The prime minister said last month that people who cannot work because of obesity or addiction problems could be compelled to have treatment if they wanted benefits. But an editorial in the leading medical journal in the field, the Lancet Diabetes and Endocrinology, says weight loss programmes rarely work long-term.

Switching to a healthy diet that meets current UK guidelines can reduce the risk of a heart attack or stroke in the over-40s  by up to a third, research by King’s College academics has shown.

The paper reports that scientists measured blood pressure, artery health and heart disease risk factors such as high cholesterol  in 162 non-smoking men  and women aged 40 to 70.

The Guardian also reports that a man who died after hospital staff decided without consultation that he should not be resuscitated was not neglected because medics were following guidelines, a coroner concluded yesterday.

Michael Richardson died at James Paget University Hospital in Gorleston, Norfolk, four days after being admitted. He had been ill for several years with pulmonary fibrosis, a lung condition.

At an inquest in Norwich the coroner concluded that Mr Richardson died from natural causes. He said he was so unwell that the existence of the DNR order did not cause his death, so it could not be said that he was neglected.

11.22am Progress may have been made in dementia care but a look back at the aims of the 2009 National Dementia Strategy that have not been achieved shows there is still much more to be done, says Jeremy Hughes.

Mr Hughes, chief executive officer of the Alzheimer’s Society, writes: “

A lack of proper support in the community results in people with dementia across the country being in hospital when they don’t need to be.

The case must always be made for the financial reasons for change, alongside the imperative of improving care and support.

11.13am Three quarters of health and social care leaders believe finding enough money for care services will be one of the greatest challenges for the next government.

But a similar proportion is not confident that the NHS will be able to meet its goal of £22bn efficiency savings over the period of the next Parliament, according to a Nuffield Trust survey.

The Nuffield Trust surveyed a panel of 100 senior figures for the fourth and final time ahead of the UK General Election.

The findings reveal greater concern than ever about the quality of social care: of the 66 leaders who responded to the latest survey, 85 per cent say standards have worsened over the last year, an increase of 29 percentage points since they were first asked in June 2014.

Despite doubts about the ability of the NHS to meet its efficiency objectives, leaders believe most of the “new models of care” described in NHS England’s five year forward view will improve both efficiency and quality. New ways for the NHS to work with people in care homes was seen as the innovation most likely to be effective.

Panellists also expected to see more use of volunteers in the NHS and social care, as proposed in the Forward View. Eighty two percent expected them to play a greater role in their own organisations, although just two-fifths think the voluntary sector is well equipped to perform a wider role within the NHS.

Helen Crump, Fellow in health policy at the Nuffield Trust, said: “Leaders in health and social care are clear that the next five years will see financial pressure continue to dominate the agenda, but our panel is not confident about the NHS’s ability to meet its tough goals for savings.

Nevertheless, there is support for many of the new care models set out in the forward view as ways of improving quality and efficiency.

“The Forward View lays out a greater role for volunteers, and leaders expect this to become a reality in their organisations by 2020. But our survey also shows they are not convinced that all parts of the voluntary sector are equipped for this yet.

“We’ve warned in the past about the impact of cuts to social care since 2010. Today’s survey suggests that concern about social care is stronger than ever among the most senior people responsible for planning and delivering our health and care services. ”

Read the survey here

11.00am To read the HSJ Frail Elderly Commission’s report, launch the HSJ app and navigate to “Magazine”.

10.47am The Daily Telegraph reports that Ed Miliband has accused the Chancellor George Osborne of a “secret plan” to cut the NHS budget.

The Labour leader seized on Mr Osborne’s “glaring” omission of the NHS from his Budget speech to claim the health service would be subject to “extreme cuts” in the next parliament.

It comes despite a Tory pledge to protect the NHS in England’s budget in real terms in the next parliament.

10.23am Responding to the King’s Fund report Acute hospitals and integrated care: from hospitals to health systems, NHS Confederation director of policy, Dr Johnny Marshall said: “This welcome report reinforces what we have been saying for some time – that all NHS bodies, including acute trusts, need to look beyond the boundaries of their own organisation, and work with key partners, including local government, to improve the health and wellbeing of their local communities.

“There are many examples of this kind of leadership across the health service but we need Government to support this approach – stability is key to building these local partnerships. The next Government must avoid another top down reorganisation of NHS structures at all costs.” 

10.20am Responding to the report’s findings,Chris Hopson, chief executive of NHS Providers, said: “This report proves that NHS providers can be a catalyst for the changes needed to realise the five year forward view.

“Systems leadership is all about the ability to lead collaboratively, drive culture change, and redesign sustainable services in the best interests of patients.

“These five case studies illustrate that providers have the capacity, the capability, the resources and the ability to do just that. And whilst the report focuses on acute trusts, we know from talking to our members in community, ambulance and mental health trusts that they are also leading in this way.

“Five of our members have taken forward exciting programmes that make a difference to the patents they care for:

• Northumbria Healthcare’s High Risk Patient programme for older people and those living with long term conditions has achieved buy in from all of its general practices across the region;
• Sheffield Teaching Hospitals has achieved better access to home based rehabilitation following discharge, and successful collaboration between acute, community and social care professionals through the Active Recovery Pathway scheme;
• In Airedale, the collaborative care team have improved intermediate care services by working with multidisciplinary teams, with an approach designed by clinicians themselves and they are making extensive use of teleheath technology;
• The team in Yeovil District Hospital has implemented a multi-morbidity care model that expects to significantly increase the efficient use of resources in the acute care setting as well as improving outcomes for patients;
• South Warwickshire’s Discharge to Assess programme employs discharge co-ordinators to work with the patient and their families at an early stage, to ensure that they are on the correct pathway for their level of care need.

“Working with their community and social care partners, providers of NHS care can be integral to moving towards a co-leadership model in their local systems, and this report offers concrete examples of how this can be done. We look forward to continuing to work closely with our colleagues at The King’s Fund to encourage stronger systems leadership throughout the NHS provider sector”.

10.18am The King’s Fund has this morning published a report entitled Acute hospitals and integrated care: From hospitals to health systems.

Here is their blurb:

10.13am This third and final report from the commission sets out obstacles to improving care and puts key questions to politicians, citizens and providers.

The HSJ commission set out to produce some practically useful tools to help the NHS improve hospital care for frail older people. Our scoping report was about supporting hospitals’ self-diagnosis; our main report set out key actions and best practice for hospital and system leaders, as well as highlighting a need to reset some expectations.

To read the report, launch the app and navigate to “Magazine”.

9.58am Good morning and welcome to HSJ Live. The NHS Innovation Challenge Prize ceremony, held in Manchester last month, featured five Acorn challenge winners. Here we find out how each winning entry impacted on patient care.