The must-read stories and debate in health policy and leadership.

Digital turnaround

A year ago, the state of digital providers made for an alarming read. The Care Quality Commission thought nearly half were, in some way, not providing a safe service.

The biggest concerns were around a laissez-faire approach to prescribing medicine, including opiates, and not telling a patient’s regular GP about prescriptions.

Roughly a year on, a few of these providers have shut down (or been shut down) and a few new ones have sprung up, but the overall number remains about the same.

What has improved is quality. An HSJ analysis of CQC reports shows, at last reported inspection, only six providers were deemed to be offering care that was not safe in some way. This compares to 16 a year ago.

Furthermore, of these six, only two are operating in the NHS. Both have said they made further improvements since their last published inspection.

Digital providers are not given a rating on a scale of “outstanding” to “inadequate” like their more traditional peers, although this is in the pipeline. This makes it difficult to compare care quality between the two markets.

The CQC also only regulates digital services that involve a human health practitioner, so the improvements say nothing about the quality of the growing market of both clinical and patient-facing health apps.

However, a positive trajectory for the quality of these services is timely. The NHS long-term plan had some bold ideas for the expansion of digital patient services, particularly in primary care. Now the NHS knows there is a cohort of safe digital providers that can help deliver on those ambitions.  

Systems stalled

Parliament’s public accounts committee had the great and the good before them on Wednesday as it put the NHS’ screening programme under its gaze.

But the big news of the day came when Simon Stevens declared NHS England would be taking cervical screening’s back-office functions off Capita and drawing them back in-house.

Many will see this as one in the eye for the outsourcing giant and a blow to its £330m Primary Care Support England contract. But, more broadly, this is a step toward finally upgrading some of the programme’s creaking IT infrastructure.

Experts have been telling the government for years that the systems the screening programme relies on need to be improved. The screening programme is 30 years old and some of its infrastructure is the same age.

The need for new kit became more urgent in 2016 when it was announced cervical screening was to be radically overhauled to introduce primary HPV screening.

The plan was to put the programme through this upheaval after a new, more streamlined database system had been installed.

Capita was supposed to be doing this, but the effort stalled in 2017. Mr Stevens told MPs this week NHS England “did not have confidence… based on Capita’s ability to manage that transition safely”.

By June, cervical screening’s back-office returns to the NHSE fold. By 2020, a new IT system should have replaced the suite of 83 databases currently underpinning the programme.

At best, that will be several months after the December 2019 deadline for all England to be running primary HPV screening. Experts are worried about the old system’s ability to support the shift to the new screen. So, cervical screening may be coming back in-house but it may not be out of the woods just yet.