Your essential update on health for the week

Tories set out NHS election offer

The Conservative party – just to be clear, that’s the one widely expected to win the election – has published its manifesto for government.

Here’s our coverage of the document:

All the best comment and reaction was gathered in our liveblog, which ran throughout launch day. Key points? Well, a little surprisingly it did at least discuss NHS funding. Unfortunately, as with the other main parties, the proposal for day to day spending offers only a further five years of historically squeezed funding. It holds up an unquantified but purportedly “ambitious” capital spending scheme.

The Nuffield Trust observed that none of the main UK parties are promising to increase spending on health as a proportion of Gross Domestic Product – a pretty extraordinary state of affairs given the funding squeeze and the positioning of the Labour Party this year.

Meanwhile HSJ bureau chief David Williams tweeted that for the NHS the manifesto was basically “2015 redux”, with the added promise of new primary legislation to support the Five Year Forward View, plus a bit of stick for NHS England’s leaders.

What did he mean by that? The Conservative Party manifesto this year has an entire section on “Holding NHS leaders to account”.

That section opens with a passage on how NHS England is in charge of organising how care is delivered, and how the Tories support its plan – the forward view. Indeed, they may be so supportive of the forward view that they are willing to legislate to remove any technical barriers to it – although there is no specific detail on whether that will involve abolishing the purchaser-provider split or simply merging NHS England and NHS Improvement.

Trust chief faces disciplinary hearing

On most days this would have been the only story people were talking about: one of the NHS’s most high profile chief executives faces a disciplinary hearing next week.

Sir Leonard Fenwick, CEO of the “outstanding”-rated Newcastle Upon Tyne Hospitals Foundation Trust, has been on “extended leave” all year. He is the longest serving chief executive in the service.

HSJ previously revealed he had been accused of bullying – although the exact subject of the 23 May hearing is not yet known. An investigation into “serious issues” at the trust is understood to have been completed, and has been passed to trust chair Kingsley Smith.

GPs, wish you weren’t here?

Sorry, workworn practitioners of Britain: this is not a guide to whether the Cotswolds or Caribbean are the most enjoyable escape location. Nor to how best to prematurely cash in on the pension pot, leaving your laggardly bleeding heart colleagues at the Village Practice in the lurch and holding the lease. There are other websites for that.

Instead we bring you, in technical terms, the health economies which are most likely to face large proportion of GPs retiring; on the basis they have the largest share aged 55 and over.

Here’s the story – areas with both an ageing workforce and existing low coverage of GPs by population include some of the usual suspects for GP and workforce gripes: Essex, Kent and Lincolnshire.

Here it is on a map: Regions with the most GPs nearing retirement.

The ransomware attack decoded

(by Ben Heather, HSJ technology correspondent)

For most trusts hit, directly or otherwise, by the unprecedented ransomware attack that hit the NHS, the worst appears to be over. For now.

An unfortunate handful continued to suffer through last week with appointments and operations cancelled, IT systems still down, patient care disrupted. For the rest, there is time to reflect and prepare for likely future attacks.

Another major cyber attack on the NHS is nearly inevitable, but the disruption to patient care is not.

Much has been made of the NHS’s reliance on Windows XP, and how that left it open for attack.

It is true that the NHS’s IT infrastructure has, and continues to be, underfunded. It is also true that long after support ended for XP in 2014, leaving it vulnerable to just these sorts of attacks, the NHS continued to rely heavily on the system.

However, in July two separate reports, from the Care Quality Commission and National Data Guardian, made the dangers of the NHS reliance on obsolete technology abundantly clear. Since then, many trusts have moved off XP, or isolated ageing devices still using the system, such as scanners, from the rest of the trust’s network.

NHS Digital claims that of the 1.5 million computers and devices running Windows in the NHS, only 70,000 or 4.7 per cent are running XP. This is down from 18 per cent last year, the agency says.

While these remaining XP computers could have been the malware’s gateway into some trusts, if NHS Digital’s figures are correct, that is unlikely in most cases.

Trusts failing to update security on more modern Windows operating systems, which is what is used on most NHS computers, probably played a bigger part in the malware spreading to a fifth of all trusts.

A software update protecting against this specific attack was available in March. On 27 April, NHS Digital urged more than 10,000 trust IT staff to apply the update. At this stage, on the face of it, it appears many did not do so.

While hundreds of other non-NHS organisation were infected globally, there is some speculation that organisations known to be vulnerable were targeted.