The NHS e-Referral Service is back online following technical problems, plus the rest of today’s news and comment

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3.42pm UPDATE: Commenting on the technical issues with the NHS e-Referral Service, a HSCIC spokeswoman said: “The service is now available  and we will continue to monitor around the clock.  Our first priority remains ensuring minimal disruption to patients and professional users. We are sorry for the inconvenience caused.”

3.25pm In response to our coverage of the technical gremlins facing the NHS e-Referral Service, a reader tweets:

2.53pm The NHS e-Referral Service, the online system replacing the Choose and Book programme to arrange hospital referral appointments, has gone offline due to a number of technical problems just two days after its launch.

The Health and Social Care Information Centre, which runs the system, had identified 33 known problems with the service since it was launched.

A notice on the information centre’s website posted at 1pm today states: “HSCIC are completing the final stage of testing a number of fixes to the NHS e-Referrals Service.

“It is hoped that the service will be available again later today. A further update will be issued at 15:00 today.”

“We are experiencing some technical difficulties. We are working hard to resolve these issues as quickly as possible and to keep disruption to a minimum. We will continue to update users regularly and are sorry for the inconvenience this has caused.

Dynatrace, a provider of software analytics tools which brought the issue to HSJ’s attention said in a statement: “The NHS England e-Referral system is already suffering from ‘technical problems’ just two days after being launched – even the service status page isn’t working!

“The Health and Social Care Information Centre had already flagged that there were over 30 existing problems with the service – this begs the question, why did the launch go ahead?

“It is much more expensive to fix application problems in the field, rather than in the testing environment – not to mention creating more frustration for customers and embarrassment for the organisations responsible.”

2.30pm Figures from the charity Age UK show an escalating social care crisis in England with 2,431,120 bed days lost to the NHS between June 2010 and March 2015 as people wait too long for vital social care.

It costs £669m to keep people in hospital waiting for social care, with most of these being aged 65 and over.

In the last year alone, April 2014 to March 2015, shortages in community health and social care services have meant the NHS has wasted hundreds of thousands of bed-days whilst patients wait for the right care and support in the right place, including;

  • 174,138 days waiting for a place in a residential home
  • 215,662 days waiting for a nursing home place to become available
  • 206,053 days for help from social care workers or district nurses to enable people to return to their own home
  • 41,389 days for home adaptations ranging from grab rails to ramps and stair lifts.

An NHS bed costs on average £1,925 a week compared to about £558 for a week in residential care or £356.58 for home care based on three hours of care per day over the course of one week. 

The average number of patients who were kept in hospital unnecessarily because social care was unavailable increased by 19.3 per cent between 2013-14 and 2014-15.

In this period 44 per cent more patients were waiting for health and care packages at home compared to the previous year, and 32.8 per cent more patients were waiting for a place in a nursing home. 

These waits for care and support outside hospital are happening against the backdrop of £2.4bn cuts (31.2 per cent) from social care budgets for older people since 2010, mostly as a result of reduced funding for local government from central government.

Caroline Abrahams, charity director at Age UK, said: “These figures show that year on year, older people are being trapped in hospital in ever greater numbers because of a delayed assessment, care home place, home care package or home adaptation.

“Without decent social care when discharged, whether to their own home or to a care home, hospital stays are often much longer than they need to be and older people are more likely to be readmitted because their recovery stalls.
“Policy makers must face up to the fact that an ageing population means increasing numbers of older people needing good social care, and unless and until we provide it the pressures on our hospitals will become more and more unsustainable.”

1.23pm The regulator Monitor has announced that it is taking action at Lancashire Teaching Hospitals Foundation Trust because of serious concerns over a deepening hole in its finances and problems with its financial management.

Following an investigation in March, the watchdog found the trust in breach of its licence to provide care, and agreed a series of actions with the trust to address problems with its financial position and the way it is being run.

The trust, which provides general care to patients across Preston, Chorley and Lancashire, and specialist care for patients across the north of England, reported a deficit of £2.8m in 2014/15 but forecast a £46.8m deficit for 2015-16.

This was the biggest deterioration in finances in the NHS foundation trust sector this year, and Monitor’s investigation found the trust lacked both the robust plans and the financial management needed to address its problems.

Lancashire Teaching Hospitals has also agreed to develop and deliver a long term plan to ensure its finances return to a stable position. Monitor will appoint a Financial Improvement Director to provide support to the trust and hold it to account for making progress.

The regulator will also amend the trust’s licence to ensure that, if the trust fails to make the changes needed, further action could be taken in future including changes to the leadership team, if required.

1.10pm The procurement of a new NHS 111 service to span 16 clinical commissioning groups in the West Midlands has been abandoned after no ‘acceptable’ bids were put forward.

Sandwell and West Birmingham CCG, the lead commissioner, said it did not receive a bid that was “acceptable and demonstrated value for money” and has ended the procurement process.

The only bid came from West Midlands Ambulance Service Trust, which currently provides the service and will continue to do so until the contract is re-procured in the autumn.

1.00pm Experts have warned that patients could end up waiting longer for treatment as acute trusts try to tackle an expected overall deficit of more than £2bn this year.

HSJ analysis of finance reports from May and June for 142 acute trusts, including specialist trusts, provides the most comprehensive picture to date of the financial challenge facing the sector.

Eighty per cent of the trusts have forecast they will end 2015-16 in the red.

12.44pm To mark Learning Disability Week, NHS Employers and NHS England are today launching a new national network to remove barriers and take steps to accelerate employment of people with learning disabilities in the NHS.

NHS England chief executive Simon Stevens said: ““The NHS family is the biggest employer in the country, and one of the largest in the world. Listening to what people with learning disabilities say about how they want to lead their own lives, now we want to expand the number of NHS employers who successfully harness the talents, expertise and experience of people with learning disabilities.”

Over the next few months, NHS England and NHS Employers will develop practical support and a network of NHS organisations committed to making progress across the NHS to increase employment of people with learning disabilities.

11.29am The Guardian reports that women should be advised to have IVF with donor eggs instead of their own when they reach the age of 44 to boost their chances of success, fertility doctors have said.

Researchers in Spain found that the chances of women having a baby through IVF was only 1.3 per cent in those aged 44 and above, but 24 per cent for those aged 38 to 39.

The chief medical officer, Sally Davies, has requested a review to shore up public confidence about the safety and effectiveness of medicines in response to the controversy around statins and the Tamiflu vaccine, The Guardian reports.

Davies wrote to ask the Royal Academy of Science if it would undertake the work.

“I am very concerned about the lack of resolution of the statins and side effects issues in both the medical and general press,” she wrote.

11.28am Looking to the newspapers this morning, The Daily Telegraph reports that Keyhole knee surgery should be phased out because it does little good and could even kill patients, a study has shown.

The benefit of surgery for middle aged or older patients with persistent knee pain is inconsequential and potentially harmful, say researchers in a study published in The British Medical Journal.

More than 150,000 operations take place each year on middle aged and older adults yet there is little scientific evidence to show that it improves movement or lessens pain. Exercise or physiotherapy is likely to be just as effective, they argue.

Elsewhere, the paper’s health editor, Laura Donnelly, reports that having an abortion could significantly increase the risk of harm during future pregnancies, a study has shown.

Research on almost two million women shows that a common surgical practice shows that a common surgical practice used during terminations results in a 29 per cent greater risk future babies will be born prematurely – putting them at greater risk of death or disability.

Separately, the paper reports on a catalogue of serious failings by NHS trusts across the country that have been outlined in a damning report by the health service ombudsman.

A litany of complaints made by patients and their families, such as a man with dementia left on a trolley for 33 hours and relatives of a woman forced to listen to her die from the other side of a curtain, highlight poor complaint handling and failures across the NHS.

The report, published by the Parliamentary and Health Service Ombudsman, contains the details of 163 investigations into unresolved complaints made over two months last year, including breaches of cancer waiting times, families resorting to putting their family in private care following unsafe discharges from A&E on Christmas Day and the death of an unborn baby following missed opportunities to deliver it early.

11.04am The Royal Free London Foundation Trust is considering a joint venture with a specialist orthopaedic hospital trust.

A report submitted to the north London teaching hospital’s most recent board meeting showed it was considering a memorandum of understanding with the Royal National Orthopaedic Hospital Trust.

This would include exploring the possibility of setting up a “joint venture of elective orthopaedics” on the Chase Farm site, which the Royal Free took over when it acquired Barnet and Chase Farm Hospitals Trust in July 2014.

11.03am Plans to roll out the use of digital technology in the health service could result in efficiency savings up to £10bn by 2020, work conducted for NHS England has estimated.

The national body will today publish plans which aim to make the NHS fully digital by 2020, including new regulatory powers and allowing patients to write in their care records from 2018.

It follows the Personalised Health and Care 2020 proposals that were put forward by the National Information Board last November, and officials will now begin gathering views from “leaders and influencers” before a final publication in September.

11.00am A charity has called for NHS England to allow all hepatitis C patients to access new treatments. It comes after the arm’s length body announced a much delayed commissioning policy for cirrhosis.

Last week NHS England unveiled £190m of extra funding for patients with cirrhosis to access the drug sofosbuvir.

The move is expected to mean 3,500 more patients will be able to access treatment in 2015-16. It was described by NHS England as the health service’s “single largest investment in new treatments this year”.

7.00am Good morning. Until we tackle the relatively recent and accelerating culture of locdfedrum working which leads to high rates of pay, the GP workforce crisis will continue regardless of numbers, writes Matthew Wright.