News / News review - June 2017

Sadly, IT professionals’ prediction that the NHS being hit by a major cyber attack was a case of ‘when, not if’ came true in May. The news focus on the general election was broken on 12 May, when 47 English trusts, 12 Scottish health boards and a number of GP practices were hit by a ransomware attack that encrypted files. IT staff worked all weekend and into the following week to restore files, but appointments and operations had to be postponed. The attackers, who did not specifically target the NHS, demanded £230 for each decryption from health bodies in the UK and private companies round the world.

The virus exploited a vulnerability in Windows operating systems. In the wake of the attack, NHS Improvement chief executive Jim Mackey emailed all trusts to outline the actions that should be taken. These included assessing the scale of the infection across the organisation and the mitigating actions taken. He added that a risk-based decision should be taken on whether unpatched PCs should be disconnected from the network. There were some changes to finance collections, which were due in the week after the attack – changes to performance against organisations’ 2016/17 control total, due by 17 May, were collected by NHS Improvement regional finance contacts, while the 2017/18 month one collection was moved from 16 May to 22 May.

The NHS faces the prospect of industrial action over pay by nurses later in the year. Nine out of 10 Royal College of Nursing members told their union that they are willing to take industrial action and 78% would strike, according to an indicative poll by the union. Though 52,000 members took part, the turnout was not high enough to lead to a formal ballot. However, delegates at the RCN annual congress backed a motion for a summer of protest, followed by a ballot on industrial action, should the incoming government not end the pay restraint policy. RCN delegates also called for Scotland, Northern Ireland and England to follow the example set by Wales of enshrining safe staffing levels in law. The RCN said about 40,000 nursing posts were unfilled in England along with 12,000 healthcare support worker vacancies, leading to concerns over patient safety. Mental health and community care providers were hardest hit. The congress also called for a pay banding review.

Meanwhile, the Health Foundation warned the NHS could face a shortfall of 42,000 nurses – 12% of the nursing workforce – by 2020. In an analysis based on the 2016 NHS staff survey, the foundation added that the overall workforce shortfall could get worse as pay for staff on band 5 and above will drop by 12% in real terms between 2010/11 and 2020/21. Its report, In short supply, said workforce planning was the service’s Achilles heel.

The latest figures for A&E performance in England and Wales showed some improvement in the face of increasing demand, but most targets remained unmet. In Wales, figures for March and April this year show 82.8% of patients were seen within four hours in A&E – 1.8 percentage points higher than March 2016 and 2.5 points higher than April 2016 – but still short of the 95% target. In scheduled care, 88% of patients had waited fewer than 26 weeks – the target is 95% – while 2.8% had waited more than 36 weeks. In both measures, this was the best performance since March 2014. In scheduled care, outpatient referrals had increased 5.6% compared with March 2016, while A&E activity was 5.1% higher than in April 2016.

The March performance figures for England showed that 90% of A&E patients were seen within four hours. Though A&E attendances were down 3.3% on March 2016, over the 12-month period they were 2.2% higher. Emergency admissions were 3.2% higher than in March 2016 – the highest number of admissions recorded in a single month. As in previous months, the targets for A&E, consultant referral and diagnostic tests were not met in March. However, the NHS continued to meet six of the eight cancer standards.

Scottish health secretary Shona Robison announced a further £9m to reduce A&E waiting times this year. She said the money would help health and integration boards focus on priorities such as daily dynamic discharge to reduce bed blocking; reducing inappropriate hospital stays; maximising discharge before noon; and closer working with integrated joint boards.

The British Medical Association said that public health is a ‘ticking time bomb’ that must be addressed. It said public health budgets face a cut of £400m between 2015/16 and 2020/21, even though rates of obesity remain high, nearly one in six adults smoke and almost 8 million binge drink. Cuts were a false economy, the doctors’ union claimed. It is estimated that, on average, more than £14 is saved for every £1 invested in local and national public health interventions, it said.

A sign of the growing lifestyle-related problems was seen in a BBC story that said ambulance services in England had spent hundreds of thousands of pounds on ambulances specially designed for obese patients. It said this had followed a 10-fold increase in hospital admissions linked to obesity over the last 10 years. NHS obesity statistics suggest nearly 60% of women and 70% of men are overweight, with the service spending £5bn in 2014/15 on treating obesity-related ill health.

Vanguards are not giving mental healthcare sufficiently high priority and have lacked ambition in plans to bring physical and mental healthcare together, according to the King’s Fund. A report, Mental health and new models of care, written with the Royal College of Psychiatrists, said there was strong evidence that treating mental and physical health needs together is better for patients and more cost effective. Some vanguards had made progress, for example Tower Hamlets in London had reduced by 12.7% the number of bed days for people with dementia, serious mental illness and depression. Lessons learnt in the vanguards should be rolled out across the country and sustainability and transformation plans should offer more mental health support in GP surgeries and hospitals, it said.

Social services in Wales will receive an extra £20m, according to social services and public health minister Rebecca Evans. The funding, which has come as a result of the consequential funding from the UK March Budget, will be invested in three priority areas, she said – £9m to manage workforce costs; £8m to prevent children entering care and improve the outcomes for those leaving care; and £3m to support respite care. 

Quotes

‘Relentless undermining has pushed us to breaking point. No more. This ends now. We’ve had the poll, let’s have the action.’

Ed Freshwater, a member of the RCN Mental Health Forum, calls for industrial action over pay restraint at the RCN congress


‘When it comes to public health, the UK is going backwards. Prevention is better than cure and cuts to public health have a damaging impact on
individuals’ health and wellbeing, and end up costing the NHS more in the long term.’

BMA council chair Mark Porter urges
 government action on public health

‘Thank you to you and your teams for the
 work that has been going on over the weekend to recover services following the cyber-attack on Friday. We know that staff have put in many extra hours to address the problems caused by this incident.’

Jim Mackey (right) applauds the efforts of NHS staff to cope with the cyber attack on Friday 12 May

‘The approaches being developed in the vanguards are intended to be a blueprint for the future of the
NHS, so mental health needs to be at their core. Getting this right means better quality care, and could also help the NHS to meet the challenge of providing healthcare free at the point of use to an ageing population.’

Vanguards must do more on mental health, says King’s Fund chief executive Chris Ham (right)

From the HFMA

 

The post-election period could offer the new government an opportunity to revisit planned health spending, according to HFMA research manager Duncan Watson (right). In a blog for the HFMA website, he said the new government could conduct a spending review. There’s scope to change not only the level of funding, but also what it pays for and how it is distributed across England – although this may be wishful thinking, he said.

He outlined two new HFMA briefings on funding flows, allocations and budget processes, part of the association’s How it works series. One focuses on the allocation process from the Treasury via the Department of Health to NHS England, while the second focuses on the flow of funding from NHS England to clinical commissioning groups.

Also this month, the HFMA Healthcare Costing for Value Institute issued a briefing on a project it supported at three acute trusts in England. The scheme looked at how easy it is in practice to link costs and outcomes at a patient level.

The HFMA board has paid tribute to Paul Briddock after he stood down from his role as policy and technical director. HFMA chief executive Mark Knight said Mr Briddock had been a passionate advocate for the association and made a major contribution to raising its profile in the past three and half years. Mr Briddock said, with the HFMA refocusing on its development agenda, ‘it was the right time to look for fresh challenges’.