Healthcare News UK

Use of the health service is more common among older and less wealthy people and these groups are less likely to have smartphones

Do you remember when there was "an app for everything" – except for people who wouldn't stop saying "there's an app for that"? The catchphrase may have lost its ubiquity, but mobile apps are here to stay – Apple recently celebrated 50bn sold. The NHS has been slower off the mark than other sectors, but enthusiasm for health-themed apps is starting to permeate the health service.

NHS Choices has started a health app library, and there has been a proliferation of articles in the healthcare press about the potential role of apps in the future of medicine. The most recent I came across was a piece by Ashley Bolser.

Bolser's article made some good points, in particular his argument for a process to ensure health apps contained accurate, reliable information. Furthermore, apps have a great deal of potential uses in the healthcare industry.

I am yet to be convinced, however, that this particular kind of technology is going to have a big impact on the NHS – at least in the short-to-medium term. The reason is very simple: NHS core customers are unlikely to have smartphones.

A report showing UK smartphone ownership by age band, as of March 2011, showed that ownership is lowest among older and less wealthy peole. Conversely, use of the NHS is more common among these same groups. Data for 2011-12 show that patients aged 65 and over accounted for almost 40% of finished consultant episodes in English NHS hospitals. The link between poverty and poor health is well established; see for instance Lord Darzi's year of life expectancy lost with every stop heading east on the Jubilee Line.

This fits with what clinicians are seeing on the front line. Dr Jonathon Tomlinson, a GP in Hackney and a medical blogger, is probably far from atypical in his estimate that 10-20% of his practice's patient list accounts for 80-90% of all appointments, and that the elderly, deprived and poorly-educated are disproportionately represented in this group.

If the NHS is going to cope with a future of static or negative funding growth, the big opportunities for cost savings are going to come from preventing these core customers from using as much healthcare as they currently do.

It is easy to conflate novelty with usefulness, especialy where technology is concerned, and it isn't hard to find NHS-specific examples of prioritising medium over message. Take Second Health that was once the future of healthcare communicationas an example. Early in 2007, online virtual world Second Life was approaching the zenith of its popularity. Imperial healthcare NHS trust spent an unspecified amount on purchasing electronic real estate and constructing a virtual community hospital and polyclinic.

The idea was to use this digital space to engage with patients, the public and clinicians. There were plans to incorporate sessions spent operating on computer-generated patients into medical training. An early highlight of the project was a surgical conference where 200 attendees were addressed by a mermaid. Today, however, Second Life's popularity has faded and the hospital and polyclinic seem to have disappeared.

Money, time and enthusiasm are all finite resources. The NHS needs to direct these resources to where they will have the greatest effect. The methods and technologies used to improve services can be arrived at by working backwards and asking: what does the customer need?

Cassander Grey works in NHS commissioning. He writes under s pseudonym about health policy and NHS management

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NHS Trusts have failed to report benefits of National Programme for IT systems leading to incomplete information on the success of the programme, says a report by the National Audit Office.

Principal GP system suppliers are backing the government's move to require open Application Programme Interfaces to encourage innovation in the primary care IT market.

She looks a bit like Frankie in real life, but otherwise the BBC drama gives a bit of a warped impression of what district nurses like Rachel Cooper actually do

I've been a district nurse in the Bristol area, like Frankie, since 2010. Most of the nurses in my team watched the first episodes of this BBC drama, glad to see a programme on what we do. But it's definitely for entertainment only: many aspects fall wide of the mark. I've kept watching, but some of the team are so frustrated they've given up.

In the first episode, we saw Eve Myles, as Frankie, visiting a man to administer insulin and noticing signs of dementia. This is something we often encounter, and the programme accurately reflected the judgments we make about whether a patient needs further assessment, or is safe to stay home. But there's no way a nurse who had been knocked down and threatened with a knife wouldn't file a report. There's a clear system in place – to ensure both our safety and the patient's.

Another storyline, in which Frankie gets involved with a pregnant woman and her ill daughter, was completely unlikely. We're not midwives: there's no way we'd be measuring a woman's bump, or rushing to her bedside to help deliver the baby – and we certainly don't have consultant paediatricians on speed-dial. If we were worried about a child, we'd speak first to the parents, then refer them to their GP. I'm concerned people will think our powers of referral are greater than they are.

A patient said to me the other day: "You look just like Frankie, don't you?" I don't really, although I do have dark hair – but it's true that, like Frankie, I'm dedicated to the job. She's had 12 appointments in a day, which is pretty accurate – my record is 14. The progamme has also tried to reflect the cutbacks happening across the NHS. We've not felt the bite quite yet, but it's good to raise awareness, so people understand why there might be delays in referrals or treatment.

I've never missed a surprise birthday party – or a proposal – because I was with a patient, as Frankie does, but the job does put a strain on your personal life and your emotions. We never let patients see it, though: what worries me most about the show is seeing nurses snap at their patients – even shout at a man for not keeping his house tidy. No nurse I know would ever treat a patient like that.• Rachel Cooper is a district nurse for North Bristol NHS Trust. Frankie is on BBC1 on Tuesdays.

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Laura Barnett
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The last government did much to dismantle the health service

To place Andy Burnham and his Labour crew back in charge of the NHS would be akin to appointing Tony Blair peace envoy to Iraq ("A&E crisis leads to surge in cancelled operations", News).

Labour took hundreds of millions of pounds that should have been used for fortifying our health services and stuffed it into the pockets of what are now the richest doctors in Europe. Not surprisingly, a lot of them preferred to work a lot less while still being well paid and the out-of-hours service (in many hospitals as well as GPs) became a sick joke.

The last Labour government removed any semblance of responsibility for NHS coalface achievement from government by creating a gross pretence of "local accountability" through trust boards that were neither local nor accountable. It was Labour that destroyed the country's community health council network. They replaced this with a "care quality commission" that was so under-resourced and poorly managed that it could do its own job with neither care nor quality.

It was Labour that wasted billions on private finance initiatives within the NHS while at the same time forcing NHS trusts to privatise a percentage of their work, even when, in some cases, no patients were treated at all.

Tony Dawson

Southport

As a GP, I often hear complaints from my patients that their surgery has been postponed. Secretary of state for health Jeremy Hunt already has found someone to blame: it must be the GP who is no longer available 24/7. Quite unimaginative, and absolutely untouched by any knowledge of the workings of the NHS and medical practice. I would like to put a few questions to Mr Hunt.

If a human being is so ill that he or she needs to be admitted to hospital urgently, how can the GP act any differently from the casualty officer? On the contrary, in A&E there is the possibility of a few basic tests to determine whether the patient is really as ill as it seems, an option not open to a GP, neither in the surgery nor on a home visit.

If a patient is sent to a ward, then that is probably because the medical officer saw this as the appropriate thing to do. If a patient is sent inappropriately to a ward, why would he or she have to stay? Perhaps it is because this person cannot just be sent home either? And if patients stay in hospital because there is nowhere else for them to go, what does Mr Hunt intend to do about that?

Could it be the cuts in funding for social care that lead to a number of people being sent to hospital because they cannot stay at home safely? Could it be the targets that demand that anyone attending A&E has to be either admitted to a ward or sent home within four hours that are responsible for an increase in admissions? Could it be the relentless pressure on GPs not to refer patients to a specialist in order to save money that has led to an increase in patients reaching a crisis where emergency admission is the only course of action left?

Mr Hunt may argue that these problems stem from policies brought in by the previous government, and he would have a valid point. But his party has been in power for three years and that excuse is wearing very thin.

Michael Meinen

Newcastle upon Tyne

I was struck by how Jeremy Hunt has accused Labour of causing the crisis by "allowing GPs to opt out of offering out-of-hours care". Previously, he had "blamed doctors' contracts ... allowing GPs to opt out of offering out-of-hours services".

I suppose it is easier to get away with blaming a previous government than the GPs themselves. Still, I look forward to a decade or so hence when a future education secretary blames the current government for "allowing" schools to become academies. I wonder, will headteachers be blamed first?

Ingrid Warren

Oxford

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The Royal College of Nursing has today congratulated Fiona Smith, RCN Adviser in Children and Young People’s Nursing, on being awarded Honorary Fellowship of the Royal College of Paediatrics and Child Health (RCPCH).

Full coverage of the final day of the NHS Confederation annual conference in Liverpool, including a keynote speech by Andy Burnham

Clare HortonSarah Johnson

Royal College of Nursing members are being asked to feed into the RCN’s response to Monitor’s consultations by 21 June.

The Royal College of Nursing has described the findings of a report by the Queen’s Nursing Institute into district nurse education as “a very worrying state of affairs”.

On every performance measure I run an efficient team, but only by doing many tasks myself – I'm exhausted

Each Friday and Monday we publish the problems that will feature in a forthcoming Dear Jeremy advice column in the Guardian Money supplement so that readers can offer their own advice and suggestions. We then print the best of your comments alongside Jeremy's own insights. Here is the latest dilemma – what are your thoughts?

I am in my mid-30s. I did exceptionally well in school, then got a decent degree from a Russell Group university. I started my career in investment banking but left after 18 months as my soul was dying, even though the money and sense of status were amazing. I joined the NHS graduate training scheme and, 10 years later, am still with the organisation. I love it and hate it in equal measure.

I manage a team of about 40 people in a support function. On every objective measure the team does well and I am frequently given positive feedback. However, this is only achieved through my undertaking many of the jobs and tasks required of the team myself. I'm exhausted, but I feel the only way I could change things would be to make people take responsibility for their own areas – and the corollary to that is to let them fail. I never feel I can let this happen, and my boss, who is on the board, and other board members expect perfection.

I feel I have done everything you're supposed to do: performance management, setting clear objectives, providing support and encouragement etc. I hate to say it, but the calibre of staff is low. It is impossible to get rid of anyone and I have maybe two or three people who are competent.

Do I try to change things, or should I admit defeat and move on?

• Do you need advice on a work issue? For Jeremy's and readers' help, send a brief email to dear.jeremy@guardian.co.uk. Please note that he is unable to answer questions of a legal nature or reply personally

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Ninety-eight per cent of the estimated benefits of several high-profile National Programme for IT programmes are yet to be realised, according to the National Audit Office.

A care home manager has been honoured for transforming the way patients are cared for in a home in Castlederg.

Mobile wireless technology gives staff the opportunity to access information whenever and wherever they need it

Innovations such as robotic surgery and advancements in imaging mean treatment that what once seemed like science fiction is routine in modern healthcare.

Mobile wireless technology is also revolutionising the way information is used, giving staff the opportunity to access it whenever and wherever they need it.

At King's College hospital, the demand for quicker access to patient information came from clinicians. The IT department was, of course, enthusiastic about this change but also in a quandary – would staff ever turn away from paper notes in favour of handheld computers?

Initially, it was clear that there were benefits to having test results available faster and that it was quicker not to write out a patient's details again and again on each request form. However, we faced a real culture change for staff around how the paper medical records were used. Paper was the preferred option but now the vast majority of staff turn to paper notes only as a last resort. Electronic notes are available wherever and whenever they are needed, and it is not necessary to pass bundles of papers between clinics because more than one person can view them at one time.

But there are logistical challenges, too. We need to make sure there is stable and reliable infrastructure in place to support every piece of technology we introduce.

It has been a gradual change but now about 80% of our processes are managed through electronic systems, and this figure is increasing all the time.

When a patient is first referred to us, DOCMAN Referral management solution allows us to ensure patients are booked into the right clinics without paper letters or faxes. It also gives us a full audit trail of the referral process, so that when patients ring the hospital we know where the referral is in the pathway. Previously, that would have meant hunting through piles of letters on desks.

E-prescribing means doctors can order medications for patients on mobile computers, sending the prescription to pharmacy where it is screened before a robot selects the drugs from the store cupboard. It is checked by human eyes just before it is sent to the ward and administered by a nurse – also using mobile technology to record that the drug has been given.

This system is in place across all of our adult wards, with complete coverage of our children's wards due in the coming months. It's quicker and more efficient: jokes about doctors' bad handwriting are becoming increasingly irrelevant.

Clipboards at the end of patients' beds are disappearing and are being replaced by bedside observation recorded by nurses on an iPod Touch. Clinicians can then order and review tests electronically, monitoring vital signs digitally while automatically recording information.

However, it's not just about efficiency but safety, too. Digital recording means departments can be audited more easily in order to check how effectively they respond to medical alerts. Our in-house IT department also developed a new app for clinicians to record information about patients as they are admitted to hospital. This will ensure that all the information collected about the patient is consistent and avoid the duplication necessary with paper forms.

It is not long since I took my son for orthodontic treatment at our local hospital. The clerk had to decipher the handwriting on the paper forms before my son was x-rayed. Then I had to carry the hard-copy film back to the orthodontist who compared it using tracing paper to the previous film. It all appeared a bit haphazard, but it also reminded me just how far we have come at King's.

Being paperless is a bold ambition and one that will take time, but right now we have areas we call 'paper-light' as we aim to be as paperless as possible.

As time goes by there will be less and less paper around, just as in other parts of our lives.

Colin Sweeney is director of IT at King's College hospital.

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• Digital engagement
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NHS England is to lead on the creation of a strategy for the health service that will try to build consensus about its future and protect it from political turmoil.

New 3D visualisation software of the head and neck is transforming medical and dental training in Scotland.

The British Medical Association has launched a web portal to help people understand the changes happening in the NHS.

Analysis by Macmillan Cancer Support points to ageing population as main driver and warns of 'herculean challenge' for NHS

Rates of cancer are rising so much that by 2020 almost half of Britons will develop the disease in their lifetime, but more people will survive the country's biggest killer, a new analysis reveals.

By 2020, 47% of the population will be diagnosed with cancer at some point before they die, according to projections drawn up by Macmillan Cancer Support.

The incidence of cancer has risen by more than a third over the past 20 years. In 1992 about one in three people (32%) who died that year in Britain had had a diagnosis of the disease. By 2010 that had increased to 44%, a jump of 38%.

Macmillan's latest estimates, based on official data on cancer incidence, all-cause mortality and projections of future cancer prevalence, predict that it will rise again, to 47%, by 2020.

The ageing population is the main driver of the trend, although lifestyle factors such as poor diet, alcohol consumption and physical inactivity are also causes, the charity said.

"In only seven years' time nearly half the population will get cancer in their lifetime. This poses a herculean challenge for the NHS and for society," said Ciarán Devane, Macmillan's chief executive.

The health service needs to undertake a fundamental shift towards proper after-care of patients, with much more care delivered outside hospitals, in or near people's homes, and better engagement with patients in deciding how their care is delivered, added Devane, who is also a board member of NHS England.

Macmillan's research does not include a gender breakdown. But it tallies with a Cancer Research UK study last December which found that by 2027 exactly half of all men (50%) would develop the disease at some point.

Macmillan's analysis includes good news too, though. It anticipates that the proportion of people who survive a diagnosis of one of the 200 or so forms of cancer will reach 38%. It has already risen from just 21% in 1992 to 35% in 2010.

Professor Jane Maher, Macmillan's chief medical officer, said improved diagnosis, drug and surgical advances in cancer treatment and better care of cancer sufferers explained the fact that more people were surviving cancer. But, she added: "The more successful we are with treatment and cure, the more people we have living with the long-term effects of cancer and its treatment.

"Many patients can be left with physical health and emotional problems long after treatment has ended. People struggle with fatigue, pain, immobility, or an array of other troublesome side effects."

Sean Duffy, NHS England's national clinical director for cancer, welcomed the growing survivability of cancer but warned that the NHS could not be complacent and needed to do more.

"We also recognise that we need to be looking at how we can help cancer survivors get back into their day-to-day lives after their treatment is complete. Whether it's specialist help to get back to work or being recommended to a physical activity group, local NHS teams need to consider providing a new range of care services for cancer survivors to tackle their needs and improve their quality of life," Duffy said. "I am determined to make sure our cancer services are world-class and that NHS patients receive the best treatment available."

The Department of Health has told NHS England that it wants it to stop about 5,000 people a year from dying unnecessarily early from cancer by 2015 through earlier diagnosis, better treatment and improved aftercare.

Ministers have pledged to reduce premature mortality in England by about 20%, potentially saving 30,000 lives a year by tackling cancer as well as heart conditions and preventing strokes, by 2020. Efforts so far in fighting cancer have concentrated on identifying those with colorectal and lung cancer earlier, so they can be treated.

"These figures remind us that while our life expectancy is increasing, this also means more of us will be diagnosed with cancer," said Clare Knight, Cancer Research UK's health information manager. "The good news is that thanks to research, cancer survival rates have doubled over the last 40 years. But it's crucial that we continue finding new ways to prevent, detect and treat cancer sooner, so that more people survive in future."

• Cancer
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Denis Campbell
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NICE, the health and social care guidance body, has issued new draft guidance proposing to recommend aripiprazole (Abilify, Otsuka Pharmaceuticals Europe), for treating moderate to severe manic episodes in adolescents aged 13 and older with bipolar I disorder.

Sir David Nicholson says coalition wasted years pursuing pro-market reforms instead of carrying out the changes needed

Sir David Nicholson, the outgoing chief executive of NHS England, launched a scathing attack on Thursday on the coalition government for wasting years pursuing its pro-market reforms of the health service instead of making important necessary changes.

In his final address to top health service managers at the NHS Confederation annual conference, he took aim at the political class, saying: "We cannot let the tyranny of the electoral cycle stop us from making the real and fundamental changes that we need to make to the NHS."

He said that before the 2010 election Conservative and Liberal Democrat MPs had criss-crossed the country telling voters that Labour's plans to reconfigure hospitals would be put on hold and then, upon taking office, they produced the biggest reforms of the NHS in decades.

Nicholson said: "So what happened when we got a new government in is we wasted those two years where you can really make change happen. We spent our time talking about reorganisation and changes and all the rest of it and we didn't talk about the really important changes that are required for the NHS."

In a speech peppered with light asides about his 35 years in the NHS, Nicholson admitted sustained criticism of his role in the Mid Staffs hospital scandal – particularly the virulent coverage in the Daily Mail which dubbed him the "man with no shame" – made it impossible for him to continue as the public face of the NHS.

"Being that story I think makes it more difficult for me to do my job. It makes it more difficult, I think, to make the changes that need to be made," he said, adding that the unrelenting scrutiny had made the job more difficult.

"Heavens above, the job is difficult enough without some of the extra things we have to deal with, some of the absolutely overwhelming scrutiny that's put on what we do, everything from the kinds of teabags we use to the hotels we stay in."

However, Nicholson aimed most of his fire at politicians. He made a thinly veiled attack on the health secretary, Jeremy Hunt, who had sought to blame the A&E crisis on a GP contract allowing family doctors to opt out of overnight and weekend care. Nicholson said: "I was particularly incensed about some of the coverage in relation to general practice."

Nicholson, who leaves his £211,000 job next year, warned that the public needed "clarity and honesty" from politicians – especially about the parlous financial state of public finances.

He said that "people in this country should beware of political manifestos that say, with a little bit of growth, with a bit of management costs savings, with a bit of improvement in procurement and, oh, a bit of integration, you can solve the longterm problems of the NHS. You can't."

Defending the service, he said the NHS was the envy of the world and asked which other country would put its health service in an Olympics ceremony.

Nicholson said that such was the focus on patient care in recent years that "we have the lowest hospital mortality rates since records began".

However, given the landmark Francis review, which blamed a target-driven culture for harming patient care, Nicholson admitted that the NHS did let the public down. "On the other side, really bad things happen to some of our patients, sometimes we fail them and their families significantly."

The Department for Health said: "For too long the NHS was run as a top-down system. We believe that it should be able to operate independently, making the decisions and changes that patients really need. That's exactly why we introduced our reforms, to put doctors and nurses in charge and set up NHS England, to deliver the high quality health service patients expect."

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Randeep Ramesh
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The health secretary keeps moving the goalposts over the NHS, yet finds more imaginative ways to score an own goal

Jeremy's Hunt strategy to blame Labour for the crisis in A&E is in tatters. Although the health secretary's aides deny that this was ever his intention, Hunt's speech to the King's Fund last month clearly said under a section entitled "Betrayal of general practice ideals", that in 2004 "some changes were made to the GP contract which fatally undermined the personal link between GPs and their patients".

Hunt then made the case that inadequacies in out-of-hours care lay behind the ongoing rise in people seeking help at hospital A&E units. To ensure this message was understood, it was briefed to two papers – the Daily Mail and the Sun – perhaps sympathetic to bashing feather-bedded workers. However, the decision to cast the crisis in emergency care as part of Labour's legacy immediately rang alarms in the NHS, wary of politicising healthcare debates that deal with delicate clinical issues.

The result was a backlash. On the day the Mail made the story its front page, the head of the NHS Confederation, Mike Farrar, was up before the health select committee and told MPs that there was no link between the crisis in hospital A&E departments and GPs opting out of out-of-hours care. Two days later, Laurence Buckman, the chair of the British Medical Association's GPs committee, accused the health secretary of "spouting rubbish".

On Wednesday night, Hunt was chided by Stephen Dorrell for making claims about emergency care and on Thursday Sir David Nicholson, the outgoing boss of NHS England, criticised the way GPs were being demonised. It has not been a good few weeks for the health secretary.

In response, Hunt has attempted to recast the debate and sensibly chose to describe the solutions to the A&E crisis as having its roots in the inability to reconfigure hospitals, moving older people out of hospitals to be cared for in the community and getting family doctors to take charge of vulnerable patients.

In a measured speech, he talked about cross-party consensus on integration and the need for all politicians to think about how to promote reform in the NHS rather than oppose it. Hunt was emollient and calm, becoming tetchy only when challenged over the issue of GP contracts.

Despite this zen-like performance there are risks here too. Publishing a list of hospital closures next April – a year before a general election – promises to energise opposition both outside and inside the coalition over the NHS.

Entering a negotiation with the BMA – which the former Tory health secretary Ken Clarke famously described as the toughest union he'd ever dealt with – might mean the medical profession denouncing the government in the run-up to national polls. It is unlikely David Cameron would thank a health secretary who got into a bare-knuckle fight with a profession that the wider public considers almost saintly.

Of course, next year the A&E crisis may have evaporated. Although waits have been rising under the coalition they have recently stabilised. Some of the problems in A&E are beyond any health secretary's power – a long, cold winter and infections outbreaks yield to no parliamentary authority. So come next April, Hunt will think long and hard about what to do with A&E.

Plainly the system has faults, but seeking to upend things at a time when the public can see no imminent need for change might be considered brave if not foolhardy.

• Jeremy Hunt
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Randeep Ramesh
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