Casebook - December 2019

December 2019 Edition


NHS e-health systems 'risk patient safety'

Everyone knows this is a problem but this story gives us a timely reminder of the scale of the challenge. It tells us:

Hospitals across England are using 21 separate electronic systems to record patient health care - risking patient safety, researchers suggest.

A team at Imperial College say the systems cannot "talk" to each other, making cross-referencing difficult and potentially leading to "errors".

Of 121 million patient interactions, there were 11 million where information from a previous visit was inaccessible.

The NHS said it was working to ensure different systems could work together.

The electronic medical records (EMRs) system was launched in 2002 with the aim of allowing clinicians easy access to all the information on a patient, even if they had previously been treated elsewhere.

But it has been plagued with delays and operational problems ever since.

The team from London's Imperial College's Institute of Global Health Innovation (IGHI) looked at data from 152 acute hospital trusts in England, focusing on the use of EMRs on the ward.

Around a quarter were still using paper records.

Half of trusts using EMRs were using one of three systems: researchers say at least these three should be able to share information.

Ten per cent were using multiple systems within the same hospital.

Writing in the journal BMJ Open, the researchers say: "We have shown that millions of patients transition between different acute NHS hospitals each year.

"These hospitals use several different health record systems and there is minimal coordination of health record systems between the hospitals that most commonly share the care of patients."

Dr Leigh Warren, who worked on the research, said: "Patients expect their health records to be shared seamlessly between hospitals and healthcare settings that they move between.

"They cannot understand why, in the NHS, this is not the case."

"Yet hospitals and GPs often don't have the right information about the right patient in the right place at the right time.

Full details:

Social care crisis will leave thousands of NHS beds out of action, warns Labour

Ignore the political source of this story. We all know that the challenges set out here are a concern to all political parties. These challenges are more acute for rural settings where the challenges of both distance and a small workforce make managing these issues more exacting, more costly and ultimately more organisationally debilitating. The article tells us:

Thousands of hospital beds could be filled with patients who don’t need to be there over the Christmas period, according to projections by the Labour Party.

Labour has analysed NHS data on so-called delayed transfers of care, where healthy patients are unable to leave hospital because of delays in organising social care and other community services.

Based on past average performance Labour says the data suggests as many as 4,400 beds could be out of action during December. In December last year, 4,155 beds per day were occupied by patients delayed in hospital every day.

Labour says since April 2017, more than 9,200 people have been forced to turn to their local council for help with care costs after running out of money.

Labour’s plans will more than double the number of people receiving state-funded care.

Full details:

General election 2019: Labour says NHS figures show decline in GP services

If we ignore the “political football” aspect this article highlights some of the challenges relating to the delivery of GP appointments. We know this is an acute challenge in rural England where the stock of GPs is declining significantly and the pipeline is not running efficiently. It tells us:

The latest data from NHS Digital show that 2.45 million patients waited between 15 and 21 days in October to see a GP or other practice clinician, which was 8.3% of the total number of appointments, compared with 8% in October 2018.

Another 1.69 million waited between 22 and 28 days for a GP appointment while 1.66 million waited more than 28 days.

In both cases there was an increase in the percentage of patients affected compared to October last year.

The overall number of appointments increased to 30.8 million in October 2019 from 29.7 million in the same month the year before.

Full details:

Private firms handed £15bn in NHS contracts over past five years

There is a rural context here. We know the most acute trusts represent a significantly disproportionate amount of debt in the system. This is due to the challenges, in part at least, of recruiting and retaining staff. The response is to have to buy more services from the private sector. This story tells us:

Private firms have been handed almost £15bn in NHS contracts over the past five years, figures show.

The value of contracts given to non-NHS providers, mainly profit-driven firms but also including some social enterprises, has soared by 89% since 2015, from £1.9bn to £3.6bn a year.

Full details:

Scientists Praise Stronger Beers as “Very Very Healthy” thanks to Gut-Friendly Bacteria

Finally a bit of fun for Christmas…I knew it! And therefore some very positive cheer for Christmas – this story tells us:

Certain beers could be considered “very healthy” thanks to the amount of gut-friendly bacteria they contain, according to scientists specialising in gut health.

Professor Eric Claassen, who works at Amsterdam University, explained that strong Belgian beers, including Hoegaarden, Westmalle Tripel and Echt Kriekenbier, are rich in probiotic microbes that offer a range of health benefits.

Presenting his research at an event held by probiotic drink maker Yakult, Professor Claassen said that unlike most mainstream beers, which go through a single fermentation process, these beers are fermented twice.

The second fermentation not only creates a drier flavour and boosts the strength of the beer, but it also uses a different strain of yeast found in traditional pints. 

This strain of yeast produces acids that kill harmful bacteria in the gut that can make us ill.

Full details:

Other Stuff

Goodbye Jon!

Jon Turner who has been a one man whirlwind recruiter of Rural Health and Care Alliance members has departed for pastures new. We will really miss him and his dynamism and drive. I’m just putting on the record the really valuable contribution he has made to moving us forward.


We held our AGM on 3 December along with a joint meeting with Rural Services Network members. I was delighted with the turnout and the quality of the discussions. We have posted the notes from the meetings on the NCRHC website and you can read them at your leisure.

Rural Proofing for Health Toolkit

Progress with this really important initiative is now moving apace. We have our first Steering Group in early January, which will frame the work and the action plan. Look out for further updates as the initiative progresses. If you would like to know more please drop me an email.

Research Plan

We have just finished our liaison with all members about their priorities for research a very engaging list of themes have emerged. The most popular, which Kay Purle will concentrate on moving to the next stage of action are on:

Older people and technology


Mental health

If you’d like to get more involved please let me know. Finally Kay has just completed a piece of secondary research in her own right on burnout in the rural healthcare workforce. If you would like to know more please email her at:


We are just putting the finishing touches to the 2020 seminar programme.  In the meantime we have our election delayed seminar on “Barriers to Access – Connectivity and Rural Transport“ in Northallerton on 15 January. Its free to all RHCA members so please do come if you can make it – the event will run from 11.30 – 2.30. I can provide more information if you wish.


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