̽��ֱ�� of Cambridge - health services

Services across England now lag far behind East Germany, as experts call for ‘universal basic infrastructure’ in UK

fpjl2 — Tue, 05 Dec 2023 10:34:16 +0000

A new report outlines the dismal state of England’s physical and 'social' infrastructure – from public services in health and education to the parks, cinemas and train stations that prop up communities – when compared to similar regions in what was once East Germany.

̽��ֱ��report’s authors call for a “universal basic infrastructure” (UBI) if the UK is to ‘level up’ its regions and lift itself out of 'flatlining' productivity rates. This UBI would see a minimum level of public and private sector services covering everything from broadband to bus routes.

Researchers matched eleven parts of England such as Manchester and Peterborough with German areas close in population and productivity, primarily in the former Soviet bloc – as this region was a central case study in the UK government’s flagship 2022 ‘Levelling up’ White Paper.

̽��ֱ��report, led by the Bennett Institute for Public Policy at the ̽��ֱ�� of Cambridge, found that in 2021, German towns, cities and regions have on average twice as many hospitals and pharmacies per 100,000 people as their English counterparts.

Places in Germany have over 11 times more mental health centres and practitioners, and eight times more further education providers, than equivalent parts of England, according to 2021 data.*

In 2020, German areas also have twice as many railway stations per 100,000 people as matching English areas, although England averages almost four times more bus stops than Germany.

“Access to physical and social infrastructure across England is highly variable, and shortfalls in provision affect both declining and growing areas,” said report co-author Professor Diane Coyle from Cambridge ̽��ֱ��’s Bennett Institute for Public Policy.

“But even England’s wealthier areas are falling short of equivalent places in Germany, and have seen notable declines in a wide range of types of infrastructure over much of the last decade.”

̽��ֱ��report shows that areas such as Cambridge and Manchester have more healthcare facilities per 100,000 people, for example – as well as more banks, museums and restaurants – compared to areas such as Bolton, Rochdale and Stevenage.

In fact, Cambridge, one of the country’s wealthiest locations outside of London, has over twice as many banks and building societies, on average, and over six times as many further education providers, as Oldham, Central Bedfordshire and Rochdale.

However, the team also found that many elements of “social infrastructure” right across all eleven English areas have tumbled since 2014, regardless of regional wealth and average rates of income.

̽��ֱ��availability of public transport, GP practices, hospitals, mental health care, police stations, banks, cash machines, post offices, primary and further education facilities, theatres, swimming pools, museums, shopping centres, and chemists have declined across almost all English areas analysed in the report.

All local authorities analysed in the report reduced at least one type of health service between 2014 and 2023. For example, Blackpool, Central Bedfordshire, Stevenage and Stoke-on-Trent all decreased their number of clinics, GP practices, hospitals, and dental treatment centres.

Even in Cambridge the number of further education facilities per 100,000 people halved between 2014 and 2023, and GP practices per capita fell by over 14%.

̽��ֱ��number of police stations per capita fell in all places except Bolton, and the number of public parks and gardens reduced in four out of the five areas with data. Contrary to public perception, however, the number of libraries increased across most authorities in the report.

“Universality across the nation is key when it comes to the infrastructure that facilitates most aspects of our daily lives,” said report co-author Stella Erker from Cambridge ̽��ֱ��’s Bennett Institute for Public Policy.

“ ̽��ֱ��community assets we should all have access to, not just schools and doctors but parks, trains, pubs and gyms, are the foundation for human wellbeing, which in turn underpins economic growth.”

̽��ֱ��researchers point out that even rapidly expanding places in England are seeing social infrastructure go in the opposite direction – an impediment to desperately needed house-building.

For example, Bedford sits in the ‘Ox-Cam-Arc’ – an economic boom region encompassing Oxford, Cambridge and London – and is growing at three times the national rate, expanding by nearly 18% between 2011 and 2021.

Yet the town has seen local services weaken, with reductions per capita in everything from bus stops and rail facilities to GP capacity, primary schools, and local banks and cashpoints, since 2014.

̽��ֱ��report calls for “provision presumptions”: thresholds at which existing services cannot be reduced. Coyle, Erker and their co-author Prof Andy Westwood from the ̽��ֱ�� of Manchester argue that a minimum UBI level should be tied to an area’s population growth.

Added Westwood: “Achieving a minimum level of universal basic infrastructure is an ambitious but necessary goal if we want to create economic opportunity across the country. It would prevent the current ‘postcode lottery’, and serve as a catalyst for growth in ‘left behind’ areas, as well as places that are growing rapidly but too often without adequate infrastructure and services.”

Full list of towns, cities and areas analysed in report as follows:
England: Bedford, Blackpool, Bolton, Cambridge, Central Bedfordshire, Manchester, Oldham, Peterborough, Rochdale, Stevenage, Stoke-on-Trent.
East Germany: Bautzen, Cottbus, Erfurt, Halle an der Saale and Rostock. ̽��ֱ��report also used data from Hagen in the Ruhr, a post-industrial town in the west of Germany.

*In 2021, German places averaged at 45 mental health centres and practitioners per 100,000, compared to 4 in English places. In 2021, German places averaged at 14 further education providers per 100,000 population, compared to 2 providers in the English places.

Per capita access to hospitals, mental health services, and further education facilities in German towns and cities – primarily in the former GDR – now outstrip equivalent areas in England, often several times over, according to research.

Even England’s wealthier areas are falling short of equivalent places in Germany

Diane Coyle

Bjoern Wylezich/Getty

Intercity 2 train at Warnemünde station in Rostock, one of the parts of eastern Germany look at in the report.

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Worsening GP shortages in disadvantaged areas likely to widen health inequalities

cjb250 — Wed, 18 Aug 2021 07:43:55 +0000

In a study published today in the BJGP Open, a team from the ̽��ֱ�� of Cambridge looked at the relationship between shortages in the healthcare workforce and levels of deprivation. ̽��ֱ��team found significantly fewer full time equivalent (FTE) GPs per 10,000 patients in practices within areas of higher levels of deprivation. This inequality has widened slightly over time. By December 2020, there were on average 1.4 fewer FTE GPs per 10,000 patients in the most deprived areas compared to the least deprived areas.

̽��ֱ��same was the case for total direct patient care staff (all patient-facing general practice staff excluding GPs and nurses), with 1.5 fewer FTE staff per 10,000 patients in the most deprived areas compared to the least deprived areas.

̽��ֱ��lower GP numbers in deprived areas, was compensated, in part, by more nurses.

̽��ֱ��analysis used data captured between September 2015 and December 2020 from the NHS Digital General Practice Workforce collection. They compared this workforce data against practice population sizes and levels of deprivation across England.

In addition to their report, the team have today launched an interactive dashboard that maps local-level primary care workforce inequalities to accompany the national-level analysis done in the paper. Clear local-level inequalities in GP distribution can be seen within West, North and East Cumbria, Humber, Coast and Vale, and Coventry and Warwickshire STP (Sustainability and Transformation Plan) areas, among others.

Workforce shortages, especially in primary care, have been a problem for health care systems for some time now, and the gap between the growing demand for services and sufficient staff has been widening. Although the number of consultations in general practice has been increasing, staff numbers have not kept up with demand. ̽��ֱ��number of GPs relative to the size of population has been decreasing since 2009, and the GP workforce is ageing. Doctors are increasingly working part-time, which suggests that shortages will grow steadily worse.

In 2015, then-Secretary of State for Health Jeremy Hunt promised an additional 5,000 GPs for the NHS by 2020, but this was not achieved. Instead, it is predicted that there will be a shortage of 7,000 GPs by 2024.

Dr John Ford from the Department of Public Health and Primary Care at the ̽��ֱ�� of Cambridge, the study’s senior author, said: “People who live in disadvantaged regions of England are not only more likely to have long-term health problems, but are likely to find it even more difficult to see a GP and experience worse care when they see a GP. This is just one aspect of how disadvantage accumulates for some people leading to poor health and early death.

“There may be some compensation due to increasing number of other health professionals, which may partially alleviate the undersupply of GPs in more socioeconomically disadvantaged areas. But this is not a like-for-like replacement and it is unlikely to be enough.”

̽��ֱ��researchers say there are a number of reasons that may account for why GP workforce shortages disproportionately affect practices in areas of higher deprivation. Previous studies have suggested that the primary driver of GP inequality was the opening and closing of practices in more disadvantaged areas, with practice closures increasing in recent years.

Claire Nussbaum, the study’s first author, added: “ ̽��ֱ��government has made reducing health inequalities a core commitment, but this will be challenging with the increasing shortage of GPs in areas of high socioeconomic disadvantage, where health needs are greatest. ̽��ֱ��primary care staffing inequalities we observed are especially concerning, as they suggest that access to care is becoming increasingly limited where health needs are greatest.

“Addressing barriers to health care access is even more urgent in the context of COVID-19, which has widened pre-existing health and social inequities.”

̽��ֱ��researchers say that the imbalance in recruitment of staff within primary care must be addressed by policymakers, who will need to consider why practices and networks in disadvantaged areas are relatively under-staffed, and how this can be reversed. Potential options include increased recruitment to medical school from disadvantaged areas, incentivisation of direct patient care posts in under-staffed areas, enhanced training offers for these roles, and offering practices and networks in under-staffed areas additional recruitment support.

Expanded use of additional roles under the Additional Roles Reimbursement Scheme, designed to provide financial reimbursement for Primary Care Networks to build workforce capacity, may partially alleviate GP workload in overstretched practices, but the report’s authors argue that there is a risk that additional workforce will gravitate to more affluent areas, further perpetuating inequity in primary care staffing.

Dr James Matheson, a GP at Hill Top Surgery in Oldham, said: "People living in socioeconomically disadvantaged areas shoulder a much higher burden of physical and mental health problems but have less access to the GPs who could support them towards better health. For the primary care teams looking after them this means a greater workload with fewer resources - a burnout risk which can further exacerbate the problem.

“General Practice in disadvantaged areas is challenging but also enjoyable and professionally rewarding but now, more than ever, we need to see a more equitable distribution of workforce and resources to ensure it is sustainable."

Reference
Nussbaum, C et al. Inequalities in the distribution of the general practice workforce in England. BJGP Open; 18 Aug 2021; DOI: 10.3399/BJGPO.2021.0066

Areas of high socioeconomic disadvantage are being worst hit by shortages of GPs, a trend that is only worsening with time and is likely to widen pre-existing health inequalities, say researchers at the ̽��ֱ�� of Cambridge.

̽��ֱ��government has made reducing health inequalities a core commitment, but this will be challenging with the increasing shortage of GPs in areas of high socioeconomic disadvantage, where health needs are greatest

Claire Nussbaum

punggolzenith

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Black researchers shaping the future

ta385 — Wed, 10 Oct 2018 09:32:12 +0000

Read the full story here

As the UK marks Black History Month, researchers from across the ̽��ֱ�� talk about their route to Cambridge, their inspiration and their motivation.

̽��ֱ�� of Cambridge researchers

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Stroke survivors and caregivers feel abandoned by health services, study finds

cjb250 — Wed, 21 Feb 2018 19:00:14 +0000

̽��ֱ��study, by researchers at the ̽��ֱ�� of Cambridge, suggests that primary care and community health care interventions which focus on improving active follow-up and information provision to patients and caregivers, especially in the first year after stroke, could help improve patient self-management and increase stroke-specific health literacy.

Globally, stroke is the second leading cause of death. Stroke-related disability burden is on the rise with a 12% increase worldwide since 1990, and contributes to the large economic burden of stroke due to healthcare use, informal care and the loss of productivity. ̽��ֱ��annual cost of stroke, including health care cost, medicines and missed days of work, is estimated at $33 billion in the USA and £8.9 billion in the UK.

Primary care could play an important role in the care of stroke survivors and their caregivers, supporting access to community services and facilitating transfer back to specialist services when new problems emerge. It could also help provide training, and identify and address health needs of caregivers. However, the feeling of abandonment that people with stroke experience following hospital discharge suggests this role is not being fulfilled.

To better understand the possible reasons behind this feeling of abandonment, a team at Cambridge’s Department of Public Health and Primary Care carried out a systematic review of qualitative evidence in the field. In total, they analysed 51 studies (encompassing 566 stroke survivors and 593 caregivers). Their results are published today in the journal PLOS ONE.

̽��ֱ��analysis found an unaddressed need for continued support in a quarter of studies. Survivors and caregivers felt frustrated and dissatisfied with a lack of proactive follow-up either from primary care, the hospital, or allied healthcare professionals. This led to feelings of dissatisfaction, uncertainty, that a stroke survivor was “forgotten and written off” and that their general practice did not care about them.

Lack of support for caregivers was reported in more than one in five studies (22%), even though they felt healthcare professionals assumed that they would provide the majority of care needed. They felt ill prepared and pressured to “become experts” in caring for stroke survivors. In addition, both survivors and caregivers felt emotional support was lacking, even though they are at risk of anxiety and depression.

Long waiting times for assessment and rehabilitation and little or no help from social services left survivors feeling “left in the lurch”. Caregivers felt that access to rehabilitation was not provided early enough, causing survivors to “go backwards”.

More than two out of five (41%) of studies highlighted gaps in information provision. Opportunities for support could be missed due to the lack of knowledge of what services were available. ̽��ֱ��lack of information about local services and how to find them was confusing and prevented access. Many caregivers and survivors had to find out information by themselves from the internet, friends and other caregivers. When information was provided, it was often inconsistent and covered only some services.

A quarter (23%) of the studies highlighted inadequate information on stroke, its consequences, and recovery. Information presented too early after stroke disempowered stroke survivors and caregivers, leading to feelings of confusion, fear and powerlessness. Survivors and caregivers wanted specific information on the significance of post-stroke symptoms and how to manage them. Lack of information led to unrealistic expectations of “getting back to normal”, leading to disappointment and tensions between the survivor and caregiver.

Ineffective communication between survivors, caregivers and healthcare services as well as within healthcare services resulted in feelings of frustration and having “to battle the system”. Gaps in the transfer of knowledge within the healthcare system and the use of medical jargon sometimes caused confusion and were construed as indifference to survivors’ needs.

“Patients and caregivers would benefit from active follow up and information provision about stroke that is tailored to their specific needs, which change over time,” says Professor Jonathan Mant, who led the study. “People take active efforts to find information for themselves, but navigating and appraising it can be challenging. What is needed is trustworthy information written in an accessible language and format, which could support better self-management.”

̽��ֱ��study found that that many stroke survivors and caregivers felt marginalised due to the misalignment between how healthcare access in primary care is organised and survivors’ and caregivers’ competencies. For example, individuals felt that in order to access services they needed an awareness of what services are available, plus the ability to communicate effectively with healthcare professionals. This situation can be compounded by cognitive, speech and language problems that can further affect a patient’s ability to negotiate healthcare access.

“Stroke survivors and their caregivers can feel abandoned because they struggle to access the appropriate health services, leading to marginalisation,” says Dr Lisa Lim, one of the study authors. “This arises because of a number of factors, including lack of continuity of care, limited and delayed access to community services, and inadequate information about stroke, recovery and healthcare services.

“We need mechanisms to encourage better communication and collaboration between generalist services, which tend to provide the longer term care after stroke, and specialist services, which provide the care in the immediate phase post-stroke.”

̽��ֱ��researchers argue that providing support from healthcare professionals within the first year after stroke would increase patients’ ability to self-manage their chronic condition. This can be achieved by providing timely and targeted information about stroke, available resources, and by regular follow-ups to foster supporting long-term relationships with healthcare professionals.

“Giving the right information at the right time will help stroke survivors and their caregivers become more self-reliant over time and better able to self-manage living with stroke,” adds Dr Lim.

̽��ֱ��team identified two key areas of improvement to address patients’ and caregivers’ marginalisation: increasing stroke-specific health literacy by targeted and timely information provision, and improving continuity of care and providing better access to community healthcare services.

Reference
Pindus, DM et al. Stroke survivors’ and informal caregivers’ experiences of primary care and community healthcare services - a systematic review and meta-ethnography. PLOS ONE; 21 Feb 2018; DOI: 10.1371/journal.pone.0192533

A systematic review of studies focused on stroke survivors’ and carers’ experiences of primary care and community healthcare services has found that they feel abandoned because they have become marginalised by services and do not have the knowledge or skills to re-engage.

Stroke survivors and their caregivers can feel abandoned because they struggle to access the appropriate health services, leading to marginalisation

Lisa Lim

Kate Whitley (Wellcome Images)

Blood pressure measurement - close-up

Researcher profile: Dr Lisa Lim

As well as being a researcher in the Department of Public Health and Primary Care, Dr Lisa Lim is also a GP. Her experience with patients helps inform her work.

“My research is with stroke survivors, looking at how we can improve things for them after stroke as well as preventing further strokes,” she says. “We know that stroke survivors and their carers often struggle after they have been discharged from specialist services and their needs are not always identified or addressed by healthcare services; this is what we want to change. This is a problem I see in my clinical practice and I know how important it is to these patients.”

Working in collaboration with researchers at the ̽��ֱ�� of Leicester, Dr Lim and the team at Improving Primary Care after Stroke (IPCAS) have spent the past two years developing and piloting a primary care intervention for stroke survivors. ̽��ֱ��intervention is now ready to be trialled and they are currently recruiting GP practices and patients.

Dr Lim says she hopes her work will demonstrate how important it is that we continue to invest in primary care research and how primary care can help people to live well with a chronic problem like stroke – “It can make a massive difference to peoples’ lives,” she says.

“It may not be considered by some to be the most glamorous research,” she adds. “We will not be ‘curing’ stroke, but what we are trying to do is make a big impact on the day-to-day lives of people affected by stroke.”

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£42m new research institute to boost evidence on improving care in the NHS

cjb250 — Wed, 31 Jan 2018 00:26:59 +0000

̽��ֱ��Healthcare Improvement Studies Institute (THIS Institute), led by the ̽��ֱ�� of Cambridge, is made possible by the largest single grant ever made by the Health Foundation, an independent charity. ̽��ֱ��new institute is founded on the principle that efforts to improve care should always be based on the best quality of evidence. Some of that evidence will be created by NHS patients and staff themselves, using innovative citizen science methods in large-scale research projects.

Director of THIS Institute Professor Mary Dixon-Woods, said: “If you ask people to describe the future of healthcare, they might describe a shiny vision of new treatments and technologies. These kinds of innovations are important. But how healthcare is organised and delivered, including its basic systems and processes, has perhaps just as much impact, and sometimes more, on patient outcomes and experience.”

Dr Jennifer Dixon, Chief Executive of the Health Foundation, said: “ ̽��ֱ��UK population clearly wants a high quality and sustainable NHS into the future. Understanding what works, in which contexts and why, is crucial, as is obtaining that evidence fast so it can be acted on. There couldn’t be a more important time to do this, and that is why the Health Foundation has put its money where its mouth is.”

One way the institute will create the evidence-base is through citizen science. Using methods already used in other areas such as biology and astronomy, THIS Institute is building a digital platform to crowdsource research ideas and collect research data from NHS staff and patients, including their opinions on the right indicators of quality of care and their views on equipment design.

Professor Dixon-Woods, Director, THIS Institute, adds: “Tackling healthcare challenges needs to involve a greater variety of people with diverse experience: the institute is looking for expertise in new places. Some of this expertise will come directly from patients – us, you, me – working alongside healthcare staff and other professionals such as engineers and designers.”

̽��ֱ��institute will be based at the Cambridge Biomedical Campus, alongside Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust and world-leading research institutes. It is made possible by a ten-year grant from the Health Foundation, whose mission is to bring about better health and healthcare for people in the UK.

Press release from ̽��ֱ��Healthcare Improvement Studies Institute.

A new research institute launching today is seeking to create a world-leading asset for the NHS by improving the science behind healthcare organisation and delivery.

DSC09477-2

kristin klein

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Cambridge awarded £40m to create world-leading health care improvement research institute

cjb250 — Tue, 28 Mar 2017 08:59:33 +0000

This is the charity’s single largest grant to date and will create an institute that is the first of its kind in Europe.

Led by Mary Dixon-Woods, RAND Professor of Health Services Research and Wellcome Trust Investigator at the ̽��ֱ�� of Cambridge, the institute will work closely with a wide range of partners across the UK including RAND Europe and Homerton College, Cambridge. Seeking to strengthen the evidence-base for how to improve health care, it will produce practical, high quality learning about how to improve patient care and will grow capacity in research skills in the NHS, academia and beyond.

̽��ֱ��Health Foundation says it is making this significant investment because it recognises the huge potential for research to shed light on how sustainable and replicable improvements to the quality of patient care can be made in the NHS more quickly.

Dr Jennifer Dixon, chief executive of the Health Foundation, says: “Faster learning and discovery is vital to achieving higher quality health care for patients at a sustainable cost. That is why the Health Foundation is making its biggest single grant to date to help build the field of improvement research.

“ ̽��ֱ�� ̽��ֱ�� of Cambridge and their partners have set out a compelling vision for this ground-breaking improvement research institute – the first of its kind in Europe. This is a significant and exciting step in developing evidence on a massive scale across the NHS about what works to improve patient care. Critically, the institute’s work will include understanding not only which interventions work, but also in which contexts and why.”

Professor Dixon-Woods adds: “ ̽��ֱ��NHS, like health systems around the world, is faced with pressing challenges of quality and safety. Yet the science of how to make improvements has remained under-developed. This funding is a tremendous opportunity to produce new knowledge about how to improve care, experience and outcomes for patients. Together with our partners, the ̽��ֱ�� of Cambridge is hugely excited at the chance to work with NHS staff, patients and carers to identify, design and test improvements.”

̽��ֱ��institute will formally launch within the next year and will be based at the Cambridge Biomedical Campus, alongside Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust and world-leading research institutes.

For more information, please visit the Health Foundation's website.

Adapted from a press release from the Health Foundation.

̽��ֱ�� ̽��ֱ�� of Cambridge is to receive £40 million over ten years from the Health Foundation, an independent charity, to establish and run a new research institute aimed at strengthening the evidence-base for how to improve health care.

This funding is a tremendous opportunity to produce new knowledge about how to improve care, experience and outcomes for patients

Mary Dixon-Woods

Lydia

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DeepMind-Royal Free deal is “cautionary tale” for healthcare in the algorithmic age

tdk25 — Thu, 16 Mar 2017 12:30:01 +0000

Researchers studying a deal in which Google’s artificial intelligence subsidiary, DeepMind, acquired access to millions of sensitive NHS patient records have warned that more must be done to regulate data transfers from public bodies to private firms.

̽��ֱ��academic study says that “inexcusable” mistakes were made when, in 2015, the Royal Free NHS Foundation Trust in London signed an agreement with Google DeepMind. This allowed the British AI firm to analyse sensitive information about 1.6 million patients who use the Trust’s hospitals each year.

̽��ֱ��access was used for monitoring software for mobile devices, called Streams, which promises to improve clinicians’ ability to support patients with Acute Kidney Injury (AKI). But according to the study’s authors, the purposes stated in the agreement were far less specific, and made more open-ended references to using data to improve services.

More than seven months after the deal was put in place, an investigation by New Scientist then revealed that DeepMind had gained access to a huge number of identifiable patient records and that it was not possible for the public to track how these were being used. They included information about people who were HIV-positive, details about drug overdoses and abortions, and records of routine hospital visits.

As of November 2016, DeepMind and the Trust have replaced the old agreement with a new one. ̽��ֱ��original deal is being investigated by the Information Commissioner’s Office (ICO), which has yet to report any findings publicly. ̽��ֱ��National Data Guardian (NDG) is also continuing to look into the arrangement. DeepMind retained access to the data that it had been given even after the ICO and NDG became involved, and the app is being deployed.

Both the Trust and DeepMind have disputed the findings in the new study. In a joint response they claimed that the paper misrepresented the NHS’s use of technology to process data and also that the analysis contained several errors. They stressed that the Streams app was making a significant difference to hospital staff, and highlighted its life-saving potential.

̽��ֱ��authors, however, said that these accusations of factual inaccuracy and analytical error were unsubstantiated, and that their article makes clear why the agreement is unusual and in the public interest.

̽��ֱ��study reviews the original agreement in depth, with a systematic synthesis of publicly available documentation, statements, and other details obtained by Freedom of Information requests. It was carried out by Dr Julia Powles, a Research Associate in law and computer science at St John’s College, ̽��ֱ�� of Cambridge, and Hal Hodson, who broke the New Scientist story and is now Technology Correspondent for ̽��ֱ��Economist.

Both authors say that it is unlikely that DeepMind’s access ever represented a data security risk, but that the terms were nonetheless highly questionable, in particular because they lacked transparency and suffered from an inadequate legal and ethical basis for Trust-wide data access.

They say the case should be a “cautionary tale” for the NHS and other public institutions, which are increasingly seeking tech companies’ help to improve services, but could, in the process, surrender substantial amounts of sensitive information, creating “significant power asymmetries between citizens and corporations”.

“Data analytics and machine learning in general offer promise in improving healthcare and clearly digital technology companies will have a role to play,” Powles said. “To the extent that it signals a move in this direction, we think that there were inadequacies in the case of this particular deal.”

“ ̽��ֱ��deal betrays a level of naivety regarding how public sector organisations set up data-sharing arrangements with private firms, and it demonstrates a major challenge for the public and public institutions. It is worth noting, for example, that in this case DeepMind, a machine learning company, had to make the bizarre promise that it would not yet use machine learning, in order to engender trust.”

Powles and Hodson argue that the transfer of data to DeepMind did not proceed as it should have, questioning in particular its invocation of a principle known as “direct care”. This assumes that an “identified individual” has given implied consent for their information to be shared for uses that involve the prevention, investigation, or treatment of illness.

No patient whose data was shared with DeepMind was ever asked for their consent. Although direct care would clearly apply to those monitored for AKI, the records that DeepMind received covered every other patient who used the Trust’s hospitals. These extended to people who had never been tested or treated for kidney injuries, people who had left the catchment area, and even some who had died.

In fact, the authors note that, according to the Royal Free and DeepMind’s own announcements, only one in six of the records DeepMind accessed would have involved AKI patients. For a substantial number of patients, therefore, the relationship was indirect. As a result, special permissions should have been sought from the Government, and agencies such as the ICO and NDG should have been consulted. This did not happen.

Such applications of “direct care” have been queried before. In December 2016, Dr Alan Hassey of the NDG, which provides national guidance on the use of confidential information, wrote that: “an erroneous belief has taken hold in some parts of the health and care system that if you believe what you are doing is direct care, you can automatically share information on a basis of implied consent”. Dr Hassey noted that direct care is not “of itself a catch-all… ̽��ֱ��crucial thing is that information sharing must be in line with the reasonable expectations of the individual concerned”.

̽��ֱ��researchers’ survey also criticises the lack of transparency in the agreement, pointing out that neither party made clear the volume of data involved, nor that it involved so many identifiable records. How that data has been, and is being, used, has never been independently scrutinised. Last week, DeepMind announced plans to develop a new data-tracking system, to make such processes more transparent, at an unspecified future stage.

̽��ֱ��authors liken the relationship overall to a one-way mirror. “Once our data makes its way onto Google-controlled servers, our ability to track it – to understand how and why decisions are made about us – is at an end,” they write.

̽��ֱ��paper says that an obvious lesson is that no such deal should be launched without full disclosure of the framework of documents and approvals which underpins it. In light of the 2013 Caldicott review of sharing of patient information, they write that: “ ̽��ֱ��failure of both sides to engage in any conversation with patients and citizens is inexcusable.”

They also suggest that private companies should have to account for their use of public data to properly-resourced and independent bodies. Without this, they argue that tech companies could gradually gain an unregulated monopoly over health analytics.

“ ̽��ֱ��reality is that the exact nature and extent of Google’s interests in NHS patient data remain ambiguous,” the authors add. Powles notes that while Google has no stated plans to exploit the data for advertising and other commercial uses, its unparalleled access to such information, without any meaningful oversight, does not rule out the possibility in future.

“I personally think that because data like this can get out there, we are almost becoming resigned to the idea,” Powles added. “This case stresses that we shouldn’t be. Before public institutions give away longitudinal data sets of our most sensitive details, they should have to account to a comprehensive, forward-thinking and creative regulatory system.”

A spokesman for both the Royal Free London and DeepMind said that both organisations were “committed to working together to support world class care for patients”. He added: “Every trust in the country uses IT systems to help clinicians access current and historic information about patients under the same legal and regulatory regime.”

Powles and Hodson are working on a second paper, analysing the terms of the revised DeepMind-Royal Free arrangement since November 2016 and the ongoing regulatory investigations. Their current study is published in the journal Health and Technology.

A study of a deal which has allowed Google DeepMind access to millions of healthcare records argues that more needs to be done to regulate such agreements between public sector bodies and private technology firms.

̽��ֱ��deal betrays a level of naivety regarding how public sector organisations set up data-sharing arrangements with private firms, and it demonstrates a major challenge for the public and public institutions

Julia Powles

NEC Corporation of America

DeepMind acquired the data for software that could send clinicians alerts about patients at risk of Acute Kidney Injury, but the agreement also gave it access to a substantial number of records about unaffected patients.

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Improving access to GP surgeries could reduce burden on out-of-hours services

cjb250 — Wed, 21 May 2014 22:30:00 +0000

Out-of-hours primary care services – such as a telephone consultation followed by a home visit or attendance at an out-of-hours centre – present several disadvantages compared to in-hours services. Not only are these services more expensive to the NHS, but maintaining the high standards of care and patient experience out-of-hours is challenging. In part this is because patients using out-of-hours services will often be seen by doctors unfamiliar with their potentially complex case histories. For these reasons, modern healthcare systems aim to reduce demand for out-of-hours primary care.

In a study published in the Emergency Medicine Journal, researchers from the ̽��ֱ�� of Cambridge and the ̽��ֱ�� of Exeter Medical School analysed data from almost 570,000 respondents to the 2011/2012 English General Practice Patient Survey to see why people used out-of-hours services and to identify ways of reducing this burden.

̽��ֱ��researchers found that a proportion of patients faced a number of potential barriers to accessing GP surgeries including an ability to get through to the surgery on the telephone or to get an appointment, urgent or otherwise, as well as inconvenient opening hours. ̽��ֱ��patients who experience these difficulties have a higher chance of resorting to the use of out-of-hours primary care services.

7.5% of respondents reported using out-of-hours services in the previous six months though not all of these were due to difficulties in accessing regular GP services. ̽��ֱ��researchers estimate that optimising access to in-hours services would reduce this to 6.7%, a relative reduction of 11%.

Dr Yin Zhou from the Cambridge Centre for Health Services Research says: “ ̽��ֱ��use of out-of-hours services is not ideal for the patient and can be costly to the NHS. If we’re to reduce the burden on the NHS and improve patient care, then we need to make improvements in providing access to GP surgeries.”

Contrary to expectations, the researchers found that the association between out-of-hours use and the convenience of surgery opening hours was stronger amongst people in part-time than those in full-time work or education. In other words, even when opening hours suited people in part-time work, they were more likely to attend out-of-hours services than those in full-time work or education.

Professor Martin Roland, Director of the Centre, adds: “Our research suggests that improving access to regular services is not as straightforward as just extending opening hours, which current Government policies favour. Even those in part-time work can struggle to get an appointment, so offering greater availability during regular surgery hours would help reduce use of out-of-hours services.”

̽��ֱ��study was funded by the East of England Multi-Professional Deanery, the Department of Health and the National Institute of Health Research.

Poor access to GP surgeries could be driving patients to use out-of-hours services and putting an extra burden on the NHS, according to researchers at the Cambridge Centre for Health Services Research. In research published today, they say that improving access could lead to an 11% reduction in the use of out-of-hours primary care services.

Improving access to regular services is not as straightforward as just extending opening hours, which current Government policies favour

Martin Roland

Julian Claxton Photography, Wellcome Images

GP consultation with a female patient

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