News in brief
Eleven NHS trusts placed in ‘special measures’ over poor care: Eleven NHS trusts are to be placed in ‘special measures’ after an examination of higher-than-expected mortality rates suggested thousands of patients could have died unnecessarily due to poor care, health secretary Jeremy Hunt has said. NHS England medical director Sir Bruce Keogh was ordered to review 14 trusts after failings at the Mid Staffordshire NHS Foundation Trust were identified by a public inquiry, reported Public Finance. Publishing Keogh’s findings this week, Hunt said none were providing consistently high-quality care. Keogh identified patterns at many trusts, including failure to act on information that suggested cause for concern, a lack of openness and an unwillingness to learn from mistakes. There was also ‘ineffectual governance and assurance processes’. As a result, a majority of the trusts will be placed in special measures, with a team of external experts sent to work with existing management in implementing changes following the report. They are: Tameside; North Cumbria; Burton; Northern Lincolnshire; United Lincolnshire; Sherwood Forest; East Lancashire; Basildon and Thurrock; George Eliot near Nuneaton; Medway; and Buckinghamshire. Click here for an overview of Sir Bruce’s findings into the 14 trusts with the poorest mortality figures.
Keogh announces new mortality measure: NHS England’s medical director has said that the UK will become the first country in the world to create a national measure of avoidable deaths, reported eHealth Insider. Sir Bruce Keogh led a review into the quality of care and treatment provided by 14 English hospital trusts with high mortality rates as measured by the Hospital Standardised Mortality Ratio and the newer Summary Hospital-level Mortality Indicator. During a press conference following the release of his report this week, Sir Bruce said there is a difference between “excess deaths” and “avoidable deaths” and it is important to be able to distinguish the two. Senior academics Professor Nick Black of the London School of Hygiene and Tropical Medicine and Lord Ara Darzi at Imperial College London will conduct research on how to measure avoidable deaths. This will feed into the implementation of a new national measure. Sir Bruce said that until organisations know how many deaths are avoidable, they will not have the extra trigger needed for improving their service.
Nurses call for increased IT training: More needs to be done to provide nursing staff with appropriate technology and the training to use it, a survey has shown. The poll, carried out by the Royal College of Nursing (RCN) shows that while 85% felt confident using information and computer technology, lack of equipment, time and training prevent them from using it to benefit patient care, reported Nursing in Practice. The majority of nurses felt they had little or no influence over the use of eHealth in their workplace. RCN chief executive, Dr Peter Carter said: “The direction of travel in the NHS is towards a greater use of technology to benefit patients, both in the quality of their care and the ease with which they can access their records. However, not enough nurses have had the training and equipment they would like to help patients access their health records online. We would like to see nursing staff more involved in the implementation of eHealth to ensure the focus of new technology is always on how it can improve care for patients.”
Row over NHS performance continues: The Conservatives are trying to “re-write” history about the performance of hospitals during Labour’s years in power, an ex-health secretary has said. The two parties have blamed each other for failings at 11 NHS hospital trusts with high death rates that have been placed under special measures. Alan Johnson told the BBC that a “political operation” was going on to discredit Labour’s record on the NHS. Tory Stephen Dorrell urged all sides to tone down their “political rhetoric”. There were heated exchanges in the Commons this week as health secretary Jeremy Hunt listed what he said were a catalogue of problems at the trusts concerned and said external teams would be sent in to work with managers to improve performance. The action, recommended in an official review by NHS medical director Sir Bruce Keogh, comes after a leading health research group said its warnings about care shortcomings had been ignored for a decade.
All trusts rated by 2015: All NHS trusts will have an ‘Ofsted-style’ rating by the end of 2015 under new hospital inspection plans announced by the Care Quality Commission (CQC), reported eHealth Insider. The CQC’s new chief inspector of hospitals, Sir Mike Richards, is introducing significant changes to the way hospitals in England are inspected. Starting next month, inspection teams will be headed up by clinicians and include trained members of the public. Trusts will be rated as either outstanding, good, requires improvement or inadequate. All hospitals will have been inspected and rated by the end of 2015. Sir Mike’s decision follows from a review of 14 trusts with high mortality rates carried out by NHS England medical director Sir Bruce Keogh and released this week. The new inspection regime will embed methods used by Sir Bruce’s review, which brought together a massive datapack including information from the ombudsman and regulators such as the General Medical Council.
New template for electronic health records developed: GPs have been issued with new guidance on how patient information should be listed in electronic clinical records in order to meet the government’s pledge for patients to be able to access their GP records online by 2015, reported Pulse. The guidance by the Royal College of Physicians (RCP) and the Health and Social Care Information Centre (HSCIC) lists requirements to ensure clinical information is recorded in a consistent way, as part of health secretary Jeremy Hunt’s plan for the NHS to go ‘paperless by 2018’. The standards for the clinical content and structure of healthcare records guidance says a full electronic record should contain amongst others, details of GP practice, referral details, patient demographics, special requirements, participation in research, relevant clinical risk factors, reason for contact, presenting complaints or issues, history, medications and medical devices, allergies and adverse reactions, safety alerts, legal information, social context and patient and carer concerns. A spokesperson for the RCP said: “Collecting patient data in this way will deliver improved patient care, high quality patient experience and greater efficiency in terms of management and research in healthcare.”
Outsourcing explored for NHS Choices: NHS England is looking to outsource the provision of the “daughter of NHS Choices” beyond April 2014, reported eHealth Insider. A letter from NHS England’s national director for patients and information Tim Kelsey, invites potential providers of the new Integrated Customer Service Platform (ICSP) to engagement days next month. Described by NHS England’s chief executive Sir David Nicholson as “the daughter of NHS Choices”, the ICSP is based on the US 311 service that enables people to access information about government services via the web, phones, Skype, Twitter and apps. The platform, due to launch this November, will become the “digital front door to health and care services for the majority of the population in the future”, the letter says. Service provisions that may be outsourced include a hosting service; social media monitoring and management service; digital content management and insight service; application and development services; and data management and visualisation services. “We wish to maximise the opportunity for the participation of the third sector and SMEs and achieve best of breed in all areas,” the letter says. The ICSP Programme Board is a sub-committee of the Informatics Services Commissioning Group, chaired by Kelsey. Supplier briefings are being held on 13 August in London and 22 August in Leeds.
NHS struggling to attract IT staff with a commercial background: IT professionals without NHS experience do not believe that there is demand for their skills within the NHS, despite reforms creating a massive demand for IT leaders with a commercial background, reported ComputerWorld UK. Research carried out by specialist recruiters max20 and ComputerWorld UK, found that although most NHS IT professionals (72%) welcome new recruits from a commercial background, over half of non-NHS IT leaders questioned (59%) believe that they would not be considered without existing experience working for the NHS. Over 200 senior IT professionals, both from within the NHS and the outside, were surveyed as part of the research. It also found that almost all (95%) of non-NHS IT staff would actively apply for a position working for the NHS if they thought it was opening up opportunities to those with a commercial background.
Senior task force working on IG: A high-level task force at NHS England is working on solutions to information governance issues that are stopping commissioners from accessing patient confidential data (PCD), reported eHealth Insider. Clinical commissioners recently wrote to NHS England saying they cannot carry out their statutory duties because lack of access to PCD is preventing them from performing essential tasks such as risk stratification and invoice validation. NHS England’s London regional head of intelligence, Robin Burgess, was a panellist at the launch of the London Connect Information Governance Community in London this week. The community has been launched to promote the safe sharing of patient information. In response to questions from IG professionals, Burgess said NHS England is a huge commissioner of services and as such, is facing the same issues accessing PCD as clinical commissioning groups.
IT solutions critical to new end-of-life care services: Innovative IT solutions are expected to become a crucial tool helping to co-ordinate future end-of-life care following the government’s decision last week to axe the controversial Liverpool Care Pathway (LCP), reported Building Better Healthcare. The Department of Health has revealed the palliative care system will be phased out over the next 6-12 months and replaced with an individual approach for each patient agreed with a named senior clinician. The move follows an independent inquiry headed by Baroness Julia Neuberger, looking at the impact of the LCP on patients and their families. Her report found ‘substantial and shocking failings’ in the care of the dying, adding that patients were left in ‘considerable pain’ and suffering distress because expert palliative care teams did not work in the evenings or at weekends. In order to help clinicians monitor their patients and the end-of-life care they receive, innovative IT solutions are currently being developed. An example of this is the London-based Coordinate My Care. The system is an NHS service currently only available in London and hosted by the Royal Marsden NHS Foundation Trust, one of the country’s leading cancer centres.
Average CCG faces £10m topslice to pay for integration fund: The average clinical commissioning group (CCG) will have more than £10m taken out of its budget in 2015-16 to pay for the government’s planned £3.8bn fund for the integration of health and social care, according to NHS England. A paper going to the organisation’s board meeting this week stated that the sum to be transferred from core commissioning group budgets to local authorities in that year will be “equivalent to around 3% of CCG allocations”, reported HSJ (subscription required). In last month’s spending review, the government unveiled plans to create a £3.8bn “pooled fund” between the NHS, the Department of Health, and the Department for Communities and Local Government for the joint commissioning of health and social care. The money will be formally transferred to councils, with the majority of it coming from CCG budgets. The document states: “£3.4bn of these funds will come from clinical commissioning budgets and will require substantial savings to be made in other costs.” That £3.4bn comprises £0.9bn already transferred from the NHS annually to support local authority funded social care, an extra £0.2bn that will be added to that pot next year, £0.3bn of “reablement” funding and £0.1bn of carer’s break funding currently included in CCG allocations, and an extra £1.9bn topslice from CCG budgets.
Summary Care Records to be available on mobile phones: NHS England has announced that Summary Care Records (SCR) are to be expanded and will be accessible through a mobile phone, reported Pulse. In its ‘Safer Hospitals, Safer Wards; Achieving an integrated digital care record’ document, NHS England said it had commissioned the Health and Social Care Information Centre to add a range of patient details to the SCR, including immunisations, significant past problems and procedures, and end of life care. This would make it more useful for secondary care doctors, the document said: “The increased level of standardised information within the SCR significantly enhances its value to secondary care clinicians.” It added: “The list of integrated solutions able to access the SCR is expected to grow and to include mobile device platforms.”
NHS reform costs 15% higher than expected: By March 31 this year, the NHS reform programme had cost £1.1 billion, or 15% more than expected by that point, said the National Audit Office (NAO). However, the Department of Health is confident that total costs will not exceed £1.7 billion, and these are outweighed by the £2 billion-plus estimated savings in administration costs arising from the reforms by March 31. The reform programme has closed more than 170 NHS organisations and created over 240 new bodies, reported Pharma Times. The NAO found the transition to the reformed health system was implemented successfully – in that the new organisations were ready to start functioning on April 1, 2013 – but not all were operating as intended at that date, and that much remains to be done to complete the transition. The NAO also found only limited assurance that care quality was maintained during this period because little data is available to track the quality of primary care. Getting staff in place was the biggest challenge for the new organisations, and all of them had enough staff to start operating on April 1. They now need to assess if the staff they have inherited are affordable and if they have the right skills.
Call to reshape primary health care: Increasing numbers of GPs are building organisations that are capable of preserving the personal, local nature of general practice while also offering patients and communities a greater range of services, a review has said. The Nuffield Trust and The King’s Fund found that GPs were acting in response to the changing health needs of the general population, reported HSJ (subscription required). But while some doctors are adapting to new models of primary care, others risk being left behind as they are caught on a treadmill of trying to meet the existing pressures from supply, demand and health service factors. This is despite the fact that they are well aware of the need for change, highlighting a lack of time at their disposal to reflect on how to provide and organise care for the future. The report, commissioned by the former NHS Midlands and East Strategic Health Authority, calls for a new national framework. It wants to see NHS England, GPs, clinical commissioning groups, professional bodies and patient groups all come together to shape the evolution of primary care.
One in six NHS hospitals ‘expanding private work’: An investigation has revealed that one in six NHS hospitals in England has begun offering private treatment options to their patients this year, reported the BBC. The British Medical Journal (BMJ) obtained data from 134 of England’s 160 acute NHS trusts. It found 21 had recently introduced private or “self-funded” services. Treatments offered include IVF treatment, varicose-vein removals and hernia repairs, charged at what they would normally cost the NHS. Many are treatments that cash-strapped NHS commissioners now restrict or for which there are long NHS waiting times. Providers told the BMJ the schemes made care more accessible to patients. However critics say the growth of self-funding has muddied the waters between private care and the NHS by creating a two-tier system – particularly in combination with government rule changes that allow hospitals to raise up to 49% of funds through non-NHS work.
Norfolk trials e-prescribing: Norfolk and Suffolk NHS Foundation Trust is piloting e-prescribing on one of its wards before rolling it out across the trust. Steven Bazire, a consultant pharmacist at the trust, told eHealth Insider that a pilot using the Ascribe electronic prescribing and medicines administration system went live in June. It will be rolled out across the trust in a phased approach. “The new e-prescribing system is being piloted with a small sample of patients on a ward, with the whole ward due to go live later this month,” he explained. The e-prescribing system is integrated with Ascribe’s electronic medicines management and pharmacy stock control robotic dispensing. This means a prescription will be screened by a pharmacist and automatically supplied without the need for manual transcription. Bazire said the potential benefits of e-prescribing are huge. “The level of controls and flexibility is now quite remarkable and also robust. The potential benefits via management of prescribing, lack of transcription and no faxing of prescriptions are going to be enormous,” he said.
Awards
Healthcare IT Champion – now six remain: The final and deciding round of voting has opened for this year’s Healthcare IT Champion of the Year award, with six nominees still in the running. Healthcare IT Champion of the Year is a special category of the EHI Awards 2013, in association with CGI, and is decided by the readers of EHI. The winner will be announced at the awards ceremony on Thursday 10 October 2013 at the Roundhouse in Camden Town, London.
Opinion
Change and controversy go hand in hand in the NHS
This week, Ruth Carnall, director of Carnall Farrar LLP, explains what she learnt after becoming a trust chief executive overnight, working in the civil service and serving as chief executive for NHS London, after originally signing up for an interim six-month period, but continuing on for seven years.
Speaking about her time as NHS London chief executive, Carnall said: “It was the most fantastic job in the NHS, and a real privilege to work with such a great team and so many brave and ambitious clinical leaders. Healthcare for London, a strategic plan developed with Ara Darzi, had huge potential. We made some real progress, especially in centralising specialist services.
“We were not so successful in investing in and developing primary care, though progress is now being made, nor did we have as much impact on that and on some other services as I would have liked. We faced a lot of controversy. In fact, the programme became Andrew Lansley’s bête noire.”
Reflecting on her experiences in the NHS, Carnall concludes: “It’s impossible to avoid controversy if you want to change anything in the NHS. You can keep your head below the parapet, and even appear successful, but you won’t move anything forward. I would have happily continued in that job till retirement, but the recent reforms intervened. This was my ninth major national reorganisation and my fifth abolition, so that feels like enough.”
Patients need power within the NHS
It is time to reject paternalism and protectionism in Britain’s health service, writes Nigel Crisp, former NHS chief executive in this week’s Financial Times (subscription required).
“Recent healthcare scandals have proved horrific for patients and shaken Britain’s confidence in the NHS. They have damaged its reputation and the morale of its staff and shamed those of us who were in leadership roles. They also reveal that, as in other sectors, regulation is not enough by itself. Even when done well, national regulators cannot reach everywhere. The NHS needs the constant scrutiny of patients to stay alert and vital.
“Successive governments have stressed the importance of patient power but none has done what is needed to make this a reality. As we saw in Mid-Staffordshire and Morecambe Bay, two NHS Foundation Trusts heavily criticised for their lack of care, patients’ voices are far too weak. They simply are not heard when they tell staff and organisations that something is going wrong or that something needs to be done.
“If the NHS targeted patient empowerment as effectively as it tackled waiting lists and hospital “superbugs” the result would be truly radical. Empowering patients would mean they own their health records, rather than merely having limited rights to see them. It would mean not just openness of data but the collection and publication of the information patients themselves want.
“Most patients are experts on their own needs and many want to do more for themselves and to understand better what they can do. This needs to be supported by shifts in power and incentives with patient and citizen representation at all levels in the NHS and with staff and organisations rewarded according to public satisfaction. The greatest shift, however, will come through changing behavior. The biggest issue here is the continuing development of professional and management education. The training of all health workers must ensure that the empowerment of patients and recognition of their views is key. Change will truly be with us when these concepts become core business and not just desirable additions.”
Why aren’t there more women leaders in the NHS?
This week Judy Taylor, senior consultant at Leadership Development, writes for The King’s Fund and asks why there aren’t more women leaders in the NHS?
“How likely do we think it is that David Nicholson’s replacement as chief executive of NHS England will be a woman? Although women make up three-quarters of the NHS workforce, they still remain under-represented in senior leadership roles. For example, only 37%t of foundation trust directors are women, and a minority of them are in chair or chief executive roles. Similar disparities are found in medical leadership across primary and secondary care.
“Why is this and why does it matter? To answer these questions we need to know more about women’s leadership styles and the barriers that prevent women achieving their full potential. A survey run by the Health Service Journal and The King’s Fund has elicited some interesting insights which resonate with much of what we hear when working with public sector leaders. They particularly echo the experiences and views of the participants on our executive women’s leadership development programme, Athena.
“Factors such as ethnicity and age appear to exacerbate gender barriers, while a significant number of respondents said that their main challenge is their own lack of confidence. Respondents identified numerous factors that could help them overcome these barriers from good managers of either sex, an enabling organisational culture, peer support, female role models and mentors, flexible working opportunities and access to leadership development opportunities.
“There are lots of fantastic leaders helping to support and drive improvements in the NHS at the moment. Some of those are women. Who knows whether the next chief executive of NHS England will be a woman, but aren’t we missing a trick if we don’t try to create the right conditions for more women to lead the NHS, alongside their male counterparts?”
NHS buildings are tools, not temples
In HSJ this week (subscription required), Barrie Dowdeswell looks at why the NHS has traditionally placed little value on buildings and the contribution they could make to improving functional efficiency.
“A King’s Fund paper, published last week, and Nigel Edwards’ article for HSJ described how the NHS is not making the best use of its estate and the backlog in maintenance. What other business would allow one of its prime assets to deteriorate to this extent?
“While healthcare needs continually change, as do the service’s response and clinical advances, infrastructure investment tends to move from one fixed point to another. This means that, too often, the buildings call the tune when shaping, or more accurately cementing, services in place.
“Perhaps two words hold the key – flow and relevance. How can we improve the flow of patients through the system and how can we ensure that we make and sustain relevant investments in buildings, technology and workforce to support the continuous evolution of care?
“The primary purpose of an NHS building is to enable staff to work more effectively. Should we be reappraising connectivity? Perhaps by placing new emphasis on the synergy between our two most valuable assets – buildings and the workforce – can we stimulate new innovations in capital strategy to match the innovation seen on the service side of the NHS?”
Highland Marketing blog
In this week’s blog, Myriam McLoughlin compares our beloved NHS to the French system and asks whether it is time we said goodbye to a free NHS.
