The UK Health Show took place at Olympia London on 27 September. Lyn Whitfield reports on three key stories from the commissioning, technology and cyber-security events; and the very latest on sustainability and transformation partnerships, the global digital exemplar programme, and new data privacy legislation.
STPs evolve in uncertain legislative climate
What is the future for sustainability and transformation partnerships? That was the question posed by the UK Health Show’s ‘STPs one year on’ session.
Forty-four STPs have been set-up to take forward ideas in the Five Year Forward View; the plan issued in October 2014 to close a gap between NHS funding and demand that could reach £30 billion by 2020-21 without action.
But some have already moved on to create ‘accountable care systems’; areas in which health and social care will work together on integrated care services and new ways to fund them.
David Smith, the chief executive of NHS Oxfordshire Clinical Commissioning Group, said two ACSs have been set up in his STP area, and that another was being developed. “Given we have got these, it does raise the question: what is the role of the STP?” he said.
“It’s worth asking, because a year ago we were being asked by regulators what we were doing as an STP. But our line was always that transformational change would happen at a local level.”
Smith said there was no doubt that some planning and funding functions would need to be carried out at a higher level; such as specialised commissioning.
But he warned against creating a new hierarchy “in which we get NHS England regulating STPs, and STPs regulating ACSs, and ACSs overseeing acute trusts – because that will not work.”
Dr Anita Donley, the chair of the Mid and South Essex Success Regime, agreed. “We need to sort out regulation in the new model. We can’t break the butterfly of transformation on the wheel of accountability,” she said.
The issue of how the health and care system will be organised and regulated in the future is vexed because the NHS is trying to introduce the Five Year Forward View’s ideas without legislation to repeal the Health and Care Act 2012.
At the start of the STP session, Malcolm Grant, chair of NHS England, acknowledged that it had been drawn up by former health secretary Andrew Lansley in a very different era; one in which independent trusts were supposed to compete for business from clinical commissioning groups.
The Conservatives promised new legislation in their last general election manifesto. However, the close outcome of the general election and the demands of Brexit have made this impossible. Instead, Grant said policy makers were “making old legislation serve new ends.”
He also said NHS England is working on a package of measures to support the reform agenda, including a “one-stop regulatory model” with NHS Improvement and the CQC, “new, devolved funding packages”, and help for staff to develop “new relationships” with emerging structures.
Grant told the show he was comfortable with all this. “If we went to Parliament, we would be concerned that we would close down some of our options,” he said. “In some ways it [the legislative position] is unsatisfactory, but this [the reform agenda] is all about relationships, so it is also an opportunity.”
GDEs will impact the whole NHS
The global digital exemplars programme is not just about trusts but about “the whole NHS”, Alex Chaplin, programme director at NHS Digital, told the UK Health Show.
The programme was set up last year following a review of NHS IT by US ‘digital doctor’ Professor Robert Wachter, but it has been criticised for focusing on a handful of large trusts, most of which are running US electronic patient record systems.
To date, 16 acute GDEs, seven mental health GDEs, and 18 acute ‘fast followers’ have been announced, with seven mental health fast followers to come.
But Chaplin said the programme was really about “creating a blueprint that can be shared with other trusts” and “empowering them to deliver world class healthcare.”
His comments were echoed by Will Smart, NHS England’s chief information officer, during a panel debate on how the GDEs will ‘capitalise on their promised £100 million pot of funding.’
He said some of the GDEs themselves “will have a long way to go” over the next two years, but the fast followers and the blueprints should be used by other trusts “to accelerate their digital journey.”
He also urged trusts to start thinking about the GDE programme in terms of clinical change. “We spend too much time talking about technology. I want people to think about the clinical models [in use at the GDEs],” he said.
“I want them to look for the clinical impact that will get them to where they want to go. This is all about sharing lessons in a very fragmented system.”
Speakers from trusts already involved in the programme said they were already moving in this direction.
Mark England, the chief of staff for the Bedfordshire, Luton and Milton Keynes sustainability and transformation partnership, said the GDE money secured by Luton and Dunstable NHS Foundation Trust would be used to “drive system change.”
While David Walliker, the chief information officer at Royal Liverpool and Broadgreen University Hospitals NHS Trust, said its GDE bid had been “a city-wide bid” that would “support transformation across the whole healthcare economy.”
Gareth Thomas, the chief clinical information officer at Salford Royal NHS Foundation Trust, said it was focused on three areas: working with clinicians to digitise stroke, dementia and other ‘early adopter’ pathways; making this kind of work ‘business as usual’ for the trust; and extending it to other organisations.
“We want to get digital embedded with clinicians. It is not a nice to have, it is key to everything we do,” he said.
Smart also indicated that the GDE programme would be extended in other ways. He said seven mental health fast followers will be created, and that ‘local’ GDEs were being considered, to complement the data-focused digital innovation hubs recently announced by NHS England chief executive Simon Stevens.
“We are working very hard within NHS England, and with NHS Digital colleagues, to build an architecture that will allow them to move data within regional communities of 3 million to 5 million people,” he said; adding that firm plans will be announced over the next few months.
Highland Marketing interviewed Mark England about his STP role and the impact of the GDE programme ahead of this year’s UK Health Show. Read the interview on our website.
NHS told to prepare for GDPR
The government has published the Data Protection Bill that will incorporate the General Data Protection Regulation into UK law, UK Health Show delegates were told.
Stacey Egerton, a lead policy officer at the Information Commissioner’s Office, said the bill would replace the Data Protection Act 1998.
However, she also stressed that it would be seen as an “evolution” of the familiar data protection legislation, rather than as a break from it. “If you are following good data protection practices at the moment, you are well on the way to doing GDPR.”
The GDPR is designed to strengthen and harmonise data protection laws across Europe. It was passed by the EU Parliament in April 2016, but organisations have been given two years to prepare for its implementation.
The directive will be enforced from 25 May 2018, after which organisations could face fines of up to 20 million Euros for the biggest infringements.
The scale of the fines has alarmed many organisations. Noel Gordon, the chair of the Healthcare Efficiency through Technology strand of the UK Health Show, described it as a “train coming towards us fast.”
“Boards cannot get enough of the GDPR, because it is so complex, and it is going to have such a huge impact on the NHS,” he said.
Egerton allowed that the GDPR contains some new provisions. She said organisations will now be required to appoint a data protection officer, and to “build privacy in at the start of projects” instead of treating it as an after-thought.
Specifically, she said organisations will be required to carry out a data protection impact assessment, and to take advice from the ICO before proceeding with high-risk projects.
Egerton said NHS organisations should also check the legal basis on which they are holding and processing personal information; and warned that they would not be able to rely on the existing defence of ‘legitimate interest’ in future.
Perhaps surprisingly, however, she suggested that organisations should not start with ‘consent’ because the GDPR sets a high-bar for obtaining this, and “there are other legal routes available to you.”
Egerton reminded delegates that data controllers and processors will have to be able to release individuals’ personal information to them, if they ask for it; and that they will need to report personal data breaches to the ICO within 72 hours.
She said NHS organisations should talk to their staff about what constitutes a breach and what to do. But she played down press reports that the ICO is planning to make an early example of some organisations.
Instead, she said it was working with its European counterparts to provide the best-possible advice on the new provisions. The government’s Data Protection Bill introduces some other important changes to data protection legislation.
For example, it takes forward a proposal in the latest Caldicott Review of NHS information governance and security to make the re-identification of pseudonymised data an offence.
This should help the government to build confidence in NHS England’s plans for regional ‘data lakes’ or digital innovation hubs, which will encourage the collection and use of information across populations of 3-5 million people.
Highland Marketing talked to Alan Hassey, a member of the National Data Guardian Panel, about Caldicott 3, before he spoke at the UK Health Show. Read the interview in Health Business.