News in brief
Patient data to be collected from GPs: The NHS in England is to start collecting data on patient care by GPs for the first time, reports the BBC. Hospital data is already collected however the NHS says extending the initiative to general practice means it will be possible to get a fuller picture. Personal details will not normally be shared outside the NHS. However some approved medical researchers may have access, in some circumstances. Leaflets will be sent to 26.5 million households across England throughout January. The NHS treats millions of people every week, and the data – which will be collated by the NHS Health and Social Care Information Centre (HSCIC) – can offer a picture of the illnesses they have, their treatments and experiences. Analysing trends can help plan health services in the future at national and local levels. Dr Mark Davies, medical director at the HSCIC said the centre was a “safe haven” for data. “We want everyone to feel confident that their information is kept private and used in non-identifiable form to improve the quality of health and social care for everyone. Equally important is that everyone knows that they have a choice and can raise an objection by simply talking to their GP.” Leading privacy campaigner, Phil Booth has condemned the £1m leaflet drop about care.data for not including an ‘opt-out’ form. The co-founder of the medConfidential campaign, told eHealth Insider that the leaflet, which is supposed to inform patients about the programme and advise them that they can opt-out, said the failure to include an easy way for them to do this was “ridiculous”.
Board level culture undermines paperless ambition: Senior managers’ lack of knowledge about the clinical and cost benefits of improved IT systems is hindering progress towards the health secretary’s ambition for a paperless NHS, an exclusive Health Service Journal (HSJ, subscription required) survey suggests. Ninety one percent of respondents to HSJ’s inaugural annual technology survey say the NHS leadership community’s lack of IT knowledge could thwart Jeremy Hunt’s 2018 target date for the goal to be achieved. Only 29% of those surveyed think the target is realistic. A lack of joined up working between different parts of the health and social care system is cited as the biggest single reason the sector could fail to achieve the health secretary’s ambition – however the message about gaps in knowledge is unequivocal. The feedback from the 419 health and health IT professionals who participated paints a picture of a sector that appreciates the need for improved IT systems – 88% say the paperless target is a “great ambition” − but is stymied by a lack of leadership and skills. The data was gathered last month from respondents from across the sector, with 28% describing themselves as senior managers, 16% as clinicians, and 7% as board members, with the others coming from private sector, medical and clinical roles. One senior IT expert told HSJ it was unsurprising that most respondents felt the 2018 target was threatened by cultural issues but he was surprised by the strength of sentiment shown.
Trusts race to complete nurse tech bids: NHS trusts say the timescale for the £100m Nursing Technology Fund is challenging as they scramble to get applications ready with one week until the deadline, according to eHealth Insider (EHI). The fund, which was announced by Prime Minister David Cameron in October 2012, only opened for bids at the beginning of December, after delays getting sign-off from Treasury. Some £30m is available for projects this financial year, and the remaining £70m will be available as a second round of funding for the 2014-15 financial year. In the first round, trusts can apply for funding for digital pens; mobile technology; systems for the collection and logging of vital signs and systems for uploading essential clinical information to digital care records. Deborah Carter, associate director for clinical informatics and former deputy head of nursing at Central Manchester University Hospitals NHS Foundation Trust, told EHI that the timescales had “constrained” the trust, but it was still working on two projects. One is to introduce mobile devices and to develop an electronic health record in community services. The other is to further roll out the trust’s Early Warning Assessment System and improve its functionality and alerting features. “As the bidding process was announced right before the Christmas period, [we have had] a challenge in terms of getting the quality of submission right and ensuring that there has been effective stakeholder involvement,” she said. “However, this has been achieved. The demonstration against return on investment has been particularly challenging in the timescale.” More information about the application process for the second round of funding will be published in spring 2014.
Ireland plans big e-health investment: eHealth Insider reported that Ireland is planning to massively increase the amount of money that it spends on healthcare IT as part of a strategy to transform its health services and boost its economy over the next seven years. An ‘eHealth Strategy for Ireland’, published in December, says national healthcare ICT spending will be “re-aligned” so that it reaches the “EU average of between 2-3%” from the current 0.85%. The strategy and spending will be overseen by a new body, ‘eHealth Ireland’, which will be headed by a chief information officer to be appointed through open competition. EHealth Ireland will publish a new IT strategy for health early this year, but the eHealth Strategy indicates that this will build on work already underway, or announced at the launch. It says Ireland will look to create a “standards-based, multi-layered information and technical infrastructure” as a common platform for e-health deployments. It also says these will use a “national health identifier number for citizens, professionals and organisations”, the enabling legislation for which was published with the strategy. In addition, it says Ireland will look to create an “open”, authoritative and internationally linked collaborative innovation ‘ecosystem’ of the type established in Catalonia and Finland to secure innovation and capture the economic benefits of e-health; which the strategy argues could add 2%-2.9% to gross domestic product.
Telehealth won’t improve care, say GPs: Almost two-thirds of GPs do not believe the government’s telehealth roll-out will improve care for patients, a GP magazine poll suggests. In the survey of 316 GPs, 61% said telehealth did not have the potential to improve the care they gave to patients, with a further 17% unsure. Only 22% said they believed the technologies can enhance patient care. GPs responding to the survey complained that the devices threaten to raise workload rather than reduce it, while others branded the drive a ‘gimmick’. Findings from a trial funded by the Department of Health (DH) found a selection of devices in patients’ homes could cut mortality and hospital admissions. However further analyses suggested that the equipment tested in the trial would not be cost effective for the NHS. Nevertheless, telehealth services are being rolled out across England under the 3millionlives campaign. Progress stalled in 2013 and a DH plan to develop seven ‘pathfinder’ sites to promote widespread adoption was eventually scrapped by NHS England. A recent investigation by GP found that just 2,368 patients were actively using the health-monitoring devices across 26 pathfinder clinical commissioning groups in September 2013. NHS England has since relaunched the programme to focus on areas already offering patients access to telehealth services.
Quarter of in-deficit CCGs lose out under new funding policy: More than a third of clinical commissioning groups (CCG’s) that are underfunded according to the new NHS allocations formula will be even further behind their target share of funding by the end of 2015-16, Health Service Journal (subscription required) analysis has found. NHS England figures showing how funding will be distributed over the next two years reveal 33 of the 95 underfunded CCGs will be further below their target allocations at the end of 2015-16 than they are due to be at the end of 2014-15. Among them are six of the 24 groups expecting to finish the current financial year in the red. The chief clinical officer of one of those six said his CCG was “very disappointed” with its allocations. Sam Hullah, of North Hampshire CCG, said the total funding growth of 2.32% that it will receive in 2014-15 was only a fraction above the minimum rise CCGs were being offered and “seemed to virtually ignore our position away from fair share”. The policy adopted by NHS England’s board last month ensures every CCG − even those ranked among the most overfunded − will receive increases of at least 2.14% in 2014-15 and 1.7% the following year. This reduced the amount of money available to bring underfunded CCGs closer to their fair share, and the biggest above-inflation increases were targeted at areas more than 5% below target. This left a situation where some in-deficit CCGs which are less than 5% below target will move further away from their fair share of funding over the coming two years.
Compassion ‘alive and well’ in NHS, says chief hospital inspector: Professor Sir Mike Richards, the first person to be appointed to the position, insisted outstanding care was possible within the NHS after completing his first wave of hospital inspections, reported the Nursing Times (registration required). It comes as a string of high-profile struggles face the NHS including failing trusts, growing pressure on accident and emergency services and the troubled NHS 111 number. He told The Independent: “We have continued to look at high-risk trusts, but have deliberately in our pilot programme looked across the spectrum. What we can now say is that there are some very good hospitals in this country and it is possible, within the NHS, to receive good, excellent, even outstanding care. There is variation between the best hospitals we’ve seen and the ones that are struggling. What is interesting is that within an individual hospital there is variation. The maternity service might be very good but the A&E service might require improvement.” The role as the head of the Care Quality Commission was set up in the wake of the high profile care failings at Mid Staffordshire Foundation Trust. Sir Mike is responsible for the watchdog’s assessment and judgment of how well hospitals put the quality of care and the interests of patients at the heart of everything that they do, as well as develop and test a new ratings system. All hospitals will be comprehensively assessed by 2015 and the new ratings system will be rolled out from this month, he said.
Report calls on NHS to consistently use simulation software ahead of big decisions: TechWorld reported that the NHS could be run more effectively if senior decision makers used simulation software to test the outcome of different approaches before rolling them out, according to a report out this week from the Cumberland Initiative. Simulation software can be used to test-drive certain situations in a relatively inexpensive and safe environment where mistakes can be made without hurting patients or staff. The Emergency Simulation report – published by a collaboration of academics, clinicians and industry partners (including IBM and BT) that are working together in a bid to transform the quality and cost of NHS care delivery through simulation – calls on NHS England to model every significant infrastructural change in advance. The report illustrates how various institutions within the NHS can effectively deploy simulation software, while highlighting a number of institutions that are already using modelling successfully within the organisation. Professor Terry Young, co-founder of the Cumberland Initiative, who are pioneering the approach in the NHS, said: “The benefits of modelling are being felt on the ground and making a difference in the current A&E crisis. We need to ensure that policy and practice are making the most of this approach particularly during this difficult winter for the NHS.” Among the trusts detailing their experience of modelling at the Westminster launch of the report is the Royal Free Hampstead NHS Trust, which has been planning a new emergency department, reported Building Better Healthcare. Mike Farrar, former chief executive of the NHS Confederation; and Lord Norman Warner, former Health Minister for NHS reform, were speaking at the launch. Farrar said: “Test-driving change like this helps everyone to work the problem together and avoid unexpected pitfalls safely for patients and inexpensively for the NHS. We want NHS England to encourage greater operational use of modelling and simulation across trusts and commissioning bodies, whenever significant service or infrastructural change is being considered.”
Non-emergency visits adding pressure to A&E: New figures suggest that some patients are visiting A&E over 50 times a year, reports National Health Executive. A BBC investigation found that almost 12,000 people made over ten visits to individual A&E units in 2012/13. In total, people who frequently attend A&E accounted for around 200,000 visits last year. The figures come from Freedom of Information requests to 175 trusts and boards on repeat attendances. Dr Cliff Mann, of the College of Emergency Medicine said: “At a time when emergency departments are very busy, it is clear that repeat non-emergency attendees are adding to the pressures.” He told Radio 4’s Today programme: “The figures show that some individuals actually attended nearly 250 times a year, which is almost five times a week, whereas other people are using it 10 times a year, which is more like once a month. There’s clearly a difference between those groups, but most of them represent groups which are to some extent on the margins of society – a lot of problems associated with drugs and alcohol, some with homelessness, a lot with mental health problems, isolation and loneliness for some individuals. Unfortunately, we are not able to guarantee them access to those other services. We don’t have direct links, by and large, into mental health services, drug and alcohol services or even primary care out of hours. I think that the lack of integration around the margins of health care is a real problem and causes people to fall between two stools far too often. The problem is that many of these services are run as individual services without a real focus on those problems of integration.”
Public trust in the NHS remains stable: Commissioning GP reports that just one in five of adults (20%) trust the NHS less than they did a year ago, new research commissioned by the NHS Alliance reveals. In a survey conducted by YouGov on behalf of the NHS Alliance of 1886 adults in December 2012, 53% said that their feelings were no different than a year ago, they still trust the NHS to look after them, while 8% said they trusted the NHS more to look after them if they were ill than they did a year ago. However, their views of politicians’ and the media’s portrayal of the NHS is markedly different. Fewer than one in 10 adults (9%) believe politicians portray the NHS in a balanced light, while only a fraction more (11%) believe the media portray the NHS in a balanced light. Dr Michael Dixon, chair of the NHS Alliance said that he was glad that patients shared his view of the NHS as a place to get passionate and committed care. He continued: “The NHS has been battered and bruised by both the media and politicians this year. In some cases rightly, but it’s too easy to let the negatives get in the way of the extraordinary positives of our health service. But the bad news will continue until we all begin to think differently. The NHS doesn’t belong to the government or to doctors or nurses. It is a precious resource that belongs to us all – an NHS Mutual if you like – and we all need to use it a little differently.” Dr Dixon called on everyone – patients, public and NHS professionals, to all do their part to ensure the NHS continues to be sustainable.
Birmingham LMC objects to shared record: GP leaders in Birmingham have serious concerns about the region’s Central Care Record project to share patient information across health and social care. In August last year, 17 health and social care organisations across Birmingham, Sandwell, and Solihull went out to tender for a joint central care record system. Project leaders say patients will be given the option to opt-out of the scheme. However Birmingham Local Medical Committee (LMC) is strongly against the project and has several concerns, especially around patients not being able to give informed consent. Dr Robert Morley, the executive secretary of the committee, told eHealth Insider that the LMC cannot support the project as currently proposed. “It is the same opt-out model that we had with the Summary Care Record (SCR), and we feel very strongly that that’s not properly informed consent. Patients won’t know what they’re agreeing to,” he said. The SCR is the national shared record promoted by the National Programme for IT in the NHS, which was repeatedly held up by rows over confidentiality and consent. It was eventually given the go-ahead for a national roll-out on an opt-out basis by the present government. Local publicity campaigns must be run before the SCR is implemented, but patients are ‘presumed’ to have consented to a record being created for them, unless they specifically opt-out. Birmingham LMC believes that patients should be told exactly what data is going to be shared, with whom, for what purpose and how it will benefit them.
Full list of NHS recipients of honours: The chief executive of Salford Royal Foundation Trust has been awarded a knighthood in the new year’s honours list, revealed Health Service Journal (subscription required). Sir David Dalton is among a group of senior NHS figures and campaigners to be recognised in this year’s cohort. Sir David said: “To be honoured in this way is not something that I could ever have imagined when I joined the NHS as an administrative trainee almost 35 years ago. However, without a shadow of a doubt, it is not just about my contribution to the NHS; it reflects the hard work of all those who strive with me to provide the safest care for our patients today and to plan for the best outcomes in the future.” Paula Vasco-Knight, chief executive of South Devon Healthcare Foundation Trust and NHS England’s national lead for equality, has been honoured with a CBE. Commenting on Dr Vasco-Knight’s honour, NHS England chair Sir Malcolm Grant said: “She has done a fantastic job at NHS England representing the needs of all staff and promoting the call for diversity to be further up the NHS agenda across the UK.” Among those also set for an appointment at Buckingham Palace are Susan Bailey, president of the Royal College of Psychiatrists, who will be made a dame, and West Midlands Ambulance Service chief executive Anthony Marsh, who will receive the Queen’s Ambulance Medal. Others on this year’s honours list include Irene Budd, awarded a British Empire Medal for the more than two decades of service working as a nurse at The Christie, the Manchester-based specialist cancer care centre.
Opinion
Removing the barriers to integrated care
This week, Chris Ham, chief executive of The King’s Fund, blogs about the progress of integrating health and social care, but warns there remains much more to be done.
Ham recognises the impact of Norman Lamb’s appointment as Care and Support Minister and the establishment of the Better Care Fund but continues by stating some of the barriers that still remain across the different systems: “Welcome as these developments are, many barriers stand in the way of translating policy aspirations into practice. While some of these barriers can only be tackled at a local level, others require changes in government policy if integrated care really is to move forward at the scale and pace demanded by current financial and service pressures. The most important changes are:
- ensuring that provider regulation does not get in the way of partnership working
- ensuring that quality regulation is not overly focused on organisational performance
- developing payment systems that create incentives to integrate care
- supporting commissioners to promote greater integration.
“Looking back, there has been welcome progress during 2013 but, for those of us who have advocated integrated care for some time, it is premature to declare victory. A coherent and consistent policy framework is needed to support the undoubted commitment in the NHS, local government and the third sector to build on the foundations that have been established. In the absence of such a framework, policy aspirations will remain unfulfilled and patients and users will be the losers.”
Another view
This week in eHealth Insider Neil Paul, a full time partner at Sandbach GPs, talks of how he is fed up of passwords. Every time he constructs a safe and memorable password, his computer wants him to change it. High time, he suggests, for someone to create an NHS identity app to take over their job.
“My desktop computer at work has once again started warning me that my password is about to change. I think it is set to change every 90 days. But the computer starts warning me from 15 days to go, which annoys me even more. If I change it now, I’ll be changing it every 75 days…
“I’d probably cope better with this irritation if I only had to deal with passwords at the surgery. But, of course, I don’t. This weekend, I tried logging-in to several websites to catch up on the paperwork associated with some of the clinical trials I run. Some don’t work on Safari and some don’t work on IE7, which means that some of the paperwork can’t be done at home, and some of it can’t be done at work. But putting that aside, I had a nightmare logging-on because of passwords. I haven’t had to use one site for two years so, unsurprisingly, I couldn’t remember what password I’d chosen. Then, the rescue email address that the site had for me was out of date, so I had to email for support.
“Another site – this time an NHS one – had a password reset option that emailed me a new password. Great. Except that the new password didn’t work. I tried going around the loop six times. I was sent six new passwords and none of them worked. About an hour into this session, I gave up as I was getting nowhere. Is there any wonder people say there are productivity savings to be made in the NHS?
“So is it time we had a NHS identity app that all NHS users could have on their smartphones or in dongle form? I think so. Have some centralised system that allows any authorised software to use it for a small fee, and you might just save me hours of time that I could spend on patient care.”
Why Sherlock could never be an NHS manager
In Health Service Journal (subscription required) this week, Blair Mcpherson looks at what makes a good NHS manager.
“The smartest people don’t get the top jobs; it is possible to be too smart. To be admired but disliked, isn’t that Sherlock Holmes’ problem?
“Getting a top job isn’t about what you know. After all, most senior managers these days don’t know much about the diverse range of services they are responsible for. It’s not about who you know either, though networking is as important in the public sector as it is in the private sector.
“They say these days it’s all about emotional intelligence. This is a bit misleading, as “emotional” implies feelings, empathy and having a heart, which sound more like the qualities required to be a social worker rather than those associated with senior management. Aren’t senior managers supposed to be logical, analytical, strategic and finance driven?
Concluding, Mcpherson suggests that senior managers need insight; they need to see themselves as others see them, recognise the effect their behaviour has on those they work with. “Armed with these insights they could adapt their behaviour to the audience and circumstances. This ability was termed emotional intelligence.”
Patient involvement is still a minority sport in the NHS
It gives people a voice and saves money – so including patients in treatment decisions should not be an optional extra, says Richard Vize in this week’s Guardian.
With increasing numbers of NHS trusts destined to slide into the financial mire this year and next, there is one resource of which hard pushed hospitals enjoy a plentiful but underused supply – patients. They are the best hope for cutting demand and transforming services.
“”Coproduction” is up there with “integration” and “transformation” in the NHS lexicon of abused words. It is intended to signify clinical staff involving patients in deciding the best course of treatment. As health secretary, Andrew Lansley pitched this as “no decision about me without me”.
“While this was certainly one of the more intelligible parts of his reform package, it conveys slightly the wrong idea about why patient involvement is so important. That slogan creates the impression that it is simply a right to be respected – but it is so much more powerful than that. Patient involvement leads to better treatment, and often less of it. It is a simple way to save money and keep people out of hospital.
“Involving people in care decisions means patients taking more responsibility for their own health. In many areas of our lives, four years of austerity have opened up the debate about the balance between personal and state responsibility.
“Amid the frantic activity of a typical NHS day there doesn’t seem to be the time to involve patients in decisions about their care. In too many cases, patient involvement takes the form of projects and pilots rather than systemic change in the way care is provided. This needs to change.
“It has to be seen not as a desirable extra, but the centrepiece of strategies to raise quality, improve the patient experience and cut costs. Listening to patients improves effectiveness and can save money – lots of it.”
Highland Marketing blog
In this week’s blog, Chris Marsom explains the five marketing tips health-tech start-ups need to take heed of in 2014.
