News in brief
Health and social care to share £5bn integration funding: Councils and NHS commissioners are set to share a pooled budget of more than £5bn to deliver integrated health and social care services, a government minister has confirmed. According to The Guardian, the care and support minister, Norman Lamb, told a social care conference that the government’s £3.8bn Better Care Fund would be supplemented by further funding from local authorities and clinical commissioning groups. “Local areas have chosen to be more ambitious, to pool more of their budgets than we had asked them to,” said Lamb. “This has to be the start of a shift towards a much greater pooling of resources.” Speaking at the School for Social Care Research annual conference in London, Lamb said closer working between the sectors was essential for delivering better patient care. Patients did not want to “feel like they are being pushed from one system to another”, the minister said, adding: “They don’t make a distinction between health and social care.” But he conceded that a lack of mutual understanding between the sectors – especially between GPs and social care – was a barrier to joining up care. Lamb told delegates that policy on personal health budgets will be extended and from October, people will get not just a right to request a personal budget, but a right to have a personal budget. However, one conference delegate commented that some medics see personal budgets as a “zombie policy”, explaining they are “still walking but essentially dead”.
England ‘being caught up on NHS performance’: The NHS in England is continuing to perform marginally better than the other UK countries, but the gap is narrowing, a review suggests, reports the BBC. The joint Health Foundation and Nuffield Trust study looked at a range of factors from waiting times to death rates. It found overall all four countries were improving – mainly because of extra money and targets. But it found some evidence the rate of improvement was faster outside England. It comes after a previous report by the Nuffield Trust in 2010 suggested England was out-performing the rest of the UK. Researchers analysed data going back up to 20 years on some measures. Health Foundation chief executive, Dr Jennifer Dixon says: “It is very good news for the public that the quality of healthcare is improving across the UK. But what is also humbling for politicians is that so far no one policy cocktail seems to be more effective than another on NHS performance.” The report was welcomed by ministers from all four countries. Scottish health secretary, Alex Neil, said it showed “significant improvements” had been made, particularly on waiting times. Meanwhile, Welsh health minister, Mark Drakeford, said steps were being taken to improve waiting times, but there were other measures, such as ambulance response times, where really good progress had been highlighted. Northern Ireland’s health minister, Edwin Poots, added his priority was to “step up” the improvements that were being seen. A spokeswoman for the Department of Health said the report reaffirmed the importance of protecting the NHS budget – a key Tory pledge during the last election campaign.
More must be done to deliver NHS savings – Department of Health: Although the NHS is making “significant” savings more needs to be done to deliver transformational change, the Department of Health (DH) has admitted. The National Health Executive reports that the DH was responding to the Health Select Committee’s report into public expenditure on health and social care, which said the NHS is not yet financially sustainable and that the Quality, Innovation, Productivity and Prevention (QIPP) savings so far have been ‘straightforward’ rather than transformational. The DH quoted the National Audit Office as saying that 91 per cent of the 2011/2012 QIPP savings were recurrent, representing an ongoing saving for the NHS. The DH therefore disagreed with the committee that the sustainability of savings made so far is “questionable”. Nevertheless, it did state that the NHS continues to face a “very significant efficiency challenge if services are to be maintained and improved within the available financial resource”. It added that a number of actions have been taken to reduce cost pressures on the NHS, including negotiating with the pharmaceutical industry to cap the NHS drugs bill at an affordable level; ensuring that visitors and migrants pay for the services they use; promoting efficiency in back office functions through NHS Shared Business Services; transforming the way the NHS buys goods and services, to ensure greater value for money; and establishing the £3.8bn Better Care Fund. Under the plans every local area must have its two-year Better Care Fund plan signed-off by April 2014. Although the Fund is for 2015/2016, £500m of the pay for performance element will be tied to improved services and outcomes in 2014/2015.
NHS England director returns as Choices chief: A senior NHS England director and former director at outsourcing giant Capita, has been made senior responsible officer for the NHS Choices programme, reports Health Service Journal (subscription required). Beverley Bryant, NHS England’s director of strategic systems and technology, was the web portal’s senior responsible officer at its inception, and oversaw the site’s ‘go-live’ in 2007, while chief information officer at the Department of Health (DH). The site, designed to help give patients more choice and information about their care, was first operated by Dr Foster Intelligence, which held the contract to develop the site as a ‘delivery partner’ from 2007 to 2009. A re-launched version of the website, to be procured next spring, is set to include new services such as the ability to allow patients to book GP appointments and repeat prescriptions. Bryant was managing director of Capita Health between 2010 and 2012. The company held the contract to run NHS Choices from 2009 to 2013. The running of NHS Choices was transferred to the Health and Social Care Information Centre in April last year, after the Cabinet Office ordered the DH not to grant Capita any further extension to its contract for the service, as had previously been an option. There is no suggestion the decision not to extend Capita’s contract is related to performance on NHS Choices. An NHS England spokeswoman confirmed Bryant’s appointment, effective from 1st April.
Flagship £50m extended hours scheme receives 250 bids: NHS England has been inundated with around 250 bids for the £50m fund to help pilot extended hour’s schemes, leading to the prospect that strong contenders will miss out on funding, according to Pulse. Dr David Geddes, NHS England’s head of primary care commissioning, said that around 250 bids for funding have been received, and area teams are looking for alternative ways to support bids which are not selected for funding. The scheme was set up by prime minister David Cameron as a means to support practices opening from 8am to 8pm, seven days a week, by setting up a series of pilots through a funding pot worth £50m. It is also reported that the original bidding process had required applicants to begin their new schemes by 1st April, and justify any reasons they were unable to do so, but are now being kept ‘waiting on the starting line’ by NHS England – who were supposed to announce successful bids last month. Geddes explained that area teams were ‘impressed’ by the bids, and were seeking ways to develop ideas that weren’t going to receive challenge funding. The issue of how successful bids will be funded has yet to be fully resolved, Geddes said: “The idea when we were looking at the bids was actually to identify…how they would become a sustainable ongoing concern.” NHS England said: “The pilots will be independently evaluated during 2014/2015 and lessons shared more widely which will include looking at sustainability and value for money.”
Community and mental health IT hots up: Community and mental health trusts in London and the South are “working like fury” to pick new suppliers and replace their RiO electronic patient record (EPR) systems by October next year, according to eHealth Insider. Thirty trusts, which had RiO delivered by BT under the National Programme for IT, are part of a ‘2015 Consortium’ that is using a framework contract to procure new systems. Nine suppliers are on the framework to supply electronic patient records, hosting and clinical portals to the trusts, which need to replace their systems before their national contracts expire in October 2015. Peter Gooch, chair of the ‘2015 Consortium’ said: “Trusts are working like fury, putting the effort in to get on to new systems before the October 2015 deadline.” He added that all of the trusts involved have plans in place to migrate in the next 18 months and said that while this will be challenging, he believes it is achievable. Gooch, who is also the associate director of ICT at Camden and Islington NHS Foundation Trust, said three more trusts have picked their preferred supplier and are awaiting board approval for the funding. He expects news of more contract awards in the coming weeks. Many other trusts in the consortium are part-way through their mini-competitions and tender phase. Camden and Islington is in the midst of reference site visits and is looking to decide which system to buy in April. Trusts are focusing on procuring from Lots 1 and 2 of the framework, which covers the EPR and hosting, but will be looking to purchase a portal in the future. BT is currently rolling out Release 2 of RiO to trusts in London and the South. Gooch said not all of the 30 trusts will take the upgrade as it would not make sense if they are switching suppliers.
Glimpse of June NHS England IT Strategy emerges: The key tenets of the much anticipated NHS England IT Strategy were revealed in a speech at a health conference last week, reports the British Journal of Healthcare Computing. At a special event in London, the Westminster Health Forum on the implementation of electronic health records in the NHS, an NHS England executive told attendees to expect big moves around telehealth, customer service and integrated digital care records. According to director of strategic systems and technology for NHS England, Beverley Bryant, priorities include 95 per cent of GP practices being able to give patients access to records, support for online repeat prescriptions, and appointment booking by March 2015. All outpatient referrals will go through the new e-referrals service by March 2017, while we are also promised a single user interface for access to GP and other NHS transactional services. Bryant told the Forum there will also be a push around “finishing the job of getting off paper and onto safe digital record keeping.” Telehealth will be an area of investment as will be ‘customer service.′ Bryant also offered an interesting perspective on exactly what a ‘paperless′ NHS will look like: “I want a paperless NHS,” said Bryant. “But that doesn′t mean the patient won′t have paper – the way we live our lives differs from person to person. The NHS should always be able to respond and interact with that,” she said. Bryant also explained why the IT Strategy, originally due for release in December last year has been pushed back twice and will now be published in June. According to Bryant, this decision was taken based on a need to perform more research into building sound business cases on the specific benefits technology will bring. “Creating that is going to be key in convincing Treasury and future government that this is not only good for patient experience and safety but for efficiency and finance,” she claimed. She and her team are also looking at building a tech strategy that can be extended beyond the NHS and into the wider health and social care system.
NHS blunders put millions of records at risk: The Telegraph reports that NHS officials have admitted that sensitive medical data covering millions of patients has been stolen despite claims that the national records database has never been compromised. Freedom of Information (FOI) disclosures reveal a string of security breaches – including the theft of an unencrypted laptop, holding details from the hospital records of more than eight million NHS patients, which could identify individuals. Plans for a giant database of GP records have been put on hold for six months amid concerns about the security of the data, and fears of its potential misuse. A central store of NHS hospital records already exists, and officials have repeatedly said that its data has never been compromised. In February, Tim Kelsey, NHS director for patient information, said: “In twenty-five years there has never been a single episode in which the rules – very strict rules – have ever compromised a patient’s privacy.” Phil Booth, coordinator of privacy campaigners for medConfidential, said: “Despite claiming a perfect record for security, we now find that patients’ hospital information has been breached multiple times – though officials have seen fit not to disclose the full details. “Were a computer containing such sensitive information to be sold on eBay or make its way onto the black market, who knows how many patients’ lives and privacy would be permanently wrecked,” he said. The Health and Social Care Information Centre which is now responsible for NHS central data, said the breaches occurred when a predecessor organisation was in charge, and said the breach in London had been committed by an external organisation. A spokesman said: “No patient harm was caused and each situation has been thoroughly investigated and appropriate action taken.”
Monitor urges NHS to pick up the pace on reform: The pace of reform in the NHS must be increased to ensure that improvements can be made to patient care, the sector’s financial regulator has said, according to Public Finance. Publishing its strategy for the next three years, Monitor said implementation of the changes introduced by the coalition government’s Health and Social Care Act needed to speed up. The reforms, introduced last April, are intended to increase choice and competition in the NHS, as well as giving GPs extra power following the abolition of primary care trusts. There is a growing consensus about the fundamental changes now required to healthcare, the sector watchdog concluded. These include better integration of health and social care provision, breaking down traditional barriers between providers, and providing less treatment in hospitals and more in the community. “If the NHS is to continue to deliver the universal health service to which we are all committed, it needs to turbo-charge changes in the way health care is delivered to patients,” chief executive David Bennett said. Monitor’s work from 2014-2017 must support ‘radical’ change while also managing the risks of failure, he said. “As the regulator we don’t deliver frontline care for patients. Our job is to support those who do – the nurses, doctors, carers, managers and many more who work inside and beyond the NHS. This means recognising and respecting the challenges they face every day and their commitment to do the best for their patients. Our philosophy is to do what we can to help all these people do the right thing for their patients.”
Royal Liverpool creates A&E app: Royal Liverpool and Broadgreen University Hospitals NHS Trust has developed a mobile app to give staff access to emergency procedure guidelines, reports eHealth Insider. In partnership with mobile app company Appitized, trust staff have developed the app called ‘The Royal Liverpool Emergency Medicine Handbook’, in order to reduce response time in emergency situations. Consultant in emergency medicine at the trust, Dr Rehman Raj, said the app is the first of its kind and supplies trainees with information on how to manage acute emergency situations. Raj said: “It links in with local, regional and national guidelines and, via the content management system, also allows trust policies to be viewed. It can also be easily updated with push notifications sent out to all users.” Users of the app can search for key words and phrases bringing up relevant information and guidelines on how to cope with the situation. Staff can also bookmark sections of the app and create a personal list of what they find useful. The guide is built on evidence based medicine and links in with local, regional and national guidelines, and aims to ensure that investigations and appropriate referrals are made. Although it has been created specifically for clinicians and students working at Royal Liverpool, it can also be scaled for future use in other trusts and departments. The app was launched in November and since then it has been downloaded by more than 15 per cent of staff and students at the trust, and has become a part of the hospital training procedure. The trust encourages users of the app to report feedback on usability which will be taken into consideration when the app is updated. The app is free to access.
NHS reveals it has only spent £1.3m on care.data to date: The NHS’s controversial care.data programme has cost NHS England £1.3m to date, with the vast majority of the money being spent on “raising awareness” leaflets sent to millions of households in the UK, reports Computing. The disclosure was made in a written response to a Freedom of Information (FOI) request by Computing. The request, made in March, asked how much the NHS has spent on the programme to date, and how much it intends to spend on care.data overall. In response, NHS England said that the 2013/2014 spend was £1.328m, but that it did not hold the information on how much it intends to spend. “This is still subject to the approvals process on the overall care.data programme,” it said. Of the total spend, £926,778 was allocated to distribution company Leaflet Co Ltd, for the handling of the care.data awareness leaflets, while £308,491 was paid to Williams Lea, a business process outsourcing (BPO) firm, which has been a managed service provider for print and print management services to central government. The FOI request revealed that £45,504 was paid to Promotional Logistics Ltd, while other suppliers paid included stop-motion animation firm Matinai (£16,620), market research company BDRC Continental (£14,325), travel management firm Redfern Travel (£5,530) and production company AV Network (£4,140). Reports have suggested that the total spend of care.data could reach £50m.
NHS hospital trust seeks private help: Britain’s most indebted NHS foundation trust has approached private sector bidders to take over its management in a move that underscores the depth of the financial crisis in the NHS, reports the Financial Times (subscription required). Peterborough and Stamford NHS Foundation Trust, which runs two hospitals in Cambridgeshire and Lincolnshire, has been left grappling with a £40m annual budget deficit after using the Private Finance Initiative (PFI) to build a new hospital. The trust spends £42m a year servicing its PFI debts – the largest in the country – and receives a £40m subsidy from the Department for Health to stay afloat; a situation the professional services firm PwC has warned is “financially unsustainable”. The trust is expected to put out invitations to tender this summer, and submitted its plans to Monitor, the foundation trust regulator, for approval last week. This could see a private sector operator such as Serco, Circle Health or the private equity owned Care UK taking over the management of an entire foundation trust for the first time. Monitor confirmed that this was the first time an entire trust had sought a private sector bidder. “This is a complicated legal and administrative process which represents uncharted territory for the NHS and it is important the trust gets it right,” a spokesperson said. “There will then be an extensive programme to test bids before a final decision is made.” Although the Department of Health is bailing the trust out to the tune of £40m a year, a report by PwC last year warned this was “financially unsustainable”. The same report also included a recommendation to put the management of the trust out to tender. Millions of pounds have been spent on management consultancy fees in the past five years as the trust attempted to come up with a financially sustainable solution to its problems.
Councils encouraged to bid for health data cash: A government fund to encourage digital health data integration will be remodelled to encourage collaboration with local authorities, according to the NHS head of technology strategy. Public Technology reports that in September, the government announced the £250 million extension of the Safer Hospital, Safer Wards Technology Fund, aimed at implementing electronic record keeping. This week, Paul Rice told the Socitm spring conference that the renamed fund would now focus on bids which included collaboration between health bodies and councils to promote integrated care. Rice said: “In the first round, the focus was on acute care. The orientation of the fund going forward is about reflecting integrated care. This can only be effectively achieved if we have information to ensure it is a joined up solution.” Rice added that he was still negotiating on the final value of the second round funding with Treasury, despite the commitment last year to a £250 million for 2014/2015 and 2015/2016 extension. “It is still a negotiation to make sure we have access to that,” he said. But he indicated that the cash would be front-loaded to make most of it available during the first of the two years. NHS bodies will be “actively encouraged” to submit joint bids with local authorities in order to help move patient data effectively across the whole care system, he said. Rice also outlined some of the criteria that councils and health bodies would have to fulfil in order to access the cash. Firstly, he said that the bids must be for capital funding for systems that are part of change management, rather than replacing existing electronic data systems. He also said that bids would need to include a cost-benefit estimate, and would only be approved if they estimated a return on investment greater than 1.5 to one. Any joint proposal must be signed off by local health and wellbeing boards, to ensure “it is not just a token joint proposal”, Rice said.
Jersey GP records to be shared: Medical records kept by Jersey GPs could be available to other medical practitioners after a £1m overhaul of the record system, reports the BBC. Currently only GPs at a patient’s registered surgery can access their information. All 15 island surgeries have signed up for the project, which will move data from the practices to a central store. Patients would need to give permission for their records to be accessed by other health services. Initially the records would only be accessible when patients visited a different surgery or the GP Out of Hours Service. The aim of the project, due to be up and running in July, is to reduce the risk of incorrect diagnosis or prescriptions. Dr Nigel Minihane, chair of the Primary Care Body which represents all Jersey GPs, said: “Medical records remain confidential and secure. Patients will always be asked before their details are accessed and they have the right to stop all or part of their medical history being shared with other medical professionals.” In the future the system may be extended to the General Hospital’s Emergency Department and other local primary care services. The Health and Social Services Department also aims to use the information in the future to gather statistical information about conditions, for example the number of people with diabetes. However, it said this would not include access to personal information.
Another NHS England director leaves: Another senior figure has announced he is leaving NHS England, according to Health Service Journal (subscription required). Professor Robert Harris, who worked as strategy director in the policy directorate underneath Bill McCarthy, announced via social networking site Twitter that he would be leaving. He wrote: “Having joined the NHS Commissioning Board [the previous name for NHS England] nearly two years ago and for [the] past year led NHS England strategy work, have decided now is good time to move on to new challenges.” Harris added: “Having started the national Call to Action debate, I now want to play a part in effecting real transformation closer to the front line.” He did not say where he was going but said “The plan is to stay in healthcare, but in a greater rolling-up-my-sleeves kind of way.” Professor Harris is the latest in a string of senior figures to signal plans to leave NHS England. National director for policy, Bill McCarthy, national director of HR, Jo-Anne Wass, and chief technology officer, Alex Abbott, all announced their departure in March. A spokeswoman for NHS England said: “…Robert made the decision to resign with immediate effect from his position as director of strategy at NHS England. This was a personal decision unrelated to the work of NHS England.”
Opinion
How much do we want to keep the NHS publicly funded and free?
In the Guardian this week, Bob Hudson explains that Lord Warner’s report proposing a £10 monthly charge for using the NHS has raised an important and fundamental question.
“Lord Warner, the former Labour health minister, must be delighted with the reaction to his report proposing, among other things, a £10-a-month NHS “membership fee” and the imposition of £20-a-night “hotel” charges for hospital stays. An obscure report from an obscure right-wing thinktank, co-authored by an obscure and unelected politician, has resulted in a media splash beyond expectations. Why is this? The answer is that despite the criticism heaped upon his ideas (and upon him personally), Warner has posed an important question – “how much do we want to keep a health service publicly funded and free at the point of delivery?”
“Warner estimates that the measures he proposes would raise around £6bn a year to plug the NHS funding gap but fails to mention other ways of raising many more times this amount. Nye Bevan famously said that “the religion of socialism is the language of priorities” and there were echoes of this in David Cameron’s recent remark while responding to the flooding crisis – “Money,” he declared, “is no object in this relief effort. Whatever money is needed, we will spend it.” People will reasonably ask why this principle might not also hold good for the NHS.
“Do we want to slide down this slippery slope towards charges, co-payments and dependence upon private medical insurance cover? The Scots and the Welsh would certainly not be coming along for the ride, and we can be sure that no sane political party will want to go to the people in 2015 offering a manifesto of co-payments for healthcare.”
Shut off the foundation trust pipeline
In this week’s Health Service Journal (subscription required), Alastair McLellan explains why for the great majority of NHS trusts, achieving foundation status is a potentially damaging distraction.
“Former health secretary Alan Milburn last week called for all trusts to be given foundation status and for the NHS Trust Development Authority (TDA) to be merged with Monitor. His inclinations are correct, but his tactics are poor.
“Foundation trust (FT) status is largely about winning the right to relatively limited freedom of action. This is important – and few FTs would surrender it – however, it pales into insignificance compared to the radical service reconfiguration required to make the provider sector fit for purpose. The focus of most non-FTs needs to be on the difficult choices this demands and not on jumping through regulatory hoops, electing governors or reconstituting their finances.
“The merger of Monitor and the TDA would also be classic NHS displacement activity; plunging the sector into a debate over organisational form and role, leadership and – of course – some very significant redundancy packages. The FT pipeline has almost run dry. Only a handful of authorisations are expected in the next 12 months.
“For the sake of clarity for patients, staff and stakeholders and to ensure that the focus of non-FTs and regulators alike is where it should be, the government should announce that no more FT applications will be processed after June. This will need careful communication, especially where organisations have linked their corporate reputation to achieving FT status, but most would welcome the chance to concentrate on the real challenges.”
New brooms, old guards, core values
Gwyn Thomas, chair of the UK Council for Health Informatics Professions, writes in eHealth Insider this week on how the NHS can renew core values of the health informatics profession using valuable experience both in and outside of the institution.
“At the heart of all professional disciplines lies a body of knowledge. One of the main responsibilities of all professional organisations is to gather the hard won experience of their members, combine it with current best practice and pass it on by encouraging professional communities to assemble, communicate and share.
“Much of this can be (and is being) done through self organisation and good will. But history shows that this is never enough. Active professional bodies are essential to preserve and transfer corporate memory, particularly at the time of ‘the changing of the guard’.
“However, for any profession to be credible, it needs to be independent, inclusive and self sustaining. It needs to be founded on a strong and stable platform constructed from codes of conduct and ethics, professional standards, voluntary registration, accreditation and regulation.
“Finally, let’s remember that the reputation of any profession is determined by the lowest standards that it tolerates not the highest that it has achieved.
“Informatics is no different. We need to build the professional credibility to be able to speak loudly with one independent voice that has the courage to tell truth to power. After all, every new broom is just an old guard in the making.”
Don’t duck the hard choices spelt out by the Barker Commission
Chris Ham, chief executive of The King’s Fund, explains why the post-war settlement that created the current divide between health and social care must be replaced following the interim report of the Barker Commission.
“The commission argues that a new settlement is needed, based on a single, ring-fenced budget for health and social care in which entitlements to care are more closely aligned. Additional funding will be required to achieve this objective and hard choices have to be faced about where this should come from.
“To argue, as I’ve heard politicians across the spectrum do, that talk of alternatives will reduce pressure on the NHS and councils to become more efficient ignores the huge efforts being made to do precisely this. It also ignores growing evidence of the difficulties facing the NHS, which we will be analysing in greater detail in a forthcoming report. For many, the transfer of resources from the NHS to social care required by the Better Care Fund will only add to these difficulties.
“If we duck the hard choices laid out by the commission, then services will progressively deteriorate with patients, users and carers the real losers. The King’s Fund will be supporting the commission in keeping the debate going in coming weeks and months ahead of their final report in September. We hope you will contribute by responding to the commission’s call for evidence and will hold politicians to account by supporting the case for change.”
Highland Marketing blog
In this week’s blog, Jeremy Nettle reports on the World of Health IT conference and exhibition in Nice, France.
