Norman Lamb: Mid Staffs would never have happened at a mutual: Health minister, Norman Lamb has suggested acute trusts could improve staff engagement by becoming social enterprises, and argued the culture and leadership problems seen in Mid Staffs would never happen in a mutually-owned company, reported Health Service Journal (subscription required). Lamb’s comments come as the Department of Health begins a review into staff engagement and empowerment. It will look at how greater use of mutual and social enterprise could improve quality. The review, which will identify models and approaches for engagement and empowerment and make recommendations about how they can be more widely adopted has been launched by the health minister and led by the King’s Fund chief executive Chris Ham. There will be a strong focus on the use of mutual and social enterprises. Lamb said: “We need to be willing to look at all the different (care) settings. We’ve seen (mutual and social enterprises) in community services – could the principle be applied to an acute hospital?” He added: “I think it’s worth exploring the opportunities for extending it into areas that haven’t hitherto (used mutual) – could you have a mutual foundation trust for example?” The review will report in April 2014.
Cover-up accusations about culture, not Burnham – Hunt: Health secretary Jeremy Hunt has responded to Andy Burnham’s threat to take legal action over a tweet he sent last week, saying it was not meant to suggest a “personal cover-up” by the former Labour health secretary, reported National Health Executive. Instead it was the culture over which Burnham presided, where bad news about the NHS was ‘discouraged,’ that he intended to criticise, Hunt said, following revelations about the way a Care Quality Commission (CQC) briefing about Basildon Hospital was handled. In a letter, of which a photo was posted by Hunt on Twitter, he wrote: “The impact of this culture was disastrous for the NHS because ‘bad’ news did not emerge quickly and the public were kept in the dark about poor care. As a result, problems were not addressed rapidly with terrible consequences for patients.” He added: “Robust and at times heated exchanges of views between politicians are par for the course in a healthy democracy. I am, of course, very happy to debate the above with you at any time, but I believe that as elected politicians the right place for us to do so is in Parliament or the media, rather than the courts.” Hunt had initially tweeted about “Shocking revelations on @andyburnhammp’s attempts to cover-up failing hospitals”. Burnham responded by writing a blog on Labour List calling it an “unfounded attack on my integrity” and said: “I am not prepared to let it go.” Burnham said he was considering legal action.
DH finalises CSC deal: CSC and the Department of Health (DH) have signed a revised contract for the North, Midlands and East (NME) that the DH says will save the NHS another £22m, reported eHealth Insider. The move marks the end of the long saga of talks between the DH and the company over the future of its local service provider deal for the three clusters. Under the National Programme for IT (NPfIT), CSC was contracted to deliver ‘strategic’ electronic patient record systems (EPR) to the NME, however, it has struggled to roll-out the Lorenzo EPR that was initially developed by iSoft. In September 2012, the two parties signed an interim agreement that removed CSC’s exclusive rights to provide IT systems to the NME, in return for compensation from the DH, and an agreement from CSC not to pursue legal action. The deal also made some central funding available for up to 22 trusts that may still want to take the system. So far, eight have agreed to do so. The final contract, which was signed last week, has brought together the three original NPfIT contracts and the interim agreement into one contract. It also underlines that CSC will no longer get paid if trusts decide not to take the company’s products. The DH says it has already saved £1 billion on the CSC contract, but that the new deal will save another £22m by reducing the value of the contract and by only paying CSC for what it delivers.
£30bn NHS funding gap by 2021, Monitor warns: The NHS is facing a £30bn funding gap by 2021, the healthcare regulator has warned in a new report, reported National Health Executive. ‘Closing the funding gap’ calls for “radical change” to secure the future of the health service and to achieve more for less. The report calls for improvements to productivity within existing services, as well as increased care in the community, development of new and innovative ways of delivering care, making one-off reductions in capital expenditure, and changing the way health spending is allocated. David Bennett, chief executive and chair of Monitor said: “Over the next eight years, the health sector faces its greatest financial challenge in recent times. We are all going to have to strain every sinew to meet it. While there are individual things the sector can do – like be more efficient in its procurement or introducing new ways of working in hospitals – what is required is a step-change. In short, the NHS must undergo radical change if it is to survive.”
NHS tears out its Oracle Spine in favour of open source: The UK government’s quest to get public services to use more open source technologies seems to be taking hold, judging by the revamp of the NHS’s Spine service, reported The Register. The upgrade from Spine to Spine2 will see the NHS shift the core of its main secure patient database and messaging platform from Oracle onto a bevy of open source technologies including the Riak datastore, Redis, Nginx, Tornado, and RabbitMQ, along with some proprietary technologies like Splunk. This also sees it enlist a British IT contractor named BJSS to help with the rollout. “While this [use of open source] is now fairly common practice at the application tier, the ability to have a resilient, distributed data storage tier on the same commodity hardware makes a significant contribution to the cost efficiency of this solution,” said Mark Pullen, chief software engineer for BJSS. Spine2 is built on Spine, which was one of the two successful components built under the disastrous NHS National Programme for IT (NPfIT). Spine supports patient programmes like Choose & Book, Electronic Prescription Service, Summary Care Record, and others. Spine2 will build on this to become a system that all other NHS services are designed to be able to hook into and use for communication and data storage. It is being designed to hold some 90 million patient records, along with 200,000 users.
Auditors urge NHS Scotland to strengthen financial planning: The health service in Scotland must tighten its long-term financial planning and change the way it delivers services if it is to cope with impending budget cuts, reported Public Finance. A report from Audit Scotland found that all 14 territorial, and nine specialist, NHS boards in Scotland have performed well in meeting their financial targets, but that pressures are now building within the system as budgets are squeezed over the next three years and demand for services continues to rise. The Scottish Government has resisted the market-orientated reforms imposed in England, increasing the overall health budget in real terms over the past decade to £10.9bn in 2012/13. Boards responded by meeting their financial targets in 2012/13 for the fifth successive year, delivering savings of £270m, a small surplus of nearly £17m, and improved patient outcomes. However, Audit Scotland warned that real-terms cuts of 1.6% are in prospect over the next three years, with a marginal 0.6% rise in revenue spend more than offset by a 61% real-terms drop in capital budgets and by growing demographic demands on health provision. Boards are also finding it harder each year to come up with new savings, the report acknowledges. Auditor general, Caroline Gardner praised the financial performance of the NHS in Scotland. She said it had made good progress in improving health outcomes, notably in relation to deaths from heart disease, cancer and stroke, and in respect of patient safety. “However, the health service needs to increase its focus on longer-term financial planning so that it is prepared for the challenges it faces,” Gardner said.
Buy services from abroad to cut costs, regulator urges NHS: The NHS will have to open its doors to international health companies from nations such as India and Mexico to tackle the long-term crisis in its finances, the health service’s economic regulator has cautioned. In a briefing this week, David Bennett, Monitor’s chief executive, outlined a radical reshaping of the health service, arguing that billions could be saved and patient care enhanced by centralising services, encouraging GPs to add extra appointments and stopping around 30 elective procedures which were “relatively ineffective”, reported The Guardian. Monitor’s work has concluded there are potential savings of up to £12.1bn from improving hospitals’ efficiency, and up to £4bn from reducing beds and shifting patients into community. However, Bennett said there would still be a funding gap of £10bn by 2021-22 even if the regulator’s recommendations were followed. He said there was evidence from other health systems around the world that patients could be treated at a far lower cost – a suggestion that sparked a political row. He pointed out that in India a hospital group specialising in cataract surgery, Aravind, delivers 60% of England’s NHS eye surgery volume at less than one sixth the cost. Applying the Indian company’s approach to NHS orthopaedics could see £800m in savings from a £2bn budget. “We must not rule out letting players outside the NHS, who can provide good quality care at NHS prices, show us how to do things differently,” said Bennett.
NHS England rules out one-size-fits-all GP model: NHS England will not impose a one-size-fits-all model on general practice in response to a wide-ranging consultation on the future of primary care, a senior health service executive has said, reported GP. However, significant reforms could emerge from the consultation, after NHS England chairman Sir Malcolm Grant told the Commissioning in Healthcare conference in London this week that for primary care provision “we need to think the unthinkable. Funding needs to follow the transfer of work from hospitals to general practice,” he said, but warned that GPs could face a ‘much more rigorous evaluation of outcome measures’. “I am not a person for a single model of primary care,” he said. “I think we at NHS England are very interested to see what funding arrangements can bring a greater rationalisation to the provision of primary care. I think that we will have a number of ways of approaching primary care.”
NHS trust admits safety failings over patient death: The much-criticised Mid Staffs NHS trust faces an unlimited fine after admitting breaching health and safety laws over the death of a diabetic patient who was not given insulin, reported Channel 4 News. The trust pleaded guilty to failing to ensure the safety of 66-year-old Gillian Astbury, who lapsed into a fatal diabetic coma while being treated at Stafford Hospital in April 2007. The case is being referred to Stafford Crown Court because of its seriousness, and the trust – which is in administration and running an annual operating deficit of around £11m – faces an unlimited fine. It admitted to breaching the law by failing to properly manage and organise hospital services, including its systems for record-keeping, patient information and communication between staff members. The criminal prosecution at Stafford Magistrates’ Court was brought by the Health and Safety Executive three years after an inquest jury ruled that the death was contributed to by low staffing levels and a systemic failure to provide adequate nursing facilities. The inquest also concluded that a failure to administer insulin amounted to a gross failure to provide basic care.
NaSH boards get dashboards: The Scottish national sexual health (NaSH) IT system has been upgraded to include patient dashboards, reported eHealth Insider (EHI). The electronic patient record system, known as NaSH, was first piloted in 2008 before being rolled out nationally and it now covers all health boards on the Scottish mainland. NaSH incorporates all the sexual health services in both primary and secondary care. The system has been upgraded to include functionalities such as a patient dashboard summary, to help clinicians assimilate information from various parts of the record. Dr Andrew Winter, a consultant in sexual health and HIV medicine at NHS Greater Glasgow and Clyde and chair of the NaSH user group, told EHI that sexual health clinics in Scotland are a fully paperless service. “In Glasgow we see more than 100,000 patients a year across different locations, but all completely paperless from beginning to end,” he said, adding that this includes e-prescribing. “We manage all results by electronic workflows. Lab requests and results are done electronically and communicated out to the patients through their preferred method.” Dr Winter added that in Glasgow, the total turnaround time was rarely longer than 48 hours from taking the test to the patient getting the result.
Confidential patient details lost in major security breach at Sutton hospital: A hospital lost a filing cabinet containing vulnerable patients’ confidential details in a major security breach, reported Your Local Guardian. Documents, containing data on 63 patients – who could be from anywhere in south-west London – disappeared from Sutton Hospital last year prompting an investigation by government inspectors. Privacy campaigners have called the Epsom and St Helier Trust’s loss of the cabinet a “fundamental failure” to protect patients’ privacy while Carshalton and Wallington MP, Tom Brake, has demanded the trust keep tighter control of patient records. The incident was one of 243 in 2012-13 relating to information security involving the trust such as data protection and confidentiality – nine of which were recorded as “serious”. Details of the high-level breach only emerged in a hospital report published last month. The filing cabinet, which was held securely behind locked doors, went missing when the building was vacated by another organisation, understood to be South West London and St George’s Mental Health NHS Trust. The security failure was reported to the Information Commissioner’s Office (ICO) – an independent authority which regulates data protection. The ICO carried out an audit including interviews with key members of staff this year and made a number of recommendations to the trust. Despite having the power to issue fines of up to £500,000 they considered the actions taken by the trust and decided not to act this time. It was the only breach that year reported to the organisation.
Whittington live with Medway PAS: Whittington Health has gone live with its Medway patient administration (PAS) and A&E system from System C, a McKesson company, reported eHealth Insider. The trust was running the legacy Totalcare PAS from McKesson and went live with the Medway PAS at the end of September. Eleven trusts running Totalcare are due to deploy the Medway PAS before the support contract for the system expires at the end of March 2014. Whittington is the first of these sites to go-live and looks likely to be closely followed by a further four Totalcare sites over the next two months. Whittington plans to be one of the first paperless NHS trusts by rolling out a full electronic patient record system over the next two years. It deployed the Medway maternity module in May this year, but waited to go live with the PAS and A&E systems in the second of its three-phase deployment. The third phase of its deployment will be a GP portal with an integrated community module, due to be implemented in late 2014. The maternity module is being trialled on iPads and interfaces with child health, radiology and results reporting, as well as the new PAS and A&E systems.
‘Successful’ extended hours model hailed by DH won’t begin until Christmas: An extended GP hours scheme in Manchester praised as ‘successful’ by the government and cited as a model for its £50m scheme to pilot practices opening in the evenings and weekends has yet to start seeing patients, Pulse has revealed. The scheme was praised by health secretary, Jeremy Hunt as ‘leading the way’ and was described in the Department of Health’s (DH) press release as being ‘successfully piloted’ when it announced last week the plans for GP practices in nine areas to open seven days a week. The claim was repeated widely in the national media, with the BBC among those to state that ‘Manchester is already piloting an extended-hours scheme’. However local GPs have told Pulse that they were ‘mystified’ by the announcement and the claims that the pilot scheme had been ‘successful’ as it is still at a preparatory stage and is not due to begin until Christmas. After queries from Pulse, the DH admitted it had made a ‘mistake’ in its press release, which it said would be amended online.
Rise in ‘avoidable’ NHS admissions: The number of emergency hospital admissions for conditions that could be avoided has risen 48% in 12 years, according to a new report, reported Health Service Journal (subscription required). Between April 2001 and March 2013, NHS hospitals in England received more than 56 million emergency admissions, of which one in five (10.4 million) were potentially avoidable. Patients were admitted with conditions including dehydration, urinary tract infections, complications of diabetes, angina, chronic obstructive pulmonary disease, which is often linked to smoking, and ear, nose and throat infections. Research suggests better management of people’s illness in the community and in GP surgeries could prevent some of these admissions. The study, from the Nuffield Trust, found admissions for potentially avoidable conditions increased from 704,153 a year to just over a million a year. This accounts for an increase of 339,760 admissions for every year of the study. Nuffield Trust chief executive Andrew McKeon said: “Given constraints in resources for the NHS and social care in the next decade, a key concern must be the extent to which the gains made in improving quality of care over the past decade may be lost.”
GP medication errors up 60%: There has been a sharp rise in the number of medication error cases reported to the Medical Defence Union (MDU) by GPs over the past five years, reported Commissioning GP. The MDU reviewed 371 legal claims and a further 408 advice files which were notified by its GP members in the five years between 2008 and 2012 to help its members understand common prescribing problems. The number of files opened in 2008 (135 files) increased by 59% to 215 in 2012 but this was mirrored by a 60% increase in the number of items dispensed by GPs over the same period (1000 million in 2012 compared to 383 million items in 2002). However, the MDU said that this upward trend was more likely due to an increase in GPs’ prescribing workload rather than a fall in medical standards. Dr Caroline Fryar, MDU medico-legal adviser, commented: “Most medications are prescribed safely and appropriately by GPs, and even when errors do occur, they may not result in harm to the patient. However, medication errors are one of the main reasons for claims settled by the MDU on behalf of GPs.” The MDU paid around £5 million in compensation and £400,000 in legal costs over the period with an average compensation award of just over £58,000.
Mersey Burns App wins EHI Awards 2013: An app that enables doctors to quickly and accurately assess the extent of a burn and so deliver the best possible treatment to patients has emerged as the overall winner of the EHI Awards 2013 in association with CGI. The Mersey Burns App was developed by a PhD student, Chris Seaton, and two plastic surgeons at St Helen’s and Knowsley NHS Trust, Rowan Pritchard Jones and Professor Paul McArthur, with further support from the Knowsley Health Informatics Service. Traditionally, doctors sketch a burn on paper to assess its extent and decide what fluids to give to a patient. The app enables them to shade the area of a burn on a plan of the human body, does the fluid calculations for them, and collects patient details that can be forwarded to a specialist unit. The app is also the first UK healthcare app to carry a CE mark from the Medicines and Healthcare Products Regulatory Agency; making it the first, regulated phone app in the UK. The black tie dinner for the EHI Awards 2013 in association with CGI was held last night at The Roundhouse in London, with 12 winners announced by compere Rory Bremner before the final announcement was made. The Healthcare IT Champion of the Year award, which is decided by the readers of EHI, went to Kemi Adenubi, the GPSoC programme director at the Health and Social Care Information Centre. Click here to see the full list of winners.
Opinion
From the Heart and Chest
This week, Johan Waktare, consultant cardiologist at Liverpool Heart and Chest Hospital, tells eHealth Insider, that it’s time for his trust to start having fun with MLMs, but the time is not yet ripe for iPads.
After explaining that his trust is using MLMs (Medical Logic Modules) to integrate multiple data sources (past medical history, demographics and medications), following the deployment of an EPR system, Waktare goes on to talk around the adoption of mobile technology:
“One of the most common questions that the EPR team were asked before go-live was “are we getting iPads?” The short answer to that was “no!” I wouldn’t have begrudged pushing for them if that would have improved system usability; but they simply wouldn’t have benefited us at this stage.
“It is no good using a nice hand-held if your software hasn’t been optimised to be used on a hand-held device. Anyway, tablet devices such as iPads are not necessarily the way forward anyway in many scenarios; the truly hand-held devices, such as smartphones or an iPod Touch, give better workflow in many scenarios.
“Again, the problem should drive the solution. There’s no point buying technology and then trying to retrofit the shiny new hardware to the task that needed doing. We don’t need “toys for the boys”, but hardware and software development that make workflows better for clinical staff and patients.
So the slightly longer answer is “not now but maybe later…”
Change can’t come soon enough for the NHS and primary care
In the Guardian this week, Dr Charles Alessi, chairman of the National Association of Primary Care, explains why this could be the start of a new age for general practice and out of hospital care.
“We are going through an accelerated pace of change. The airwaves are full of impending changes from better management of older people to a review of out of hours. Why is this all happening now and is it welcome?
“2012 and 2013 have been difficult years for the NHS. We have been through major structural reform, not always welcome by all, and have also been rocked by scandals as profound as Mid Staffs, Winterbourne View and Morecambe Bay.
“The proposed changes around the accountable GP and a rethinking of the organisation of out of hours are thus welcome as they reintroduce care, compassion, dignity and respect back into the way people are cared for.
“Similarly the return of practice responsibilities around out of hours care is to be welcomed. The model which was introduced disenfranchised primary care and this needs to be put right. Yes, we need to think around new models of delivery but there are many now to act as exemplars.”
Concluding, Alessi says that this could be the start of a new age for healthcare: “An age where we restore the morale of the professionals by empowering them to make change and regain responsibility and allowing them to regain the trust of people and populations. This will not be an easy journey and there will inevitably be setbacks but the age of out of hospital care wrapped around a person who receives care has started.”
Patient data: finding the right balance
In HSJ this week, Andrew Fenton, associate director of commissioning at Central Southern CSU, argues that there is a feeling among commissioners that the Caldicott Review will make sharing data harder, which will affect patient care.
“On the ground in commissioning land, there is much disquiet and frustration about the new information governance arrangements resulting from the Health and Social Care Act and by implication the recommendations of the Caldicott review. There is a view that in reality the balance has been tipped further in the direction of locking down information that is essential to the improvement of patient care”.
“This sounds perverse, as the intention and claim of the review is that sharing of information for patient care should become easier, no longer bound by the old “IG says no” approach to information sharing. However, where the review talks about information sharing for patient care, it is largely focused on individual bilateral messages and communications between providers − for example, relating to a referral, a discharge, a lab result or a care plan”.
“What this misses is that the ambition of more joined up, patient focused health systems requires not fragmented and complex sets of patient data flying between providers (including GPs), but a more advanced and holistic approach to electronic patient record integration. The development of “health information exchanges” or virtual shared care records within local health communities is a key enabler to the ambitions of integrated care”.
“At a time when we are working towards more holistic, system wide and patient focused delivery of care, the management and use of information is at risk of being fragmented or exchanged only through isolated communications between providers. The new information governance landscape taking shape risks sitting uneasily with the aim of properly integrating and improving care across our health and social care communities”.
Austerity kills – we must invest
In HSJ this week, Brian Fisher, a retired GP and chair of the Socialist Health Association, explains why investing in health is not just the morally right thing to do, the numbers across Europe show it reaps economic benefits as well.
“NHS England has made it clear. An extra £30bn will need to be found, on top of the £20bn of savings that are already an NHS target. That’s £50bn to be saved by 2020. However imaginative and thoughtful, these cuts will damage people’s health. There will be deaths.
“We know this because of the effects of austerity in other countries. It is clear that imposing austerity while cutting social, health and benefits support spending at the same time kills large numbers of people. The UK is doing all these things at once.
“Why does the government continue in this path, knowing the consequences full well? We know the answer: ideology, corporate greed and corruption are all at play. Austerity is being used as a shield to shrink the state at scale and pace. Privatisation is part of a corporate scam to maintain profits by bleeding the statutory sector. And all this driven by a government whose hands are in the till with complex, deep and wide interests in the very private sector planning the gains.
“So, NHS England, don’t cut £30bn. Expand funding to the NHS. Even in conventional economic terms it is the right thing to do.”
Highland Marketing blog
In this week’s blog Joanne Murray gives an insider’s view of the annual Healthcare Efficiency Through Technology Expo.
