News in brief
Hospital productivity report shows how NHS can make large savings: Lord Carter has worked with 22 leading hospitals to see how the NHS could save money by doing things more efficiently by spreading best practice, reported Gov.uk. His report finds that the NHS could save up to £5bn every year by 2020 by making better use of staff, using medicines more effectively and getting better value from the huge number of products it buys. Health secretary Jeremy Hunt is now calling on the NHS to ensure every penny is spent in the most effective way for patients to improve standards of care while reducing costs. The government particularly wants to see lessons learnt by hospitals who are not being as efficient as they could be across all areas of their work, and could therefore make bigger gains for patients. The Prime Minister has set out that the NHS must modernise and move to a 7-day service. The size of the NHS means that by doing several small things better, huge savings are possible to help achieve that aim. These include: better management of staff, rotas and shifts and optimising the medicines used in hospitals. Lord Carter said: “The NHS has some of the best hospitals in the world both in terms of quality, innovation and operational efficiency. The challenge is to lift hospital efficiency to a consistently high standard in every area of every NHS hospital and, where we already perform well, innovate to improve further. I do not think there is one single action we can take but I do believe there are significant benefits to be gained by helping hospitals, using comparative data, to become more productive.”
Keogh: ‘Quality should define finance’ for chief execs: The NHS England medical director has said the quality agenda ‘should define the financial strategy’ for NHS chief executives, amid growing pressure to make cost savings. Sir Bruce Keogh also explained his decision to remove two of the three elective waiting time targets, and to change publication of accident and emergency performance data from monthly to weekly. He spoke to Health Service Journal (subscription required) last week, as national leaders made announcements focusing the NHS’s priorities on making large efficiency savings this year. These include limits on agency spending for clinical staff, and the Care Quality Commission measuring efficiency as well as quality. He said the changes he had recommended to NHS England chief executive Simon Stevens on performance targets were not related to finance. He said: “Let me be absolutely clear. My focus on [referral to treatment standards] has zero relationship to the finances of the NHS and a 100 per cent relationship to how we make it easier for organisations to do the right thing.”
Care.data re-launched this month: The Blackburn with Darwen Clinical Commissioning Group (CCG), one of four care.data pathfinders will start communicating with patients about the government’s care.data programme at the end of June reported DigitalHealth.net. Other pathfinder CCGs, Somerset and West Hampshire, will start testing their public communications at the beginning of September and Leeds have not confirmed when it will begin the process, but is working towards the end of September. The first data extractions are likely to take place between September and November this year. The care.data programme will extract data sets from different organisations, starting with GP practices, and link them to an expanded set of Hospital Episode Statistics within the “safe haven” of the Health and Social Care Information Centre. NHS England says this new data set will help to determine where the NHS needs to invest and to highlight where excellent care is being delivered and where there may be local problems. The pathfinders will test different communication strategies with patients, including individual letters sent to their homes from their GP, explaining the benefits and risks of data sharing. So far, 104 practices across Blackburn with Darwen, Somerset and West Hampshire have signed up.
Radical commissioning changes essential for integrated care: Integration of health and social care faces a major obstacle in the fragmentation of commissioning, according to The King’s Fund. In its latest report it said that integration cannot succeed without radical changes to commissioning, and made a series of recommendations to ensure that there is integrated commissioning in all parts of the country by 2020 to improve outcomes for people, reported OnMedica. The ‘key challenge’, according to the charity, is to implement these without embarking on a top-down structural reorganisation. The King’s Fund said in Options for integrated commissioning: beyond Barker that health and social care services need to be much better co-ordinated around the individual to ensure that the right care is offered at the right time and place. This report follows on from the final report of the independent Commission on the Future of Health and Social Care in England (the Barker Commission), which called for an end to the historic divide between the NHS and social care.
Essex, Cumbria and Devon face NHS England ‘success regime’ measures: NHS England chief executive Simon Stevens has earmarked three areas in England where local health and care organisations will work together to make improvements for patients as part of a new so-called “Success Regime.” The regime involves NHS regulators taking control of health services in entire regions where hospitals are perceived to be failing, reported Government Computing. Essex, North Cumbria and Northern, Eastern and Western Devon are the areas affected by the move, which seeks to “create the conditions for success” in challenged areas. Its purpose is to protect and promote services for patients in local health and care systems that are struggling either with financial or quality problems. It will provide increased support and direction and aims to secure improvement in three main areas: short-term improvement against agreed quality, performance and financial metrics; medium and longer-term transformation, including the application of new care models where appropriate; developing leadership capacity and capability across the health system, ensuring collaborative working. The success regime will be overseen jointly at local and national levels by NHS England, Monitor and the NHS Trust Development Authority to ensure consistent oversight of the whole health economy.
GP records to be shared without patient permission to tackle ‘high cost’ patients: Identifiable information from GP records will be shared without patient permission under a new local care.data-style scheme to intervene in the care of ‘high cost individuals’. Pulse has learnt that NHS Southend Clinical Commissioning Group (CCG) hopes to start extracting identifiable data from GP records next month, with the aim of identifying ‘high cost’ patients and reviewing their care. The CCG says it is the first scheme of its kind to extract, link and share identifiable information in GP records for use other than direct patient care. But GP leaders have questioned the focus on cost, rather than the quality of patient care. Patients will also not be informed about the data extraction in advance and will have to ask their GP to opt out if they are not comfortable with identifiable information from their medical record being shared. The NHS Southend scheme will identify patients with complex care needs though their NHS number, age and post code, with the aim of ‘reviewing’ their care. The scheme will also extract data including the number of appointments with the GP or practice nurse, prescribed medications, and unplanned admissions for individual patients.
E-Referrals service to be rolled out to all GPs from next week: Choose and Book will be deactivated at 7pm on Friday 12th June, and the new NHS e-Referrals service will launch at the start of next week, long after the intended November 2014 launch date. The programme team said most of the early changes will not be apparent to GPs or patients, but once the service is implemented and tested they will begin adding new features, such as booking follow up appointments, a search function for local services and booking via mobiles. But Dr Stephen Miller, the scheme’s medical director and a GP himself, told Pulse that the central issue of unavailable referral slots, which saw uptake of Choose and Book stall below 50%, would not be solved by the new service.
Cumbria Partnership insources IT: Cumbria Partnership NHS Foundation Trust has said it will save £1.4m over the next five years by bringing its IT services in-house. The community and mental health trust will use 40 permanent IT staff members to support and develop its IT systems rather than an “expensive, out-sourced support solution.” Previously, 64% of IT support services were provided by contractors. Ian Waterhouse, head of IT at Cumbria Partnership said the benefits of insourcing went beyond the potential efficiencies. Speaking to DigitalHealth.Net, he said one of the main drivers was to use the skill set that already exists in Cumbria. He also argued that a local workforce can appreciate the benefits it is delivering for healthcare in the local community. Waterhouse also mentioned that using full-time NHS staff meant the possibility of greater engagement with other NHS organisations as it would be easier to converge services. To support the development of this team the trust has ring-fenced funding to re-invest in staff training and development, while there are two apprenticeships on offer.
E-prescribing could save 20,000 lives a year, says Birmingham NHS CIO: E-prescribing software could help save 20,000 lives a year across England and Wales if adopted by all NHS trusts, according to NHS IT director Stephen Chilton. The software digitises the prescriptions process, making it more efficient for patients and healthcare workers and helps to ensure clinicians don’t give patients the wrong medicine. The finding was part of a peer review of University Hospitals Birmingham NHS Foundation Trust’s prescribing information and communications system (PICS), which it developed in-house 10 years ago. The system has a rules engine to check doctors are not giving medication to a patient they are allergic to or is incompatible with their other medicine. It also has bedside observation functions to check vital signs, Chilton told ComputerworldUK. PICS has not only helped the hospital to improve patients’ outcomes but it’s also reduced average length of stay, something the hospital badly needs as the number of patients has almost doubled from 500,000 to 900,000 in five years, he said. The software has been such a success in Birmingham it has now been commercialised by UK-based technology group Serverlec and can be bought by other trusts, with profits going back to Birmingham.
Michael Thick joins IMS MAXIMS: Clinical IT veteran Michael Thick has joined IMS MAXIMS as the company’s chief medical officer and chief clinical information officer. Thick is best known for his work as chief clinical information officer for the National Programme for IT, where he led the 2008 “Health Informatics Review”. Thick, who started his career as a consultant transplant surgeon, more recently worked with McKesson UK, where he led on clinical strategy and governance. Thick told DigitalHealth.net that he found his job winding down after McKesson UK decided to dispose of its electronic patient record business (now System C) but he wanted to find a similar role. Thick said: “For me, the really important point is that this organisation understands the transformation agenda and the requirement for change, and is prepared to build the systems required to respond to that.” IMS MAXIMS, he argued, can be more agile. The company has pioneered the use of open source EPRs in the NHS by releasing the code for its openMAXIMS product suite, and forming a community interest company to develop it.
CSC settles SEC charges: The Securities and Exchange Commission (SEC) has charged Computer Sciences Corporation (CSC) and former executives with manipulating financial results and concealing significant problems regarding the company’s NHS contract, reports DigitalHealth.net. The company has agreed to pay a £124m penalty to settle the charges, and five of the eight charged executives have agreed to settlements. The SEC alleges that CSC’s accounting and disclosure fraud began after the company learned it would lose money on its NHS contract because it was unable to meet certain deadlines. The SEC has filed complaints in federal court in Manhattan against former CSC finance executives Robert Sutcliffe, Edward Parker, and Chris Edwards, who are contesting the charges against them. The SEC’s investigation also found that CSC and finance executives in Australia and Denmark fraudulently manipulated the financial results of the company’s businesses in those regions. A statement from CSC says the company is pleased to have settled the long-standing investigation. “Putting this matter behind us is in the best interest of CSC, our stakeholders, and our ongoing business transformation,” it says.
Monitor and TDA to join under new chief: Monitor and the NHS Trust Development Authority are to work much more closely together and under a single leader, with a new chief executive due to be appointed by the end of the summer, reported Health Service Journal (subscription required). The two organisations will not formally merge this year, a move some have called for. They will work under a single chief executive, an appointment which will be made by the Department of Health (DH) in the near future. The join between the organisations has been described as “a closer relationship”, but details of what this will mean remain unclear. The DH said in a statement: “This change will mean that all NHS providers, whether they are foundation trusts or trusts, are under the oversight of one chief executive, overseeing teams working closely together. All hospitals need access to the same kinds of support, and should be subject to the same kinds of intervention if their performance isn’t delivering the level of care that patients have a right to expect. It said that “no changes to the foundation trust model are currently envisaged” and that “we support strongly the principle that NHS organisations should have access to greater freedoms as their delivery for patients and taxpayers improves.”
NHS Supply Chain reveals new customer board: NHS Supply Chain has announced the details of a new structure for engaging with its stakeholders, including four local customer boards and a clinical reference board, to boost hospital efficiency, reported Supply Management. The structure follows a review to identify how NHS Supply Chain and the NHS can optimise value for money from non-pay spend. The review, which came after the appointment of Sir Ian Carruthers as the independent chair of the NHS Supply Chain customer board in December 2013, looked at how it could deliver the £150m in savings it has been tasked to make by March 2016. A proposed framework for the customer board was shared and agreed in June last year. This included a national unitary board, together with a clinical reference board and four local customer boards. The chairs of the local customer board and clinical reference board also sit on the national unitary board along with John Warrington, deputy director for procurement policy and research at the Department of Health, Steven Pink, director of change and commercial delivery at the NHS Business Services Authority, and Nick Gerrard, CEO of NHS Supply Chain.
Opinion
Never a better time to make integrated care happen
Despite attempts over the last 40 years to better align health and care services, there has never been a better time to make the radical changes needed for integration, says Richard Humphries, assistant director for policy at The King’s Fund. Writing in a blog he outlines a number of options which would work in some areas but not necessarily others, due to diversity in local geography and circumstances.
“Rather than prescribe a one-size-fits-all solution, we therefore propose the approach should be agreed locally by CCGs and local authorities on the basis of a clear national policy framework developed by the Department of Health, NHS England and the Local Government Association,” he writes.
“The starting point for this should be to focus on the outcomes of integrated care through a new, single national outcomes framework. Local partners would be expected to agree which option would work best for them in achieving those outcomes and agree a local integration programme to establish a single commissioning function and integrated budget by 2020 (areas than can move more quickly should do so from 2017). The single budget should include all spending on adult social care, community health, primary care, mental health, public health and defined acute services. Local plans should bring together existing Better Care Fund plans so there is one plan, for one place with one set of oversight and support arrangements.”
How nursing informatics leaders can help make a digital NHS a reality
The NHS faces unprecedented demand from patients and technology is seen as a key enabler to reduce inefficiencies and support patient safety improvements. But is enough being done to engage nurses? Asks Debbie Guy, leading authority on the provision of out of hours care.
“Technology is becoming more important to clinical practice, not just as a management reporting tool, but as an instrument to change the way we deliver care for the better. The government’s ambitions are clear – Simon Stevens, NHS England’s CEO is calling for technology to help “drive down variations in quality and safety of care” and reduce instances of avoidable patient harm in his Five Year Forward View.
“In a subsequent report that focuses purely on modernising technology in the NHS, the National Information Board’s (NIB) Personalised Health and Care 2020 says that it is essential that care professionals and carers have access to all the data, information and knowledge they need in order to improve care delivery.
“The ambitions above are very admirable, however, the reality is that achieving technology adoption on the wards is not always easy. As a nurse with over twenty years of experience working on a ward, I have seen IT products introduced across hospitals which have been designed and implemented with little input from the clinical staff who actually use them. This has meant that clinical effectiveness is often lost and the system is not adopted wholeheartedly.
“I believe in giving the right tools to every hospital clinician so they can do their job effectively. For example, a desktop PC, as a device, is often not the right tool for the job. This is a common issue for both doctors and nurses as we do not sit behind the desk; we are on our feet, caring for patients or moving between wards.
“For this to happen however, nursing teams need to be able to trust the technology they are going to use. It needs to be suitable for nurses’ requirements and easy-to-use. Technology that ticks the IT teams’ boxes, but does not comprehensively consider the needs of clinical staff is doomed for failure.”
NHS and internet of things: ‘The future of care is about the patient taking control’
Internet-connected devices could impinge strict data security rules. But for doctors and nurses already monitoring their patients remotely, it’s a no-brainer says Steve Mathieson.
“Healthcare is seen as one of the most promising arenas for the internet of things. The potential for doctors and nurses to monitor patients remotely through internet-connected devices could lead to a much more efficient health system – with fewer needless checkups and quicker identification of problems.
“England is beginning to experiment, through its NHS Test Bed programme. But it is early days for most healthcare professionals. The NHS has a reputation for introducing new technologies later than other organisations – and there are specific concerns with the internet of things. These include problems integrating data from devices with heavily-secured patient record systems, as well as concerns about overloading professionals with data.
“Patricia Robinson, a consultant nurse specialising in long-term health conditions, says this means staff spend less time travelling to patients to take routine measurements. ‘It absolutely frees you up. This enables you to prioritise individuals with symptoms that require intervention,’ she says. ‘We’re into rituals as healthcare professionals, saying ‘come back in two or four weeks and we’ll check you out.’ Telehealth reduces the number of routine reviews required.'”
‘It’s like anything new. There is a learning curve for professionals. But for me it’s a no-brainer,’ she adds.”
Blog
Integrated care, standardised processes and local devolution are another heady mix for the NHS, writes Rob Benson.
