News in brief
Hunt moves to shield hospitals from integration fund failure: Jeremy Hunt’s warning that there must be a “proper risk sharing profile” in all better care fund plans has been interpreted as a move to protect fragile acute hospital finances ahead of the general election, according to Health Service Journal (subscription required). The health secretary told last week’s NHS Confederation Conference in Liverpool that hospitals should not bear all the risk if investments made from the £3.8bn better care fund failed to curb acute admissions. Clinical commissioning groups will have to transfer £1.9bn of their allocations into the fund when it is launched in 2015-16, to spend jointly with local authorities on out-of-hospital care. Hunt told delegates: “Any out-of-hospital organisation that is benefiting from extra resources as a result of the better care fund, on the basis that they are going to reduce emergency admissions into hospital, must share some of the risk if what they are doing doesn’t, in fact, reduce emergency admissions. By making sure we have a proper risk sharing profile in all the better care fund plans, what we will do is make sure incentives are properly aligned.” Organisations “benefiting from extra resources” could include GPs, social care or community providers. Hunt’s words follow months of lobbying by the acute sector, which is concerned that the project could leave hospital trusts out of pocket if financial transfers to out-of-hospital care do not match changes in acute activity.
Open data could add £216bn to UK economy: A move towards open data could add £216bn to the UK economy by 2017, says a joint report by NHS England and OpenGovLab. The report entitled “A Blueprint for the Open Data Era in Health and Social Care” was published at the Health Datapalooza conference in the US. The collaboration between NHS England and the Governance Lab at New York University recommends the NHS created an open data learning environment, reported eHealth Insider. This will include setting up an open health data academy “soliciting calls for questions from the academic community, and posing challenges and offering prizes for the best uses of open health data” and share its failures and successes with everyone. It identifies six domains that could benefit from open data: accountability, choice, efficiency, outcomes, customer service, and innovation and economic growth. It says that if the UK collects and distributes more data, it will make it an “attractive destination for health research as well as health innovation”. “Considerable evidence exists to suggest that open data can spur economic growth and innovation at both a national and regional level,” says the report. “The Centre for Economics and Business Research estimates that the EU’s move towards more openness in data will create 58,000 jobs in the UK by 2017 and add £216bn to the nation’s GDP.” Commenting on the blueprint Tim Kelsey, NHS England’s director of patients and information said there is an “urgent need” for the NHS to use better information to make decisions and investment. “We know with scientific and medical research, the rate of discovery is accelerated by better access to data,” he said.
NHS waiting list passes three million for first time in six years: The number of people waiting for NHS treatment has hit three million for the first time in six years, amid warnings that the growing demand for care means it could soon start routinely missing key targets, reported The Guardian. The latest official figures from NHS England show that in April a total of 2,993,108 patients were on the waiting list for treatment, supposedly within 18 weeks. However, the real total was more than three million because six hospital trusts did not submit data due to computer problems. That was the highest number since the 3,057,163 recorded in March 2008 and led to claims by Labour that millions of people were now waiting in pain and discomfort to have an operation and that David Cameron had breached a key pledge. It was significantly up on both the 2,748,808 seen in April 2013 and 2,508,495 in April 2010, the month before the coalition took office. In April this year 29,417 of the 295,641 patients admitted and treated that month had waited more than the 18 weeks enshrined in the NHS’s politically important referral-to-treatment target. That means that the NHS met – just – the requirement to treat 90% of such patients within 18 weeks, having narrowly missed it in February and March. A Department of Health spokesman insisted the 90% figure showed that “under this government, the NHS has kept waiting times consistently low and ended the scandal of thousands of people having to wait more than a year for treatment. We know elective waiting lists always tend to grow at this time of year but NHS staff are working hard to get this back on track in the coming months.”
Lack of real-time information affects 88% of community healthcare workers’ ability to do their jobs: eHealthNewsEU.Portal reports on a UK study of 17 healthcare organisations that shows that a lack of access to patient information in real-time is affecting the ability of 88% of community health workers to perform their roles. The study undertaken by mobile solutions provider, TotalMobile, questioned community nurses, health visitors, mental health nurses, and matrons, among others. It underscored a strong need to access clinical information in real-time, and exposed how simple connectivity issues are impacting on the NHS’ goal of going ‘paperless’ by 2018. Over 85% of participants said poor device connectivity was preventing them from completing tasks, suggesting there is a requirement for applications that work both on and offline for maximum productivity, according to Colin Reid, TotalMobile’s CEO. “Frequent lack of connectivity at the point of care is one of the biggest challenges facing mobile health workers and a key consideration for healthcare organisations when implementing successful mobile strategies in community environments”, said Reid. “Our study clearly shows lack of access to clinical information in real-time has a significant impact on community health workers’ efficiency and effectiveness. However, 70% of participants said mobile working technology had resulted in greater patient involvement in care and the management of conditions, and had also improved the quality of visits, with more time focused on treatment.”
IMS MAXIMS releases source code for EPR: IMS MAXIMS has released the open source code for its electronic patient record system on its website and plans to set up a “community of interest” for trusts using the software in the next three months. Speaking at NHS England’s Open Source Open Day, Shane Tickell, chief executive at IMS MAXIMS, announced that the company has made the code for its open MAXIMS product suite fully available. The electronic patient record system includes modules such as a patient administration system, A&E, theatres and reporting modules. The software is currently available under the Affero General Public Licence, which allows the client to use and distribute modified copies as long as the modified code is made available to other users. Tickell said that the release of the code is the first step in the company’s move towards open source. Speaking to eHealth Insider, Tickell said that the company decided to become open source because it believes it is the best way to improve its software. “The more we looked at open source, the more interest and excitement we had, because it helps us to achieve our ambitions and match our principles of best practice. We believe that by making this available now, we can accelerate our ambitions, because we’re already competing against world-class vendors.” Tickell said IMS MAXIMS is offering implementation and support services to trusts who want to use the open source software.
Government to outlaw wilful neglect and ill-treatment of adults in social care: Community Care reported that wilful neglect or ill-treatment of adults in health and social care services could become criminal offences from next year, the government has announced. In a consultation response, published this week, the Department of Health (DH) said it planned to introduce the new offences as part of the existing Criminal Justice and Courts Bill, which should come into effect in 2015. The DH said the offences would also apply to services where children receive healthcare, including young offenders’ institutions, but not to schools, children’s homes, residential family centres and childcare services. The legislation will not apply to children’s social care. The new measures will protect adults receiving domiciliary care but not those cared for informally, such as by a friend or family member. The DH said it would make the legislative changes, which would apply in England and Wales, after “the bulk” of consultation respondents backed the move. The new offences would allow the prosecution of both health and social care staff and organisations. The DH said penalties for individual offenders would be similar to those for committing similar crimes under the Mental Capacity Act 2005, which are imprisonment for up to five years and/or fines. Penalties for organisations will be similar to those for corporate manslaughter, such as fines, and/or “naming and shaming” through publicity orders and remedial orders to require the company to address the failing that led to the offence.
NHS England defends care.data following ‘enormous outcry’: NHS England has defended the controversial patient record-sharing programme care.data following what it admits was an ‘enormous outcry’ in the way it was initially implemented. Tim Kelsey, NHS England’s director for patients and information, suggested there should have been more discussion with patients about the ownership of their health records before the sharing regime was launched in the last year. NHS England has now scrapped its timetable for the roll out of the data sharing regime which had been due to restart in September after a six month pause. This delay had been introduced to help restore public confidence in the project after concerns were raised about how it would handle confidential health data. Kelsey told the NHS Confederation’s annual conference in Liverpool last week that “one of the most important conversations we all need to have, if we are going to liberate ourselves as patients, citizens, managers and clinicians…is a conversation about the rights I have to my own data and how it should be shared”. He admitted that this conversation had not taken place before the care.data scheme had been conceived. “It has never occurred in any public service, certainly not in healthcare,” he added. We paused [care.data] because there was this enormous outcry and uncertainty [from people asking] ‘What’s happening with my data?’” Speaking to Health Service Journal (subscription required), Kelsey said that regulations, which detailed what counted as acceptable uses of data would be put out to consultation soon.
Survey confirms telehealth ignorance: More than 90% of people in the UK do not know what telehealth and telecare technologies are, research from the government’s Technology Strategy Board has found. The researchers, who surveyed more than 2,000 people in the UK, also found that more than 70% of people are not aware of health and care apps available on smartphones and tablets, reported eHealth Insider. The survey was done by the Delivering Assisted Living Lifestyles at Scale, or DALLAS programme, which was set up by the government in 2011 to enable more independent living for people through the use of digital technology. The £37m programme aims to benefit 169,000 people across the UK by 2015 by giving them access to “innovative products, systems and services to transform their health and care choices”. However, the research found that 43% of people would not consider telehealth because they would prefer to be seen by their clinician face to face. Hazel Harper, assisted living innovation platform programme manager responsible for DALLAS, said that the lack of understanding of health technologies creates an opportunity for telehealth and telecare to make a difference in the UK. “There is obviously a significant awareness gap among the general public when it comes to health and care technologies and how they may support people to remain healthy, independent and happier for longer in their own home,” she said.
Lorenzo trusts record catalogue of problems: Four of the seven trusts that failed to publish waiting times data last month had previously reported serious concerns with the Lorenzo electronic administration system, a technology the Department of Health (DH) has paid trusts to adopt. Three of the seven trusts – Derby Hospitals Foundation Trust, Ipswich Hospital Trust and Walsall Healthcare Trust – told Health Service Journal (HSJ, subscription required) they had failed to meet their statutory duty to provide the data because of problems with their Lorenzo patient administration systems. All three introduced the system between February and March. Derby said “the implementation of Lorenzo” had “hindered the production of referral to treatment and activity data”. Walsall said its Lorenzo implementation had “impacted upon the trust’s ability to report accurate referral to treatment information”. Ipswich said the system was behind its failure to report the details. The fourth trust – Tameside Hospital Foundation Trust – awarded its Lorenzo project the highest rating of 25 on its April risk register, which cites the “potential risks to patient safety quality, information governance and performance trajectories”. The trust’s failure to produce waiting times data last month had been due to “data quality” issues, a Tameside spokesman said. Tameside was the first trust to accept a sweetener payment from the DH to install the system when it introduced the Lorenzo system in October. HSJ has also uncovered a series of other concerns recorded in recent months by the trusts using the system or with their commissioners. HSJ’s findings come a year after Public Accounts Committee chair Margaret Hodge branded the system “completely useless” and described the £600m the DH set aside to pay trusts to deploy the system as “bribes”.
Homerton chooses ‘flexible’ image management system: Homerton University Hospital NHS Foundation Trust in north east London is deploying a new flexible image archive management system, reported ComputerWorldUK. The trust is using BridgeHead Software’s Vendor Neutral Archive (VNA) for a pan-organisational image management strategy, prior to its selection of a replacement PACS (picture archiving and communication system) imaging system. BridgeHead’s VNA promises to enable the trust to take a more strategic approach to its data management, enabling it to more efficiently locate and share all patient data with multiple clinical teams across multiple healthcare departments. Triggered by the imminent ending of the national NHS PACS contract, with Homerton’s system having to be fully decommissioned next year, the trust chose VNA as its primary data repository. It will be initially used for radiology images, but there is the intention of expanding the solution to manage images from other departments within the hospital. Dzinja Kabambe, head of strategic IT projects at Homerton, said: “We had options, namely do we select a PACS solution with ‘bundled’ image management capability, or do we separate our image management from the PACS altogether and opt for a VNA solution? We decided on the latter because we wanted to de-risk our impending PACS replacement. BridgeHead’s VNA is able to work with all major PACS providers in the UK. This means we will have the flexibility to make an objective decision about what PACS solution is right for us.”
New guide to help patients ‘take control of health’: A new guide to the NHS Health Check has been made available – providing information, videos, case studies and lists of health and fitness apps designed to help people take control of their health, reported National Health Executive. Developed by NHS Choices, which is managed by the Health and Social Care Information Centre (HSCIC), in close collaboration with the NHS Health Check team at Public Health England, the guide also features advice for the elderly on how to improve and maintain quality of life and encourages users (men in particular) to attend their NHS Health Check. Eligible adults in England aged 40 to 74 are invited to have a free NHS Health Check every five years. The check can detect early warning signs of heart disease, Type 2 diabetes, kidney disease and other common causes of death and disability in the UK. Recently, Public Health England revealed that more than 1.3 million people have accepted an offer to attend an NHS Health Check in the last 12 months, a 9.5% increase compared to the previous year. Jamie Waterall, national lead for the NHS Health Check Programme, and part of Public Health England, said: “The NHS Health Check programme, which began in 2009, is now available for the first time across England [by all 152 local authorities]. It is important that those eligible are aware of the benefits of the programme and the new interactive guide on NHS Choices will help people understand what the NHS Health Check is, and crucially, how it can help.”
Oxford creates mobile electronic health records with Advanced: Oxford Health NHS Foundation Trust has signed a multi-million pound five-year contract to create mobile electronic health records (EHRs) using technology from Advanced, reported ComputerWorldUK. The trust’s 6,200 staff will use the electronic health record system to manage and deliver care across Oxfordshire, Buckinghamshire, Wiltshire, Bath and North East Somerset. Support for mobile clinical staff is at the heart of the project, with Advanced rolling out its integrated clinical mobile working solution to 3,500 users equipped with iPads. The new solution will capture the trust’s data in real time and will “interface seamlessly” with the NHS Summary Health Care record and legacy systems, said the hospital. As well as providing information to clinicians and administrative staff, the solution will link with health and social care systems before, during and after a patient’s discharge from the trust’s care. Dominic McKenny, director of informatics at Oxford Health NHS Foundation Trust, said, “Our main objective in undertaking this procurement was to secure a next generation EHR for the trust and service users. With the Advanced Health & Care solution we are confident that the trust has achieved this objective.” The five-year Advanced contract may be extended to 10 years.
Hunt hails rise in number of GP appointments: Health secretary Jeremy Hunt has hailed an extra 6,000 GP appointments per day as a success for the Conservative Party, despite GPs warning about the dangers of rising appointment rates, reported Pulse. Speaking at a House of Commons debate on health, Hunt listed the improvements to the NHS since the previous Labour Government, including members of the public accessing more GP consultations. He also hailed 3,000 more ‘vulnerable people’ being treated in A&E and 10,000 more diagnostic tests as successes for the party. The political exchange came despite GP leaders warning about the dangers of rising appointment rates to both patient safety and the stresses placed on GPs, with the Royal College of General Practitioners highlighting that many GPs are now working 11 hour days with 60 patient appointments in one day. Labour’s shadow health secretary Andy Burnham responded to Hunt by quoting Pulse’s survey on appointment waiting times, which showed that underfunding of general practice has led to GPs predicting two-week waits will become the norm by next April. Burnham said: “Another way in which the NHS has got worse, and every patient knows this to be true, is that it is becoming harder and harder to get a GP appointment. It is a common experience for people to ring their surgery early in the morning only to be told that there is nothing available for days. A survey has found that almost half of GPs predict that the average waiting time will exceed two weeks by next year.” He said the ‘clearest measure’ of growing problems in the NHS was continued missed targets in A&E departments, adding: “Why is that happening? The fact is that cuts have been made to general practice, social care and mental health, which are pushing more and more people towards the acute hospital and placing it under intolerable pressure.”
£2.5m competition launches to develop healthcare solutions: Businesses in the West Country are being encouraged to submit products and services to help improve patients’ treatments in a £2.5m competition, reported Integrated Care Today. The Small Business Research Initiative for Healthcare (SBRI), an NHS England-funded initiative, is designed to develop innovative products and services, which address unmet health needs. The SBRI initiative is a three-phased approach, which starts with a six-month feasibility phase with an award of up to £100,000 and then moves on to more detailed product development and NHS validation, where companies can secure up to £2m in funding in support. Dr Elizabeth Dymond, deputy director of enterprise and translation at West of England Academic Health Science Networks, said: “We are encouraging organisations to get involved as this is a fully-funded opportunity for businesses to access support to bring their innovative products and services to new markets.” Businesses will be able to submit applications for the competition until 12pm on 10th July 2014.
This weekend Gregor MacKenzie of Highland Marketing is taking part in the Caledonian Challenge 2014 fundraising for Yorkhill Children’s Charity and Foundation Scotland. The challenge is to walk 54 miles within a time limit of 24 hours, starting off on Saturday 14th June at 7am near Fort William and walking all day and through the night aiming to finish on Sunday morning not far from Highland Marketing HQ. The walk takes him mainly along the West Highland Way, notably walking along the Caledonian Canal, through Glen Nevis, Glen Coe and Glen Orchy, over Rannoch Moor and climbing up and over the dreaded ‘Devil’s Staircase’.
To find out more about the Caledonian Challenge check out this inspirational video. If you would like to sponsor and support Gregor you can do so by visiting his team page.
Opinion
Blogging: patient led therapy in a digital world
“In many ways digital technology has opened up this world of sharing stories” writes Roz Davies, director of community engagement at HealthBeMe, in Health Service Journal (subscription required) this week.
Citing the bravery of bloggers Shane Burcaw (Laughing at My Nightmare) and Adam Bojelian (In the Blink of an Eye), Davies describes how blogs can empower patients to take control of their lives and conditions: “More people can tell their stories to more people, any time they want to and in their own style and words. Choice and reach has been transformed by technology for many people.
“The strength of character showed by Adam and Shane touched me [when I read their blogs] that evening. They made me reflect on challenges in my own life and inspired me to be more determined to overcome them.”
Davies concludes by suggesting that blogging is becoming an act of citizenship: “People from many different walks of life are spending much time, energy and emotion writing and sharing their story, and in doing so spreading their approach to life and giving something very personal and important back to society.
“Blogging as a therapy can be life changing. Reading these stories is an education, an emotional experience, a journey. There are some very practical insights, some philosophical points and some clear messages for developing a great and relevant future healthcare system.”
Power to the people on the high cost of change
Paul Hodgkin, the founder of Patient Opinion, deliberates on eHealth Insider, whether the NHS isn’t too big to adopt the latest calls for fundamental changes.
“OK, so it’s a clichéd question, but tell me again: Exactly why is it that the NHS is so much worse at innovating than Apple, Google or Facebook? Why wasn’t public health in the lead with its own version of Spotify for health information? Why wasn’t Fit Bit developed by cardiologists? Why is that it every single chief executive that I meet in the digital health small and medium sized enterprise sector complains about the appallingly high cost of sales to the NHS: with many choosing to sell abroad rather than face the death by indecision that is the health service? Standard answers include risk aversion, complexity of health, vested interests and a lack of competition – or was that integration?
“The standard ways to reduce transaction costs in business include: reduce regulation, merge to get economies of scale, re-engineer business processes, reduce variation, tweak incentives, integrate databases, provide more management, or add more competition. To which the NHS can pretty much say: “Been there. Done that.”
“The NHS is in a class of its own when it tries to innovate because it is (rightly) subject to multiple conflicting accountabilities. Accountability to the patient, the payer/commissioner, the tax payer, the local community, the professional community, the research community, pharma, the educational industry.
“It doesn’t matter whether you are talking about the costs of getting organised to oppose a local hospital closure, tracking the amount of exercise you and your friends do via a Fit Bit group, or Skyping the children in New Zealand. It’s all getting easier isn’t it? Stuff you couldn’t do five years ago is now humdrum.
“Network effects drive the increasing returns to scale behind social media and all other rapidly inflating digital phenomena. Instead of the decreasing returns to scale to which the dear old NHS (or any large hierarchical organisation) is subject, network effects mean that in our on-line lives you and I experience increasing returns to scale.
“Truly networked formats have yet to fully emerge in healthcare and until they do talking about them has an air of unreality – just as the idea of Wikipedia seemed completely implausible before it actually emerged.”
Will an anti-innovation culture in the NHS kill off technological progress?
Hackday system has the best chance of overcoming bureaucratic regulatory process that stops apps getting traction they need, says Dick Vinegar, the Guardian’s Patient from Hell.
“Two years ago, I came across a great new way of writing healthcare software at an NHS hackday. The idea behind a hackday is that clinicians and software writers decide on an app for solving a “real-ward” problem; design and write it within 24 hours. The hackday system has a better chance of success, because the clinician is at the heart of the design process. The system is designed to be tweaked; if it does not work, it can be binned, and because it is written in open source, it can be latched on to mainstream systems.
“Attracted as I was by all this disruptive thinking, I was worried that the young chaps writing apps would not realise three things; the importance of making their programmes interoperable, that regulators will demand proof that the apps are safe, and that selling and marketing software in the NHS IT chaos is a nightmare.
“To see how these disruptive guys were getting on, I attended the Handi Digital Health Spring Symposium last month. Handi (Health Apps Network for Development and Innovation) helps startups to write apps for healthcare and is the intellectual powerhouse behind the hackday approach to writing healthcare software. It believes in open source, fast prototyping, co-production (clinicians and geeks), crowdsourcing, multiple platforms – PCs, tablets and smart phones – and disruption, to keep the hospital IT bosses rattled.
“At the symposium, I found that the Handi people were not just innovative geeks with bright ideas, but were well aware of the “real world”. They have to get through a bureaucratic NHS approval and regulatory process, to have the app registered on the NHS app store. One speaker claimed that testing could take eight months.
“I hope British Handi-style apps developers will join, or maybe lead, the gold rush. But the danger is that the fragmented anti-innovation culture of the NHS will kill them off.”
Highland Marketing blog
In this week’s blog, industry advisor Ravi Kumar questions Apple’s introduction to the healthcare market.
