News in brief
Farrar leaving NHS Confederation in three weeks: Mike Farrar has announced he is to stand down as chief executive of the NHS Confederation on 30th September, reported National Health Executive. Many expected that Farrar would apply for the role of chief executive of NHS England, however he will leave the NHS to launch a healthcare consultancy. Farrar will continue to work on a number of major projects for the NHS Confederation, such as the Bureaucracy Review. Dean Royles, chief executive of NHS Employers will take on his responsibilities while trustees recruit his replacement. Speaking on his decision to step down Farrar said: “It has been an enormous privilege to work in the NHS for more than two decades. I have had the opportunity to lead work at the NHS Confederation, in the north west and nationally in the Department of Health.” Michael O’Higgins, chair of the Confederation said: “Mike Farrar has reinforced the NHS Confederation as the voice of the NHS. His NHS career marks him out as one of the leading public servants of his generation.” The NHS Confederation stated that Farrar will not receive any form of severance payment.
Jeremy Hunt confirms commitment to balance patient safety and privacy: People will be able to feel confident that information about their health and care is secure, protected and shared appropriately to create better services and deliver better care, Jeremy Hunt confirmed. The health secretary’s comments came as the government’s full response to the Caldicott review on information governance was published, alongside new guidance from the Health and Social Care Information Centre (HSCIC) that sets out the responsibilities of health and care staff towards personal confidential data. The response accepts the recommendations of the original report and highlights that while information sharing is essential to provide good care for everyone, only the minimum amount of information should be shared and there must be strict rules to govern it, reported The Department of Health. Hunt said: “Sharing information securely is a major part of making health services safer. Having the right information about patients means professionals can make sure they get the right care and treatment. Without that information, research to find new cures and therapies for killer diseases and other conditions would not be possible.” The response sets out the responsibilities of different organisations in health and care when it comes to keeping patient information safe and secure. Hunt said that clinicians should ask patients to view GP patient records but said that in emergencies this can be overridden, if it is in the best interest of patients, reported GP. The health secretary said that any patient who does not want to have their personal data from their GP record shared with the HSCIC, will be able to veto it. But patients cannot object to their anonymised data being collected from their GP patient records, by the HSCIC. Click here to read the full report.
‘Dramatic’ changes to GP contract by next April as Hunt spells out detail of general practice reform: GPs can expect major changes to their contract terms by 2014 – including greater responsibility for out-of-hours care and a major reduction in box-ticking targets – after health secretary Jeremy Hunt revealed a list of changes he intends to make within the next few months, reported Pulse. Speaking at a conference on the future of primary care at the King’s Fund in London, Hunt said: “Without a profound reform of out-of-hospital care the NHS will be simply unsustainable, so this is an issue of critical importance. This is the first time I have pulled together a number of strands of the current government’s thinking for reforms of primary care.” Hunt’s key announcements include amongst others – the GP contract will be rewritten by next April to ensure a ‘dramatic simplification’ in targets and incentives, with the aim of removing the ‘bureaucratic overlay to the work of a GP’ and additional funding to be channeled to general practice to help support GPs’ new responsibilities, which will come from savings made by a reduction in unplanned admissions. The health secretary said the new ‘named GP’ role represented a return to a traditional model of general practice, which had been lost as a result of the additional demands of the 2004 GP contract.
Nurse tech fund open soon: Bidding will begin “shortly” for the £100m Nursing Technology Fund, reported eHealth Insider (EHI). Almost a year after Prime Minister David Cameron announced £100m to go towards nurses and midwives to spend on new mobile technology, NHS England says it is nearly ready to open up a bidding process for the fund. An NHS England spokesperson said: “NHS providers will shortly be able to bid for funding and we will be providing more details to NHS providers and commissioners in the coming weeks in advance of the bid process opening. This is a real opportunity to make a difference and it is important that the fund is used to deliver the maximum benefits for staff and patient care.” Since the fund was announced last year, little seems to have happened, but NHS England attributes this to the “major organisational transition” the NHS has gone through. An NHS England statement to EHI says that the fund should be used for, “a combination of technologies to help reduce administration” and help nurses and midwives to spend more time with patients. The government also recently announced that an extra £240 million would be added to the existing £260m Safer Hospitals Safer Wards Technology Fund. NHS England says there will be some collaboration between the two funds.
Electronic patient records key to personal care for elderly plans: The government looks set to make greater use of technology to make its plan to offer a ′personalised′ GP service a reality, reported The British Journal of Healthcare and Computing. Earlier this week the Department of Health (DH) committed to improve care for vulnerable older patients by assigning a so-called “named clinician” for each case – likely a GP, though this is not certain as yet and would require a change in doctor′s contracts to happen. The idea is to ensure older patients do not end up in pressured A&E departments simply because, to quote health secretary Jeremy Hunt, they have “fallen through the cracks”. Central to the whole plan will be successful and wide-scale adoption of electronic patient records – as information and patient records must be shared across the NHS and social care services so that accurate clinical information is available at all times to everyone involved in people′s care, and staff can spend more time providing care, not form-filling. As part of the commitment, Hunt has demanded that, by the end of 2014, at least a third of A&Es should be able to see the GP records of their patients and a similar number of NHS111 services should also be able to see the GP records of callers. The proposals, which have been taking shape over the summer in response to a consultation exercise run by the DH, will also look to integrate health and social care systems, too.
Ten bidders announced for £800m older people’s contract: Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) have announced the 10 bidders that have passed the first stage of a contest to provide integrated older people’s services worth up to £800m, reported Health Service Journal (subscription required). Among the bidders that have passed the “pre-qualification” stage of the controversial tender are outsourcing giant Serco, private healthcare provider Virgin Care, and United Health UK, a subsidiary of the US-based health and well-being company. Other bids going through to the second stage of the tender came from consortia of NHS and private sector providers. These include a consortium made up of Capita, Circle, Cambridgeshire Community Services Trust, Oxford Health Foundation Trust, another from Care UK, United Health, Lincolnshire Community Health Services Trust, and Norfolk Community Health and Care Trust. The purpose of the tender is to find one or more “lead providers” to be responsible for providing and coordinating older people’s services across geographic and organisational boundaries. The shortlisted bidders will soon be invited to submit “outline solutions” illustrating how they would provide these services. According to tender documents published by the CCG over the summer, the full value of the services out to tender is expected to be between £700m and £800m over five years. The expected start date for the new contract or contracts is July 2014.
RCP launches Future Hospital: The Royal College of Physicians (RCP) has called for a new approach to IT, built around “structured, standardised records”, to underpin its new blueprint for hospital care, reported eHealth Insider (EHI). The RCP launched what its president, Sir Richard Thompson, described as a “radical” report at its headquarters in London’s Regent’s Park this week and used a chapter of it to promote the record keeping standards developed by its Health Informatics Unit. The ‘Future Hospital’ report argues that electronic records based on the standards and supporting SNOMED CT coding will be essential to realise its vision of care rebuilt around more use of generalist physicians to co-ordinate patient care, both in hospital and in the community. It also argues that patients should be “fully engaged in the design and implementation of electronic health record systems and other digital health tools” so they can contribute to their own care and provide feedback. The chair of the Future Hospital Commission, Professor Sir Michael Rawlins, told EHI that the RCP would be looking for hospitals to develop the report’s ideas and that this might include piloting the IT elements. “Different trusts will pilot different aspects of the report and they will develop those in different ways, so we should be able to find out what works and to encourage others to learn from that,” he said.
GPs set for funding boost as NHS England considers ‘redirect’ of £3.8bn integrated care funds: A health minister has said NHS England are looking ‘very closely’ at how to inject more investment into general practice, including redirecting money from hospitals using a new fund earmarked for more integrated care, reported Pulse. Earl Howe told the Family Doctor Association conference in Nottingham last weekend that NHS managers were looking at how the £3.8bn integrated health and social care budget could be used to help boost investment into primary care. The new budget – announced by the chancellor George Osborne in his Spending Review in June, was to be used to jointly commission services across health and social care by 2015/16. The Department of Health said the pool will include: £1bn taken from the existing NHS budget, £800m that has already been announced for social care and £2bn of new money being invested. Pulse revealed last month that CCGs in the north west of England have applied for funds for GPs to offer routine appointments seven days a week, under radical plans to help ease pressure on A&E services. Earl Howe said that they were looking at how ‘existing funding can be used up more effectively’ than it is at the moment.
£600m in LPfIT costs post 2011: eHealth Insider (EHI) reports that more than half of the estimated £1.2 billion cost of the London Programme for IT (LPfIT) is being paid out after March 2011, six months after the national programme was officially axed. According to documents released to EHI by the National Audit Office (NAO), LPfIT had cost nearly £600m by March 2011, £760m a year later, and will cost more than £1.2 billion by the end of life of the programme. Actual benefits realised at these milestones are just £18m by March 2011 and £20m by March 2012. However, the London programme is estimated to reap £780m over its life, which ends in 2021. BT signed a contract in 2003 to deliver systems for the whole of the NHS in London, including all of its acute trusts. However, a renegotiated deal in early 2010 agreed that of the 32 trusts still to receive the Cerner Millennium electronic patient record system, approximately half would not deploy it. The final benefits statement for the National Programme for Information Technology, produced by the Department of Health (DH) and vetted by the NAO for the Commons’ public accounts committee, says that initial deployment was completed for almost all acute trusts included within the contract by March 2012. The DH report, released in June, says: “Over time, contracts and funding for each local programme may be owned outside of the department (as is now being planned for in London) and be closer aligned to local delivery”.
Huge variation emerges in CCGs’ efficiency ambition: Health Service Journal (subscription required) has revealed that there is a 23-fold variation in the scale of clinical commissioning groups’ (CCG’s) efficiency targets, with at least 11 groups planning to make savings of under 1%. The findings come from 143 CCGs’ non-integrated single financial environment reports obtained under the Freedom of Information Act, which also show a significant minority of groups are already falling behind on their savings plans. The returns detail CCG performance on the quality, innovation, productivity and prevention programme, their expected financial risks and their use of the 2% of their budget that is supposed to be spent non-recurrently. The reports, for the first quarter of 2013-14, show NHS England is now focusing strongly on the level of savings, rather than monitoring how they are made. Last year it gathered progress reports on individual local savings schemes, showing exactly where in the system savings were being made, but this year’s reports only divide the savings into figures for “transformational” and “transactional”.
Hunt – NHS must fundamentally change to solve A&E problems: Alongside specific plans to support NHS A&E departments in the short-term this winter, health secretary Jeremy Hunt has set out proposals to fundamentally tackle increasing pressures on NHS A&E services in the long-term – starting with care for vulnerable older patients with complex health problems, reported The Department of Health. Fundamental changes mean joined-up care – spanning GPs, social care, and A&E departments – overseen by a named GP. Many vulnerable older people end up in A&E simply because they cannot get the care and support they need anywhere else. These changes will reduce the need for repeated trips to A&E, and speed up diagnosis, treatment and discharge home again, when patients do need to go to hospital. Also this week the health secretary set out how £250 million would be used by 53 NHS trusts this winter. It includes around £57 million for community services – for example better community end of life care and hospices and around £51 million for improving the urgent care services – for example for patients with long-term conditions. The health secretary said: “This winter is going to be tough– that’s why the government is acting now to make sure patients receive a great, safe service, even with the added pressures the cold weather brings. But this is a serious, long-term problem, which needs fundamental changes to equip our A&Es for the future.”
Medical college report calls for seven-days-a-week hospital care: Hospitals must be reorganised so patients do not have to move beds or wards unless medically necessary, a new report says. Nursing Times reports that care must also be provided seven days a week, with full access to scans and lab testing even at weekends. The study, from a commission set up by the Royal College of Physicians (RCP), makes 50 recommendations on the future of NHS hospital care. It says a rise in admissions and more older patients with complex needs means “hospitals are struggling to cope”, while units are not equipped to provide excellent care on weekends. It is not unusual for patients to move beds several times during a single hospital stay which “results in poor care, poor patient experience and increases length of stay”. The study said that, in the future, moves between beds and wards will be minimised and the authors call for a shift to seven-day working, with consultants having a presence on wards and the full range of tests available every day of the week. Dr Cliff Mann, president of the College of Emergency Medicine, said: “This report has major implications for emergency medicine. The emergency department is reliant on comprehensive medical services from a range of other specialties. The implementation of this report will be a challenge – but we agree that it must be addressed. Unifying and integrating the hospital and wider healthcare facilities, including those related to primary and social care will benefit the care for our present and future patients.”
FairWarning care provider customers lead expansion of trust in electronic health records: ProHealth Service Zone reports that FairWarning has announced record growth in the adoption and deployment of the company’s software. FairWarning now has 180 enterprise production customers representing 900 hospitals and over 3,600 clinics, amounting to a 70% growth from 2012 through 2013 year to date. The company has seen its solution go into production in the first four Scottish Boards in the national roll-out by NHS Scotland. A number of NHS trusts have also gone into production across England and Northern Ireland. These include Cumbria Partnership NHS Foundation Trust, which has selected FairWarning to strengthen privacy in digital healthcare and emphasise its reputation as a trusted provider of care. Homerton University Hospital NHS Foundation Trust is also now successfully deploying the FairWarning Patient Privacy Monitoring solution across its hospital sites, with plans to roll it out to GP and community. Kurt Long, CEO and founder of FairWarning said: “FairWarning will continue to aggressively invest in additional customer service programs, assuring that care providers are able to grow trust with their patients and confidently expand their electronic health record investments. Further, we are expanding FairWarning’s expert service programs that give care providers affordable access to best-in-class compliance and privacy experts as well as providing training to grow their own staff’s expertise.”
Royal Society of medicine goes electronic with ClinicalKey: The Royal Society of Medicine (RSM) will provide its 21,000 members with electronic access to thousands of peer-reviewed medical and surgical journals and reference books, reported eHealthNews EU Portal. The RSM will be able to offer its members access to more than 540 journals, including The Lancet, and 1,060 books, including titles such as Gray’s Anatomy and Netter’s Anatomy, through Elsevier’s ClinicalKey or via the RSM’s online library catalogue. The RSM’s decision follows a review of its library strategy, which emphasises making such information available electronically to meet the demands of its members. By utilising ClinicalKey’s content, the Society will ensure that multiple members are able to access reliable clinical reference material at any time, and away from the physical library building. This will assist them in their studies and support them in their clinical work enhancing the care they give to their patients. Members will also be able to access, download, store and, if necessary, print an article or chapter whenever they require, including in the hospital setting. “The library is cited as a key reason for members joining the RSM,” said Wayne Sime, director of library services at the Royal Society of Medicine. “Therefore it is imperative that we provide trusted information in the format that they require to support them in their roles as medical professionals.” The RSM library, which has more than 600,000 volumes, aims to be virtually electronic by January 2014, with the exception of its historical archive and rare books collection.
EMIS buys Ascribe for £57.5m: Primary care systems supplier EMIS has purchased clinical software supplier Ascribe for £57.5m, reported eHealth Insider. The purchase of Ascribe, a pharmacy and e-prescribing software specialist, is by far the largest acquisition yet made by AIM–listed EMIS. The deal will significantly strengthen the position of EMIS in the increasingly competitive NHS clinical software market for hospital, community and mental health systems. Chris Spence, chief executive officer of EMIS Group, said in a statement: “The acquisition of Ascribe represents a significant milestone in our stated strategy of providing clinically led, integrated cross-organisational healthcare systems, and represents a rare opportunity to acquire multiple significant positions in an adjacent but not overlapping market.” In a market statement EMIS said that it believes there are “significant growth prospects in the combined business”, resulting from “failure of the NHS National Programme for IT”, the need to meet the £20 billion savings of the “Nicholson Challenge”, and “the recently announced £1 billion NHS interoperability challenge fund”.
Junior doctors must cover up to 124 patients on a night shift: Junior hospital doctors are expected to care for up to 124 patients each during nightshifts, according to new figures. Deadline.co.uk reported that a total of six Scottish hospitals require junior medics – some in their first year on the wards – to cover at least 100 beds. Experts said young doctors could be “stretched” even further if staff were off work. The Royal Alexandra Hospital, Renfrewshire, requires junior doctors to cover 124 beds on nightshifts. The Western General in Edinburgh had a ratio of one doctor to 116 beds at the weekend. Inverclyde Royal, Greenock, Crosshouse Hospital, Kilmarnock, and the Victoria Hospital, Kirkcaldy, all had more than 100 beds per doctor, it was revealed. The information was released by Scottish health boards, who insisted staffing ratios on nightshifts were safe. Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, said: “It can be difficult to predict how many of these patients will require urgent treatment during the night, so it is essential to provide sufficient capacity within these rotas to cover both planned and unplanned care. The patient-to-doctor ratios reported by some NHS boards would suggest there may not be much capacity within some of these rotas to cover a high level of unplanned care, particularly if these rotas are further stretched by unfilled vacancies or staff absence.”
NHS hospital death rates among worst, new study finds: NHS medical director, Sir Bruce Keogh says he is taking very seriously figures revealed by Channel 4 News which show that health service patients are 45% more likely to die in hospital than in the US. Channel 4 News has revealed previously unpublished data which shows just how badly our hospital mortality rates compare with other countries. The data is the work of Professor Sir Brian Jarman, who pioneered the use of hospital standardised mortality ratios, as a way of measuring whether death rates are higher or lower than expected and which are adjusted for factors such as age and the severity of the illness. For more than a decade, professor Jarman collected hospital data from six other advanced economy countries, adjusting them where possible to take into account the different health systems. Shocking findings include figures from 2004 showing that NHS had the worst figures of all seven countries. Once the death rate was adjusted, England was 22% higher than the average of all seven countries and it was 58% higher than the best country. That meant NHS patients were almost 60% more likely to die in hospital compared with patients in the best country. The figures prompted Sir Bruce Keogh, to say he will hold top-level discussions in a bid to tackle the problems.
Sepsis lives can be saved, says ombudsman: More must be done to save the lives of patients with sepsis, says a report from the Health Service Ombudsman. It found significant failings in treatment of the condition, which is caused when the body’s immune system overreacts to infection, reported the BBC. It focused on 10 patients who were not treated urgently enough and died. The National Institute for Health and Care Excellence (NICE) will produce guidance for GPs and clinicians to help them recognise sepsis at an early stage. Around 37,000 people are estimated to die of sepsis each year, accounting for 100,000 hospital admissions. The Ombudsman, who investigates complaints from people who have received poor service from the NHS in England, said diagnosing and treatment presented some real problems because the condition was hard to spot. Julie Mellor, the Health Service Ombudsman, said it was time for the NHS to act. “In the cases in our report, sadly, all patients died. In some of these cases, with better care and treatment, they may have survived. We have worked closely with NHS England, NICE, UK Sepsis Trust and Royal Colleges to find solutions to the issues identified in our report. NICE and NHS England have already agreed to take forward the recommendations of our report.”
Opinion
NHS is a national treasure. We must continue to guard it
In the Guardian this week, Michael West explains how managers need to retain focus on quality of care and the patient experience, according to a study into the culture of the NHS.
“While there has been progress in the NHS on standards of care, it takes only one high-profile case of inadequate services to unsettle levels of public confidence and add to vague public perceptions that NHS care is disintegrating. The reality is far from this.
“In the biggest ever such research programme, funded by the Department of Health policy research programme and published in the British Medical Journal Quality and Safety, we used observations, interviews, archival data, surveys and national data sets to study acute, mental health, ambulance and primary care across the whole of England. The findings have clear implications for the NHS and have already informed the Berwick and Keogh reviews.
“NHS England, the Care Quality Commission, patient organisations, politicians, Monitor, clinical commissioning groups and others with a powerful say in the NHS and social care must integrate, align and work effectively as partners to provide clear direction focused primarily on the delivery of high quality and compassionate care. And such organisations should reflect on their own cultures and the extent to which they encourage compassion and patient focus.
“The best organisations have cultures of positivity, self-belief and compassion rather than fear, anxiety, hierarchy and defensiveness. Everyone is responsible for creating such cultures beginning with politicians, regulators and boards but also including staff, patients, media and the public. The NHS is a national treasure. We must continue to guard it rather than undermine it.”
How football is helping unlock dementia patients’ memories
This week, Tony Jameson-Allen, director of community interest company, Sporting Memories Network, tells the Guardian how a new hospital unit is using sport as a focus for reminiscence therapy.
A new unit, built close to Sunderland Football Club’s Stadium of Light, will provide 14 beds for men aged over 65, and has been encouraged by previous reminiscence therapy results from sporting memories, Jameson-Allen explains: “Finding meaningful ways to connect and engage with dementia patients is always challenging. Football provides an alternative focus for men who are reluctant to join in other group and reminiscence based activities. Memories of players, matches and sports events from 30, 50 or 60 years ago can remain clear when prompted.”
Jameson-Allen quotes the ward manager, who confirms the success of this method: “It’s often difficult to engage older men in meaningful activities,” says ward manager Geoff Willis. “But using sporting memories as a framework has worked for us, most clients are keen to share their memories about football. They become animated and passionate and have so much to tell you. Events like this have impressed relatives. They have commented on how animated their loved ones became on these special afternoons.”
NHS must get better at measuring quality
This week in Health Service Journal (subscription required) Caroline Clarke, finance director and deputy chief executive of the Royal Free London Foundation Trust, explains that for years the NHS has struggled to define and measure quality, but are close to agreeing on a common language that benefits everyone.
“Over the past decade or so, we’ve become used to the language of industry: turnaround, competition, marketisation, regulation and choice.
“There’s nothing necessarily wrong with that, except that we seem to have lost a common language of caregiving − something that allows me as a finance director to quickly connect with a clinician or patient, and to authentically communicate with the groups of people who are going to have to transform our services to make them fit into the austerity backed NHS of the future.
“Against this backdrop, we are now facing a distinct and sharp drop in public and political confidence, combined with a general malaise around investment in public services. Now more than ever, I need a common language that will allow me to unite with clinicians and other colleagues involved in delivering care.
“Enter US academic Michael Porter and his work on value. Porter uses the concept of value systems in a number of industries to define a shared goal or result. In health, value is defined as the relationship between quality and cost across the whole patient journey.
“That means we have to define quality. The NHS has struggled for years with the question of how to measure quality effectively.
“So who is good at measuring? Turns out the accountants have hidden uses.”
Leading with courage
In Commissioning GP this week, Shane Tickell, CEO IMS MAXIMS explains the importance of learning from mistakes and why it takes boldness and bravery to take a step back and admit that decisions made early on might not have been the right ones.
“While the Francis Report was voluminous and in parts failed to give clear direction on next steps, the most recent Berwick Report was criticised for being ‘soft’ and ‘over simplistic’ but in its digestible 46 pages, it distilled the key issues that the NHS continues to face in putting patient safety first. At its most basic, it said learning and leadership must be wholeheartedly addressed.
“But perhaps the difficulty in adding further detail to the report, which was said to be ‘light on practical solutions’, comes partly with a wider inability for people to describe what makes a good leader, a leader that encourages learning, is visionary, adaptive and responsible. To me all of these attributes come down to one key quality that every leader must exert ‘courage’.
“Good leaders in my mind are those who have the courage to step up and say ‘this isn’t working, this needs to change’ or ‘things were different when we first started on this path, let’s reassess what we are doing’. This is irrespective of whether they devised the plan, signed it off, or oversaw it. The point is that great leaders are those who have the courage to take responsibility and move things forward regardless of whether they could be considered ‘wrong.’
“It takes boldness and bravery to take a step back and admit that decisions made early on might not have been the right ones but it takes courage to change and adapt in order to stop a strategy failing completely.”
Highland Marketing blog
In this week’s blog industry advisor, Ravi Kumar shares his thoughts on the Royal College of Physician’s ‘Future hospital’ report.
