News in brief
Sir Stuart Rose to advise on NHS leadership: Sir Stuart Rose, who turned around the fortunes of Marks and Spencer, will advise how another British institution, the NHS, can attract and retain the very best leaders to help transform the culture in under-performing hospitals, health secretary Jeremy Hunt has announced. It will run alongside a separate review into how the NHS can make better use of its best existing leaders, so-called “superheads”, who could spread the highest standards for patients across the system by taking on struggling organisations or establishing national networks of NHS hospitals and services according to Gov.uk. Sir Stuart, one of the most highly-regarded business leaders in the country, will advise the health secretary on how the NHS can build on existing work to recruit top talent from within and outside the NHS. Drawing on his experience as a former M&S chairman, he will also advise on how NHS trusts can improve organisational culture, through leaders being more visible and in touch with frontline patients, services and staff. Through a series of hospital visits Sir Stuart will mentor NHS leaders and examine the challenges facing doctors, nurses and management boards. He will provide advice in an unpaid capacity until the end of the year when he will submit a short report to the department. Sir Stuart Rose said: “Clearly the NHS is a very different institution from M&S, but leadership, motivating staff and creating a culture where people are empowered to do things differently are crucial to the success of any organisation, and I’m looking forward to helping in any way I can.”
£10m of Healthwatch cash ‘goes missing’: Nearly a quarter of the funding for local Healthwatch groups has gone missing, according to research by the national body representing them reports Health Service Journal (subscription required). England’s 148 local Healthwatch groups, which were set up as “consumer champions” for the NHS under the Health Act 2012, were allocated £43.5m by the Department of Health (DH) last year. But research by Healthwatch England, has found the groups only received £33.5m of this – leaving £10m unaccounted for. The group said the DH had verbally confirmed it passed £43.5m to the Department for Communities and Local Government (DCLG), which was tasked with distributing the money to councils to give to their local Healthwatch groups. However, Healthwatch England said it was unclear whether the DCLG passed on the full amount or whether it was subject to cuts to the department’s overall budget for local government. It is also unclear whether councils handed Healthwatch groups the full amount they needed to pay for the service, or whether councils retained some of this money. A spokesman for the DCLG said: “Funding for Healthwatch was included in the local government settlement for 2013-14 and as such is being paid in full. It is up to councils to account for how it is being spent locally.”
Tech fund money claimed retrospectively: NHS trusts can claim funding from the ‘Safer Hospitals, Safer Wards: Technology Fund’ for money spent on their projects since April last year according to eHealth Insider. As the first round of money from the fund is being released and trusts are signing their memorandums of understanding, it has been revealed that some will be using the fund to claim back for costs already incurred. More than 230 projects worth around £220m have been approved by NHS England in the first round of the technology fund and £90m of this money must be spent in this financial year. Both trusts and suppliers had expressed concerned about the tight timescales involved in spending the money by the end of March when it is only being released in February. However, NHS England’s head of technology and strategy Paul Rice has confirmed that as long as the money has been spent on the approved project in this financial year, successful trusts can claim it back within the rules of the capital funding. Rice said: “All reasonable project costs can be capitalised within the rules of public dividend capital in the financial year that they have been incurred – physical assets, licences, people who are delivering enabling project management, business process redesign etc.” An industry source, said that being allowed to claim for money already been spent undermines trusts and suppliers that are working hard to meet the March deadline.
Cash penalties axed for care fund failure: The Department of Health (DH) has scrapped plans to withhold money from areas that fail to deliver performance improvements through joint commissioning with local authorities reports Health Service Journal (subscription required). Instead the DH, together with NHS England and the Local Government Association, will offer “support” where the £3.8bn better care fund does not lead to improved performance on metrics including delayed transfers and reduced emergency department admissions. When the expanded fund was announced last summer, the care and support minister Norman Lamb said an element of it would be tied to performance. The proposal was fleshed out in December when NHS England published its planning guidance for the fund. But the DH has since scrapped the idea. Mr Lamb said: “This is a big reassurance for councils and clinical commissioning groups [But] it’s really important people do hit the objectives, and if they don’t there will have to be support going in to help improve their performance.” Steve Kell, co-chair of the NHS Clinical Commissioners leadership group, welcomed the move. “It makes absolute sense given we are exploring new relationships as well as new financial models,” he said. “The whole point is to get to a better system – to penalise when places are under financial pressure is not good management in the long run.”
Treasury approves £168m for NHSmail2: A tender for NHSmail2 is due out this month following Treasury approval for £168m in funding to transition to a new service. Health and Social Care Information Centre programme director Mark Reynolds told eHealth Insider that the outline business case covers the procurement of a new mail service and continuation of the existing service until that is in place. Worth £168m, it covers all expenditure for five years. The Crown Commercial Service is due to issue a formal tender this month for a ‘managed email framework’, which will be available for all public sector to use. Procurement was going to be done by creating a secure email ‘lot’ on a Public Services Network framework, but a separate framework for email will now be created. A nine-year contract for NHSmail was awarded to Cable and Wireless in 2004 and was worth around £30m a year. This has been extended to June 2014 with provision for a two-year transition. “From the start we recognised the need to work with industry to develop the requirements. Because it’s a financially constrained time we didn’t want suppliers to spend quite a lot of money on a bid when it’s not in their best interest or they wouldn’t win,” Reynolds said. He added that the range of suppliers involved is very high quality and the tender process will be a “tough competition”. There are 650,000 users of NHSmail, but capacity could be increased depending on the prices offered by bidders.
Senior MPs blame commissioning for lack of integration: The Commissioning Review reports that fragmented commissioning structures are making it harder to integrate health and care services, the health select committee has claimed. The committee’s annual inquiry into public expenditure on health and social care has recommended that health and wellbeing boards (HWBs) take over commissioning of joined-up health and care services. Committee chair Stephen Dorrell said: “As health and wellbeing boards have been established to allow commissioners to look across a whole local health and care economy, their role should be developed to allow them to become effective commissioners of joined-up health and care services. The committee has called for “fundamental changes” if the health system is to meet the needs of patients. John Appleby, chief economist at The King’s Fund said: “A combination of unremitting financial and demographic pressures is having a significant impact on social care services – although welcome, implementing the Dilnot reforms is only part of the solution. And while the establishment of the Better Care Fund provides an important opportunity to promote integrated care, it will not offset inadequate funding for social care and will increase financial pressures on hospitals.”
Delivery of electronic health records in UK hospitals at risk of failure: NHS hospitals will “risk failure” if they are not better prepared for the full costs of implementing new electronic health record systems (EHRs), new research warns. The Information Daily reports that a study published in the Journal of the American Medical Informatics Association points to how the delivery of EHRs has proceeded at a much slower pace than expected, with hospitals cutting back on training and implementation costs. Certain factors were systematically under-appreciated in project planning, the researchers found, including the need to back fill staff due to lost productivity and the need to test the system due to inadequate vendor testing. EHR systems can improve the safety, quality, and efficiency of healthcare in hospitals, and their adoption is a priority for the UK government. However, the study authors argue that despite the existence of EHRs in UK primary care for several decades, hospitals have been slow to adopt the technology, citing cost as a significant barrier. Some of the hospitals incurred significant costs in testing the software while some spent a lot of money training clinicians and administrative staff to use the new system. “Failure to adequately train staff or to follow key steps in implementation has preceded many of the failures in this domain, which can create new safety hazards,” the study authors conclude.
GPs may face penalties for not using new-look Choose and Book for referrals: GPs may face penalties if they do not refer all their patients via the new e-referrals service due to be launched later this year, under plans being considered by NHS England, reports Pulse Today. Chief executive Sir David Nicholson admitted that managers had been ‘unable to persuade’ GPs to use Choose and Book for all referrals, but that he was considering whether to make the system mandatory after it is re-launched as a new ‘e-referrals’ site by the end of 2014. NHS England has set its sights on getting 100% of practices using the new system by 2017 – based on flight-booking websites – and this is the first time that managers have raised the prospect of forcing GPs to use it to make referrals. NHS England had previously said that they would prefer not to mandate the use of e-referrals and want GPs ‘to be persuaded to use it, want to use it because they see the value of it.’ It will be available on mobiles and will automatically update the GP record. Patients will be able to book follow-up appointments, which will be linked to ensure that they happen in a pre-determined order. The e-referrals system will come into operation at the end of 2014, and is central to health secretary Jeremy Hunt’s plans to create a ‘paperless NHS’ by 2018. The current system ‘Choose and Book’ accounts for around half of GP referrals currently being made, but this proportion has been falling of late.
Lancashire trust uses ‘Safer Hospitals, Safer Wards’ technology Fund to improve efficiency and save money: Following a successful pilot programme to automate their paper-based pre-operative assessment process within the orthopaedic outpatient clinic, East Lancashire Hospitals NHS Trust (ELHT) has signed a five year contract with Caradigm to deploy its solutions trust-wide reports eHealthNews.eu Portal. The pilot used the Caradigm Intelligence Platform and self-service kiosks to collect pre-op assessment data from clinicians and patients. It is envisaged that the trial will result in a reduction in the number of cancelled operations due to inconsistencies in data, which could result in a saving of approximately £75,000 per year. Taking advantage of the ‘Safer Hospitals, Safer Wards’ technology fund, ELHT has decided to roll out the solution across all of its surgical outpatient clinics, helping the trust to achieve health secretary Jeremy Hunt’s paperless NHS ambition by 2018. Emma Birchall, the trust’s Associate Director of IM&T explained: “We wanted a ‘best of breed’ application that can aggregate clinical data from systems across the trust and present it in one view. We were already using Caradigm’s Single Sign On and Context Management solutions, so in October 2012 we approached them to explore how they could help us further.”
Hospitals must stop providing certain services or shut to sustain NHS – MPs: Some hospitals must stop providing certain services or even shut altogether if the NHS is to remain viable, even though such changes are “notoriously controversial”, an influential group of MPs warns. According to The Guardian the Commons health select committee said in a report that a dramatic expansion of the centralisation of hospital services was needed to help the NHS cope with the increasing pressures on its budget. In a report on the finances of the NHS and social care, the MPs say that integrating the currently separate services, which ministers and NHS leaders say is vital for the NHS to remain sustainable in the face of rising demand caused by ageing, “will also require reconfiguration”. In recognition of the controversy such proposals generate and the pressure MPs feel under to oppose a rundown of their local hospital, the MPs say: “Advocating service integration without recognising that the consequence of integration is reconfiguration of acute services … is simply dishonest.” While much of the savings so far have come from pay restraint imposed on NHS staff, including a two-year pay freeze, that will not be enough to meet the £20bn target, they add. Jeremy Hunt, the health secretary, who has asked the NHS pay review body to cancel the 1 per cent rise previously promised to all NHS staff by George Osborne, because the service cannot afford it, has already accepted the committee’s view on that.
NHS failing to adopt E-rostering and save £71m: The NHS is failing to adopt electronic rostering systems despite it offering around £71m in savings, a report has suggested. According to Integrated Care Today the report by the Policy Analysis Centre and the London School of Economics found that many trusts have only partially adopted electronic rostering systems and this was limited to certain staff groups. “If the NHS is to rely on increasing productivity to maintain standards, then it is clear that better knowledge over the form, type and uses of the labour force is required,” said the report. The report also found that only certain staff groups have so far been included in many e-rostering systems. A 2012 survey carried out by NHS Employers found that while 90 per cent of trusts had implemented e-rostering, only 17 per cent included staff other than nurses. Basildon and Thurrock University Hospitals NHS Foundation Trust implemented e-rostering in 2008 and incorporated timekeeping and attendance a year later. On the basis of savings made at that trust, the authors estimated that trusts across England could reduce their overheads by a further £41m. This would be achieved through the elimination of general errors and corrections in payroll systems, adding up to a total of £71.5m in annual savings.
Technology transforming referral management at Lincolnshire Community: IT Analysis reports that Lincolnshire Community Health Services NHS Trust (LCHS) has deployed technology that allows healthcare professionals to proactively manage patient referrals and deliver care more efficiently out in the community. The deployment of Cayder’s Patient Flow Management System supports a county-wide acute admissions reductions programme, which includes a focus on pro-active care, case management and early intervention to avert crisis and keep patients in the most appropriate care setting. The Cayder software is being used by more than 200 staff, such as service advisors and clinical leads, at LCHS’ ‘contact centre’ which takes calls from colleagues across health and social care to proactively manage any referrals that can be treated in the community, helping to reduce the number of hospital admissions. The software helps LCHS staff access the current location and status of patients allowing them to make better and more efficient decisions on managing referrals. Jo Cudmore, business lead for winter management at LCHS said: “Due to the huge geographical area we cover, we wanted to know what capacity we had at each community hospital and in each of our community nursing and therapy teams in real time. Now our teams are able to get information on our inpatients and those in the community (through virtual wards) very quickly on our electronic whiteboards in any of our four hospital sites.”
Report calls for radical changes to community care: Radical changes to community services are needed to realise the ambition of moving more care out of hospital and closer to people’s homes, says a new report published by The King’s Fund. The report, which is based on the findings of a working group of community trusts convened by the Fund, argues that previous policy has failed to achieve this longstanding ambition according to The Commissioning Review. The report argues that the scale of community services is poorly understood and not well served by the way the debate on health services is often dominated by ‘GPs and hospitals’ or ‘primary and secondary care’. Nigel Edwards, Senior Fellow at The King’s Fund said: “There is an emerging consensus about the value of community services. Although some progress has been made, radical change is needed to realise the ambition of moving more care out of hospital and closer to people’s homes. With the health system under increasing pressure, especially the hospital sector, improving the effectiveness of community services is essential.” The King’s Fund has set out a seven-step ‘plan for change’, based on community services working more closely with groups of general practices and building multidisciplinary teams to care for people with complex needs.
Department of Health and Microsoft in talks over end of Windows XP support: The Department of Health (DH) and Microsoft are negotiating a deal to extend security support to NHS PCs running Windows XP, which will be vulnerable to attack if they miss the end of support deadline on the 8th April, reports ComputerWorldUK. An investigation found that thousands of PCs across England are due to miss the deadline, the government department has now revealed that it is in talks with Redmond to develop a migration plan for NHS organisations. Part of the deal will see Microsoft offer the NHS ‘extended support’ which will come at a cost. Extended support is being charged at a higher cost in a deliberate attempt to prompt people to move to newer versions of Microsoft’s OS. The NHS in England has 1.086 million PCs and laptops running Windows XP at trusts, GPs and other health groups – and extended support is charged at $200 (£120) per desktop for the first year. However, without it, NHS desktops and networks could be exposed to attacks and attempts to steal data via unprotected holes in the software. The DH said: “We are discussing plans with Microsoft for putting in place a migration plan and extended support for the NHS. As well as mitigating against the potential risks of unsupported Windows XP, we hope this will save a lot of money for the NHS alongside the benefits of more modern operating systems. The Whitehall department said that negotiations over extended support and migration plans will conclude shortly.”
Enter the EHI Awards 2014: Entries have just opened for the eHealth Insider (EHI) Awards 2014. The awards now have more categories than ever before to recognise the work being done by healthcare IT teams across the UK. The 14 categories include a new award for ‘digital trust or health board of the year’ and an addition to the list of personal awards in the form of ‘rising star of 2014.’ Further new categories recognise the growing imperative for trusts to have excellent ‘business analytics’ and to ‘share information with patients and carers’; while the integration category has been adjusted to recognise the growing importance of ‘integrated health and care services’. The awards will be judged by a panel of experts and a full list of the categories are available on the dedicated awards website. Entries will be open for three months, and must be received by 9 May. Further information about the healthcare IT champion of the year award will be announced later this spring.
Opinion
‘NHS has to adapt to survive’, says chief executive
In The Telegraph this week, outgoing chief executive Sir David Nicholson says front-line NHS care must be rebuilt from the bottom up.
“For the past eight years I have had the privilege of leading the NHS, one of this country’s greatest institutions. In that time we have successfully fought some major battles… now I believe the NHS needs to embark on a programme of transformational change to front-line care.
“There are two big reasons why we need to do things differently. Firstly, the NHS has to transform the way it provides care in order to deliver better outcomes to patients. Secondly, the NHS has to change because, like every major health system in the world, we face a big financial problem for the future… we face a funding gap that could be £30 billion by 2021.
“Bruce Keogh has already set out his vision for urgent and emergency care, with a solid base of different ways to get help for minor problems over the phone, online or close to home, and coordinated networks of emergency departments, with designated units for the most serious cases. We must now put this into place.
Concluding, Nicholson says we need to: “[give] people still more information about the quality of services and [ensure] the power of information is harnessed and used more intelligently. Our NHS does a superb job, but it cannot stand still – it needs to adapt to survive.”
The new NHS structure is unstable
In this week’s Health Service Journal (subscription required) Holly Jarman, a research assistant professor with a joint appointment at the Centre for Law, Ethics, and Health and the department of health management and policy at Michigan University, explains that since the reorganisation of the health service, many people have been left wondering who can or should decide the future of healthcare provision.
“History tells us that separating policy and management is virtually impossible in health services. Many governments have tried and failed to take the politics out of the NHS by reforming its structure and governance.
“The reorganisation of healthcare delivery and governance in April 2013 was big, even by the standards of NHS England. NHS chief executive David Nicholson famously said the reform demanded “such a big change management you could probably see it from space”.
“The reform, launched under the banner “liberating the NHS”, rests on some familiar ideas.
Commissioning GPs and increasing provider competition were seen as ways to improve the quality and efficiency of care.
“The Department of Health was viewed as too big and dictatorial, while mid-tier management bodies in the NHS such as strategic health authorities were seen as bureaucratic and superfluous. It was also considered possible and desirable to create a structure for the NHS that would be immune to politics.
“The new structure of NHS governance does not change the fact that the public and media will continue to attribute the success or failure of health policy to the government. It seems likely, therefore, that the secretary of state will keep the responsibility for health while being unable to effectively use the tools to solve problems that arise in the NHS.”
What can clinical commissioning groups learn from Oxfordshire?
This week in The Guardian, Richard Vize says that Oxfordshire CCG’s experience demonstrates that although commissioners control the finances, providers are still in charge.
“The unravelling of the plans by Oxfordshire clinical commissioning group to introduce outcomes-based service contracts shows that while commissioners have the money, providers are still running the system. What will it take to break their power?
“Oxford health foundation trust and Oxford University hospitals trust’s forceful objections to plans for outcomes-based commissioning of adult mental health, maternity and older people’s services included the fact that the changes would introduce new financial and clinical risks and affect the local health workforce. But they supported the overall aims, of course.
“It is clear from divisions in Oxfordshire CCG’s own ranks that it could have made a better job of building a coalition of support for its radical plans. Contracting is only a powerful tool for large-scale change if it is accompanied by convincing clinical evidence and political support.
“Many providers and CCGs are beginning to develop strong and trusting relationships, on which they are building a shared vision of the need to change. But where the relationship is less constructive, CCGs simply do not have the clout to batter through change in the face of concerted opposition. If pushing through change involves having a scrap with the incumbent provider it will require political guile, and lots of it. Commissioners cannot allow providers to be seen as having the exclusive right to represent patients’ interests.”
From the Heart and Chest: on names and roses
In eHealth Insider this week, Johan Waktare, the clinical lead for IT at Liverpool Heart and Chest Hospital, reflects on whether: “A rose by any other name would smell as sweet.”
“In e-health, we love bandying names around. Our favourite habit is to put “e-” in front of other, perfectly good words to give us e-forms, e-documents and e-health itself. It is like our political contemporaries putting “-gate” after every scandal they uncover. On reflection, however, I think we have done the right thing by using a prefix rather than a suffix – and I am confident my haematology colleagues would blood-e agree.
“How about EPR vs EMR vs EHR? In the UK, we have ended up largely settling on electronic patient records as our standard term for the hospital digital version of care records. In the US, it’s more common for “medical” to turn up as the middle initial. Sometimes “health” is used. I am not sure how that happened and would be delighted if someone could enlighten me. It is firmly engrained in our psyche that our goal is health maintenance rather than sickness management, and has been for some time. At Liverpool Heart and Chest Hospital, we did actively consider having an EHR project rather than an EPR project. However, we decided that we were swimming too much against the tide, and decided to go with the flow – even if this did mean mixing our metaphors.
“My issue with EPR isn’t actually with the second letter, but the third. Talking about a “record” limits our aspiration to positively intervene in the care process through the use of technology. A major part of the whole benefit of switching to paperless technology is that it isn’t just an alternative to paper, but a powerful technology that actively intervenes to support the highest standard of patient care, for example via things like clinical decision support.
“I tend to use the term IT-enabled healthcare, but pick your own as long as it sets the right agenda. As Juliet will attest, names are important. In order to move forward at Liverpool Heart and Chest, we are pursuing a move away from talking about our EPR to talking about an integrated suite of clinical systems.”
Highland Marketing blog
In this week’s Highland Marketing blog, Gregor MacKenzie focuses on wearable devices and their place in the future of the health tech industry.
