News in brief
NHS England to unleash people power: NHS England will release an NHS technology strategy for the next decade called ‘unleashing the power of people’, this December, reported eHealth Insider. Beverly Bryant, NHS England’s director of strategic systems and technology, spoke at the Commissioning Show in London this week. She said the new strategy would draw a line under the past and some of the old national programmes. It would include details of support to attract people to work in the NHS from the private sector as well as apprenticeships to ensure the NHS had the skills to make the digital transformation. “I want you to start supplementing the skills you have got by engaging the market – small medium enterprises and large firms – to get people who understand how to implement technology and build the skill base to help Clinical Commissioning Groups and other NHS organisations achieve this,” she told the audience. A key focus of the strategy would be on customer service, such as offering patients online records access, e-consultations and online ordering of repeat prescriptions. The strategy will also focus on electronic record keeping.
NHS data revolution coming: The NHS has announced that, from 2014, all NHS trusts and providers must use NHS numbers as the primary patient identifier, reported Computing.co.uk. The move – which seems simple, but could save a huge amount of unnecessary paperwork – means medical records can be more easily tied together because hospitals will be able to keep multiple visits logged under the NHS number, rather than taking a name every time. Tim Kelsey, NHS England national director for patients and information described the existing service as one that is “unintelligent about its patients, carers or clients, that does not always know with accuracy who it is treating, cannot guarantee its safety,” and said using the NHS number was one of the “urgent steps” needed to “make the data revolution real” within the health service.
NHS trusts taking ‘many routes’ to electronic patient records: Following the end of the £12billion NHS National Programme for IT and the opening up of the market, NHS trusts are pursuing diverse strategies in order to develop electronic patient records systems, reported Building Better Healthcare. A new report from EHI Intelligence details how since the programme was scrapped in 2011 and with a move away from nationally-specified and purchased systems, a far more vibrant and diverse picture is evolving in a market that could be worth £2.7billion over the next five years. Entitled Routes to EPR, the report details how hospital trusts across England are now developing and pursuing a variety of strategies based on differing local needs, clinical and strategic priorities, historic IT investments and technology choices. These range from £200m state-of-the-art fully integrated electronic patient record (EPR) systems, to integration and portal approaches and innovative open-source developments. The Routes to EPR report also reveals that trusts are looking to create as integrated a suite of systems as possible, regardless of whether they use one supplier or many.
E-referrals service gets official launch: The new NHS e-referrals service has been officially launched by Beverly Bryant, NHS England’s director of strategic systems and technology, reported eHealth Insider. Use of the service, which will replace Choose and Book, will not be made mandatory, Bryant told the Health+Care conference in London this week. However, she said she was confident that it could create a tipping point for e-referrals around the NHS. “We don’t believe that mandating and saying things are compulsory are going to work. We need to persuade people that it’s the right thing to do,” she said. As previously revealed by eHealth Insider, two suppliers have been shortlisted to develop the service, using open source software. BJSS and Valtech are in the running to develop a new integration engine to re-platform the product, which is currently built around functionality from Cerner Millennium. A final choice will be made in July. Bryant said she hoped that the service would be ready in “about a year.” She also indicated that a number of front-ends could be developed, on the model of travel websites. But if patients want to receive referrals by post, they will be able to do so.
Staffordshire NHS trust fined thousands over patient data breach: North Staffordshire Combined Healthcare NHS Trust has been hit with a £55,000 fine after a serious data breach in which it mistakenly sent sensitive medical details to a member of the public, the Information Commissioner’s Office (ICO) has confirmed. The trust faces the penalty after the records of three patients showing their names, addresses, medical histories, and details of their physical and mental health were faxed three times to a member of the public, reported Public Service. Guidance on phoning ahead of faxes had not been communicated to the staff involved and they had received no specific training on the secure use of fax machines, the ICO added. Enforcement group manager, Sally Anne Poole said: “Let’s make no mistake, this breach was entirely avoidable.” This is the latest in a growing list of fines to be imposed on NHS bodies for breaching the Data Protection Act, some of which have been much larger. The ICO does have the power to fine up to £500,000 for the most serious breaches.
Local variation in avoidable death rates revealed: The “shocking” local variation in early death rates has been exposed by health secretary Jeremy Hunt to drive public awareness and boost council and NHS action to tackle public health problems, reported the Department of Health. The figures are part of ‘Longer Lives’, a new Public Health England website which allows local people to see easily how their areas perform on early deaths from the major four killers, like heart disease and cancer, and how this varies across the country. Using a traffic light rating system, it ranks areas showing those performing above average in tackling avoidable deaths as green, and exposes the worst that are lagging behind and need to do more as red. Overall it shows that the north of England has a higher risk of earlier death than the south. The data and website will provide local areas with information to help them understand their own position and better target efforts to improve the public’s health. The health secretary said: “This shocking variation in early and unnecessary deaths means people’s lives are needlessly cut short, and that cannot continue unchecked. I want areas to use the data released today to identify local public health challenges like smoking, drinking and obesity and to take action to help achieve our ambition for saving 30,000 lives a year by 2020.”
Cancer database could save thousands of lives: Millions of patient records, detailing each cancer and the method of treatment used, will be collated to form the biggest cancer registration service in the world, reported The Telegraph. The system is expected to lead to each patient benefiting from highly personalised treatments. It will bring together clinical information on all 350,000 cancers diagnosed in England and will include more than 11 million historical records of cases from as far back as 30 years ago. Cancer specialists across the country will then, for the first time, be able to draw on the extensive bank of detailed clinical data when working out how to treat each new case. Jem Rashbass, who leads the Cancer Registration Service at Public Health England, hailed it as “the most comprehensive, detailed and rich clinical dataset on cancer patients anywhere in the world.” The database will be announced to hundreds of cancer experts at the Cancer Outcomes Conference in Brighton, hosted by the National Cancer Intelligence Network. Public Health England, which was set up as part of the NHS reforms, will have responsibility for it.
Surgeons ‘can block performance data’: Surgeons will be able to block the planned publication of data on their individual performance, revealed the BBC. League tables for 10 specialities, including vascular and orthopaedic surgery, are due to be published in England this summer. Such detailed information is currently published on heart surgeons only. However NHS leaders have now said Data Protection Act rules prevent them from requiring any surgeons to release individual information. The publication of surgery-specific data was first called for in 2001 by Prof Sir Ian Kennedy, who chaired the inquiry into the excessive number of deaths of babies undergoing heart surgery in Bristol. Since then, only heart surgeons have published data down to an individual level. Some doctors have been resistant to widening publication of data, as there is a fear that it may give a misleading impression. NHS England reported that so far 4% of surgeons had said they did not want the information disclosed – although this does not mean the data is hidden from regulators which investigate cases where performance is outside of the normal range. Health Secretary, Jeremy Hunt has described the pans to publish the data as a “major step forward”. Hunt said that surgeons who refuse to publish their performance data including mortality rates should be publicly named and promised to take tough action.
Salford Royal live with Allscripts: Salford Royal NHS Foundation Trust went live with its Allscripts electronic patient record (EPR) last weekend, three months ahead of schedule, reported eHealth Insider. The trust, which was due to go-live in September, pushed forward the launch after extensive testing and the successful migration of more than 1 million patient records from its old system, iSoft’s iCM. Mark Hutchinson, the trust’s director of IM&T, told eHealth Insider that the hard work his team had put in made it possible to go live with Allscripts Sunrise Clinical Manager sooner than expected. “Clinicians within the organisation were keen on getting it sooner, so we took a brave decision to go live early,” he said. The system is now live across the trust with what Hutchinson described as all the core functionalities of an EPR, including order communications, results reporting, clinical decision support and e-prescribing.
Quarter of CCGs facing financial ‘difficulty’: About a quarter of clinical commissioning groups (CCGs) are facing “real difficulty “ in “making ends meet” this financial year, the NHS England finance director has said. Paul Baumann was speaking at the Commissioning conference in London, reported HSJ (subscription required). He set out NHS England’s requirement for all CCGs that they make a surplus of at least 1%, spend at least 2% of their budget non-recurrently, and hold a contingency reserve of at least 0.5%. Mr Baumann said: “The latest [CCG] plans, submitted in May, show the CCG sector as a whole is broadly meeting these aspirations. But, more troublingly, about a quarter of CCGs are having real difficulty making ends meet, with little or no reserves to fall back on.” In recent months CCGs have complained about being informed at short notice that their 2013-14 budgets are smaller than they had expected, or that they were responsible for services they had not anticipated. However, there have also been transfers in the opposite direction, from NHS England to CCGs.
NHS ratchets up role of PR to refocus on service’s reputation: Amid intense media scrutiny of the service, the role of PR has been ratcheted up, said a senior figure at the NHS, reported PR Week. Steve Gladwin is director of comms for the Trust Development Authority (TDA), which was created in April as part of NHS reforms and oversees efforts to drive up standards in hospitals and a range of health services. Following a wide-ranging consultation, the TDA is developing best-practice tips. These will be sent to 100 hospital trusts that it has been tasked with helping improve. Gladwin said that during the reforms there had been a “loss of focus” across the service. Recent media coverage has also concentrated on February’s Francis Report, which exposed massive flaws at Mid Staffordshire NHS Trust and was followed by NHS chief Sir David Nicholson announcing his decision to step down. “The NHS is under the spotlight”, added Gladwin. “The Francis Report said we needed to listen to patient concerns far more, and if the public hasn’t got confidence in the NHS, then the NHS itself begins to suffer. This major piece of work we are doing is to make sure comms has much more of a voice at the top table, to help stop that happening.” Though the guidance is still being developed, it is set to be distributed this summer. It will include tips on explaining changes in service and how to engage with patients.
CSU improves its safeguarding for vulnerable children: Central Eastern commissioning support unit (CSU) has developed the first of a kind portal that enables GPs to view relevant information about children who are deemed at risk by colleagues within the community trust to improve their protection, reported Commissioning GP. The system will provide GPs with a view of crucial data that includes basic demographics, the names of a child’s family members and any recent A&E attendances, to enable them to make more joined-up decisions about a child’s health and well-being. GPs currently rely on manual processes for gathering safeguarding information from other health professionals who may be involved in a child’s care. Lloyd Baker, assistant director ICT informatics and chief information officer at Central Eastern CSU, who initiated the project said: “There is a wealth of information that is locked away in different IT systems that GPs and other health and social care professionals simply do not know exists or cannot access.
Head of NHS blames Treasury for use of secret gagging orders: Sir David Nicholson, who is retiring next year after criticism over his role in the Mid Staffs trust scandal, was accused of misleading Parliament after he told MPs he did not know how many of the gagging orders had been signed, reported The Telegraph. In March, he claimed that he had only come across one of the orders, used for gagging whistle-blowers, but pledged to investigate the issue and write to NHS trusts. However, the scale of their use only became clear when requests under Freedom of Information showed that at least 52 staff have been silenced using the orders since 2008, at a total cost of £2million. Nicholson has been accused of an “abnegation of responsibility” and “misleading Parliament” for failing to follow up on his pledge at a meeting of the Public Accounts Committee. Stephen Barclay, the MP who obtained the figures, said: “You gave an undertaking… and you decided that you would not even have the courtesy to write back to the committee and tell us about what is self-evidently a potential conflict of interest within hospital trusts.” Sir David strongly denied accusations that he had been complicit in a “cover up” about the use of the gagging orders and said that he had “always supported people who have stood out against the system”.
Manchester hospital set to introduce ‘rate my doctor’ scheme: University Hospital of South Manchester (UHSM) is to become the first in the country to publish performance ratings for all its consultants, allowing patients to rate their doctor and make choices about who provides their care, reported The Independent. UHSM will publicise “mortality ratings” for each of their heart and lung surgeons online along with patient feedback on the performance of individuals. By the end of the year, information will available on all of the hospital’s 250 consultants. Information will be regularly updated on the UHSM Foundation Trust’s website. The NHS has pledged to improve transparency and patient choice following the recommendations of the Francis Report into catastrophic clinical failures at Mid Staffordshire NHS Foundation Hospital. Sir Bruce Keogh, the medical director of NHS England, who has advocated “league tables” for surgeons, said that the “pioneering” scheme was a “great example for the wider NHS.”
HSJ Clinical Leaders: In this launch year of HSJ Clinical Leaders, HSJ (subscription required) sought to identify those clinicians making the greatest impact on health policy, service transformation, and innovation. The HSJ team prepared a long list of candidates over the spring and a panel of judges was put together with knowledge of influence in healthcare and who represent a broad spectrum of opinion. Top of the list was Professor Sir Bruce Keogh, NHS medical director for England. Click here for the full list.
Opinion
How can doctors prepare for new roles in clinical commissioning groups?
In the Guardian this week, Mark Wilkinson, chief officer at NHS Barnsley Clinical Commissioning Group, discusses how healthcare leaders need to seek alternative training in order to meet the demands of the new clinical commissioning groups.
“Changes in how health care is delivered, the absence of significant new money for the foreseeable future, and ageing populations threaten to overwhelm our UK health system if we don’t change.
“However, for those who have now accepted the need for change, the situation is being viewed as an opportunity to help challenge things that were perhaps never questioned when NHS resources were increasing. It has also shifted the demands placed upon healthcare professionals. There is a growing trend for those in the industry to seek alternative training to cope with increased managerial and financial demands.”
Wilkinson explains how he completed a programme known as the International Masters in Health Leadership in Canada: “It is among a number of new programmes offered by business schools that aim to fill what they claim is a growing skills gap between healthcare managers and the changing demands of the industry.” It also believes that “…the greatest hope for the improvement of health lies in a deep understanding of how the entire health field works, coupled with a sophisticated appreciation of its management.”
Wilkinson concludes: “Traditional education in the health sector does not contain enough managerial or broader professional awareness of how other organisations work. If we don’t start to equip healthcare managers to deal with the changed environment then we could start to see a decline in the quality of healthcare and a growing debate will arise as to what we can sensibly provide as a nation.”
Integration without boundaries
Integration is now a buzz-word in healthcare, with the Holy Grail being that care is joined-up and provided to patients across both care and geographical boundaries. But, in all the excitement Wayne Parslow, VP EMEA for Harris Healthcare, asks in Commissioning GP this week whether we have lost sight of what true integration could look like and how it can be achieved.
“Following the passage of the Health and Social Care Bill, the term ‘integration’ is now frequently described as ‘removing the invisible divide that has for many years sat between primary, secondary, community, mental health and social care’. Already we are looking at how integration has the potential to redesign care around the needs of patients rather than NHS structures to provide more joined-up, patient-centred and value-based care, which improves patient outcomes and provides the support needed for our changing and ageing population.
“There are already limited, but great examples of NHS commissioners and local authorities developing shared visions, plans and budgets and of different sectors collaborating with providers to design coherent, reliable and efficient care pathways.
“But with such a vision in mind, healthcare professionals are looking for modern information systems that provide better access to all relevant patient information at the point of care, enabling the provision of the best possible care regardless of the setting and source of information.”
Health apps won’t reach core NHS patients
This week, Cassander Grey, who works in NHS commissioning, argues that despite the potential for apps to have a huge impact on healthcare, uptake will be limited in the short to medium term because the NHS’ core customers will not have smartphones.
“A report showing UK smartphone ownership by age band, as of March 2011, showed that ownership is lowest among older and less wealthy people. Conversely, use of the NHS is more common among these same groups. Data for 2011-12 show that patients aged 65 and over accounted for almost 40% of finished consultant episodes in English NHS hospitals. The link between poverty and poor health is well established; see for instance Lord Darzi’s year of life expectancy lost with every stop heading east on the Jubilee Line.
“This fits with what clinicians are seeing on the front line. Dr Jonathon Tomlinson, a GP in Hackney and a medical blogger, is probably far from atypical in his estimate that 10-20% of his practice’s patient list accounts for 80-90% of all appointments, and that the elderly, deprived and poorly-educated are disproportionately represented in this group.
“If the NHS is going to cope with a future of static or negative funding growth, the big opportunities for cost savings are going to come from preventing these core customers from using as much healthcare as they currently do.”
We can learn from America
In this weeks’ HSJ (subscription required) Norman Lamb MP, care and support minister at the Department of Health, says that by looking at how primary care services and organisations in the US are improving the population’s health and the efficiency of healthcare services, we may be able to better the situation here.
“As more people live with multiple long-term complex conditions, all parts of the system are feeling the strain. Hard working GPs face the treadmill of 10-minute appointments, feeling frustrated that they are unable to give the time to patients who really need their attention.
“Travelling to the US for a solution seems counterintuitive, yet within that healthcare jungle there are some gems. A community clinic on the outskirts of Seattle provided a glimpse of a better way of doing things, having redesigned the way primary care works. By putting in place systems that free up precious GP time, the patients that really need focused attention can be seen.
“Through smarter use of IT, patients can book their appointments or order prescriptions via their mobile phone. They also have the option of consulting their GP by telephone or by email – we saw how a third of all patient consultations are by email.
“We have some inherent advantages in this country, not least the state’s commissioning of social care services. At the same time, public health (now sitting in local government, with an increased budget) can play a central role in preventing ill health.
“I believe we have real opportunity – working with doctors, nurses, social workers and other professionals – to develop a shared vision of better care for patients, a much greater focus on prevention, a more fulfilling and rewarding life for those who work in the NHS and care services and far better use of the resources we have available to us.”
Highland Marketing blog and news
Highland Marketing engages the services of experienced healthcare writer Paul Curran: Highland Marketing has engaged the services of Paul Curran as a writer and communications advisor to support the company’s expansion and growing client base. He joins the team with over 25 years’ experience as a business writer and marketing communications specialist across both B2B and B2C. Over the past 10 years, Paul has written extensively about the application of ICT within the healthcare marketplace, contributing regularly to Microsoft’s NHS Resource Centre, eHealth Insider and other industry information sources. Mark Venables, Highland Marketing CEO, said: “Highland Marketing has grown significantly in recent months and we need experienced writers and communications specialists to ensure we maintain our high level of service. Paul’s experience both in journalism and healthcare will enable us to continue developing our service offering and providing our clients with the best possible solutions using high calibre expertise.”
In this week’s blog, “To tweet, or not to tweet?!” Gemma Thomson discusses why the NHS is reluctant to adopt social media.
