Healthcare Roundup – 14th November, 2014

News in brief

Health and social care leaders set out plans to transform people’s health and improve services using technology: New plans to improve health outcomes and the quality of patient care through digital technology and innovation have been unveiled by national health and social care organisations, reported Gov.UK. Established by the Department of Health and chaired by NHS England’s national director for patients and information, Tim Kelsey, the National Information Board has set out a vision for how technology should work harder and better for patients and citizens by 2020. The vision commits to giving everybody online access to their GP records, viewed through approved apps and digital platforms, by 2015. GP practices are well on their way to achieving this but national leaders want to offer people access to all of their health records – held by hospitals, community, mental health and social care services – by 2018. In just 4 years, every citizen will be able to access their health records, detailing every visit to the GP and hospital, every prescription, test results, and adverse reactions and allergies to drugs. The alliance will establish a national digital standard for people at the end of life – building on the success of Co-ordinate My Care in London – so their care preferences are respected. The digitisation of the Personal Child Health Record (the red book) will offer new mothers personalised mobile care records for their child. Kelsey said: “We must embrace modern technology to help us lead healthier lives, and if we want – to take more control when we are ill. Our ambition is to make the NHS a digital pioneer for our patients and citizens.” To support the understanding of the report, the National Information Board have released a number of videos to help explain about the advantages offered by healthcare services going digital – you can view them here.

Kelsey: Digital ambition will need carrots as well as sticks: NHS England’s information director has acknowledged trusts will need “incentives” as well as “consequences” to encourage them to hit new national standards for information technology. Tim Kelsey spoke to Health Service Journal (subscription required) as the pan-NHS National Information Board set out plans to give regulators a role taking action against trusts that were missing the proposed targets. The NHS England national director for patients and information said: “We agree with the NHS Five Year Forward View that it can’t just be a matter of consequences but we must also develop incentives. There is an important [part of Personalised Health and Care 2020] which is about developing data standards to support new tariff incentives in terms of new models of care. I think we will be thinking differently about how we incentivise the system.” The document says new data quality standards developed by the Health and Social Care Information Centre, the Care Quality Commission, Monitor and the NHS Trust Development Authority will be published by October 2015. They will be for all NHS care providers, and will include standards for “the progressive improvement in the timeliness, accuracy and completeness with which data is entered into electronic records and made accessible to carers and patients”.

Dame Fiona Caldicott named as National Data Guardian: Dame Fiona Caldicott has been appointed to a new role as National Data Guardian for health and care, where she will become the “the patients’ champion on security of personal medical information”. As part of her new role, Dame Fiona will oversee the safe use of people’s personal health and care information and hold organisations to account if there is any cause for concern, ensuring public confidence, reports National Health Executive. Currently Dame Fiona and her panel, the Independent Information Governance Oversight, provide advice to the government on healthcare information sharing, but the latest appointment strengthens her powers. In particular, if she is concerned by how an organisation is sharing data she can refer concerns directly to the Information Commissioner’s Office (ICO) and the Care Quality Commission (CQC) to investigate and sanction where necessary.  Health secretary Jeremy Hunt said: “I am delighted that Dame Fiona Caldicott, who has done so much outstanding work in this area, has agreed to be the first National Data Guardian for health and care. She has agreed that it will be her responsibility to raise concerns publicly about improper data use. I intend to put the National Data Guardian on a legal footing at the earliest opportunity, but the CQC and ICO have decided to sanction organisations that do not comply with her recommendations even before that legislation is passed so patients will benefit immediately from the security of a much tougher and more transparent regime.” Dame Fiona said: “Everyone should feel confident that their healthcare information is shared safely. As the first National Data Guardian I am committed to holding the health and social care system to account and acting on behalf of patients and care users.”

Campaign calls for patients to choose who can access their GP record through care.data: Campaigners are calling for pilots of NHS England’s flagship GP record sharing scheme, care.data, to be halted until further safeguards to block information sharing with private companies have been implemented. Campaign group 38 Degrees is looking to develop a website to help people opt out of the scheme. In a message to their supporters, 38 Degrees said care.data could be used to improve the NHS. However, it added: “Right now, NHS England won’t let us decide who gets our data: NHS doctors and researchers, or private companies. If the pilot goes well, care.data will be rolled out across the country. Together, we need to stop it now – and get it fixed – before it goes national. NHS England could change the system so that we can opt out of private companies getting our data. So let’s make sure they do.” A spokesperson for NHS England told Pulse: “We are working hard with pathfinders who have agreed to test out communications with patients. We’re also talking to 38 Degrees to understand their concerns.”

NHS winter fears ‘prompt cash boost’: Fears of a winter crisis in the NHS in England have prompted ministers to increase the emergency funds available, according to the BBC. The government has released an extra £300m bringing the total winter pot to £700m – 75% more than the system received last year. It will help beef up staff numbers and services, particularly at weekends. A&Es have struggled to hit their four-hour waiting time target this year, but health secretary Jeremy Hunt said performance should improve now. Hospitals are expected to see 95% of patients within four hours. But since April they have averaged 94.8% with performance dipping below 94% in recent weeks despite the period covering spring, summer and the start of autumn. In one week during mid-October the figure hit 93% – worse than at any point during the whole of last winter. This is despite the mild weather, prompting fears that the winter could be particularly bad. However, Hunt said, with the extra money and measures being put in place, he would expect “performance to improve on current levels”. “We are boosting front-line services and expect the NHS to ensure strong performance is delivered locally, drawing on the multi-million pound support package that the government has provided,” he added.

Warning issued over cost of NHS 24 IT delays: Difficulties and delays faced by Scotland’s NHS 24 telehealth organisation in implementing a new IT system have significantly impacted the likelihood of the group meeting its financial targets for 2014/15, the country’s auditor general has said. Government Computing reports that the claims have been made in recently published findings into NHS 24, which call for a revised business case counting all costs to date spent on the IT project and wider reforms of its ‘Future Programme’ to decide on the viability and sustainability of the current strategy. Revisions to this business case, which will also details costs in maintaining NHS 24’s existing IT model, are scheduled to be finalised by February 2015, according to the report. NHS 24’s board estimate that the earliest potential date for developing or implementing a new system for its operations would be October 2015. In regards to NHS 24’s spending for the 2013/14 fiscal year, the auditor’s findings warned about “significant financial implications” resulting from the delays to the new IT system. On the basis of these concerns, the report said that achieving the board’s future financial targets would be extremely demanding.

NHS breaches data laws ‘six times a day’: Confidential patient records are being lost and inappropriately shared by the NHS an average of six times a day, according to new research. A survey of NHS trusts across Britain by a privacy campaign group found there had been 7,255 breaches of data protection rules in three years, including at least 50 cases of information being posted on social media, reported The Telegraph. There were also at least 143 cases when patients’ private records were accessed inappropriately by NHS staff for “personal reasons”. Big Brother Watch, the civil liberties and privacy group which obtained the details using freedom of information laws, said penalties need to be toughened to force the NHS to improve. The group said the situation appeared to have “worsened” since the last time it carried out similar research in 2011. However, it was impossible to draw a direct comparison between the new report and the previous study. Emma Carr, director of Big Brother Watch, said: “The information held in medical records is of huge personal significance and for details to be wrongly disclosed, maliciously accessed or lost is completely unacceptable. With an increasing number of people having access to patients’ information, the threat of data breaches will only get worse. Urgent action is therefore needed to ensure that medical records are kept safe and the worst data breaches are taken seriously.”

Cancer diagnosis rate of 1,000 per day to ‘push NHS to limit’: The NHS will be “pushed to its limit” by the end of 2016 by rising numbers of cancer patients, a charity says. By then, every day would see another 1,000 people diagnosed, Macmillan said, meaning about 361,000 – equivalent to the population of Cardiff – would be living with the disease. An ageing population and NHS cutbacks would stretch cancer care to breaking point, it added. The Department of Health said it had invested £750m in cancer care. “Cracks in the NHS are already beginning to show,” said Macmillan Cancer Support chief executive Lynda Thomas. “Whichever party is voted in at next year’s election, they will face a colossal challenge to make sure the NHS is ready to support the wave of people who will be diagnosed with cancer during their time in power,” she said. The number of NHS trusts missing the target for access to cancer treatment waiting times had doubled in 2014, the charity added. The NHS was under pressure in part due to funding cutbacks, the charity said. “It’s very difficult for the NHS at the moment,” Macmillan Cancer Support director for England, policy and research Dr Fran Woodard told the BBC. “At a time when the number of people being diagnosed with cancer is growing rapidly, real-term spending on cancer services decreased by [£200m] between 2009-10 and 2012-13,” she said. “On top of this, the NHS is dealing with the biggest reforms in its history and hospitals are struggling to cut costs without damaging patient care,” she added.

NHS to prescribe government approved health and fitness apps to patients: The UK government is to coral a new generation of health and fitness apps together under the NHS banner, with the aim of encouraging GPs to prescribe them to patients seeking to improve their health, reports The Drum. The strategy would see approved smartphone apps given an NHS kitemark to encourage take-up, offering an ever expanding range of services from diet and exercise tracking, fitness coaching and even monitoring blood sugar levels. To be rolled out as part of NHS England’s Health and Care 2020 programme the initiative will permit approved developers the opportunity to make use of the NHS logo. Tim Kelsey, national director of NHS England, said: “We want to provide GPs, citizens [and] carers with some level of reassurance… that the NHS has taken a view of a particular digital tool or service and is able to endorse it.”

Norman Lamb: The NHS will “crash” without £1.5bn extra funding: Liberal Democrat health minister, Norman Lamb, has urged the Chancellor, George Osborne, to pledge extra funds for the NHS in the autumn statement. Lamb warned that an extra £1.5bn is necessary before the next general election to prevent the NHS from suffering a “crash”, reported HITC Politics. He says that it is also vital that an extra £1bn is poured into the health system a year to maintain standards: “The NHS could crash, this is the risk. If we don’t get the additional resource, then you would see increasing numbers of trusts getting into financial difficulty, you would see growing numbers of people waiting longer for access to treatment, and longer waiting lists to get to see your GP. None of this we want, and I think we have to grasp the nettle now and acknowledge that the system needs more resources.” In the next five years, the NHS is expected to see an overall shortfall of £30bn. At a time where budgets are being squeezed further by the impact of the ageing population, obesity, and more people visiting A&E, it is vital that the NHS sees the investment it so needs to be able to function correctly.

NHS facing £700m black hole over failing Better Care Fund: A pioneering plan to save the health service £1bn a year by keeping patients out of hospital has been branded a “shambles” after the government’s spending watchdog found at best it would save less than a third of the amount projected at best, the Independent has reported. In a highly critical report, the National Audit Office said proposals to transfer nearly £2bn of NHS funding to social care in a bid to reduce hospital admissions had been inadequately thought through and could have left the health service with a massive budget black hole. It added the plans had been based on “optimism rather than evidence”. Even after the scheme was redesigned to reduce the financial risk to the NHS, the NAO said it was still far from convinced that the Better Care Fund would result in its primary aim of reducing emergency admissions to hospital. “There is limited evidence that integrated care is cost-effective in sustainably reducing unplanned hospital admissions,” the report says. It added that the assumption that these would fall by 3.5% in a year was highly ambitious when they had risen 47% over the past 15 years.

Wolverhampton pioneering use of tracking technology to prioritise patient safety: The Royal Wolverhampton NHS Trust is leading the fight against healthcare-associated infections (HCAIs) following the deployment of a revolutionary tracking technology system by healthcare operational management specialist, TeleTracking Technologies, reports Building Better Healthcare. The deployment is part of the trust’s Safe Hands programme, an organisation-wide, government-funded programme that aims to improve staff compliance with handwashing standards through the use of TeleTracking’s Real Time Locating System (RTLS) which monitors staff and patient visits to handwashing stations using infra-red and radio-frequency technology that detects electronic badges attached to patients, staff and equipment. This allows infection prevention nurses to view and improve the hand hygiene behaviours of staff. The trust’s RTLS technology recorded over 1.2 million instances of handwashing in the past year; compared to just 600 recordings made by an observer in person over the same time period and has enabled the trust’s New Cross Hospital to increase handwashing monitoring by 1,000% in a single month. Michael Gallup, TeleTracking’s president, said: “Figures show that every year at least 300,000 patients develop an HCAI. This is believed to cost the NHS at least £1bn every year. The human and financial costs associated with HCAIs have made the issue a top priority for the NHS and policy makers. Our work with Royal Wolverhampton means that New Cross Hospital now tracks the hand hygiene practices of clinical staff, from domestics and porters to the chief executive and chief nursing officer, 24 hours a day, seven days a week.”

NHS wi-fi access ‘up, but not by enough’: A rise in the number of healthcare staff who have wireless internet access is “good but not good enough”, according to the organiser of a survey on NHS wi-fi. EHI Intelligence commissioned GP Marcus Baw to run the second edition of the nationwide survey on wi-fi use in the NHS, in conjunction with NHS Hackday, OpenGPSoC and HANDI. Baw decided to run the first survey last year, after speaking to fellow GPs and healthcare professionals about the inconsistencies in access to wi-fi across the health system. This year’s results show that 51% of survey respondents have access to wi-fi at their place of work, a significant increase from only 28% last year. Just over 30% of the 500 respondents are able to connect to the wi-fi with their own device, while 23% said wi-fi access is only for work devices and they have not been given one. Baw told eHealth Insider: “I think [the results] are in line with what I was expecting – we’ve got an improvement, and it is a good news story because things are moving in the right direction.” However, Baw said the result is “good but not good enough”, with more effort needed to change attitudes about access to wi-fi. “If you aren’t using it for your job, it’s easy to think [wi-fi access] is just a toy – something nice and fun – but GPs need to use a range of internet-based knowledge resources. If you want to search through a whole lot of information and find the best fit for something, you can only really do that on the internet.”

NHS running thousands of unpatched Windows XP PCs: Eighteen NHS trusts are running Windows XP PCs without the latest security patches, according to an investigation conducted by The Register. Support for Windows XP ended in April this year, with organisations now requiring a Premier Services Agreement (PSA) with Microsoft to continue receiving patches for the operating system. Yet, 18 of the trusts who responded to a freedom of information request from The Register admitted that they had no such agreement in place, reported PC Pro. Some of those trusts were running as many as 4,500 Windows XP machines. The implications for the security of the trusts’ networks and sensitive information such as patients’ medical records is unclear. Much will depend on whether the machines are networked, with unpatched machines providing a potential route to attack more modern PCs that are fully patched and protected. A letter sent by the Cabinet Office in April warned of the “urgent action” required of NHS departments that had yet to migrate from Windows XP. NHS departments were told they had until 13 May to sign a PSA if they wished to continue receiving security updates.

#HMvideo @EHILive

At EHI Live 2014, Highland Marketing met and interviewed senior personnel from various healthcare IT vendors and healthcare providers to ask their views on what they consider to be the essential issues facing the industry and the improvements technology can bring to healthcare service delivery.

Below we continue with our series of published videos, with more to come in future issues of the Healthcare Roundup.

 

Opinion

Is your board ready for a more open and transparent NHS?
Tony Yeaman, national head of healthcare at WeightmansLLP, writes at Health Service Journal (HSJ, subscription required) about what is required of healthcare organisations in case of a requirement of a more transparent NHS.

“There has been much debate and focus on a new statutory duty of candour, but with all the other changes they are coping with, there is a real danger that boards will have failed to have taken full account, or understood, the significance of a number of new provisions shortly to come into force.

“The Department of Health has said that the CQC will “require providers to be taking steps to ensure that there is good organisational management and leadership in place to encourage and support staff to be open with service users and to drive a culture change towards more openness and transparency”. 

“What is important for boards to grasp is that a duty of candour cannot be viewed in isolation as one new provision to comply with; it is part of a wider system/culture change, where the whole health economy becomes more open and transparent. It is important that all healthcare organisations create the culture and environment in which members of staff are encouraged to report patient safety incidents, while feeling supported to counter the impact the incident may have had on them and the personal consequences of highlighting their own or others’ failures. 

“What is clear is that by placing in the hands of the CQC oversight and enforcement of this new raft of openness and governance provisions, the intention of the regulation is to ensure providers are open and honest with service users and other relevant persons when things go wrong. Boards, take note.

“Some commentators fear the new obligations and criminal sanctions will do little to contribute to an open culture of learning from mistakes. That is clearly possible but needs to be countered by an engaged board building support for clinical staff and a culture of openness to support learning.”

How the NHS should listen and act on patient complaints
Little or nothing is being done to respond to patient stories – a new culture of listening in the NHS is necessary for change, says James Munro, Guardian professional.

“This month, the government will report on the progress that has been made over 2013-14 in the wake of the Francis inquiry into the well-publicised failings of NHS care in Mid Staffordshire. Among other things, there will be much talk of transparency and (as last year’s Berwick report on patient safety urged) the need for a culture of listening and learning across the NHS.

“Public opinion clearly supports this: an Ipsos Mori poll in April 2013, in the immediate aftermath of the Francis report, asked people – based on their personal experience – what NHS hospitals most needed to improve. The most frequent response was “listening to patients and carers about how services should be improved”. A simple request? Well, it all depends on what you mean by listening.

“So what is required for people to feel they have been listened to? Well, a response to their feedback or concern seems to be the least the NHS could do.

“Of course, a good listener will do more than simply nod. They will acknowledge concerns, take action where necessary, and report back on what was done. For example, when a patient posted on Patient Opinion about the attitude of a member of staff at Crosshouse Hospital in East Ayrshire, the hospital responded immediately, with empathy and practical steps. The result, in the patient’s own words, was “positive and constructive … the complete opposite to my experience of making a formal complaint about a previous issue”.

“And this is where the industrialised collection of patient stories seems to be a very one-sided business. Stories, like data, are being fed into the machinery of the NHS, but little or nothing is coming back to those telling them. And that’s important, not least because one of the major reasons people give for not wanting to raise concerns about their care is the belief that nothing will be done as a result. On the outside, we must all simply trust that some good has resulted. And that doesn’t feel like a listening or transparent health service.”

How the NHS can sweat its data assets
Making the most of existing assets is a must for healthcare leaders, and technology and data are some of the most valuable ones they possess, says Dr Chris Tackaberry, chief executive officer of Clinithink.

“Are doctors seeing everything they need to know? Patient information comes in many forms. Patient notes, referral letters, relevant reports, patient wishes… a mixture of unstructured narrative and coded data that, whilst electronically accessible, can be difficult to bring together in a timely, coherent fashion.

“For healthcare, this is a significant issue. Industry experts estimate that 80% of clinically relevant information may be held in an unstructured form. If this data cannot be used when needed, diagnoses can be missed. The most effective treatment plans may not be put in place. Valuable insights can be left at the bedside.”
To leverage the powerful, untapped asset of unstructured data for healthcare planning, Dr Tackaberry insists innovative technology, such as clinical natural language processing (CNLP), must now deliver: “This [technology] has the potential to transform healthcare, both for the individual and for society at large. This level of innovation may seem daunting. Traditional ways of accessing patient information, such as paper notes, have worked for many years. True, they are excellent for one-on-one patient care, but they can only hold so much information, and only a fraction of the information available is there.

“EPRs represent a step forward in bringing together important and diverse kinds of information. The digital revolution for patient information has come. As the use of EPRs and related clinical documentation systems grows and grows, so will the amount of data they hold, structured and unstructured. The challenge is to make sure all of that data is useful and useable.”

 

Highland Marketing blog

In this week’s blog, Rob Benson examines the National Information Board’s much anticipated framework on digitising UK healthcare services and asks ‘was it worth the wait?’