Guest blog
Following the Caldicott report, now is not the time to put the issue of the use of data on a back burner, writes James Norman, EMC public sector CIO and Highland Marketing industry advisor
News in brief
Jeremy Hunt retains post as health secretary
New prime minister Theresa May retained Jeremy Hunt as health secretary despite a wide-ranging cabinet reshuffle that saw most ministers sacked or moved. Hunt is one of the few members of David Cameron’s cabinet to have survived the May cull, although earlier reports had suggested that he was in the running for another cabinet post, reported OnMedica. And with nearly four years at the helm of health, he is one of the longest serving health secretaries of recent times. Mr Hunt took to Twitter to announce: “Reports of my death have been greatly exaggerated… Thrilled to be back in the best job in government.”
But the news is likely to disappoint medics who took to Twitter to celebrate Hunt’s departure from Richmond House following false reports that he had been sacked, said DigitalHealth.net. Staff took to the social media platform to claim there had been cheering in their hospitals when the news filtered through, and to post jokes about how he would now be able to enjoy his weekends. Hunt’s reputation among medical staff was badly damaged by his draining dispute with the British Medical Association (BMA) over new contract terms for junior doctors, which focused on weekend working.
The BMA responded by urging Mr Hunt to negotiate junior doctor contract terms, reported Pulse. BMA chair Dr Mark Porter said what the NHS needed now was “period of stability and a working environment that encourages partnership and co-operation”. He said the government and BMA “still need to agree a contract for junior doctors in which they have confidence”, adding that he would “urge Mr Hunt to build on the progress that has been made so far to address outstanding issues and regain trust from junior doctors, who are the future of the profession”.
Doctors told to treat sepsis as an emergency: Doctors and nurses should treat sepsis as urgently as they would a heart attack, a prominent health watchdog has said. According to Sky News, the National Institute for Health and Care Excellence (NICE) has said medical professionals must do more to check for signs of sepsis in patients with infections, like they would rule out heart problems if someone was suffering from chest pains. A life-threatening condition, 44,000 people die from sepsis annually – and there are delays in diagnosing more than a third of the 150,000 cases seen each year. Under new NICE guidelines, GPs have been advised to send any patients who might have sepsis to hospital in an ambulance so they can be seen by a senior doctor or nurse immediately to start treatment. Unless sepsis is quickly treated with antibiotics, the condition can cause multiple organ failure and death. Professor Saul Faust, the chairman of the group which developed the new NICE guidelines, said: “Sepsis can be difficult to diagnose with certainty. We want clinicians to start asking ‘could this be sepsis?’ much earlier on so they can rule it out or get people the treatment they need. Just like most people with chest pain are not having a heart attack, the majority of people with an infection will not have sepsis. But if it isn’t considered, the diagnosis can be missed.”
Electronic observations technology can help hospitals fight against sepsis: Frontline doctors and nurses should be able to use electronic observations technology to help with the urgent identification and treatment of sepsis Patientrack, has said in response to a National Institute for Health and Care Excellence (NICE) report. Digital Health Age reported that the watchdog had published its new guideline on the recognition, diagnosis and early management of the condition. Alongside awareness, education and appropriate processes, electronic observations and alerting systems can play an important part by providing real-time information about those at risk of the condition, enabling assessment and prompting and monitoring compliance with guidelines, said Patientrack. The SME provides this technology, which monitors a patient’s vital signs and automatically alerts doctors when those observations indicate urgent need, to help a growing number of hospitals across the country identify the condition early. “Spotting sepsis in hospitals is an ongoing challenge, and this new guidance from NICE will help greatly in the fight against this devastating condition,” said Donald Kennedy, managing director at Patientrack. Dr Luke Hodgson, intensive care research registrar at Western Sussex Hospitals NHS Foundation Trust, said: “Work being carried out at Western Sussex Hospitals NHS Foundation Trust is raising awareness and improving treatment of sepsis. The Patientrack alert we have in place, from admission to hospital, automatically triggers when patients show physiological signs that they may be at risk of sepsis on the National Early Warning Score (NEWS) and asks clinicians whether they consider infection to be likely. If the clinician agrees, this triggers the sepsis six care bundle to be automatically generated on Patientrack, facilitating early appropriate intervention by clinical staff to prevent harm.”
NHS budget control ‘will require staff cuts’: Staffing levels within the NHS will have to be cut if the government wants to bring NHS finances in England under control, The King’s Fund think tank has said, reported the BBC. It said the government should be honest about NHS spending plans at a time when patient demand is rising. The Department of Health said the government wanted to make the NHS the safest healthcare system in the world. The King’s Fund warned that if the government wants to balance the health service books, then staffing levels will have to be reduced and waiting time targets relaxed, meaning that patient care could be compromised. Helen McKenna, senior policy adviser at The King’s Fund and one of the authors of the report, said: “Politicians need to be honest with the public about what the NHS can offer with the funding allocated to it. It is no longer credible to argue that the NHS can continue to meet increasing demand for services, deliver current standards of care and stay within its budget. This is widely understood within the NHS and now needs to be debated with the public. There are no easy choices, but it would be disastrous to adopt a mind-set that fails to acknowledge the serious state of the NHS in England today.”
Cambridgeshire’s £800m NHS outsourcing contract ‘wasted millions’: Millions of pounds of taxpayers’ money was wasted on an NHS outsourcing contract, investigators have found, reported the BBC. Under the £726m deal, UnitingCare was meant to provide care for older and mentally ill people in Cambridgeshire. But the consortium claimed the contract was not financially viable and pulled out of the deal in December. A joint statement from the two organisations in the consortium said the National Audit Office’s (NAO) findings provided “clarity”. Cambridgeshire and Peterborough Clinical Commissioning Group had been in charge of care for older and mentally ill people but put these services out to contract because it was trying to save money. The UnitingCare Partnership’s business case estimated net savings of £178m to the local health economy by 2020. But the NAO’s investigation into the contract has criticised the planning and the lack of data setting out the true cost of the service. The report found the consortium had not taken account of VAT costs and underestimated both the changeover and running costs of delivering the service in drawing up its bid for the contract. Amyas Morse, head of the NAO, said: “This contract was innovative and ambitious but ultimately an unsuccessful venture, which failed for financial reasons which could, and should, have been foreseen. Limited oversight and a lack of commercial expertise led to problems that quickly became insurmountable.” A joint statement from the two organisations behind UnitingCare, the Cambridgeshire and Peterborough NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust, said: “We believe that the report is balanced and provides clarity on the reasons why the contract ended.”
Council tax boost won’t meet social care costs, ADASS warns: The introduction of a council tax precept to boost social care funding will fail to cover the extra costs faced by the sector from the National Living Wage according to the Association of Directors of Adult Social Services (ADASS), reported Public Finance. An analysis by the group found that the 2% levy, which is being introduced following last year’s Spending Review and is set to raise £382m this year, would not address the sector’s funding crisis. The poll of all 151 adult social services directors in England found that the National Living Wage will likely cost authorities £600m this year. ADASS president Harold Bodmer said councils are working hard to protect adult social services budgets, with adult social care accounting for 35% of council spending for the third year running. “However, with more people needing support and having increasingly complex needs, the impact of the welcome National Living Wage, and other cost pressures, fewer people are getting help, and councils are having to make reductions which will impact on people who receive care,” he added. Commenting on ADASS’s findings, Saffron Cordery, director of policy and strategy at NHS Providers, said: “The variations between local authority areas in terms of budget, coupled with the fact that the social care precept will not raise sufficient income in the areas of most need, makes finding a solution to the funding of social care even more important.”
Life-or-death 999 call target missed for year: Ambulances have missed their target for responding to the most life-threatening calls for a whole year, new data shows, reported the BBC. Crews are meant to reach patients who have had cardiac arrests or are not breathing – so-called Red 1 calls – within eight minutes 75% of the time. But performance data from NHS England for May showed for the twelfth month in a row the 75% target has been missed. The target for Red 2 calls, for other life-threatening cases such as strokes, has not been met since January 2014. NHS England blamed the problem on the rising number of calls – there have been nearly 11 million in the past year, an increase of 7% on the previous year. The figures from NHS England also showed the health service was struggling on a number of other fronts. Targets for A&E, cancer care and routine operations have also been missed, while delays discharging patients from hospital have reached record levels. Matthew Swindells of NHS England, said the figures showed the frontline was under “intense pressure”, but added on a number of measures performance had improved on the previous month. He said accessing social care services run by councils remained a major issue in tackling the delays discharging patients from hospital.
NHS England chief to face first post referendum Common’s questions: NHS England chief executive Simon Stevens is expected to discuss the potential impacts of the European Union (EU) referendum result on UK healthcare and the sector’s wider technology transformation ambitions with the House of Commons Health Committee next week, reported Government Computing. With the UK having voted in favour of leaving the EU, the implications of what this will mean for funding, procurement and better aligned systems between different care bodies is understood to be among questions Stevens will be asked to address during a session scheduled for Tuesday 18th July. Considering current commitments to closely integrate health and social care through technology and data outlined in NHS England’s Five Year Forward View, the organisation said it was too early to comment on the impacts a UK exit from the EU will have on these aims. Addressing staff in light of the vote, Stevens said that an NHS Europe Transition Team has been established to work with the Cabinet Office, Department of Health and other stakeholders to contemplate “new arrangements” expected to impact care services and patient care. “More generally, as the UK government considers its negotiating stance on a changed relationship with the rest of Europe, we’ll play our part in ensuring that opportunities and risks for the NHS are properly understood and factored in,” he said in a statement delivered to NHS England staff.
NHS England defends appointment of Professor Keith McNeil as CCIO: NHS England has defended the appointment of former Addenbrooke’s Hospital CEO professor Keith McNeil as chief clinical information officer (CCIO), claiming that McNeil beat a number of other good candidates in a fiercely competitive recruitment process, reported V3. A NHS England spokesman staunchly defended the appointment. “Dr McNeil is an internationally respected specialist, and the electronic record system at Addenbrooke’s is now one of the best in the NHS,” he said. “This post was filled following advertisement and open competition, and Dr McNeil beat a number of other candidates.” NHS England emphasised that, at the time of McNeil’s resignation, patient outcomes at the trust were among the best in the UK and Europe, and that the bad rating awarded by the Care Quality Commission was largely owing to difficulties in recruiting nursing staff and the considerable demand for emergency services at the hospital. Dr Bob Wachter, who has launched a review of computer systems across the NHS, said that McNeil understood why transformation is necessary, and how to make it happen. “He ‘gets’ the necessity of clinical engagement and the real-world complexities of technology adoption. The journey may not always be smooth, but the electronic record system at Addenbrooke’s is now one of the best in the NHS, a real example of how technology can improve outcomes for patients,” he said.
CCGs face ‘significant barriers’ to improving care: Clinical commissioning groups (CCGs) have made improvements in engaging GPs in the commissioning process but still face barriers to using this to improve care, a new report has said. A joint report from The King’s Fund and the Nuffield Trust said that the clinically-led model of commissioning faced barriers because CCGs felt they are not being given the autonomy they need to involve GPs in decisions about commissioning services, reported National Health Executive. It said that financial pressures were also a problem, because reduced running-cost budgets and the transfer of new functions without sufficient additional resources meant that CCGs were struggling to develop a highquality clinically-led commissioning function. They also felt that they lacked support from the government and NHS England in making tough prioritisation decisions. Ruth Robertson, fellow in policy at The King’s Fund, said: “Our research shows that while CCGs have made good progress in engaging GPs in local commissioning decisions, there remain significant barriers to effective clinical engagement and to translating this into improvements in quality of care.” The King’s Fund and the Nuffield Trust recommend that NHS England and the Department of Health should outline a clear strategy for the future of commissioning support that recognises the likely changes in CCGs’ support needs over the next few years, as the role of CCGs changes and provide them with ‘air cover’ for tough funding decisions by being honest with the public about what is achievable with the money available.
Health and social care integration needs ‘substantial progress’, CQC says: Older people are denied effective and personalised care due to poor integration across local systems, reported LocalGov. A new report by the Care Quality Commission (CQC) warned that despite widespread commitment to health and social care integration, ‘substantial progress’ is needed to better support people who use a number of services. The report highlighted the UK’s rapidly ageing population and argued it is older people who would typically benefit from integration because they have the most complex needs and receive care from across multiple locations. CQC inspectors gathered evidence from a range of sources, including speaking to older people and their carers within eight areas across England to understand their experiences. They found people with complex needs who use a range of services often say they are satisfied with individual providers, but when they move between different services, they report their care can become fragmented and have an adverse impact on their care experience. David Behan, CQC’s chief executive, said: “Older people who use health and care services tell us that they want their services to be joined up and work together. This study found examples of effective integrated care but these small steps need to become significant strides to move joined-up services into the mainstream.”
Controversial ‘technical’ measures cut £900m from provider deficit: Numerous one-off accounting measures helped boost the reported performance of the NHS provider sector by around £900m last year, according to figures obtained by Health Service Journal (subscription required). The “technical adjustments” taken by trusts included revaluing some NHS property, extending the expected lifespan of some sites, and taking a more optimistic view of debt recovery and potential liabilities. The measures, along with separate actions to defer £320m of capital expenditure, helped limit the provider sector deficit to £2.45bn in 2015-16. Although the actions were taken locally, regulators urged trusts to take them wherever possible, in what was described as a “desperate” attempt to help the Department of Health (DH) stay within its overall spending limit. The DH accounts were due to be published this week. Earlier this year, after providers were told to consider these actions, one NHS finance director wrote to the Commons Public Accounts Committee to warn that trusts were under pressure to “cook the books”. Other finance professionals said the measures were legitimate to explore, but they were concerned that some trusts may have felt pressured to make unreasonable adjustments.
‘Vanguards’ trial new care models to transform NHS: Redefining patient pathways and trialling new ways of working could have a significant impact on improving care, according to a report looking into the role of NHS vanguards in the development of new commissioning structures, reported PharmaTimes. The NHS ‘Vanguard’ programme, an integral part of the NHS Five Year Forward View, was launched last year to encourage creative and innovative solutions to address health and social care needs at a local level, as well as shape plans for long-term investment to boost population health and ease pressure on services. Now, a report by NHiS Commissioning Excellence, which helps the NHS plan and commission patient services, found that NHS vanguards are already successfully demonstrating the value of re-jigging patient pathways and assessing new ways of working. It revealed, for example, how some vanguards have integrated healthcare and social care services, while others have seen GP practices widen their activities to incorporate more specialist roles, or link with other GP services to create super-practices. “The focus of care needs to shift from managing ill health to preventing it developing in the first place. This will involve investment in care pathway development in order to facilitate earlier diagnosis and intervention, and define the best care pathways,” noted Sue Thomas, chief executive of Commissioning Excellence for NHiS.
InterSystems TrakCare at heart of improvements in quality of patient care: NHS Grampian is harnessing the power of InterSystems TrakCare, a unified healthcare information system, to improve health outcomes for the 45,000 people who live in Shetland and Orkney, reported eHealthNews.eu. Hosted by NHS Grampian, but available to clinicians across the region, the seamless exchange of patient data will support quicker decision-making and enable more flexible ways of working that will benefit patients through better diagnosis, treatment and care. In addition to improving the quality of care, the system is also expected to help the NHS Orkney and NHS Shetland health boards save money, as fewer patients need to make expensive trips to the mainland for consultations and treatment. The implementation of TrakCare is an ongoing process, with the three boards now working together to develop an electronic patient record that meets their respective needs. Alison Hawkins, ehealth lead at NHS Grampian, said: “The implementation of the national patient management system is in keeping with our vision: To offer everyone in Grampian, Orkney and Shetland access to an NHS that helps them to keep well and provides them with high quality care when it is needed, whilst employing a skilled and committed local workforce who are proud to work for the NHS. We plan to continue to work with both boards to ensure that all our systems are flexible enough to meet current and future needs.” BBC Radio Orkney’s Around Orkney programme also reported on the benefits now being delivered to patients: https://soundcloud.com/user-121593544/intersystems-bbc-radio-orkney.
CQC calls for national risk assessment model and data set: The Care Quality Commission (CQC) has called for national action on data to support integrated care, in a report that said current initiatives are struggling, reported DigitalHealth.net. The CQC published a ‘thematic review’ of efforts to integrate health and social care, which it noted has been “a national policy commitment and ambition for many years”. The regulator said its fieldwork found “many initiatives that aimed to deliver integrated care” and “some good practice”. But it also said “we did not find many examples of it working really well”. On the data front, it found that: “not all providers routinely used standardised assessment tools for identifying and reviewing people at risk”. Even GPs that did use standardised assessment tools had “reservations” about them “because they did not know if they had been formally validated or accredited”. The CQC said an example of good practice is North of England’s Commissioning Support Unit’s RAIDR, or reporting, analysis and intelligence delivering results system, which uses information from secondary and primary care to determine whether people are at high, medium or low risk of admission to hospital.
Opinion
The King’s Fund response to the Jeremy Hunt remaining in his post
Jeremy Hunt will face formidable challenges as he remains in post as health secretary, says Chris Ham, chief executive of The King’s Fund.
“[Jeremy Hunt] is on record as saying the NHS will need more money and he must now lead an honest debate with the public about what the health service can deliver with its budget,” says Ham.
“This means reviewing current priorities and avoiding making new commitments which cannot be funded.
“Tackling the growing crisis in social care will be a key test of the prime minister’s promise of a country that works for everyone and must move much higher up his agenda. He must reignite the stalled debate on funding reform and make the case to his Cabinet colleagues for it to be a key priority for the government.
“The secretary of state will need to provide exceptional political leadership by supporting radical changes to NHS services and making the case for a new settlement for health and social care that provides adequate funding to meet current and future needs. He must also rebuild trust with NHS staff, especially junior doctors, to ensure that a motivated, engaged workforce delivers the best possible care for patients.”
Big hires mark new chapter in digital policy
Health Service Journal’s technology reporter, James Illman, reflects on NHS England’s appointment of three senior technology directors, and what it means for the digital policy in the NHS.
“Their appointments are bold and send a message from the centre that ducking the digitalisation challenge will no longer wash. To paraphrase Bob Wachter, the US technology expert and leader who is currently advising the NHS: to try and then fail is not necessarily a good thing – but the worst thing is not to try at all.
“Aside from the individuals, NHS England’s move to appoint a chief clinical information officer (CCIO) came as a surprise to many local NHS tech leaders – not least trust CCIOs, who were left wondering why there was no job advert for such a high profile national role.
“The background is that NHS England, anticipating the departure at the turn of the year of Tim Kelsey, who held board level responsibility for technology, initially sought to recruit to the post of chief information and technology officer.
“It struggled to find a suitable candidate, however, and opted for a change in tack, which it said would reflect the forthcoming recommendations of Professor Wachter’s government review on the future of information systems in the NHS.
“It is notable NHS England says the CCIO will be “supported by” the chief information officer, and not the other way round. This suggests a dynamic in line with many healthcare organisations in the US, whose chief medical information officers are hugely influential.
“Professor Wachter – whose review is largely complete but must wait until September for publication – has made public his concerns that NHS CCIOs do not have the influence of their US counterparts, undermining clinically-led digitalisation.”
Will the electronic health record be good for our health?
Ireland’s electronic health record might be the most important healthcare investment of the decade, writes Fergus O’Dea from NDRC (formerly National Digital Research Centre).
“In August of last year, the HSE released a vision and direction statement for the establishment of a national Electronic Health Record (EHR). There is one particularly noteworthy phrase: ‘The imperative to act differently’. There can hardly be a better summation of the nation’s current attitude to healthcare than this.
“The momentum in the EHR programme has been a welcome surprise in an industry hardly noted for its pace of change and, in Richard Corbridge, the HSE has found a leader behind whom the organisation and, indeed, the wider community can rally.
“EHRs represent an essential shift within global health IT systems from tracking the information required by that particular institution to a patient-centric repository of information. This unlocks the potential for major cost savings through efficiency of operations and communications alone, but perhaps more importantly creates a platform upon which a digital revolution in healthcare can be founded.
“The possibilities are almost endless but a few in particular are worth emphasising. First, there’s a holistic patient record that supports multi-disciplinary care transcending specialities and keeps chronically ill patients healthy, and at home, for longer.
“Second, a digital health passport for everyone in the state provides a technological basis on which to build personalised applications to self-manage our health. It’s worth noting that this platform is necessary but not sufficient, as the tricky part here is around engagement and behaviour change. Third on the list of possibilities is an aggregated database that supports better decision-making and resource allocation at a population health level.
“And, finally, there’s the possibility of a predictive healthcare record. While the ethical implications and the legislative framework that would be required to implement this are not insignificant, imagine the ability to predict and potentially prevent diseases before they occur, or support behavioural change to prevent the onset of lifestyle disease.”
Highland Marketing blog
In this week’s blog, Chris Marsom discusses Jeremy Hunt’s ongoing legacy and continued commitment to the digital health agenda.
