News in brief
Plan for two-tier A&E as part of radical shake-up: A two-tier A&E system in England should be created as part of an overhaul of services, NHS chiefs say. The review by NHS England suggested the biggest 40 to 70 units – specialising in heart attacks, strokes and trauma – be called major emergency centres, reported the BBC. It would leave the remaining 70 to 100 A&Es – known as emergency centres – to deal with less serious conditions. It also suggested changes to the way ambulance crews and the new 111 phone service work to “decongest” A&Es. Greater co-ordination between community services, such as GPs and pharmacists, would also help, it said. The measures have been put forward in response to the growing pressures on accident and emergency departments. Patient numbers have risen by 50% in the past decade and last winter the problems got so severe that the NHS missed its four-hour waiting time target. Extra money has been set aside to help the NHS through this winter and the next one. However this review aims to set out the long-term vision for the service.
GPs take on extra role for frailest patients: The government and GPs have agreed a new contract, reported ITV. Among the changes are that the 100,000 most frail patients in England will be identified and given a named GP to co-ordinate their care. The move has been agreed by the British Medical Association and NHS England in talks over next year’s GP contract. Ministers had been pushing for doctors to take greater responsibility for the most vulnerable patients in society to relieve pressure on hospitals. An analysis by NHS England showed many of the winter pressures on A&E came from frail elderly patients. A third of emergency admissions are among the over-75s – many of which could be avoided if they received earlier and better care in the community. This is where the agreement with GPs – which will kick in next April – will help, ministers say. Under the terms of the deal, doctors have agreed to carry out a trawl of their registers to identify the frailest 2% of patients. This is likely to include people at the end of life, in care homes and those who are frequently in and out of hospital. They will then take responsibility for overseeing their care across the NHS and social care sectors. The aim is to create a much more proactive service whereby their needs – from home adaptations to intensive nursing support – are met much more quickly. The health secretary has also revealed proposals for GPs’ salaries to be made public.
Mandate tells NHS England to push tech: A number of commitments to encourage the NHS to use new technology have survived a tussle between the government and NHS England and have appeared in the revamped NHS Mandate, reported eHealth Insider. The government published the first mandate to NHS England a year ago. The document is the government’s permission for the commissioning board to function and sets out the objectives on which it is meant to deliver. A consultation on a revised mandate was published to coincide with the NHS’ 65th anniversary in July, however it was criticised for being overly prescriptive. Ahead of the publication of the original mandate, Sir Malcolm Grant, the commissioning board’s chair, said he would like a short mandate that could be “published in the Sun.” But NHS England said the draft incarnation moved too far from this, setting too many new objectives, and too much detail on how they should be achieved. The final mandate, which was published this week, is generally shorter and less prescriptive than the draft. However, it still contains a number of IT commitments, in line with policies and targets already announced by ministers. On IT, the mandate says that “it is crucial that the NHS not only operates at the limits of medical science, but also increasingly at the forefront of new technologies. The board’s objective is to achieve a significant increase in the use of technology to help people manage their health and care.”
NHS Confederation announces new chief executive: The NHS Confederation has announced the appointment of a new chief executive following the recent resignation of former head Mike Farrar, reported Pulse. Rob Webster, who is currently the chief executive of Leeds Community Healthcare NHS Trust, will take up the role in February 2014. The membership body, which represents the organisations that commission and provide NHS services, has also appointed Sir Andrew Cash, the chief executive of Sheffield Teaching Hospitals NHS Foundation Trust, as deputy chair. Webster has previously had national leadership roles in the Department of Health on access, primary care, workforce, NHS modernisation, finance and efficiency, and worked for the Prime Minister’s delivery unit on civil service reforms. NHS Confederation chair Michael O’Higgins said: “The NHS Confederation took massive strides in the past few years under the leadership of Mike Farrar, and there is still immense respect for Mike throughout the health service. While we are delighted he will continue to work with us as an associate, it is imperative that the NHS Confederation builds on the foundations that form his legacy. As a former primary care trust chief executive, now heading up a successful community health services provider, Rob brings with him a diverse range of talents, including superb leadership, listening and engagement skills, as well as a strong track record of innovation and delivery.”
Only 16% of patients have access to electronic medical records: A report carried out by consulting and IT services firm Accenture has revealed that only 16% of patients currently have access to their electronic records in the UK, reported Computing. Accenture surveyed 9,000 consumers from nine countries in a bid to examine their attitudes to accessing their own electronic medical records and managing their own health. It found that of the 1,000 adults from the UK that were surveyed, 77% believed they should have full access to their electronic medical records. However, when compared with Accenture’s Doctors Survey, only a third of doctors (34%) share this belief, with the majority (60%) believing that patients should only have limited access to their electronic records. The vast majority of UK consumers (97%) and doctors (94%) who were surveyed agree that patients should have some degree of access to their records, but 36% of UK consumers said they did not even know whether their medical provider offered the ability to access their records online. Of the 847 respondents that said they did not have access to the records, 42% said they would consider switching to a physician who offers online access. Health secretary Jeremy Hunt, has given all medical practices a 2015 deadline for providing online access to their records, however statistics from the survey show there is still a long way to go.
Cameron takes centre stage on NHS: This week whilst being asked to comment on reports in the Financial Times (subscription required) that David Cameron was personally overseeing plans to prepare the NHS for a cold winter that could put pressure on accident and emergency departments, the prime minister’s official spokesman said: “Is the PM working very closely with the secretary of state for health on health matters, with a particular focus on A&E? Absolutely he is doing that.” He was then asked if it was true that the prime minister had demanded weekly updates on how many people were being admitted to A&E. The spokesman replied: “Yeah, he does want to and he continues to be up-to-date with the very best and latest figures, including the A&E statistics.” So at a time when Labour is warning gloomily of what it calls a “winter crisis” in A&E, when some doctors are saying that emergency care is already under pressure, when some weather forecasters are predicting a bitterly cold snap as the gulf stream heads south, the prime minister has chosen to get personally involved, reported the BBC.
Ministers to order staffing reviews in response to Francis: Hospital boards will be ordered to review and publish nurse staffing levels at least twice a year as part of the government’s full response to the Francis report, reported Health Service Journal (HSJ, subscription required). Action on nurse staffing is expected to form a significant part of the government’s much anticipated full response to Robert Francis QC’s report into care failings at Mid Staffordshire Foundation Trust, which is expected next week. HSJ understands the government will say it either fully or partially accepts the vast majority of the report’s 290 recommendations and will publish a line by line response that runs to two volumes. However, despite the length of the response, it is understood it will set out few major new policies. It is also expected to reject Francis’ call for a statutory duty of candour to be imposed on individuals. A statutory duty of candour for organisations, announced back in March as part of the government’s initial response to the report, will still be implemented. The government’s response is also expected to reconfirm it will ask the National Institute for Health and Care Excellence to develop guidance on staffing levels in different settings, as recommended by Francis.
Greater role for enhanced NHS 111: NHS 111 will be enhanced to allow clinical staff to view patients’ medical information under plans to overhaul urgent and emergency care provision announced this week, reported eHealth Insider. NHS England’s national medical director Sir Bruce Keogh has published a report on the first stage of his review of urgent and emergency care, aiming to make it more responsive and personal, as well as deliver better safety and clinical outcomes. It says the NHS will enhance the 111 telephone triage service to create a 24-hour, personalised priority contact service. “This enhanced service will have knowledge about people’s medical problems, and allow them to speak directly to a nurse, doctor or other healthcare professional if that is the most appropriate way to provide the help and advice they need,” the report says. It will also be able to directly book a call back from, or an appointment with, a GP or at whichever urgent or emergency care facility can best deal with the problem.” NHS England has put NHS 111 procurements on hold while it develops a new NHS 111 service specification, which will go live during 2015-2016. This will be designed in line with the recommendations of Sir Bruce’s review. The report says clinicians in the new NHS 111 service will have access to relevant aspects of a patient’s medical and care information, if they consent to this being available. It will allow patients to speak directly to a wider range of professionals, including a mental health specialist or pharmacist if appropriate.
Integration fund could lead to ‘yet more structural change’: The government’s allocation of £3.8bn for integration across the NHS and social care “will be used to fund yet more structural change” and “cannot succeed without behaviour change of all actors in the system”, according to a report. A Question of Behaviours, produced by the consultancy iMPOWER, argues that “trust, relationships, behaviour and experience are the real drivers of positive outcomes”, reported Health Service Journal (subscription required). The report adds: “We are in danger of losing sight of the behavioural dimension as we become entangled with system and structure change which could cause more disintegration than the integration it aims to achieve.” The report says that while most integration plans placed GPs at the heart of integrated systems, GPs “don’t know enough about social care, and don’t trust what they do know”. More than 600 GPs were surveyed as part of the report. Fifty six percent rated their relationship with adult social services as either poor or unsatisfactory. Only half said they trusted hospital discharge teams to make decisions in the best interests of their patients. iMPOWER managing director Alex Khaldi, who wrote the report, said: “The data shows that we’ve got a serious problem. Professional relationships and patient behaviours are the key tools we have to keep people out of hospital and making local, integrated care really work.”
Glasgow praised for IT crash response: A report has blamed a “rare corruption” of an Active Directory database for a major computer crash at NHS Greater Glasgow and Clyde, but said that it is not possible to establish “the exact root cause of the failure,” reported eHealth Insider. The report, which sets out the findings of a review team set up by the health board and the Scottish Government, says the crash between 1st and 3rd October led to 709 patients having their hospital appointments postponed. However, it also says that no data was lost, that the initial implementation of Active Directory was in line with industry best practice and that – despite its rarity – the health board had included the possibility of a problem with the system in its contingency plans. It also says that recovery procedures worked well. Indeed, the review, led by the Scottish government’s chief technology officer, Andy McClintock, praises the health board’s IT team and suppliers for their professional handling of the incident. Health secretary Alex Neil said: “This review has shown that the technical team took the appropriate actions and did everything possible to restore services under enormous pressure.”
Blackpool Teaching Hospitals NHS Foundation Trust implements Nervecentre Hospital at Night: Blackpool Teaching Hospitals NHS Foundation Trust has extended its implementation of Nervecentre to deliver the benefits of mobile working, workflow and governance across Blackpool Victoria Hospital, reported eHealthNewsEU. Portal. The extension includes: hospital-wide management of the Acute Response Team (out-of-hours working); hospital-wide Mobile Handover and management of patient referrals to 90+ specialties. Prior to this most recent contract, Nervecentre was implemented as a six-month trial for Acute Response Team management across medical wards and implemented in full across all wards for management of portering requests. Dr Victoria Ellarby, vision programme director said: “Our initial implementations of Nervecentre has proven to be very successful and we are excited about extending our relationship with Nervecentre. Our Acute Response Team and Portering services have demonstrated improved responsiveness, we have additional levels of audit and governance and mobile working has increased staff efficiency. By extending the use of Nervecentre to standardise other clinical and operational processes and to provide real-time visibility of the hospital’s activities, we believe that we will provide a safer, higher quality, more consistent service for our patients. The project will have a direct impact on two of our key strategic aims – zero delays and zero harm.” The Acute Response Team at Blackpool Victoria Hospital provides out-of-hours cover across the site.
Southern England NHS deploys first phase of electronic patient records: Accenture and The Phoenix Partnership (TPP) have delivered the first phase of a new electronic patient record (EPR) system across nine NHS systems for the Southern Community and Child Health Procurement consortium, supporting community hospitals, children’s health, mental health and minor injuries units, reported ComputerWorld. The Southern Community and Child Health Procurement consortium extends from Kent in the east to Cornwall in the west. The first phase of the Accenture-TPP effort included the clinical implementation of an EPR system called SystmOne, for clinicians to access and exchange health information across the various care settings in the NHS. Dorset Healthcare University NHS Foundation Trust was the first to fully launch TPP’s SystmOne platform, which is being used initially by more than 500 clinicians. The trust will continue to work with Accenture over the next few months to roll out the system to its broader community teams. Val Graves, director of community health services at Dorset Healthcare, said: “The introduction of a patient administration system is a huge leap forward for both patients and staff. It will enable greater coordination of care, reduce the burden of paperwork and streamline our clinical and administration processes.”
Shortage of 20,000 nurses in NHS, report warns: Nurse leaders said that safety was being jeopardised because of widespread shortages after NHS trusts froze vacant posts in a bid to save money, reported The Telegraph. Earlier this year an investigation into 14 hospital trusts with unusually high death rates highlighted inadequate staffing as a common factor. In some cases, patients were left unattended for so long that inspectors stepped in to comfort them. Freedom of Information requests conducted by the Royal College of Nursing (RCN) found that average vacancy rates are around 6%. Extrapolating the figures from 61 NHS trusts, the College said this would amount to nearly 20,000 full-time equivalent nursing, midwifery or health visitor vacancies. Dr Peter Carter, chief executive and general secretary of the RCN, said: “Understaffing remains a real issue across the NHS, and we know that many trusts are down to the bone in terms of the number of frontline nursing staff they have due to cutting posts to save money. Unsafe staffing levels have been implicated in a number of high-profile investigations into patient safety. We call on employers in the NHS to put an end to boom-and-bust workforce planning and develop clear standards to ensure safe staffing levels are met, supported by robust inspection based on reliable data.”
First RiO trust picks new supplier: The first of thirty community and mental health trusts in London and the South has picked a preferred supplier to replace its national RiO contract, which expires in 2015, reported eHealth Insider (EHI). West London Mental Health Trust has chosen CSE Healthcare to deliver its RiO electronic patient record (EPR) system to the trust’s 25 locations. Thirty trusts, which had RiO delivered by BT under the National Programme for IT, formed a consortium and went to tender for a framework agreement in June last year. Nine suppliers are on the new framework worth up to £300m to supply EPRs, hosting and clinical portals to the trusts, which need to replace their systems before their national contracts expire in October 2015. Peter Gooch, chair of the ‘2015 Consortium’, and associate director of ICT at Camden and Islington NHS Foundation Trust, said West London is the first to pick a preferred supplier and the majority will make decisions on which system to migrate to next year. “I would anticipate three to six trusts by March-April with the majority in the months following throughout 2014,” he told EHI. He added that Sussex Partnership NHS Foundation Trust has joined the consortium and three or four other organisations are also considering joining.
Framework for cloud based digital healthcare services: IMS MAXIMS has been awarded a place on the UK government’s G-Cloud 4 framework, allowing healthcare organisations to purchase specialist cloud based digital services from the company, reported ProHealthServiceZone. The G-Cloud framework is designed to make it easier for government and suppliers to work together and utilises the CloudStore, a marketplace of cloud-based services, which can be used by public sector buyers to compare and easily procure services to meet their needs. IMS MAXIMS has been listed on the G-Cloud 4 framework in two key categories – Software and Professional Services. Under the software category, IMS MAXIMS is offering its clinical systems including Maxims Dementia Module, Maxims Order Communications, Maxims A&E, Maxims Integrated Care Pathways and Maxims Nursing. Paul Cooper, director of research and development at IMS MAXIMS added: “Being awarded a place on the G-Cloud framework, not only identifies us as a supplier of high quality services but offers potential customers, across the public sector a simple and flexible way of purchasing our services. It presents a very cost-effective way for customers to purchase from IMS MAXIMS without the headache and overhead of a lengthy Official Journal of the European Community procurement. As clinicians become even more dependent on IT, we are committed to providing more options and greater flexibility to meet those needs and the framework is a great way to enable that.” The G-Cloud framework allows the public sector to buy cloud-based digital services off the shelf, avoiding lock-in to expensive contracts with single suppliers, and encouraging cost-effective, innovative solutions.
NHS patients to get personalised healthcare advice through TV and games consoles: NHS patients in Scotland may soon be able to get personalised healthcare advice through their television or games console, under a new digital health project, reported The Herald Scotland. Living it Up (LiU) is designed to link patients’ needs and interests with professional advice, local services, activities and events through devices such as TV sets, desktop computers, smartphones, tablets and games consoles. Video conferencing between patients and healthcare professionals is also being trialled in the £10 million project. LiU was designed in consultation with a pilot group of 5,000 people, including 61-year-old Bernard McGuckin who is on the lung transplant waiting list. He said: “Since I was diagnosed with COPD (chronic obstructive pulmonary disease) I have been offered tremendous support that has helped my condition. LiU will give me the chance to share the things that have helped me manage my condition and hopefully this will in turn help other people.” Speaking at the product launch Scottish Health Secretary Alex Neil said: “LiU looks at care in a rounded way, not just treating people as patients but linking them into their local community and helping them to pursue interests that keep them healthy. That includes supporting people to live independently at home, one of our key priorities. That it is generally better for people’s health and will also help our health service cope with our ageing population.” LiU users will be encouraged to help develop the local services they would like to have provided digitally.
Opinion
Service leaders face a scrap to identify a coherent vision
In Health Service Journal (subscription required) this week, Alastair McLellan, discusses how Andrew Lansley’s vision of an NHS distanced from political interference is disappearing, with the government churning out reports and reviews − but no coherent vision.
“Has there ever been a time in the past 15 years when health policy has appeared more confused? The Lansley vision of an NHS distanced from political interference is disappearing rapidly as Number 10 confirms that David Cameron is asking for weekly updates on the NHS’s emergency care performance and Jeremy Hunt oversees the service’s winter plans.
“NHS England appears to have successfully prevented the Department of Health from turning the annual mandate into a “shopping list”. But there remains significant concern within the organisation that too many government promises effectively constitute an uncosted manifesto for the government’s post-election NHS aspirations.
“However, the relentless production of government reviews and responses − on vulnerable elderly people, urgent care, Francis and seven-day working − while worthy in their own right, seem as much to do with creating an impression of a government firefighting on behalf of patients as creating a coherent vision for the service.”
McLellan concludes by suggesting that a coherent vision will have to wait for NHS England’s new chief executive Simon Stevens: “…whose spring arrival is already being freighted with expectations which would have daunted a freshly freed Nelson Mandela.”
Continuing as we are is not an option for GPs
This week, Dr Chaand Nagpaul, chair of the GP Committee (GPC) and a GP in Stanmore, Middlesex, champions the need to ‘set the agenda’ for change and speaks about the GPC’s suggested vision for the future of general practice.
Nagpaul says: “Grassroots GPs gave a worrying list of examples of how bureaucratic box ticking has left them unable to innovate or get through their clinical work. Many face the real prospect of burnout in the years ahead and there is a clear crisis not only in workload and workforce, but also in morale unfolding across the profession. This has been exacerbated by the unfair scapegoating of GPs by some politicians and elements of the media, and the devaluing of general practice financially through progressive disinvestment (from 10% to 7.47% as a proportion of the total NHS spend in the past decade).”
On the consultation document, Developing General Practice: Providing Healthcare Solutions for the Future, published by the GPC, that looks into ideas about the long-term future of GP care, Nagpaul says: “We would like to be clear that we are not suggesting that GPs should be asked to work longer hours, nor backing Government proposals for consumerist extended hours, especially as many GPs are already struggling to cope with spiralling workload, increasing patient demand and falling resources. On the contrary, we want to support GPs to have a manageable and rewarding workload, reclaim professionalism and have time to care for patients, who are the main focus of every GP.”
Telehealth can play an important role in the future of healthcare
In The Guardian this week, Ian Jackson, managing director at Imerja, explains why applications of telehealth can speed up diagnosis, as well as improve patient treatment and longer-term outcomes.
“Telehealth has already helped to transform the way healthcare services are accessed and provided. For any healthcare organisation, patient care is the priority, and telehealth has proven to be a groundbreaking way of providing fast, high-quality and convenient care services.
“GPs and hospitals are beginning to realise the potential for face-to-face video communication, improving access to care and easing pressure on the healthcare system. Virtual consultation and remote diagnosis have become reality and offer incredible potential to shape the GP surgery of the future and increase access to specialist services from within the primary care system. This technology could significantly reduce the burden on secondary healthcare provision in the UK, particularly at a time when A&E services are struggling to deliver crucial care.
Telehealth is continually evolving and can be adapted to many different situations. Renal care and optometry have already been identified as areas in which telehealth could be used; patients using dialysis machines can be observed remotely in their own homes, and eye examinations can be carried out via video link. The next step for telehealth is its integration into mobile devices, enabling patients to contact their doctor using video streaming as new and emerging technology becomes more reliable and affordable. Such mobile telehealth methods would also reach thousands of nurses, support staff and GPs, widening access to convenient, timely care.
“While telehealth has potential, personal, face-to-face contact cannot be replaced. However, telehealth is coming of age as an effective measure that can harness new, affordable technology with the potential to deliver convenient, effective care to patients willing to embrace it, and provides an alternative way for an overburdened NHS to deliver outstanding health outcomes.”
An appetite for regulation
This week in eHealth Insider, Lis Evenstad says that the regulation of apps was a hot topic at EHI Live 2013 with most agreeing that something needs to be done, however she has discovered that there is no consensus as yet about what that should be.
“Health apps are increasingly popular, and with the average smartphone user having 13 apps on their phone, the probability of one of them being a health app is quite high.
“One of the hot topics to emerge at EHI Live 2013 was app regulation. How do we know if the apps we use give sound advice? How do we make sure they do not give advice that could put the user in danger?
“Ideas range from self-regulation and user reviews, to having a central authority to run formal regulation.
“The FDA said it will regulate any app that makes the device on which it works into a medical device. The European Union and NHS England have indicated they are interested in a similar approach.
“But there was considerable debate about whether this is necessary – or even possible – in the UK.
“Stifling innovation, extending development times, and trying to apply an approach to apps that simply doesn’t work with the ‘build it and they will come – or not’ ethos of developers, are all reasons that many people have been sceptical about regulating health apps until now.
Highland Marketing blog
Following the floatation of Twitter, in this week’s blog, Gregor MacKenzie explores ‘the value of #potential’ of this communication channel and looks at its impact on the modern day healthcare industry.
