News in brief
NHS and care sector: Safety a ‘big concern’ in England: The Care Quality Commission (CQC) found three-quarters of the 79 hospital trusts visited under its new inspection regime so far had safety problems, reported the BBC. Lack of staff, in terms of skills and numbers, was identified as a major issue. The way medicines were managed and how mistakes were investigated and learnt from were also highlighted. So far more than 5,000 organisations have been inspected – nearly half of hospitals, 17% of care services and 11% of GP surgeries and out-of-hours providers. However, those deemed most at risk have been predominantly targeted first, so the level of failure is not necessarily representative of the overall sector. David Behan, CQC chief executive, told Radio 4’s Today programme: “What we know from our report and from other research is that the leadership of an organisation sets the culture of that organisation. If the leadership says the important things around here are quality and safety, then that’s what people attend to.” Rob Webster, of the NHS Confederation, warned the financial pressures and negative publicity was creating a “toxic environment, this is bad for the health service, and bad for patients”.
NHS performance assessment needs radical simplification – King’s Fund: The number of national bodies that assess performance in the NHS is causing duplication and “unnecessary complexity”, according to a new report from The King’s Fund. The think tank’s review, commissioned by the Department of Health in June, recommends a “radical” simplification of the assessment process and greater alignment, reported National Health Executive. It says the three national outcomes frameworks – The NHS Outcomes Framework, Public Health Outcomes Framework and Adult Social Care Outcomes Framework – should be consolidated into a “single entity” covering the NHS, public health and social care. The ‘Measuring the performance of local health systems’ review noted: “We would particularly emphasise the need for alignment between the metrics used to assess local health system performance and those used in the Clinical Commissioning Group Assurance Framework developed by NHS England.” “Disparate” public-facing websites should be rationalised to help people searching for an integrated view of services in an area, it added. Chris Ham, chief executive officer of The King’s Fund, said: “We strongly support the secretary of state’s commitment to promoting intelligent transparency in the NHS. Done well, performance assessment can help to strengthen accountability to patients and the public, as well as to support commissioners and providers to improve care. A radical simplification and alignment of the current frameworks and better presentation would do this.”
Mid Staffordshire NHS Foundation Trust charged over four deaths: The trust which ran Stafford Hospital is to face criminal charges related to the deaths of four patients – one as recent as last year, reported The Telegraph. The Health and Safety Executive (HSE) has brought charges against Mid Staffordshire NHS Foundation Trust over the deaths of four elderly patients between 2005 and May 2014. Mid Staffordshire NHS Foundation Trust was at the centre of one of the biggest scandals to hit the health service over the deaths of hundreds of patients, amid appalling failings in care. The HSE said the charges related to the deaths of Patrick Daly, aged 89, who died in May 2014, Edith Bourne, aged 83, who died in July 2013, Ivy Bunn, aged 90, who died in November 2008, and Lillian Tucker, aged 77 who died in October 2005. The HSE said it had charged Mid Staffordshire NHS Foundation Trust following a “thorough and comprehensive investigation into the circumstances of four deaths of patients under its care”. The trust is due to appear before Stafford Magistrates on November 4. A new trust began to run the hospital last November.
Simons Stevens creates three frontline roles to drive NHS reforms: NHS England boss Simon Stevens has created three new roles to strengthen the body’s work on primary care, cancer services and specialist commissioning, as well as help “turbo-charge” the implementation of Five Year Forward View reforms, reported National Health Executive. In his announcement at The King’s Fund this week, Stevens said he appointed “exceptionally high-calibre” frontline leaders to these roles, handpicked to work alongside national medical director Sir Bruce Keogh. The first, Dr Arvind Madan, will become NHS England’s director of primary care, building on his work as GP at the Hurley Group. Cally Palmer was selected to implement recommendations from the NHS Cancer Taskforce’s five year strategy in her new job as NHS national cancer director. She will also work with new cancer vanguards to use outcomes-based commissioning in an effort to redesign care. Palmer will continue to act as chief executive of the Royal Marsden Hospital NHS Foundation Trust while seconded to NHS England. The last appointment, Dr Jonathan Fielden, will serve as NHS England’s director of specialised commissioning to lead the development of a strategy for specialised services. Similarly to Dr Madan, Dr Fielden will also serve as a deputy national medical director to Keogh.
Dell makes $67bn bet on EMC in tech history’s largest acquisition: American computer company Dell is buying digital storage giant EMC for $67bn in the largest tech acquisition in history and a move that marks another transformation for the once pre-eminent maker of consumer PCs, reported The Guardian. Shares of EMC surged on news of the deal. Dell, by contrast, is not publicly traded. Founder and CEO Michael Dell took the company private at a price of $25bn in 2013 largely to escape the clutches of investors who wanted to oust him. Most computer users will be familiar with Dell, the third-largest computer vendor in the world behind HP and Lenovo, but fewer will know EMC, a company with a large legacy business in packaging, selling and making software for computer storage systems. It’s a core business that has been in decline as more companies move to cloud storage, and while EMC has invested in similar products related to the cloud, they have not managed to offset the declines in the company’s main business. Dell was the number one global PC vendor by market share between 2003 and 2006, thanks to aggressive marketing to institutional computer buyers, close alliances with hardware and software manufacturers and the “Dell dude”, a stoner-ish advertising pitchman.
NHS ID assurance work mulls secure patient access options: UK health authorities are in the process of undertaking general user research around online identity, but are yet to commit to testing or using any specific tools relating to possible solutions for secure patient access, the Health and Social Care Information Centre (HSCIC) has confirmed. The organisation said that discovery work was being conducted around possible options for ID assurance to allow patient access to online services, reported Government Computing. These options could potentially include use of the government’s GOV.UK Verify ID assurance platform. “Work around online identity verification for patients is still in a discovery phase where a variety of options and solutions are being considered,” said the HSCIC. “We are working closely and collaboratively with both NHS England and the Cabinet Office on this project, including about options for using Verify.” As part of its plans for a non-patient secure access, HSCIC said its Care Identity Service (CIS) was already up and running to authenticate users in accessing the NHS Spine services that were brought in house last year. With an estimated 250,000 staff authenticated each day, the organisation claimed CIS was possibly one of the world’s largest public secure identity services in operation. In looking to expand on its work around CIS, HSCIC said it was also in the early stages of working with suppliers to investigate options for more secure mobile access to Spine services.
Patient data: not sharing a ‘breach’: According to the Information Commissioner’s Office (ICO), GPs could be investigated for failing to share patient data when there is a duty to do so, reported DigitalHealth.net. Dawn Monaghan, group manager for public services at the ICO, said that any GP who steadfastly refuses to share data with other health and care professionals at the point of care could be in breach of the Data Protection Act. “What we would do is hold GPs to account if they were absolutely, categorically not sharing any data whatsoever when there should be times they are sharing,” she said. “If that is the case, that might be considered unfair and a breach of principle one [of the Data Protection Act] depending on the circumstance. If that was brought to us as a complaint we would look at it.” Her comments came during a discussion on the NHS needing to get the right balance between security of data and effective use of information as it moves towards a more integrated model of care. Several commentators have discussed the need for the ICO to control inappropriate sharing of data, but Monaghan said that a failure to share is just as big a problem. “If what you are sharing for is direct clinical care there is going to be serious detriment. If you do not share that data you are more likely to be held to account doing that than you are for breaking a data protection principle,” she said.
Scottish auditor warns of “substantial” NHS 24 financial risks: Audit Scotland has said “substantial financial risks” face the NHS 24 telehealth organisation over the next few years resulting from additional expenditure in delivering and maintaining a new operational system. A new report from Scotland’s Auditor General has found that delays in implementing a new system designed to modernise NHS 24’s core telephone and online technology has created additional costs and risks for the project’s financial targets, reported Government Computing. Total forecasted overspend on the delayed implementation of the new system is now valued at £41.6m, according to the auditor’s findings. Although the new system is anticipated to launch later this month, the costs associated with the maintenance of existing technology used to support the service are also being counted among key risks factors facing the project. As part of a “future programme” designed to overhaul NHS 24’s service provision, significant investment has been made over the last five years into the new system. The technology’s launch has been postponed indefinitely since failing to meet an original implementation date of 2013. The outlined business case for the new system was originally valued at £75.8m, but is now currently predicted to be £117.4m. The report noted that delays had resulted from a failure to meet critical patient safety performance measures.
Code4Health helps the NHS to innovate and collaborate: Code4Health has re-emerged to stimulate innovation in the NHS and encourage clinicians to get involved in building open-source technology fit for a 21st century NHS, reported ComputerWeekly.com. Richard Jefferson, NHS England’s head of business systems, said although managed by NHS England, Code4Health is based on communities of front-line NHS workers, suppliers and anyone else who wants to encourage better use of technology across the health service. The programme teaches clinicians how to code, serves as the home of several open-source projects and actively encourages people to come up with their own health-focused technology ideas. Jefferson said: “We want to get to a point where the communities are self-sustainable. [NHS England] can facilitate it, but it has to be driven by people in the NHS itself. We want to stop it being perceived as an ivory tower.” Code4Health has created a series of challenges to give anyone who is interested the chance to submit ideas around how to solve specific problems. The ideas will then be assessed and the winning projects will be supported by Code4Health in developing further into something that can actually be used in the NHS.
NHS Health Apps Library set to close: The NHS Health Apps Library, which launched as a pilot in 2013, is set to close this week and will now be taken in a new direction, reported Digital by Default. The news followed the recent revelation that a large number of the NHS-approved apps were found to leak data. The Health Apps Library reviews and recommends apps on the premise that they are “clinically safe, relevant to people living in England and compliant with the Data Protection Act”. According to NHS England, it does not formally “accredit” apps. A spokesperson for NHS England commented on the Health Apps Library’s imminent upgrade and revealed that a series of “app stores” will now be launched, inspired by the Mental Health Apps Library. The public body will now be working with clinical leads to decide on appropriate assessment criteria for the new stores in a range of areas. As well as the new app stores (that will be launching on NHS Choices), it has also been confirmed that the “learning from the Health Apps Library has been taken forward by the National Information Board to create a more thorough assessment model for apps which begun piloting this month”.
South Manchester NHS signs up to take Allscripts EPR: University Hospital of South Manchester NHS Foundation Trust has decided to implement the Sunrise electronic patient record (EPR) system from US supplier Allscripts, reported ComputerWeekly.com. The trust went out to tender for an EPR system in the spring of 2014 together with two other Manchester trusts and is the only one of the three to have chosen Allscripts as its supplier. South Manchester is aiming to become a top 10 NHS provider in England. Chief executive Attila Vegh said that buying and implementing an EPR system is “an important step”. “The EPR system will enable us to transform the way we work, and as a project it will empower clinical staff to lead the new design of the system and service across the whole pathway of care for patients,” he said.
Alder Hey hospital upgrades IT system: Alder Hey Children’s NHS Foundation Trust has gone live with a new version of the Meditech electronic patient record. The Liverpool-based trust implemented Meditech v 6.x over the summer, replacing its previous Meditech v 5.64, which had been in place since 1997. The updated system brings with it a variety of extra tools, such as electronic prescribing, paperless referral management, and early warning systems for nurses. The trust has already scanned thousands of patient historical notes onto its digital archiving system. Speaking to DigitalHealth.net, Jamie Barnes, director of international service and implementation, said that the successful go-live was due to several factors, including strong leadership at the trust all the way to the chief executive and making sure staff were involved throughout. “They certainly recognise the importance of engaging the whole organisation, in particular the clinicians, and they did a real good job of communication,” she said. Cathy Fox, associate director of informatics at Alder Hey, said: “The passion of the staff was incredible; they believe they can make a difference by using the Meditech system to its fullest potential. The fact that it’s a children’s hospital encourages everyone to really make the experience better.”
Orion Health technology central to success of double EHI Awards winner: Orion Health technology has played a crucial role in the success of the double prize-winning Connecting Care Partnership announced at October’s EHI Awards 2015 reported eHealthNews.eu. The “Connecting Care” shared care record scheme in the South West was named the “Overall winner” at the ceremony, shortly after being named as the winner for the “Best use of IT to support integrated healthcare services” category. The programme shares data between hospitals, GPs, community providers, mental health and local authorities and social services departments using Orion Health clinical portal technology, and has been live since December 2013. Managing director of Orion Health in UK and Ireland, Colin Henderson said: “The integrated record they have established is proof that the whole system delivers the benefits one might expect from more transparent information sharing. We have been working with the team for some time on the project, and they have not only driven forward the information sharing agenda in their region, but their approach has acted as a template for similar initiatives throughout England and is attracting interest in other geographies. It is great to see their leadership acknowledged in this manner.”
Home secretary lifts controls on nurse immigration: The home secretary has moved to immediately relax controversial immigration controls on nurses working in the UK, reported Health Service Journal (subscription required). This will mean nurses from non-EU countries will no longer run the risk of having their visas rejected, while non-EU nurses earning less than £35,000 a year who have been in the UK for six years will not have to leave the country from April 2016. Health secretary, Jeremy Hunt said: “Safe staffing across all our hospitals and care homes is a crucial priority. The temporary changes will ensure the NHS has the nurses it needs to deliver the highest standards of care without having to rely on rip-off staffing agencies that cost the taxpayer billions of pounds a year.” Responding to the news Danny Mortimer, chief executive of NHS Employers said: “We are delighted with this positive announcement that nurses are to be included on the shortage occupation list as an interim measure. We will continue our focused work with the NHS and our colleagues in wider health and social care provision to ensure that MAC [Migration Advisory Committee] receive robust evidence to enable nursing to remain on the list of shortage occupations.”
Opinion
Tom’s digital disruptors: mobile video consultations
More and more private GP companies are setting up video consultation apps; and the NHS is being urged to move in the same direction. But what problem are they solving, asks Thomas Meek.
“When Prime Minister David Cameron announced his ambition for a seven-day NHS back in May 2015, one of the ideas that stood out for a tech audience was that patients should regularly use a video phone service such as Skype or FaceTime to speak to a clinician.
“But uptake in the NHS remains low, leaving room for innovators in the private sector to create mobile apps that can link a user to a doctor directly and then allow them to have a consultation using a smartphone or tablet.
“The question still remains whether this is a solution that a significant number of patients will want to make use of, and, significantly, whether they will be prepared to pay for it.
“No doubt the calls for greater use of video consultations will persist among politicians, senior NHS executives and tech-savvy patients who are used to FaceTiming and Skyping friends and family across the world.
“But the deep-running problems of access to GP and other care are unlikely to be solved by pay-for apps that offer a convenient, but expensive, route into a private service; or even by an NHS version of a video access service.”
Community services are vital to the NHS, they must speak out on its future
Transforming care outside hospitals is Jeremy Hunt’s ‘biggest priority’ but community services are held back by a failure to make themselves heard, says Richard Vize, a reporter and commentator on public policy and management.
“Community services should be at the centre of debate about the future of the NHS. Patient focused, cost-effective and at the forefront of prevention and early intervention, they are crucial to making the health service sustainable in the face of rising demand. Health secretary Jeremy Hunt even described transforming care outside hospitals as his “biggest priority”. But community services are being held back by the relentless focus on hospitals and their own failure to make themselves heard.
“The effectiveness of community services is often undermined by two problems. Services are fragmented because they are run for a particular group of patients with little thought about how that service fits into the wider care system, and new community services are often poorly implemented – instead of making changes across the system, providers pursue what the King’s Fund dismisses as “piecemeal initiatives”.
“Solutions to these serious shortcomings need to be found among NHS England’s 50 vanguard sites developing new models of care. One of the central aims of the vanguards is to erode the traditional divide between primary care, community services and hospitals. Among those with a strong community element is one based around Harrogate in North Yorkshire, which plans to reduce emergency admissions using community hubs and an integrated care team involving GPs, community nurses, adult social care, occupational therapists, physiotherapists, mental health support and voluntary organisations.
“Progress will only be made when the leaders of community services find their voice in the professional bodies and national policy debates. When junior doctors, GPs, hospitals and social care are all fighting to be heard, community services cannot wait to be called; they need to speak out.”
How can the performance of local health systems be assessed?
The public must be consulted in the creation of performance measures and intelligent transparency necessary to deliver a single definition of success, says The King’s Fund chief executive Chris Ham, in a blog this week.
Reflecting on the think tank’s report and contribution to health secretary Jeremy Hunt’s ambition to put intelligent transparency at the heart of NHS performance improvement, Ham outlines what must happen.
“Intelligent transparency demands a clear line of sight from the secretary of state through NHS England and CCGs to the populations they serve, based on indicators that reflect what really matters to the public and NHS priorities. This would deliver the single definition of success for local systems of care and CCGs that the health secretary has spoken of as being needed for providers.
“To deliver this clear line of sight, we recommend radical simplification and better alignment of existing frameworks for assessing performance in the NHS. Our report also argues that there should be rationalisation of the disparate public-facing websites to provide the public with an integrated view of health and care services in an area. The public should be consulted on which aspects of performance should be covered and how information should be presented – at the moment this is an evidence-free zone.
“Intelligent transparency demands careful attention to how performance indicators are selected and presented if it is to achieve its desired results. Done well, performance assessment can help to strengthen accountability to patients and the public, as well as support commissioners and providers in improving care.”
Highland Marketing Guest blog
Patientrack’s managing director, Donald Kennedy, writes on how health technology SMEs can help the NHS address some of its biggest challenges.
