News in brief
Consecutive years of productivity growth achieved: There have been two consecutive years of productivity growth in the NHS for the first time since the late 1990s, according to research shared exclusively with Health Service Journal (subscription required). A study by the Centre for Health Economics at York University found NHS productivity increased by 2.1% from 2010-11 to 2011-12. This is on top of its 3.2% growth the previous year. The centre uses 12,000 categories of data, including hospital episode statistics and reference cost returns, to measure growth in the amount of healthcare provided for patients and the level of resources, for instance staff and equipment, used to produce it. From 1998-99 to 2011-12 NHS output grew by 79%. Inputs grew by 78% in the same period, although there have been fluctuations. Productivity growth was negative from 1998-99 to 2003-04 because the average growth in inputs was greater than the growth in outputs. For the subsequent five years it fluctuated between positive and negative. The centre found “significant increases in NHS activity over the past 14 years”. Since 1998-99 there has been a 68% increase in hospital output, 130% increase in outpatient attendances, 24% growth in primary care consultations and 126% growth in prescribing. The research also reveals the quality of care has improved, with the survival rate of elective patients 30 days after discharge improving from 99.29% in 1998-99 to 99.78 in 2011-12. The corresponding improvement for emergency patients is 94.72% in 1998-99 to 96.12% in 2011-12.
‘Do not opt out of Care.data’ plead health charities: According to Computing, leading health charities including Cancer Research UK are pleading for patients not to opt-out of the NHS’s data sharing scheme, Care.data. Charities such as the Wellcome Trust, The British Heart Foundation and Arthritis UK are backing a new campaign to emphasise how valuable the data held in medical records is to them. Under the programme, researchers will be able to access non-identifiable data collected from health records. The charities say that it can help researchers to better understand diseases, improve patient care and develop better treatments. “Locked inside our medical records is a mine of vital information that can help medical scientists make discoveries that can improve patient care and save lives,” explained Professor Peter Weissberg, The British Heart Foundation’s medical director. “With the right safeguards in place to protect confidentiality, this new system will be of enormous benefit to patients and help reduce the burden of heart disease in the future,” Weissberg added. GPs were to have sole responsibility for raising awareness of the scheme under controversial plans made by NHS England. However after protests from GPs, the NHS decided to spend £2m on sending out leaflets to householders to explain the Care.data scheme. The charities are concerned that people may believe that the programme will infringe their privacy, and are launching adverts in national newspapers in a bid to encourage people not to opt-out. eHealth Insider has also reported this week that the strategic outline business case for the care.data programme is yet to go to Treasury for approval and involves a spend of more than £50m.
Commissioning support framework scoped: NHS England has released a draft scope of the commissioning support lead provider framework with the full tender to be launched on 3 March, reported eHealth Insider. The new framework, announced last October, will allow clinical commissioning groups (CCGs) to purchase commissioning support services on a ‘call-off’ basis. Up to 15 organisations are expected to be on it, including commissioning support units, charities and private companies. The official tender for the framework will be released at the Health and Care Innovation Expo in Manchester on 3 March. All supplier bids will be evaluated by 14 November and the framework will be live in early 2015, allowing CCGs to run mini-competitions to pick suppliers. The new draft document sets out the proposed scope of the framework and the range of commissioning support services it will cover, as well as a short description of each proposed service line. Infrastructure services, IT and desktop support, will come under Business Support Services in Lot 1. This includes: provision of secure IT and desktop support services; IT strategy services; managed data hosting; network services and systems; integration; telephony; mobile device management; and services for primary care IT. Business intelligence, excluding the work of Data Management Integration Centres which are regional outposts of the Health and Social Care Information Centre, will also come under Lot 1. Applications will include reporting tools such as dashboards as well as risk stratification, alert systems and workflow management systems. The framework will be optional and will be launched alongside procurement information that outlines other choices available to CCGs and the support available.
Minister vows to ‘scrap’ OFT involvement in procurement decisions: A government minister says he wants to ‘scrap’ the involvement of the Office of Fair Trading (OFT) in procurement decisions, as it is a barrier to developing more integrated services, according to Pulse. Health minister Norman Lamb said he had a problem with the OFT being involved in procurement decisions and that ‘it has got to change’. The comments were made at a conference to discuss how clinical commissioning groups (CCGs) and local authorities can prepare plans for the government’s £3.8bn ‘Better Care’ fund, which aims to better integrate services. In its plan for 2013/14, the OFT signalled an increased focus on the public sector ‘including markets such as healthcare’, saying that it would tackle any breaches of competition law. The OFT reviews mergers involving foundation trust hospitals in order to determine whether overall the merger is in the interests of patients, in a role confirmed in the Health and Social Care Act. But speaking at the King’s Fund this week Lamb said: “I have a problem with the OFT being involved in all of these procurement issues. I think it has got to change. In my view, I think it should be scrapped… We have got to look at the barriers and address them and sort them out.” CCGs and local authorities are expected to present a first draft of their integrated care plans by next month, if they want to tap into the £3.8bn fund that will become available in the 2015/16 financial year.
Battle over new NHS IT system could cost millions: A legal challenge over a new computer network for the public sector in Scotland could land taxpayers with a multi-million-pound bill, it has emerged, as a court battle is due to start. NHS National Services Scotland (NHS NSS) has spent the last year negotiating with potential bidders for the Scottish Wide Area Network (SWAN) – a new IT network which it is hoped will be adopted by public sector bodies across the country, according to The Scotsman. However one of the bidders – BT – launched legal action after it appeared it would not be awarded the contract, which is worth £110m initially, rising to more than £300m once more organisations come on board. The company served the summons on NHS NSS on 6 December to start proceedings in the Court of Session, seeking to have the procurement process re-run. If this does not happen, BT is seeking £20m in damages. NHS NSS has launched a legal bid in an effort to halt BT’s case. With potential savings of £300,000 a month under the new contract reported by NHS NSS, the hold-up will cost the public sector more than £400,000, with further costs if the delay continues. At present, public bodies use various computer networks, making it difficult for organisations to easily share information securely. The SWAN system is designed to deliver a single network for passing information among bodies and carrying out tasks such as video-conferencing, which is available to all Scottish public service organisations. Initially, the new network will be used by the NHS, Education Scotland councils including Highland, Argyll and Bute and Orkney, with others joining as their existing contracts run out.
Care sector failing to utilise IT to boost profits: Less than a third of care sector businesses use IT to deliver service user data to staff, a worrying new report suggests. The report commissioned by Advanced Health & Care reveals that care sector managers, who are unclear of how software can contribute to delivering efficiencies and profitable growth, are routinely overlooking new technologies. Jim Chase, managing director at Advanced Health & Care, said: “The report shows a lack of clarity and understanding in the care sector about how new technologies can boost profits.” The research finds that less than a third of care organisations currently use IT to deliver service user information, with only 22% currently using software that allows staff to submit electronic time sheets, reports The Information Daily. Additionally, only 48% of care staff use software that is capable of updating individual care records. Chase said: “Many managers are not seeing the benefit of investing in new technology now, for financial and operational gains in the future. The reality is, however, more efficient processes naturally lead to savings.”
Research shows GPs are switched on to EPS: New research from doctors.net.uk has revealed that GPs’ use of electronic prescriptions is gaining momentum, reported eHealthNews.eu Portal. An online survey of 834 GPs in England found that 15% of respondents had already switched to Electronic Prescription Services (EPS) R2, with 25% of those not currently using electronic prescriptions planning to upgrade in 2014. The research, conducted on behalf of NHS-contracted mail order pharmacy Pharmacy2U, is the first to present a comprehensive view of the EPS landscape in England. It showed that many GPs have faith in an electronic future. Forty-three percent of respondents – including those who have not yet switched – were confident that EPS would enable them to provide a more efficient repeat prescription service. However, the research also revealed confusion among GPs around the introduction of greater patient choice of pharmacy – a key element of EPS R2, as digital scripts remove the need for patients to take a paper copy to the pharmacy. Almost half of the GPs surveyed (48%) admitted they did not know enough about the nominations process to explain it to patients. And 46% did not know that under EPS, patients have the freedom to nominate any EPS-enabled pharmacy, anywhere in England. Despite this confusion, 56% agreed that greater choice of pharmacy was valuable because it allowed patients to find the most convenient option for them. Dr Julian Harrison, a director of Pharmacy2U said: “It’s encouraging to see the increased uptake of electronic prescriptions but concerning that a key element of the service – greater patient choice of pharmacy – is not yet fully understood by the profession.”
Private firms ‘win 70% of NHS contracts’: The BBC reports that almost 70% of contracts for NHS services in England between April-December 2013 were won by private firms. NHS reforms mean “qualified providers” can bid to provide clinical services, such as scans and out-of-hours care. The NHS Support Federation, which opposes a competitive market in the NHS, said that, of 57 contracts awarded, 39 went to private firms. The government said the figures were “selective and misleading”. The NHS Support Federation said 15 of the 57 contracts went to the NHS, two went to charities and one was shared between the NHS and a non-NHS supplier. They cover everything from mental health services, GP and out-of-hours services and diagnostics such as blood tests, X-rays and scans. The campaign group says that contracts worth a total of £5bn were advertised between April-December 2013. Of those, contracts worth £510m were actually awarded in that time with £450m worth awarded to non-NHS suppliers. The figures come from an analysis of competitive tender notices on the European public procurement website, compiled by the federation. Director Paul Evans says the big question is whether private companies will provide a better service for patients. “I think people are going to be genuinely surprised by what’s happening,” he said. “The scope of this change means that it is affecting all kinds of care that you might experience as a patient, everything from your first visit to the GP, diagnostic tests, treatment in hospital and care further on from that. We’re talking about the whole gamut of care and a massive change in the way we use services in the future.”
Tool-kit to boost health and social care integration in UK: A new tool-kit is to be made available, providing help and advice for councils and NHS trusts that are integrating health and social care in to practices, Integrated Care Today reported. The Local Government Association (LGA) will issue a set of practical advice, designed to help commissioners and providers navigate the complexities of integrated care implementation. The tool-kit has been made in response to the government’s introduction of the Better Care Fund, by a partnership between the NHS, LGA and care organisations across the UK. Claire Kennedy, co-managing director, PPL & senior advisor, Integrating Care said: “From 2015/16 onwards the UK health and social care landscape is going to look very different, and we need to ensure the entire sector is ready for it. This tool-kit will help national and local care providers work together to make a substantial difference to the quality of life of individuals and communities across the country.”
Four CSUs form ‘strategic alliance’: Four commissioning support units (CSUs) covering a vast swathe of the Midlands and Yorkshire have announced they are forming a “strategic alliance”. NHS Arden, Greater East Midlands, North Yorkshire and Humber, West and South Yorkshire and Bassetlaw CSUs have come to an agreement. However, they confirmed to Health Service Journal (subscription required): “This is not a merger. Our Memorandum of Understanding specifies that individual organisational sovereignty will be retained.” In a joint statement, the CSUs said: “The alliance will deliver market-leading, cost-effective services that meet the needs of our customers.” They are now in the processes of deciding the operational details of the alliance. CSUs across England have been in discussions to form networks since NHS England published its guidance on the procurement framework for support services in October, which said there will be a reduction in the number of CSUs offering a full range of services. Decisions over which CSUs will be accredited as a lead provider are expected to be made in spring 2014. The discussions have been closely monitored by NHS England’s Business Development Unit.
Graphnet care record embedded in Emis: Emis Web users can see the shared care record of patients from within their clinical system following an integration with Graphnet, reported eHealth Insider. Graphnet has embedded its CareCentric electronic health record into Web, meaning GPs can access care records from across the care community for the patient they are seeing without logging onto a new system. The integration is live in two GP practices and will be rolled out to several hundred over the next 90 days. The first go-live was at the Vitality Partnership under a project supported by Central Midlands commissioning support unit. The deployment allows GPs at the partnership to call and view real-time patient data held by Sandwell and West Birmingham Hospitals from their Emis Web screens. The CareCentric health integration engine pulls the information and displays it into a single shared care record. Data available to the GPs includes all A&E, inpatient and outpatient activity, results and clinical correspondence. “The significance is that we now get fast and painless access to full clinical information on a patient, literally with a single click. This is an important part of the process of providing high quality integrated care to our patients”, said a Vitality spokesman. A Graphnet statement says audit data shows that clinicians are more than twice as likely to use a shared record when it is embedded into local systems.
NHS England backs QOF suspension as an ‘innovative’ way of commissioning GPs: NHS England has backed its local area teams in allowing some GP practices to ditch the Quality and Outcomes Framework (QOF) for the rest of this financial year, saying that it was an example of an ‘innovative solution to commissioning primary care’. According to Pulse, the body said that it supported a radical agreement between NHS Somerset Clinical Commissioning Group (CCG) and the local area team to ‘switch off’ QOF reporting and pay practices for their estimated achievement for the rest of the financial year. NHS England said that it was important to encourage local collaboration to ‘deliver high quality services’ and it supported moves to ask GPs to provide new services and making a ‘payment to compensate for loss of QOF income’ as a result. It also backed a move by area team officials in Devon and Cornwall to suspend work on QOF work that would be removed from the framework in April to focus on other priorities, although it said that it was not a ‘blueprint’ that it was recommending other local area teams to follow and that it would not be suspending the QOF nationally. The plans to suspend QOF reporting in Somerset from January, and still pay practices what they would have earned under the framework, is designed to encourage practices to participate in a CCG-wide project to ‘redesign GP services’ before April 2014. However it has caused consternation at the General Practitioners Committee, with deputy chair Dr Richard Vautrey saying that breaking away from the national contract in this way could leave practices adrift if they come against problems.
Welsh boards share info via portal: Two health boards in Wales are sharing patient information across hospitals using the Welsh Clinical Portal, reports eHealth Insider. In a four-month pilot, eight clinicians at Abertawe Bro Morgannwg Health Board have used the portal to view information about patients referred from Hywel Dda Health Board. Dr Stephen Dorman, consultant cardiologist at Morriston Cardiac Centre, said the project has improved the speed with which they are able to view a patient’s details. “The Welsh Clinical Portal cross border pilot has enabled us as clinicians to access vital test results on our patients in a much more timely fashion,” he said. “In a tertiary care centre we often see patients who reside in other health boards and this facility has proved invaluable in planning and implementing their care.” The Welsh Clinical Portal was developed by NHS Wales Informatics Service to provide clinicians with a ‘single view’ of information from the different systems in use in Welsh hospitals. Previously, tests would have to be requested despite having already being undertaken at a different hospital. An NHS Wales Informatics Service update says the ability to immediately view test results from a different health board has taken away the need to re-order duplicate tests. This meant that the seven cardiologists and one oncologists taking part in the pilot were able to view results before seeing a patient in the clinic. Moving forward from the pilot, the next steps are to improve information governance and audit processes to allow wider cross-border use of the clinical portal.
CQC appoints Deputy Chief Inspectors of Hospitals: Commissioning GP reports that four deputy chief inspectors have been appointed by the Care Quality Commissioning (CQC) to support the chief inspector of hospitals, professor Sir Mike Richards in inspecting hospitals to ensure they are safe, effective, caring, well-led and responsive to people’s needs. The deputy chief inspectors will lead multidisciplinary teams that carry out scheduled and responsive inspections across acute, community health, mental health and ambulance services in England. The CQC’s deputy chief inspectors of hospitals are: Ellen Armistead – currently chief executive of Lincolnshire Community Health Services NHS Trust and a qualified nurse, professor Edward Baker – currently medical director and deputy chief executive of Oxford University Hospitals NHS Trust, Dr Andrea Gordon – currently regional director (Central Region) at CQC and Dr Paul Lelliott – former consultant psychiatrist at Oxleas NHS Foundation and director of the Royal College of Psychiatrists’ Centre for Quality Improvement. Dr Lelliott will have a particular responsibility for CQC’s regulatory activities across mental health services. Professor Sir Mike Richards, CQC’s chief inspector of hospitals, said he was delighted to have appointed the deputy chief inspectors of hospitals, who “each bring with them a wealth of experience across regulation, leadership and frontline practice”.
Opinion
How much longer can the NHS live within its means?
In the Guardian this week, Jennifer Dixon, chief executive of the Health Foundation, explains that good care has been protected so far despite budget cuts, but more collaborative policymaking is needed in the long term.
“It’s easy to be despondent about the NHS. The last couple of years have been tough, with a funding freeze in real terms, controversial reforms to implement, and, of course, all the fallout from scandalous lapses in quality of care, in particular from the Mid Staffordshire NHS Foundation Trust.
“For the past few years, the NHS has come in slightly under budget – not for lack of need or demand, but because of effective mechanisms not to spend. And public satisfaction with the NHS, for its staff and for the quality of care received remains very strong. All this has been achieved while implementing a large reform programme following the Health and Social Care Act 2012.
“A big question is whether efficiencies can be made fast enough to reduce the need for unpopular cuts to services. An analysis published by Monitor makes several suggestions – including delivering care in more appropriate settings and allocating resources more effectively – but still could not find more than about 60% of the efficiencies needed to close the potential budget gap by 2021. Yet despite this, the mantra is that there is significant waste to cut – a mantra not just coming from policymakers remote from action, but from staff within the NHS who can see it for themselves every day yet feel powerless to do anything.”
Dixon concludes by saying, “Making savings is a tall order for any service-based organisation; let alone one based on as complex an area as healing and care. The chancellor may have little option than to get out his cheque book at some stage in the near future. However, the price that might be extracted from the NHS for that cheque is well worth pondering.”
Who should pay for social care services?
This week in The King’s Fund, Yang Tian, senior research analyst for health policy, asks if it makes sense to have separate funding systems for health and social care.
“Recent surveys suggest that the public’s understanding of the distinction between health and social care is generally poor – with people often assuming that social care will be free as part of the NHS. Ipsos MORI’s latest polling of Londoners shows that nearly three in five Londoners incorrectly believe that they won’t have to pay anything towards the costs of their old-age care. Most people are not financially prepared for their own future care needs and do not plan ahead.
“To understand more about what the public think about who should pay for care, we have taken a look at previously unpublished results from the most recent British Social Attitudes (BSA) survey. The results show that the public is divided: half of those surveyed feel that the state should fund social care; the other half think that individuals should contribute to their care costs. More than one in five support a threshold for means-tested support and more than one in four support a cap on the amount individuals would need to contribute (although the level of the cap is not specified).
“The BSA survey results show a clear split in public views – highlighting the need for a bigger debate about how the kind of health and care system we need in the future should be paid for. The issues are complex: difficult choices lie ahead about how much to spend on health and social care and how to fund this. The government, in the Care Bill going through parliament, is proposing to introduce a cap on the costs of care for the individual – set at £72,000 from 2016. This will protect people from some of the worst iniquities of the current system, but will not solve the social care funding challenge.”
Better information means better care
This week Dr Geraint Lewis, NHS England’s chief data officer, explains why patients can be confident in agreeing to allow their health records to be shared.
“Over the course of the next four weeks, every household in England will receive a leaflet, ‘Better Information Means Better Care’. If you believed everything you read in the newspapers about this upgrade, you would think the NHS was either about to give away everyone’s confidential data free of charge or flog it to the highest bidder. Needless to say, we are doing no such thing: to do so would be unethical, illegal, and unconstitutional. But what actually is the plan?
“As the OECD reported recently, the NHS has some of the best health information systems in world. Dating back to the 1980s, we have been collating information about every hospital admission, nationwide. By pulling this information together and then analysing it in de-identified formats, analysts can compare the safety of different NHS hospitals, monitor trends in different diseases and treatments, and use the data to plan new health services. At the moment, we are missing this type of information for much of the care provided outside hospital. We do not collect it nationally from all GP practices, for example, nor from ambulance trusts or community health services. As a result, we know worryingly little about how all the different parts of the NHS are working together to provide safe, joined-up care for patients.
“So the purpose of the care.data project, which has secured support from the BMA and the RCGP, is to address these shortcomings. Building on the successes of our existing hospital episode statistics (HES) system, we will bring together all of this missing information in order to obtain a more rounded and more complete picture of the care being delivered by the health service.
“Ultimately, this is an opportunity for all of us to help the NHS deliver high quality care for all by making the most of the information collected about us.”
From the Heart and Chest
This week, Dr Johan Waktare, consultant cardiac electrophysiologist at Liverpool Heart and Chest Hospital, tells eHealth Insider about his new year resolutions, concluding that investing money into a new hobby, or indeed an IT project, does not necessarily mean you achieve what you are aiming for.
“Similarly, I have been known to buy more running gear if I’m not getting out and running regularly. Who am I kidding? All you need to do running is a pair of trainers, some other clothes, and the drive to step out of your front door.
“Do you think this kind of thinking was what went wrong with the National Programme for IT? The idea that if we throw a lot of money at healthcare IT, then we will a really good outcome? We certainly managed to spend a lot of money, but we don’t seem to have that much to show from it.
“In running terms, we put in a couple of decent showings in some 10k races, but we certainly didn’t win a marathon. Most would say we didn’t even finish the race.
“In fairness, significant thought and planning went in to NPfIT. While it is self-evident is that there was a failure of strategy, and that probably relates to the depth of the strategy, it was more complex than my personal foibles in self-motivation.
“When all is said and done, NPfIT is also in the past. You can’t change the past – just learn from it. Are we doing things “right” now or just “differently” with stringent tests on value for money to receive a share of the pot? Only time will tell, but it feels more positive overall.”
How big data could be used to predict a patient’s future
Datasets will soon be used to foresee and prepare for individual illnesses as well as periods of increased demand on services says Wayne Parslow, general manager EMEA at MedeAnalytics, in the Guardian this week.
“Healthcare was once about trying to heal the sick patient. But organisations around the world, including the NHS, now have an opportunity to shift this focus to one of keeping the public healthy and anticipating health issues before they become a problem. The ability to create and capture data is exploding and offers huge potential for the NHS to save both lives and scarce resources.
“Healthcare and life sciences are the fastest growing and biggest impact industries today when it comes to big data. In the UK, huge anonymised datasets are being developed for areas such as pharmaceutical research, with the aim of vastly improving the efficacy of drugs. Disease research is also being supported by big data to help tackle conditions such as diabetes and cancer.
“But the UK has an opportunity to go much further in unleashing the real power of big data – the potential to personalise healthcare for every NHS patient. Identifying people at risk of becoming ill or developing a serious condition and providing the foresight to prescribe preventive measures is a very real possibility.
“Although currently shielded by privacy rules, the personal data that can risk score every NHS patient already exists. And it is already far more centralised and normalised than in countries such as the US, giving the UK the opportunity to become the world leader.
“Essentially, we will see hugely improved financial, operational and clinical outcomes and better performance in a healthcare environment where medical professionals do not need to rely on gut feelings. This will allow the NHS to save more lives and make its money go much further.”
Highland Marketing blog
In this week’s blog Joanne Murray asks whether communication is the real barrier to a paperless NHS?
