News in brief
£260 million invested in patient safety plans: Responding to the Francis report, which called on the NHS to make better use of technology to improve safe, effective care, Health Secretary Jeremy Hunt has announced a new £260 million fund for hospitals, reported the Department of Health. Last year at least 11 people died in the NHS because they were given the wrong prescriptions. This fund will be used to increase the use of technology which will help stop drugs being prescribed incorrectly because patients’ notes have been lost. Errors in prescriptions are present in as many as 8% of hospital prescriptions and studies have shown that the use of technology can cut these errors by half. The fund will help protect patients by ensuring that doctors and nurses are able to access accurate details about the care of a patient. It will make a patient’s journey through different parts of the NHS much safer, because their records can follow them electronically wherever they go. Jeremy Hunt said: “This fund will allow doctors and nurses to make the NHS safer by harnessing the very latest technology.”
National partners make commitment to join up health and social care: In the first ever system-wide ‘shared commitment’, 12 of the national leaders of health and care have signed up to a series of commitments on how they will help local areas integrate services, reported The Department of Health. ‘Integrated care and support: our shared commitment’ sets out how local areas can use existing structures like Health and Wellbeing Boards to bring together local authorities, the NHS, social care providers, education, housing services, public health and others to make further steps towards integration. The plans, which will be delivered by national leaders and local areas working closely together, include: an ambition to make joined-up and coordinated health and care the norm. This also features the first ever agreed definition of what people say good integrated care and support looks and feels like, developed by National Voices. Health Minister Norman Lamb said: “People don’t want health care or social care, they just want the best care. This is a vital step in creating a truly joined-up system that puts people first. Unless we change the way we work, the NHS and care system is heading for a crisis. This national commitment to working together is an important moment in ensuring we have a system which is fit for the future.”
Cost is main barrier to adoption of electronic records: Fears over costs are preventing doctors from embracing healthcare IT, according to new findings, reported OnMedica. A survey of 3,700 doctors, launched at the World of Health IT Conference reveals that doctors in England indicate that the main barrier to Electronic Medical Records (EMR) and Healthcare Information Exchange (HIE) adoption is cost (25%, up significantly from 14% in 2011). Privacy and security of patient information also remains a concern, although less so than in previous years. The survey of doctors across eight countries (500 of whom were in England), launched by technology company Accenture, explores doctors’ adoption, utilisation and attitudes towards healthcare IT. Despite concerns, doctors’ use of healthcare IT and HIE has risen slightly in England. Some 31% of doctors are routine HIE users, up from 29% in 2011 and the majority of doctors (82%) use Electronic Medical Records. Additionally, doctors in England are embracing the Internet with 77% reading online forums and 58% viewing online videos. Most doctors (86%) believe that electronic health records will become integral to effective patient care in the next two years – in line with the government’s ambition to have a paperless NHS by 2018.
Rotherham plans to ‘deconstruct’ Meditech EPR: The Rotherham NHS Foundation Trust is planning to deconstruct its Meditech EPR implementation. According to eHealthInsider the trust says it will ‘re-work’ its Meditech V6.0 system and implement TPP’s SystmOne in A&E. The move comes despite having spent more than £21m on its Meditech EPR. The foundation trust has faced a series of issues with the EPR since deploying the system in June last year, contributing to a financial crisis and intervention by regulator Monitor in February. In addition, eHealthInsider also reported that City Hospitals Sunderland NHS Foundation Trust has delayed the deployment of its own Meditech EPR version 6.0 until 26th May 2013.
Lamb invites bids from ‘integration pioneers’: Health economies have been invited to bid to become integration “pioneers” running large-scale experiments in integrated care, in an initiative launched by health minister Norman Lamb, reported HSJ (subscription required). Those areas awarded pioneer status will be offered support and advice to help overcome barriers to care integration from a central Integrated Care and Support Exchange team, the Department of Health (DH) said in a statement. Sources with knowledge of the initiative said there were expected to be 10 pioneers selected in the first wave, and the selection panel would be looking for ambitious, large-scale experiments in integrated care. Expressions of interest must be submitted by the end of June, so the “panel of national and international experts can choose the most innovative and appoint them in September”, said the DH statement. Speaking at a King’s Fund event this week, Lamb said the local areas that were chosen as pioneers could be offered “flexibilities” around payment mechanisms so that hospitals had a financial incentive to help patients to be supported in community settings.
GP IT funds sitting with area teams: GP IT funding of £186m has gone to NHS England’s area teams, which are working with local commissioners to verify individual budgets, reported eHealth Insider. NHS England announced that it was devolving responsibility for GP IT to clinical commissioning groups in June last year. A spokesperson for NHS England said financial planning and budget allocations had now been devolved to its 27 area teams. “An indicative budget of £186 million has been allocated for GP IT and other primary care IT services. The budget available for primary care IT in 2013-14 matches levels in 2012-13,” the spokesperson said. eHealth Insider established in February that the total allocation would be £186m, spread between 211 CCGs. This figure was based on reported spend by primary care trusts on GP IT. However, a document released under the Freedom of Information Act revealed a massive disparity in reported expenditure nationwide.
A&E must change or face collapse, NHS warned: Urgent changes must be made to the way A&E units are run – or the system could collapse, doctors and managers say, reported the BBC. Both the College of Emergency Medicine and Foundation Trust Network have put forward proposals to overhaul the system. Funding and staffing have been highlighted as key issues. Health Secretary Jeremy Hunt said it was “very tough out there” and ministers would deal with it by “better joining up” health and social care. The warnings come as fears grow over whether the NHS can continue to cope with rising demand. Last week both ministers and the NHS regulator admitted the problems were a cause for concern. A&E attendances have risen by 50% in a decade and this winter the NHS in England started missing its four-hour waiting time target. Pressures have also been noted in other parts of the UK.
Barking picks Medway from System C: Barking, Havering and Redbridge University Hospitals NHS Trust has signed a contract with System C for its Medway patient administration system according to eHealthInsider. The trust runs McKesson’s Totalcare legacy PAS, but the support contract for the system expires in March 2014. The trust, which signed the contract in January but only announced the deal now due to “clarification and amendments” it required, is planning to go-live by the end of the year. The trust will also implement electronic ordering and results reporting system, which was due to go live in November.
Francis presses government on criminal sanctions: The absence of an ability to prosecute individual NHS staff in cases of serious patient neglect would cause “public confidence” in the service to “evaporate”, Robert Francis QC has told HSJ (subscription required). Francis gave his most detailed analysis of the government’s response to his public inquiry report in an in-depth exclusive interview. The barrister said it was “only right” for criminal sanctions to be available to be used against staff guilty of serious incidents of poor care. However, the government currently has no plans to implement this recommendation from Robert Francis’ report into care failings at Mid Staffordshire NHS Foundation Trust. He said prosecutions would only occur for the most “extreme cases”, and added: “I’m talking about the sorts of behaviour we saw so many distressing examples of in Stafford. Of absolutely appalling care − insulting to human dignity and in some cases life threatening behaviour, leaving people naked, unfed and covered in faeces. These are things which everyone agrees just should never happen.”
NHS hospital staffing levels dangerous, say nurses: The Safe Staffing Alliance (SSA) – which includes the Royal College of Nursing, Unison and the Patients Association has warned that staffing levels on a number of hospital wards in the NHS in England are “unsafe”, reported Pharma Times. The group of nursing and patient organisations says wards often have just one registered nurse looking after eight patients. In a statement, the SSA said: “For the sake of clarity, more than eight patients per registered nurse is the level considered to be unsafe and putting patients at risk. It is not a recommended minimum. For nurses to provide compassionate care which treats patients with dignity and respect, higher levels will be needed and these should be determined by every healthcare provider.” The SSA says research shows that when nurses are asked to look after more than eight patients there is an increased risk of harm or death. In response to these findings, the government Health Minister Dr Dan Poulter said in a statement: “It is for hospitals themselves to decide how many nurses they employ, and they are best placed to do this. Nursing leaders have been clear that hospitals should publish staffing details and the evidence to show that staff numbers are right for the care needs of the patients that they look after.”
IMS MAXIMS launch VTE system to help prevent 25,000 avoidable hospital deaths a year: IMS MAXIMS, a leading provider of clinical information systems, is implementing software into NHS trusts that will ensure risk assessments take place that will help to significantly reduce the number of preventable deaths caused by VTE (venous thromboembolism) in UK hospitals every year reported ProHealthServiceZone. In June 2010, the Department of Health required that VTE risk assessments take place for each adult patient who is admitted to hospital. In addition, the National Institute for Clinical Excellence (NICE) recommended that all adult inpatients should be assessed for risk of developing thrombosis on a regular basis, including 24 hours after admission, whenever their medical condition changes and at discharge. The IMS MAXIMS VTE System enables clinicians to identify, review and input VTE assessment details in line with the national target.
Further woes for 111 NHS advice line as number of abandoned calls rises to 29,000: The extent of the new NHS non-emergency advice line’s teething problems has been laid bare after official figures show that the proportion of abandoned calls almost trebled in a month, revealed The Telegraph. The number of people who hung up after waiting for more than 30 seconds increased from 6,976 in February to 29,100 in March, according to NHS England figures. The average call length also increased from 14.19 minutes in February to almost 18 minutes in March. However, it should also be noted that the number of calls to the line increased by more than half a million between the same timeframe. Last week, leading doctors warned that the “problematic” roll-out of the NHS 111 advice line has left patients not knowing where to turn to for help. The service was supposed to be rolled out on April 1st, but officials were forced to relax the deadline after it emerged that many of the advice lines – which are run by 44 individual local bodies across the country – were not ready to “go live”.
Monitor and NHS England to redevelop NHS payment system: The NHS payment system is to be reformed, reported National Health Executive. Monitor and NHS England have published a new discussion paper setting out options for how the system could be redesigned to deliver more and better care within current funding levels. Hospitals are currently paid through the Payment by Results system, but feedback suggests this is not always based on good quality information, is not sufficiently patient focused and can act as a barrier to integrated care. The discussion paper sets out possible improvements on setting objectives, and includes a call for evidence on the way hospitals are reimbursed for some emergency admissions. Adrian Masters, managing director of sector development, Monitor said: “We believe the way NHS services are paid for can help deliver the best possible care for patients, for example by encouraging more integrated care, as well as helping the NHS deliver better value for the taxpayer. This is an opportunity for us to make a real difference to NHS services and we want to work with the sector to achieve this.”
GPs launch national federation to counter rising pressure on practices: GPs based in locations across the UK have launched a national federation to help practices compete for contracts and cope with falling resources, reported GP Online. Quality Practice was launched by six founder practices in Bristol, South Gloucestershire, London and Manchester, but aims to bring together the top 10% across the UK. Its founders believe the federation will provide a unique structure for collaboration in the development of quality general practice. It aims to champion the future of general practice underpinned by NHS values, sustain and grow independent practices, deliver new NHS and private sector income streams, and influence the development of primary care provision. Dr Simon Bradley, a GP in South Gloucestershire and a director of the new organisation, told GP Online the federation would provide a national corporate structure to strengthen independent practices with a focus on quality in the new developing healthcare market.
Big EPR Survey reveals components of EPR: EHealth Insider readers say that the government should maintain a clear focus on electronic patient records as it pursues its vision of ‘paperless’ working. Readers who completed The Big EPR Debate Survey rated PAS, clinical noting, order communications, pathology and eprescribing as the highest priority building blocks of an EPR. Clinical decision support and advanced scheduling were given a low priority, as blocks that could wait. Health Secretary Jeremy Hunt has said that he wants the health service to be paperless by 2018, and has clarified this by saying that he wants to see it using electronic records and communications by this date. Respondents to The Big EPR Survey said that promised guidance, due in June, should provide much greater clarity on electronic patient records and what paperless actually means. Nine out of ten (90.2%) of the 264 respondents said “we need to be clear about what we mean by phrases such as EPR” and that NHS England should define its terms. Almost nine out of ten respondents (88.5%) also felt that “a paperless NHS requires EPRs “as a pre-requisite”.
Opinion
Why did doctors and the BMA keep quiet for so long about Mid Staffs?
In the Guardian Healthcare Professionals Network this week, Dick Vinegar explains why in his opinion whistleblowing doctors, who were chased out of their jobs, should be invited back to change the culture of the NHS.
“In his first reaction to the Francis report on Mid Staffs, Dr Mark Porter, who chairs the council of the British Medical Association (BMA), made all the right noises: “I have been profoundly disturbed and saddened to hear again how a series of failures at Mid Staffordshire NHS trust resulted in such tragedy for so many patients and their families. The accounts of appalling and unnecessary suffering are truly shocking. It is not enough to say that lessons must be learnt. It is essential that we all – politicians, NHS organisations, doctors, managers, nurses, and patient groups – work together to develop a different kind of health service where the system will not tolerate poor quality of care.
“He points the way forward, but does not explain why BMA members were so reluctant to blow whistles, when all their professional codes and training should have made them blow like mad. To its credit, however, the BMA set up a blog called “How could this happen?”.
Vinegar goes on to say that the responses make for uncomfortable reading. Some of the doctors just blame successive governments, and most blame the managerial culture. They claim that doctors, not managers, should rule the NHS roost. Vinegar disagrees with this to some extent: “I applaud managers who try to get consultants to work weekends, so that patients don’t die because of a lack of medical expertise and those who insist that the consultants send in timely discharge summaries when the consultants consider these to be a demeaning chore.
Doctors, already prone to playing God, have shown that they ought not to wield power on their own. Indeed, I sometimes get the feeling that the lack of whistleblowers at Mid Staffs was not just because the doctors were afraid of the managers, but because they had closed ranks, and were protecting each others’ backsides. GPs complained that when they raised concerns with hospital doctors about the treatment of their patients, their voices were ignored.
“What I find in the BMA’s blog are a lot of intelligent and principled doctors who figured out ages ago what was wrong with the NHS, suffered for it, and vamoosed to Australia or elsewhere. They should be rewarded for their prescience and courage. They have shown that they have the grit and determination to change the culture of the NHS. They should be invited back to replace all the failed clones and jobsworths, who are still in place at the head of moribund Royal Colleges and other medical bodies.”
Why frontline staff should embrace a paperless NHS
In this week’s Guardian Matt Smale, a community district nurse at Cardiff and Vale University Health board, discusses how mobile devices can reinvigorate frontline staff by giving them more time to focus on patient care.
“Recent figures released by the Royal College of Nursing suggest that on average British nurses spend 17.3% of their time on paperwork and clerical tasks instead of caring for patients. This rounds-up to 2.5 million hours a week. To combat this issue, district nurses in my region, Cardiff & Vale University health board (UHB), have been using mobile working technology in conjunction with our electronic patient records system, Civica Paris.
“As a community district nurse, I used to spend hours hunting down paper files and information before I jumped in the car to do my rounds. Typically I’d see around six patients, but occasionally it would be as many as sixteen in one day. These records were shared by a few different teams spread around the city, which often made it impossible to be fully informed of the current care being delivered in time for a visit. I would regularly visit a patient knowing little more than their name and address. Getting back to base in rush-hour traffic to write up and take actions such as ordering equipment was another challenge. A lot of my time was spent in the car, feeling stressed about the mountains of admin I had to do.
Smale continues “A few years ago, the health board decided to take steps towards becoming paperless. After a period of consultation with Civica, who provided us with expertise in healthcare technology and helped us re-design our internal processes, we were kitted out with clinically designed netbooks.
“I’ve been using the device for over two years and have seen the benefits for myself. The ability to view live patient data, whatever shift I’m working and wherever I am, is invaluable for community staff like me. Patients are also responding positively to staff using mobile working as they feel more involved in their care. We are able to order medical supplies for them in their homes using the mobile devices during visits. We’ve been able to visit 9% more people in the field since implementing this new technology, which equates to an extra 14,000 home visits each year. My job is to care for sick people and having tools like Paris and mobile working gives me more time to do that. The technology allows me to use my time more effectively and keeps me safer when visiting patients who have risks identified and lone-worker alerts highlighted. I’ve found it hugely beneficial and I’m sure others in the profession would do too.”
How past leaders can inspire today’s leaders
This week, Karen Lynas, deputy managing director at NHS Leadership Academy tells Nursing Times about their inspiration behind launching the NHS Leadership Academy.
Lynas says: “Just for a second, think about [a nurse] you know in your community, ward or at board. For them, there is nothing more important than improving patient care, experience and outcome; nothing more important in making this happen than ensuring their staff are supported, developed and cared for so they can do their jobs. And there is nothing more likely to create that than having skilled, compassionate and well developed leaders.”
Lynas continues to describe how some great healthcare professionals have inspired the names of the academy’s programmes: “…Elizabeth Garrett-Anderson was the first qualified hospital doctor who not only strived to provide great clinical care for patients, but showed the passion and tenacity needed in adverse circumstances to battle prejudice and ignorance. We have named our Masters programme after her.
“Or Nye Bevan, the man whose vision led to the creation of the NHS, is the inspiration behind the executive leadership programme. For nursing inspiration, our choice was clear. Mary Seacole was a nurse who provided the kind of compassionate care we still see in the nursing profession today. We have named our Leading Care I programme after her.
“We carry the legacy of the NHS from one generation to the next, and want to support our current generation of nurses to develop their skills and knowledge so their influence can grow beyond the boundaries of their current role and make an even better difference to patients and carer’s experience of the NHS.”
How can we enable integrated care?
In the Guardian this week, Tony Lambert, director of strategy at Monitor, discusses how enabling integrated care requires a collaborative approach from all local health systems.
“In recent years, the health and social care sectors have both faced a series of unprecedented challenges. These have included the upheaval caused by recent NHS reforms, a tough financial climate, and resulting pressure on services because of an increasing gap between needs and resources.”
Lambert continues by discussing the possible solution. “As part of Monitor’s new role, we have a duty to enable integrated care. We believe that this means enabling the delivery of responsive, cost-effective, person-centred, co-ordinated care. Therefore, we will support local health systems to deliver the right care in the right settings, and develop new and innovative ways of working.
Effective regulation of choice and competition issues will also be vital in enabling integrated care to flourish. We believe that a fair playing field for all providers will enable the best providers of integrated care – public, third-sector or private – to flourish and hence benefit patients.”
Lambert finishes by saying: “The unprecedented pressures facing health and social care also create a perfect opportunity to seize the patient and system advantages offered by integrated care. Making progress towards realising these will involve national-level organisations playing their part.”
Highland Marketing blog
In this week’s blog, Kimberley Robinson asks why the media focus on negative healthcare stories and choose not promote the excellent work of frontline staff.
