News in brief
Spine outage leaves users without access: A major outage of the NHS Spine has caused problems across the NHS and affected users were unable to access any Spine services. The problems, which eHealth Insider (EHI) understands began yesterday, are related to errors with smartcard authentication. The Health and Social Care Information Centre (HSCIC) told customers in an update that it is “continuing to report a ‘Severity 1’ issue with the spine services.” A spokesperson from the HSCIC told EHI that it has “identified an issue with smartcard authentication which may have caused difficulties for some users in accessing Spine services both yesterday and this morning. BT deployed an overnight fix but this has not fully resolved the issue, although service has improved. HSCIC is continuing to monitor the system and is working closely with BT and both local and national system suppliers to resolve any outstanding issues. Any users who continue to experience problems should initially restart their machine to ensure that they are being connected to the correct datacentre. If this does not resolve the problem they should report this using their normal service support route.” EHI understands that the issues have affected the majority of users of the electronic prescription service, which allows practices in England to produce prescriptions electronically. One third of GPs and nearly all pharmacies are live with the Electronic Prescription Service Release 2.
Surgeons unaware of paperless plans: More than half of UK surgeons are unaware of the government’s plans to move to a paperless NHS by 2018, according to a new survey. The Association of Surgeons of Great Britain and Ireland says the findings from its report show that frontline clinicians must be engaged more thoroughly by politicians and healthcare officials, reports eHealth Insider. The association’s report, ‘Operating within a digital NHS?’, found that 57% of those surveyed were not aware of the plans to become paperless. “If the paperless agenda is to be a success within surgery, as well as the wider NHS, more will have to be done to raise awareness of the agenda amongst healthcare professionals to promote front-line clinical leadership,” says the report. To address this concern, the association recommends that each of NHS England’s national clinical directors prepare a “vision document” outlining how the paperless NHS agenda will be implemented in their specialty, including an assessment of benefits, examples in practice and metrics to measure progress. The survey found that 56% of surgeons believe a paperless NHS will improve the quality and efficiency of care provided by surgeons, while 44% were not convinced of the benefits. “This reflects a lack of understanding of the potential benefits of paperless or ‘paper-lite’ working amongst a large number of clinicians, such as facilitating the collection and reporting of data for clinical audits, or a more significant contribution to disease-specific national registries.”
NHS staff shortages pose risk to patients, warns watchdog: Some A&E departments and maternity units are so short of doctors and nurses that they pose a danger to patients, the NHS care watchdog has warned. Despite the Mid Staffordshire scandal, too much care in too many hospitals is still too poor, inspectors say in a report that identifies lapses in safety, patients having to wait on trolleys in corridors and chronic bed shortages as major problems. In its annual report assessing NHS and social care services, the Care Quality Commission (CQC) said that while much care is excellent, “the variation in the quality and safety of care in England is too wide and is unacceptable”. David Behan, the regulator’s chief executive, told The Guardian that not all hospitals had improved enough since Robert Francis QC’s report into Mid Staffordshire was published in February 2013. “There has been progress since the Francis report. What we found is that the vast majority of NHS staff were compassionate and caring, and patients were very positive about the care they received. But there is also too much variation in the safety of care”, he said. Jeremy Hunt, the Health Secretary, said he and the CQC were “confronting underperformance in the NHS as never before” and backed “a relentless focus on safety to drive up standards of care across the country”.
Government ditches plan to roll out telehealth solutions to three million patients: It has been revealed that the Government has dropped its much-lauded plan to roll out telehealth solutions to three million patients in England over the next five years, reports Building Better Healthcare. The flagship 3millionlives scheme to get patients emailing their vital signs to their local GP surgeries has been quietly shelved. The plan was first unveiled in 2011 with the claim that it would save the NHS £1.2billion a year and improve management of long-term health conditions, such as diabetes and COPD. The scheme involved patients monitoring their vital signs, such as blood pressure and blood sugar readings, at home, then sending this information remotely to their GP surgery where it would be read and, if necessary, action could be taken. The Government said this would save money as fewer patients would need GP or nurse appointments. There was also a hope it would cut down on emergency hospital admissions as problems would be picked up and treatment given at the earliest opportunity. However over the past few years several pilot projects have failed and older people, in particular, have been put off using the high-tech solutions. And, while nurses largely welcomed the plan, GPs complained they were bogged down with data. This has led to the Government shelving the project amid fears it would be too expensive and largely ineffective. Instead it is expected they will announce a watered-down version where ‘Technology Enabled Care Services’ are available, but with no ambitious targets attached.
London should be digital health pioneer: London should lead the digital health revolution and create an ‘Institute for Digital Health’, according to a report by the London Health Commission. The report, drawn up by a committee chaired by Imperial College surgeon and former health minister Lord Darzi, says that London “has the potential to lead the way” in the new health economy and global trends, reports eHealth Insider. However, it adds that the capital is a difficult market in which to launch digital health products, especially for small and medium enterprises. “More support can be provided for innovators to undertake local development with patients and clinicians, helping to demonstrate the impact of their products,” the report says. The London Health Commission is an independent inquiry, established in September 2013 by London Mayor Boris Johnson. It was asked to examine how the capital’s health and healthcare can be improved for the whole population. The final report sets out 60 recommendations, one of which is that NHS England should develop a single “London-wide online platform to encourage and inform people” about how to participate in their own care, and to provide them with digital tools to support this. “People should be able to access data held within their health records 24/7; they should be able to provide consent and filter sharing of their information; and as a result they should be able to be true partners in care delivery, contributing to clinical conversations and taking greater responsibility for their own care”, says the report. The new Institute for Digital Health would form partnerships with other organisations, such as academic health science networks and the National Information Board.
TechUK hopes ‘three point plan’ will improve government IT: TechUK has launched a ‘three point plan’ to help address problems in the public sector ICT market identified by the Office of Fair Trading (OFT) earlier this year, reports ComputerWorldUK. Julian David, chief executive of techUK, which represents over 860 companies, admitted that the IT industry “could do better” in the way it works with government. In an open letter published this week, techUK suggested three ways to help improve the relationship between government IT buyers and suppliers. Firstly, it said its members have committed time and money to engage more constructively with government, supporting civil servants earlier in the process of developing projects and helping to provide a proper understanding of what technology can do. Secondly, techUK said that the industry will agree a standardised data and evaluation scheme, which will help reduce the variations of reporting requirements on public sector contracts and make it easier for Whitehall to compare, assess and choose suppliers. Finally, the group said it will help civil servants try out new ideas by providing a platform for government and industry to experiment, test and explore innovation safely, without fear of failure. TechUK said it has started this process with ‘innovation dens’, events which allow small innovative firms a chance to pitch to figures from government and large suppliers to the public sector. The industry body hopes the initiative will go some way to help address the concerns highlighted by the OFT in its report into public sector IT published in March. The study concluded that “competition could work better” in the public sector IT market, worth about £14 billion a year.
Homerton first for child info system: Homerton University Hospital NHS Foundation Trust is set to go live by the end of the month as a first-of-type site for a nationwide Child Protection Information Sharing project. The system will flag children identified as vulnerable by social services to NHS staff if they attend A&E or other unscheduled care settings, with the information held centrally in a secure database and accessed via Spine2. The project, which will cost £8.6m over the next five years, has been developed by the Health and Social Care Information Centre (HSCIC). Steven Ouko, Homerton’s system integrations manager, told eHealth Insider that the trust is ready to go live, with an exact launch date dependent on delays at the HSCIC’s end. “We’ve tested the connection and should be able to go live within the next few weeks.” Ouko said the trust’s safeguarding lead is on the project board and has helped to define the solutions for the project and work with local authorities and other trusts to design a system that works for them. “We wanted to have a seamless electronic record so clinicians don’t have extra processes to go through and all the information is available to them easily and quickly.” Niall Canavan, the trust’s director of IT and systems, said a “very challenging” aspect of the project has been integrating the alerts into the record so they do not need to be viewed through a different system.
Google trials doctor video consultations: A new trial run by search giant Google offers users instant access to a doctor, as the company looks to extend its ‘helpouts’ professional advice service, according to The Telegraph. Searching for medical symptoms can lead web users to inaccurate self-diagnosis, meaning they either ignore or over-react to their conditions. In what Google describes as ‘a limited trial’, video consultations with doctors are free. Other similar services, however, are charged for, with weight-loss consultations often costing $30 per session. A full-scale launch of medical consultations would be likely to see substantially higher charges. Google has not released details of the service, which would be likely to carry greater requirements for doctors to prove they are verified practitioners than existing services. The company already warns search users to ‘consult a doctor if you have a medical concern’. The NHS is already trialling a range of so-called ‘telehealth’ services. Health Secretary Jeremy Hunt has said the service needs to follow banking and shopping and embrace a “technology revolution,” which will allow far more tailored and personal patient care. He admitted that the health service has “barely scratched” the surface of potential advances, and fallen far behind major industries but said he believed it was on the “cusp of one of the most exciting changes in delivery of health care that will ever happen in our lifetimes”.
NHS strike: Staff carry out biggest strike in 30 years over 1% pay row: Midwives, nurses, paramedics, ambulance staff, hospital porters and cleaners have walked out as part of the NHS’s biggest strike in 32 years, reported The Independent. The four hour strike, staged from 7am to 11am on Monday, was in protest against the government’s refusal to give workers a recommended one per cent pay rise. Around 400,000 staff were expected to join the picket lines, with members of the Royal College of Midwives (RCM) taking part in the action for the first time in its 133 year history. Several other trade unions were involved in the strike, including those representing ambulance crews, paramedics, nurses and hospital porters. Cathy Warwick, chief executive of the RCM, said: “At a time when MPs are set for a 10% pay hike, we’re told that midwives don’t deserve even a below-inflation 1% rise. And politicians wonder why the public does not afford them more respect.” A recent independent pay review body’s recommendation to award all NHS staff with a one per cent pay rise was rejected by the government, which elected to give the one per cent pay rise to those on the top of their pay band. Health Secretary Jeremy Hunt said: “the department of health is prepared to talk to the unions over the pay dispute if they’re prepared to look to reform the system of increments, which is unclear and unfair […] The most important thing here is doing the right thing for patients. It would be irresponsible for any health secretary to accept a pay package that means the NHS has to lay off nurses.”
Wales tenders for community system: The NHS Wales Informatics Service (NWIS) is tendering for a community care information solution to integrate social care, community and mental health services across Wales. The system will include functionality for care pathways, assessments, referrals and workflows and will link up local authorities with the seven local health boards covering primary, secondary, mental health and community care. Andrew Griffiths, the chief information officer for NWIS, told eHealth Insider the tender for the system is due to be completed in December. Griffiths said the tender is part of Wales’ planned approach to healthcare, as opposed to the market-driven focus in England, and is aimed at improving integration between care providers and reducing unnecessary obstacles to joined-up care. Griffiths said the service is still working on its plans for the system, including how it will be implemented across Wales and what “footprint” it will have in each health board area. He said he has been heartened by the collaboration between health providers and local authorities working on the system. He added: “When we first started out, it was with the two different sides working on their own proposals and planning to merge them later, but now it’s really come into one document. We had to get a business case together across health and social care, and you get arguments and challenges. If you asked me 18 months ago whether we’d be in the position where we are today, I’d have hoped so but I wasn’t sure we would be.”
NHS mistakes ‘waste £2.5bn’ a year – Hunt: A culture change is needed in the NHS to stop as much as £2.5bn a year being wasted on ‘basic’ mistakes in hospitals, health secretary Jeremy Hunt has said. His comments come after a Department of Health commissioned report, conducted by Frontier Economics, revealed that the costs of preventable (adverse) events is likely to be costing the NHS more than £1bn per year, but could be up to £2.5bn annually, reported National Health Executive. The report highlights that the cost is incurred through problems like medication errors, avoidable infections after surgery, and litigation. In a speech to staff at Birmingham Children’s Hospital, Hunt said: “I want every director of every hospital trust to understand the impact this harm is having not just on their patients, but also on their finances. And I want every nurse in the country to understand that if we work together to make the NHS the safest healthcare organisation in the world, we could potentially release resources for additional nurses, additional training, and additional time to care… nobody should be in any doubt that the path to lower cost is the same as the path to safer care.” But Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “Poor care is usually caused by a lack of investment”. He added that if there are not enough nurses on a ward to care for vulnerable patients, there will inevitably be more falls and more preventable conditions.
Fewer than half of complaints to NHS receive an apology, watchdog finds: Only 49% of NHS patients who complain about poor care receive an apology, according to an investigation by the official complaints watchdog. Healthwatch England described the complaints system for NHS patients “utterly bewildering and often ineffective” as it called for a raft of changes to be made to the process, reported ITV News. The report, titled Suffering in Silence, said that red tape within the NHS and local authorities is making it too difficult for people to complain and there is not enough independent advice to help unhappy patients. Some patients described the complaints procedure as a “nightmare” and a “waste of time” while many felt their complaints were ignored or passed around the system, the watchdog found. It found that overwhelming public opinion was that “hospitals, GPs and care homes are still failing to grasp fundamental principles about how to deal with those they have let down”. The watchdog estimates that at least 250,000 incidents of poor care went unreported last year. Anna Bradley, chair of Healthwatch England, said: “There is already universal support for the need to improve complaints handling and the public has helped us highlight some quick wins for the system. But having examined the experiences of thousands of patients, it is clear that the problem goes much deeper than a bit of tinkering with what we already have. We are calling for legislative time to be dedicated to this issue as soon as possible following the election, with the aim of creating a new, streamlined and genuinely responsive system that will give people what they want and ultimately provide the system with the insight to learn from its mistakes.”
WHO warns 10,000 new cases of Ebola a week are possible: The Ebola outbreak could grow to 10,000 new cases a week within two months, the World Health Organisation warned on Tuesday as the death toll from the virus reached 4,447 people, nearly all of them in West Africa. Dr Bruce Aylward, the WHO assistant director-general, told a news conference in Geneva that the number of new cases was likely to be between 5,000 and 10,000 a week by early December. The Guardian says that WHO’s regular updates show that deaths have resulted from 4,447 of the 8,914 reported cases, but Aylward said that any assumption that the death rate was 50% would be wrong. He put the death rate at 70% because many deaths are not reported or recorded officially. Where detailed investigations have been carried out, it was clear that only 30% of people were surviving, he said, adding that the figure was almost exactly the same in the three hardest hit countries, Guinea, Liberia and Sierra Leone. “This is a high-mortality disease in any circumstances but particularly in these places,” said Aylward. The grim forecast came as the first returning passengers from west Africa to Heathrow airport were asked to undergo temperature checks and questionnaires about their contacts with Ebola patients. The £9m screening exercise has been criticised by some experts, who say it will not pick up those who have the virus but are not yet symptomatic.
Opinion
The US strategy that could fix UK healthcare
We need to engage patients, public and staff in a conversation about the need for change so that change can happen and the service we all aspire to can become a reality, says Ben Gowland, chief executive of the NHS Nene Clinical Commissioning group on The Information Daily.
“Michael Porter and Thomas Lee published ‘The Strategy that will Fix Health Care’ in the Harvard Business Review last year. Recording the latest RealityBites podcast (no 8) with Joe Tibbetts we found ourselves revisiting what they wrote.
“‘The Strategy that will Fix Health Care’ starts with the premise that there needs to be a ‘transformation to value-based health care’. This is essentially a shift in the focus of health care delivery from value and profitability of services provided to the patient outcomes that are achieved. This transformation, it claims, is on its way. There is no longer any doubt about how to increase the value of health care. The question is, which organisations will lead the way and how quickly can others follow.
“Some in the NHS understand this. The development of the Outcomes Framework is a good example of a simplistic attempt to shift the system with one golden bullet. Many, however, do not, hence the reason the Outcomes Framework has been largely ignored despite its stated importance. What is clear is that achieving this shift is far easier to say than to do in practice. So how will this be achieved?
“The strategic agenda for moving to a high value health care delivery system has 6 components, which are interdependent and mutually enforcing.
“As leaders in and of the NHS our starting point has to be an acceptance of the basic premise of the article that the focus of health care delivery must become solely about improving outcomes for patients. We need to be less protective of the NHS that we have today, and engage our patients, our public and our staff in a conversation about the need for change so that we can serve them better, and so that some of the changes suggested can move from the theoretical and aspirational, to being realistic and implementable.”
Another view of simple tech
GP Neil Paul is a huge fan of technology. But what some of his more tech phobic patients need is not a smart phone or a smart app, but a nice, simple device with a big red button on it.
“I watched the Apple launch of its latest phones and software on the iPhone and was particularly interested in the HealthKit stuff. As I’ve said in other articles, the trick, for me, will be whether you can share your data with your doctor without bombarding them. I dread people coming in with 50 different apps – all presenting the data in different ways – wanting to know why their pulse rate at 8:14am was 74 not 63. At the same time, while I’m all for patient empowerment, it does seem that the main users of this tech are white, middle class, IT literate, fitness obsessed, nerds. Is my 85 year old patient really going to be able to afford such a device just to measure how often she gets out of the chair?
“Ok, one of the advantages of an iPhone or smartphone is that the computer is there. You don’t need to design a new computer every time. You can use it as your interface. I’m a photography nut and the latest thing is controlling your camera from the iPad. But why can’t they produce a kit that others can just plug into their devices – that allows just one or two apps to carry on working, using the interface that people are familiar with?
“One way or another, it occurs to me that in our rush for a ‘do everything’ device are we missing the ‘do one thing well’ device. Particularly for people who only want – can only cope with – a device that does one thing at a time. Perhaps a Kindle is an example?
“The other day a patient came in to see me, having had a fall at home. They had a necklace on it with a call button. It’s a huge red button. On the floor, in their flat, all they had to do was press it. That’s all. Ok, my patient had a complicated system. They had speakers in rooms. A control centre came on and tried speaking to them. When that didn’t work, the call centre rang an ambulance. A big red button that calls an ambulance when you need one is great tech. Would a smartphone have done as well?”
Community care reaches a mobile moment
The government must ensure mobile communications are embedded in UK healthcare says Colin Reid, CEO of TotalMobile.
“The term ‘mobile moment’ was coined by Forrester analyst Ted Schadler to explain how mobile technology is redefining the customer relationship. To take advantage of the ‘mobile moment’, the health sector must understand the patient and care worker needs and put it into context and then design mobile applications round that so called ‘moment’. As the healthcare industry changes into more collaborative patient care models, frontline healthcare workers want access to as many tools as possible on their mobile devices that enable them to deliver timely, quality care efficiently.
“Over the last decade, healthcare has had mixed fortunes automating its processes using digital technology. Although primary care has made good progress, information technology to support healthcare workers in the field has been limited. This has resulted in labour intensive paper-based documentation both in the field and back at base. Communication with other provider organisations such as hospitals and GP practices has also been paper driven. More recently, much of the concept to utilising technology to support remote working has focussed on electronic health records. A step in the right direction? Yes, but essentially trying to recreate an organisation-based environment in the field is an upside-down way of looking at things and does not take advantage of the opportunities mobile working brings.
“The time has come when community services need to be connected to other parts of the health and social care system, not viewed in isolation. Services considering mobile technology need to take a step back first and take a holistic view of its offering and how it can be provided in a more innovative, consumer-orientated way. In order to arrive at the mobile moment in the community, organisation-wide solutions must provide users with a fully integrated mobile experience.
“Mobile technology has a key role to play in providing more efficient care and increasing independence. It can enable greater participation for patients, reducing isolation and improving motivation and well-being as well as care-worker job satisfaction. We should be looking to embrace a mobile strategy that links the entire chain of connections to significantly improve social care provision over the coming years.”
Ebola: Skype consultations could help prevent an outbreak in the UK
Rachel Pugh from The Guardian interviews Sirfraz Hussain, a GP practice in Manchester who uses Skype to examine and diagnose patients.
“We need a national strategy for GPs to access Skype technology and be comfortable using it,” says Hussain, who leads on IT matters at the practice. “At some time in the future there is going to be an outbreak of Ebola that will threaten lives. In the case of such an outbreak we need service readiness and at-a-distance screening, to protect ourselves and the patients. With swine flu that was on the telephone, but now we have Skype.”
This practice feels itself to be on the frontline – as one of Hussain’s colleagues says, “The world is at our doors.” It is an area of serious health deprivation with a 6,000-strong, ethnically-diverse patient list representing virtually every nation, including those currently affected by Ebola.
Hussain himself had been convinced of the power of the Skype consultation after an incident with a patient with back pain, who rang his mobile. Frustrated, because he was not able to get to the surgery, the man asked Hussain, whether he had Skype on his mobile and they had an impromptu consultation.
“I could see beautifully what this man could do,” says Hussain. “I got him to touch his toes and all the other exercises, and could see his back perfectly. I realised that here was a technology that we could use to improve the quality of patient care.”
A spokesman for Public Health England, which is in charge of organising the medical response to Ebola, said Skype had not been considered as part of the guidance to frontline services. He said: “Other much more common illnesses than Ebola (such as flu, typhoid fever and malaria) have similar symptoms in the early stages, so proper medical assessment is really important. This would have to be done in a hospital to determine the cause of the illness not via Skype or something similar.”
Frontline clinicians like Dr Hussain and his colleagues insist that the NHS is missing a trick if it ignores the potential of Skype. He says: “It could really come into its own in triaging, to narrow down the serious and milder cases and to arrange their management as symptoms emerge. The key is that it could handle lots of patients.”
Highland Marketing blog
In this week’s blog, accountant executive Marta Sieczko evaluates who is really reached by the important healthcare industry news.
