News in brief
Patient power ‘to raise the red flag on poor care’: Patients who receive poor nursing in hospitals should be able to prompt immediate increases in staffing numbers under a new “red flag” system to improve safety, according to The Telegraph. Guidance from the National Institute for Health and Care Excellence (NICE) on safe staffing levels identifies breaches in care so serious that they should trigger an instant investigation to check if staffing levels are adequate, with extra nurses sent in if shortages are found. Patients, relatives and nurses are being advised to raise the alarm if those being treated in hospital are forced to wait too long for pain relief, denied help going to the bathroom or left with food out of reach. Nurses could then be drafted in from other wards in the hospital or agency staff brought in to address the shortfall urgently while the total number of red flags reported would shape future staffing levels. NICE officials said the plans intended to ensure that staffing levels were set “from the bottom up” with assessments based on the needs of different types of patients. Professor Gillian Leng, deputy chief executive at NICE, said: “The red flags are there to empower nurses to be able to say things have changed and we need more staff now. The key point of a red flag is that additional staff are required pretty urgently.”
A quarter of NHS finance chiefs expect budget overspend: One in four finance directors of NHS trusts expect to overspend their budgets, according to the King’s Fund think-tank. In the latest evidence of the financial strains facing the health service, the think-tank’s quarterly monitoring report says the number forecasting a deficit stands at its highest since 2011 when it began reporting on the data, reported the Financial Times (subscription required). The King’s Fund warns that “cracks are beginning to appear in NHS performance as a result of the growing financial pressures and rising demand for services”. Although accident and emergency waiting times met overall targets between April and June, hospitals with major A&E departments missed it for 51 weeks in a row. A total of 4.9% of patients spent four or more hours in A&E over the last quarter, the highest level for this time of year since 2004-5. More than three million people had been waiting at least 18 weeks for hospital treatment at the end of the quarter, the highest since 2008. The number of patients waiting more than six weeks for diagnostic tests was more than 18,600 at the end of May 2014 – an increase of nearly 12,000 on the same month last year. Hospitals have been under pressure to increase nursing numbers following the publication of the Francis report into poor care at Mid Staffordshire NHS Trust. The King’s Fund analysis showed that the nursing workforce rose by nearly 9,000 over the past six months to almost 315,000 – the highest on record. The think-tank said this “underlines the difficult choice facing hospitals about whether to balance the books or maintain quality of services, with many choosing to recruit more nurses despite their budgets being stretched to the limit”.
North Tees uses tech fund to support EPR: North Tees and Hartlepool NHS Foundation Trust is using its £7m tech fund monies on a large scale, integrated electronic patient record (EPR) system project. The trust received one of the largest sums from the first round of NHS England’s ‘Safer Hospitals, Safer Wards: Technology Fund’. It will use the money to implement the TrakCare EPR from InterSystems, and to update infrastructure and hardware. North Tees became the company’s first major English EPR site when it chose InterSystems as its preferred bidder in February this year. The trust’s director of finance, information and technology, Lynne Hodgson, told eHealth Insider that with the help of the tech fund monies, the trust will aim to have a paperless environment by 2018. “The central monies will be used to help in the implementation of the TrakCare solution, including infrastructure improvements, up to date hardware purchases and a dedicated internal project team, which will work alongside InterSystems to transform the patient record system,” said Hodgson. “The monies will also be used to expedite the roll out of our current electronic document management system in line with the EPR timescale and a significant amount will be allocated to enable electronic prescribing, a project that will improve patient safety”, she added.
Migrants must pay more to use NHS, say ministers: Patients from outside the EU are to be charged 150% of the cost of treatment in the NHS in a fresh crackdown on so-called “health tourism”, the BBC reports. The move is designed to incentivise NHS trusts in England to recover the cost of operations from migrants and others. The UK seeks to reclaim 100% of the cost of treating EU and non-EU nationals where charges are applicable. However, only a fraction of the £460m in chargeable procedures performed every year is currently recovered. Most foreign migrants and overseas visitors can currently get free NHS care immediately or soon after arrival in the UK but they are expected to repay the cost of most procedures afterwards. The charges are based on the standard tariff for a range of procedures, ranging from about £1,860 for cataract surgery to about £8,570 for a hip replacement. The BBC News channel’s chief political correspondent Norman Smith said many trusts did not bother chasing patients because of the time and cost involved in tracking them down compared with the financial rewards. From next year, trusts will be able to charge 150% of the normal cost of treatment for non-EU patients who are “non-permanent residents” in the UK. Under these plans, non-EU patients receiving a £100 procedure could get a bill of up to £150.
Pennine digitises 450 million paper records: Pennine Acute Hospitals NHS Trust is using Kainos Evolve and EDM Group to digitise approximately 450 million paper records over eight years, as it works towards removing paper case notes from the trust. The trust has procured the Evolve electronic document management system from Kainos in a deal worth £12.3m, the company’s biggest ever order and what it says is one of the largest electronic patient record projects in the UK. The trust is also outsourcing the document scanning to EDM Group using its data capture services. Christine Walters, the trust’s director of IM&T, told eHealth Insider it will use the system to start removing paper case notes from its hospitals. “We were originally four separate hospitals which merged, so we have a large number of case notes, both from prior to the merger and after the merger.” Walters said the trust has outsourced the scanning work to EDM Group, which will do a “bulk scan” of over 100 million images to take the pressure off its libraries. A programme of regular scanning will take place afterwards, with an eventual goal of scanning 450 million images in eight years.
Majority of hospital trusts missed their own nurse staffing targets: More than three quarters of acute NHS providers have missed their own targets for the number of hours worked at their hospitals by registered nurses, Health Service Journal (HSJ, subscription required) analysis of latest published data has revealed. Of 139 acute trusts that reported staffing data for May 2014 to their boards, a total of 105 failed to meet their own targets for total nursing hours worked during both day and night in at least one hospital site. More than four out of five providers, 86%, failed to meet their targets for registered nursing hours worked during the day, while 112 trusts, 80%, missed their targets for nursing coverage at night. Under requirements introduced as part of the government response to the Francis inquiry, NHS trusts must now publish monthly staffing data showing their planned number of nursing hours against the number they managed to fill. A summary of the staffing data published in June on the NHS Choices website used aggregate figures for registered and non-registered nursing staff, which had the effect of obscuring trusts’ results for registered nurses only. HSJ’s analysis uses the same staffing data, but unlike the summary figures presented on NHS Choices it looks only at the proportion of nursing hours filled by registered nurses, stripping out the effect of healthcare assistants. There is mounting evidence of the importance of registered nurses to the delivery of safe high quality care with research suggesting harm begins to occur at a ratio of one nurse to eight patients. The majority of trusts that missed their own registered nursing hours targets did so by less than 5%. However, 50 trusts had sites recording fill rates of lower than 95% both day and night, and 13 had sites recording fill rates of lower than 90% both day and night. Elaine Inglesby-Burke, executive nurse director and deputy chief executive at the Salford Royal Foundation Trust, told HSJ: “I think some trusts have a long way to go in determining what safe staffing is in their organisation and the standards people are being compared against [are not] comparable until everyone is using an evidence based tool.”
Increase in harm free care in the UK: There has been an increase in the percentage of patients receiving harm free care, according to data released by the Health and Social Care Information Centre (HSCIC). As Practice Business reports, data revealed that 93.6% of patients surveyed in March 2014 received harm free care compared to 89.7% in April 2012. The NHS Safety Thermometer tool was developed by the HSCIC to support patient safety as part of a wider programme of work involving frontline NHS clinicians, improvement experts and the Department of Health. Using the data submitted by organisations from the monthly patient surveys, the tool provides valuable data for frontline teams to monitor their performance in delivering harm free care. From April 2012 to March 2014, 1,058 organisations have submitted results from over 4.4 million patient assessments across 10 care settings. HSCIC chair Kingsley Manning said: “It is encouraging to see that the percentage of patients recorded as receiving Harm Free Care has increased to nearly 94% in 2014. As the number of providers who fill out this monthly survey increases, it is hoped that this will enable the NHS to have a more detailed picture of care provisions in order for them to monitor care and make further improvements.”
Hospital failure regime extended to care homes: A system of special measures designed to improve failing hospitals in England is to be extended to care homes, the government has announced. The process was introduced by the Care Quality Commission (CQC) a year ago at 11 failing trusts. Most have since made progress – although only five have been or are being taken out of special measures. Health Secretary Jeremy Hunt said the scheme would be introduced for care homes and home-care agencies next year, the BBC reports. That will cover 25,000 services and could lead to the closure of those that fail to improve. The details of the regime for care homes are still being worked out, but it is likely to involve less external support and instead rely on shorter deadlines to shock the providers into action. The first services will be placed in special measures from April, as the underlying ratings regime will be rolled out in the social-care system from the autumn.
Imperial rolls out check-in kiosks: Imperial College Healthcare NHS Trust is rolling out 75 self-service patient kiosks across five hospitals to speed up check-in times and ease the pressure on its staff, eHealth Insider reports. The trust is deploying the kiosks, provided by Jayex Technology, at its St Mary’s, Charing Cross, Hammersmith, Western Eye and Queen Charlotte and Chelsea hospitals to cover about one million outpatient encounters. Kevin Jarrold, the trust’s chief information officer, said the kiosks will help to reduce pressure on staff by enabling them to manage patients, and has already received “excellent feedback” from administrative teams. The kiosks let patients confirm their arrival using a touchscreen, direct them to the correct waiting area and then alert staff to their presence before calling them for consultations via screens and an audio system. The first phase of the deployment has been completed, covering 11 departments and 50% of outpatient activity, while the second phase will cover up to 15 more departments for the remaining 50% activity.
Better use of electronic health records makes clinical trials less expensive: Using electronic health records (EHRs) to understand the best available treatment for patients, from a range of possible options, is more efficient and less costly for taxpayers than the existing clinical trial process, a new study shows. Research led by Professor van Staa, carried out while he was a member of the Clinical Practice Research Datalink (CPRD) and who is now based at The University of Manchester’s Health eResearch Centre, published in Health Technology Assessment (HTA) looked at the use of statins in 300 people with high risk of cardiovascular disease by tracking their EHRs. Researchers installed a new computer programme in 23 approved GP surgeries across England and Scotland, reported eHealthNews.EU Portal. This programme was able to confidentially identify which patients were eligible to take part and allowed doctors to sign up relevant participants at the click of a button, saving time and money for the public purse. Researchers then used the patients’ EHRs as recorded in the Clinical Practice Research Datalink, updated as part of their regular medical appointments, to monitor the impact of the treatments they had been prescribed. By studying these records, researchers are able to understand health patterns in relation to specific medications with potentially much larger and more diverse members of the public, and to understand which treatment offers the best results.
Scottish board builds shared care record: NHS Dumfries and Galloway is creating an electronic shared care record to integrate primary and secondary care data, reports eHealth Insider. The Scottish health board is using the CareCentric software from Graphnet to build the integrated care record, which will be an extension of its already existing care record. It has also integrated GP data from Emis Web into the Graphnet software to allow sharing of information between primary and secondary care data. The health board’s head of information management and technology, Graham Gault said it is looking to create a modern model of integrated care. “We want to provide clinicians with access to all the information they need about a patient when and where they need it. We see this as the key to providing efficient, joined-up services centred around the needs of the patient,” he said. The health board has developed a range of data feeds to provide access to acute and mental health records as well as admissions data, clinic lists, patient alerts and in- and outpatient appointments. These are imported with a real-time feed from the Royal Infirmary’s Topas patient administration system from Cambric. Gault said that the next step is to introduce electronic forms, which will replace more than 500 paper forms. Dumfries and Galloway is also talking with social care providers to integrate social work information into the record. The health board is building a new infirmary, due to open its doors in 2018, which has no facility for storing paper case notes.
Probe after NHS Orkney patient records found on pavement: NHS Orkney is to carry out an internal investigation into what has been described as a “serious breach of patient confidentiality”. The admission and treatment records for seven patients were found by a member of the public lying on the pavement near Balfour Hospital this week. The records include detailed information about each patient’s condition and treatment. They were found by a member of the public and handed to BBC Scotland. The information is thought to have been printed off and dropped by a member of staff outside the hospital. NHS Orkney’s chief executive Cathie Cowan said: “I have to be put my hands up and say there has been an error here – a significant error – and I’ll do everything in my power to identify how it’s happened and take steps to stop it happening again.” She insisted that incidents like these were “very, very rare”. “We investigate, we take steps and we take corrective steps to prevent them happening again,” Cowan said. She explained that the misplaced documents were handover notes given by doctors in the changeover of shifts. NHS Orkney would be writing to all the patients and family members involved to apologise, she added.
Symphony buys stake in Graphnet: Symphony Technology Group has purchased a 40% stake of shared record specialist Graphnet, reported eHealth Insider. The news comes just a week after Symphony completed its acquisition of McKesson’s UK clinical IT business, now re-named System C, and appointed Ian Denley and Markus Bolton as joint chief executives. The new Symphony investment will provide a partial exit for Graphnet’s founders and shared record pioneers, Dave Garnett and Tony Sharer, who have led the development of some of the most successful shared record and interoperability projects in the NHS. The acquisition will see a substantially new management team brought in and be used to accelerate product development. Denley and Bolton have previously invested in Graphnet through their Shearwater health IT accelerator vehicle. Both are directors and investors in the company. The new management team includes Brian Waters, who has been appointed chief executive. Waters was previously vice president at McKesson and held director positions at System C and CSC. Andy Bratt will continue to be managing director, with overall responsibility for operations at the company. They will be joined by Antony Smith, who has been appointed the company’s finance director. Antony was previously finance director at Dr Foster Intelligence. Bolton and Denley are retaining their 46% stake in Graphnet and active involvement as director and chairman respectively. Announcing the changes, Graphnet’s director’s Dave Garnett and Tony Sharer revealed they would be moving to part-time roles. Garnett and Sharer founded the business 20 years ago with partner James Leeming.
Big congratulations to Jane and Graeme Eccles for completing the Charity Bike Ride of over 1000 miles in 14 days!
As you may know, eight and half years ago Jane Eccles had an emergency c-section and gave birth to a son, George. Whilst in hospital she fell ill contracting Necrotising Fasciitis (NF), more commonly known as the flesh-eating superbug. She was given two hours to live as once NF gets a hold there can be no stopping it. Jane was in Intensive Care and had numerous surgeries in a short space of time. Surviving against all odds, Jane was told that she would most probably never be able to walk again, let alone return to her role as a teacher. In the same defiant form that helped her survive, Jane spent the next few months in a wheelchair focusing on learning to walk.
Incredibly Jane and her husband Graeme have now completed over 1000 miles in 14 days, with no backup support, raising money for the Lee Spark NF Foundation. The Foundation helps medical professionals become more aware of the NF disease, symptoms and treatments. It’s a huge challenge for Jane, especially as she could not even lift her leg over a crossbar two years ago.
To find out more about the charity cycle visit Jane’s website. To sponsor Jane visit her Virgin Money Giving page. Many thanks for your support!
Opinion
Mark Dayan, policy and external relations officer at The Nuffield Trust, talks to Public Finance about some of the radical changes to the Better Care Fund (BCF).
This includes the introduction of “performance pots” for reducing unplanned hospital admissions by 3.5%, which has its drawbacks, Dayan writes: “For a start, a 3.5% reduction in admissions is not enough for the NHS to break even if it loses £1bn of funding. If BCF plans work perfectly, deliver reduced admissions in every area, and get their money, the health service would still be left facing a gap of hundreds of millions. Given that 2015-16 will almost certainly see the NHS in a state of financial crisis, this still looks like a serious problem.
“On the other hand, missing the £1bn would leave local authorities without the money to make many BCF schemes actually happen. That would be a shame, because they include many promising ideas for monitoring and rehabilitating vulnerable people – and because social care, more than the NHS, has already been cut to the bone.
“And the path for local plans to succeed has become a narrow one. The success of the BCF is in theory meant to be judged against five other metrics alongside emergency admissions, including reductions to delayed transfers of care, and to permanent admissions for care homes.”
“The unpredictability and risk associated with the performance pot is also a concern – as we’ve pointed out.
“It’s hard to criticise the government for looking for an escape route, and the “performance pot” is a solution which might salvage some of the genuinely good ideas and intentions contained in BCF plans. But as the platform blazes, there may be no way to avoid somebody getting caught by the flames.”
Practising NHS consultant psychiatrist Joe McDonald speaks out about the death of a self-confessed drug addict and argues that the medication information in the NHS Summary Care Record may have stopped the death.
“I review many serious untoward incidents every year, including the deaths of young people addicted to opiates. Lately, I have been checking how many patients we review have come from a practice that has gone live with the NHS Summary Care Record. Increasingly, people do have SCRs. A tipping point has been reached. If a secondary care service cannot access the SCR – and it has no other means of seeing into the GP record – I think it may shortly find itself explaining to a coroner why it hasn’t explored its use.”
“In the past, the excuse ‘it’s not worth checking the SCR because he probably hasn’t got one’ was valid. But now that 40 million people have a record, and numbers are growing by a million a month, ‘he probably has’; and it won’t be too long before not viewing the SCR might be considered negligent. So well done SCR people. I said 18 months ago that the programme needed to get really useful really quickly and now it is really useful.”
“Those of us in secondary care now need to press for access, particularly in areas where the reconciliation of primary and secondary care medication is critical to safety of vulnerable groups. Maybe nothing could have saved Johnnie; but maybe the SCR would have done. It would have been long odds; perhaps a million to one shot? But among 40 million records a million to one shot will happen 40 times. That’s 40 Johnnies still alive and charming, living long enough to get clean and take their places at drama school – rather than among the trash.”
Forget reform, the NHS is beyond repair
Melanie Phillips argues in the Times (subscription required), that the NHS is undergoing a moral and financial crisis, but because of its untouchable status not much can be done about it.
“The NHS, permanently staggering from crisis to crisis, is currently staring at a £30 billion funding “black hole” by 2021. The Office for Budget Responsibility predicts that healthcare spending will rise from 6.4 per cent of GDP in 2018-19 not just to 8.5 per cent half a century from now, but to nearly 15 per cent once healthcare productivity rates are factored in. No wonder voices are sounding an alarm that something has to give. Even Simon Stevens, the new head of NHS England, has agreed that it must “reinvent” itself.
“This is, however, not just a financial but a moral crisis. Callousness and cash are linked, undermining the NHS at its very core. Of course, it is not wholly to blame for the widespread erosion of the caring ethic — the decline of religion is arguably the principal cause.
“The NHS, though, has made this culture worse for two fundamental reasons. First, politicians are impelled to claim that the NHS is constantly improving. The whole service therefore has to dance to that tune. This sets up the second factor, the irresistible pressure to sustain a big lie.
“Politicians know that while demand for healthcare is inexhaustible, the public’s willingness to pay for it is finite. So everything has to be massaged to sustain this Potemkin structure of universal, comprehensive coverage free at the point of use.
“The health service is untouchable because, in a country that lost its global purpose at the same time as the NHS was founded, it is viewed as the one unambiguous moral good that furnishes pride in British national identity.”
The NHS is on the cusp of its ‘iPod moment’
There is a transformation coming as health and technology increasingly intersect – but has the NHS noticed? And will the shake-up of those responsible for where NHS technology will sit in the new health structures help drive things asks Matthew Swindells, chair, BCS Health, The Chartered Institute for IT, and senior vice president, Cerner.
“Simon Stevens said in his first Health Service Journal interview as NHS England chief executive that “when it comes to IT, our critical interest is the ‘I’. The ‘T’ is supporting infrastructure that others can help bring about”. He was more right than he probably knows. While the NHS is still trying to decide whether electronic patient records are a good idea for hospitals, and found itself the bemused host of a religious debate about the merits of “open source”, health systems around the world are moving forward.
“Conversations that I have had around the world – from Scandinavia to Singapore, Canada to Sao Paulo – show health systems are now looking to the benefits of digitised healthcare far beyond the simple automation of healthcare providers. Investment in electronic patient records around the world has opened up the potential for the next generation of innovation. Healthcare stands on the brink of a revolution that is analogous to the transformation of the music industry in the past.
“The NHS’s comprehensive and relatively equitable structure – allied with its world class academic institutions – still gives it a unique opportunity to lead the world in the use of information and technology to change healthcare.”
Highland Marketing blog
In this week’s blog, our account executive Marta Sieczko discusses the pros and cons of the medical jargon and its impact on the patient’s journey.
