News in brief
Patient information to be shared with care.data: The Health and Social Care Information Centre (HSCIC) and NHS England are launching a £2m, public awareness campaign about care.data – the new programme that will link patients’ data together to boost care, reported National Health Executive. Throughout January 2014, all 22 million households in England will receive a leaflet explaining how the new system will work and what benefits it will bring. After the campaign, patients will have four weeks to tell their GP if they want to opt out of their personal medical data being forwarded on to the HSCIC, before any extraction of patient data begins. Data from different NHS providers will be brought together to give commissioners, Clinical Commissioning Groups and Commissioning Support Units a more complete picture of the health challenges in each region, and to plan and design services using the best evidence. HSCIC will routinely extract data from all GP practices and hospitals, with the information made available in a form that is stripped of information that could identify patients. This will include information about diagnoses, investigation results and prescriptions, but not ‘sensitive’ information including marital status, complaints, abuse and convictions. Tim Kelsey, NHS England’s director of patients and information, said: “I believe the NHS will make major advances in quality and patient safety through the use of this data. At the moment, the NHS often doesn’t have the complete picture as information lies in different parts of the health services and isn’t joined up. This programme will give NHS commissioners a more complete picture of the safety and quality of services in their local area which will lead to improvements to patient outcomes.”
Innovation fund axed amid confusion over specialised services: NHS England has scrapped a £50m fund designed to promote innovation as part of a flagship government policy – just two months after its launch, reported Health Service Journal (HSJ, subscription required). The introduction of a specialised services commissioning innovation fund (SSCIF) was a commitment of the Innovation, Health and Wealth programme launched with great fanfare in 2011. Originally due to be up and running by September 2012, the fund was not launched until August this year. More than 1,000 expressions of interest were lodged by organisations both inside and outside the NHS, including patient groups, charities and industry. However, this week each organisation received an email from NHS England’s clinical director of specialised services, James Palmer, announcing the fund would be suspended “indefinitely”. The fund was to be taken as a top slice from NHS England’s £12bn specialised commissioning budget. In the email, seen by HSJ, Mr Palmer said “unplanned expenditure” due to the scale of the work to move from a regional to national approach for commissioning specialised services meant NHS England had to look at what was needed to deliver “core business”. As a result we have taken the difficult decision not to proceed with the SSCIF as this programme sits outside the mainstream commissioning responsibilities on which we need to focus,” he said.
Complaints about doctors ‘double in five years’: The number of complaints against doctors in the UK has doubled in the past five years, reported the BBC. Data from the General Medical Council (GMC) showed there were more than 8,100 complaints in 2012, compared with just under 4,000 in 2007. About a third of complaints led to a full investigation by the regulator. However, doctors’ leaders said the figures still represented a small proportion of the amount of care given in the NHS – there are 250,000 doctors in the UK. Nonetheless, the rise in complaints – and the subsequent investigations – are still causing concern. The upward trend has happened during a period when there has been mounting concern about NHS care following the Mid Staffs scandal. Of the 8,109 complaints made last year, 2,673 were taken forward for an official investigation. A total of 179 sanctions and warnings have already been made, while nearly 900 cases remain open. The GMC said it was important to learn from the trend, but the regulator believes there may be an issue with patients not knowing to whom they should direct their complaints. The majority of complaints – nearly two-thirds – came from patients, but just a fifth were deemed within the GMC’s scope to follow up. GMC chairman Prof Sir Peter Rubin said: “Overall the standard of care that patients receive in the UK is good and doctors continue to deserve the trust and respect of the public. What our report shows is that some patients don’t know where to go to raise a concern about their treatment and more needs to be done to help them raise issues.”
Second wave of trust inspections announced soon: The second wave of trusts to be inspected by the Care Quality Commission’s (CQC’s) new quality teams will be announced shortly, reported Health Service Journal (subscription required). The commission’s director of strategy and intelligence, Paul Bate, told a session at the Foundation Trust Network’s annual conference this week that the next 16 trusts being inspected would soon be announced. Bate said the old system of generalist inspectors visiting “a dental practice one day and a tertiary teaching hospital another” was “broken”. Eighteen acute trusts have either had their inspection from teams led by chief inspector of hospitals, Sir Mike Richards, or are due to by the end of December. The CQC’s two waves of inspection followed the investigation of 14 trusts, which were outliers on hospital mortality indicators which was announced by the government in its response to the Francis inquiry into poor care at Mid Staffordshire Foundation Trust. Of the trusts inspected by the CQC so far, some had high mortality indicator rates and some low. All acute trusts will be inspected over the next two years.
Review of NHS staff engagement launched: An Independent review which aims to ensure NHS staff are able to give higher quality care has been launched, announced the Department of Health. The review will consider options for supporting employee voices and their stake in organisations providing NHS services, and will assess a range of options, including models such as social enterprises and mutual organisations. Chief executive of the King’s Fund, professor Chris Ham will lead the review supported by an independent panel of experts from healthcare and other sectors. Ham said: “Evidence shows that engaging and empowering staff can improve performance and lead to higher quality care for patients. I am delighted to be leading this independent review, which I hope will support the development of innovative provider models that give NHS staff a stronger voice in their organisation. The review aims to ensure that staff in all organisations delivering NHS services are empowered to make the greatest possible contribution to the delivery of efficient services and high quality care.” The review will identify the barriers preventing some NHS providers from engaging and empowering staff, outline good practices within the NHS and other sectors, and recommend how these can be adopted throughout the NHS. It will look in detail at the hospital sector but will also consider primary and community care and relationships with social care.
Google Glass delivers patient data: A proof-of-concept that uses Google Glass to deliver patient data to doctors has been announced by Philips and Accenture, reported eHealth Insider. The Google Glass head-mounted display, which is connected to Philips IntelliVue Solutions, is designed to improve the effectiveness of surgical procedures by providing doctors with hands-free access to critical clinical information. A demonstration of the technology shows how a doctor wearing the display could simultaneously monitor a patient’s vital signs and react to surgical procedural developments without having to turn away from the patient. The display also enables the doctor to monitor a patient’s vital signs remotely or enlist assistance from doctors in other locations. Michael Mancuso, CEO of patient care and clinical informatics at Philips Healthcare, said: “This research explores how doctors can achieve better access to the right information at the right time so they can focus on more efficient and effective patient care.” The proof-of-concept was created by researchers from Philips’ new Digital Accelerator Lab in collaboration with researchers from Accenture Technology Labs as part of a project to explore the potential use of Google Glass in clinical settings.
Jeremy Hunt predicts ‘extremely difficult’ winter: Health secretary, Jeremy Hunt has predicted this winter will be as “difficult” for the health service as last, when many patients waited for long periods in accident and emergency units, reported Health Service Journal (subscription required). Speaking at the Foundation Trust Network conference in Liverpool this week, Hunt said: “I think this winter will be as difficult (as last). We’ve tried to do everything we can at the centre to help prepare the system.” Last winter saw large numbers of hospitals miss the target for 95% of patients to be seen within four hours of arrival at A&E, many by a large margin. There were also many waits of 12 hours or more for beds. The health secretary referred to complaints from some hospitals in recent weeks that the national £250m fund to support them in winter had been directed at those expected to struggle with performance. “I know some people were upset we didn’t divide the money up evenly,” he said. “I felt we had to concentrate those resources where they are needed.” In past years additional winter funding has been given to all trusts. Hunt also told delegates at the conference the government was willing to support changes to services to make them sustainable.
Royal Cornwall sets up overnight clinical management system: Royal Cornwall Hospitals NHS Trust (RCHT) has developed a system to manage clinical teams and medical tasks more efficiently and effectively throughout the night, reported Government Computing. The ‘Hospital at Night’ system, deployed as part of the trust’s Service Improvement Programme has been developed with improved patient safety in mind. RCHT says the system has transformed the trust’s night shift handover process by allowing doctors to create an electronic work schedule of clinical tasks for patients who require extra attention or intervention during the night. The IMS MAXIMS’ developed system allows hospital staff to add, update and remove patients from the Hospital at Night work list through a data entry screen that means they can finish their daytime shift with the reassurance that the night team have all the information and instructions necessary to complete a safe, efficient night shift. The trust says the move from a manual, paper-based system to a more automated, electronic process, means that senior nurses can analyse the levels and types of tasks being carried out, and so allocate the correct mix of clinical experience and skills on each night shift.
Central Manchester shows off in-house IT: Central Manchester University Hospitals NHS Foundation Trust has created a central intelligence portal with 800 active users, reported eHealth Insider (EHI). The web-based portal has been created solely by the trust’s IT team and publishes all reporting and information tools. The trust’s data warehouse developer, Darren Griffiths, told EHI that the portal was customised to the trust’s needs. “We couldn’t find one on the market that did everything we wanted to do. We can adapt to the requirements as we progress, which is bespoke to our needs,” he said. Central Manchester data warehouse extracts information from several trust systems, with new ones added on a regular basis. The portal consists of several different modules, such as trust wide reporting, divisional reporting and individual dashboards for clinicians. The project has also included the development of customisable departmental websites and portals for sharing information with commissioners and GPs.
Price comparison site to revolutionise NHS procurement: NHS trusts will be able to compare the price they pay for goods and services following the launch of a comparison website that aims to curb wasteful spending and improve procurement processes, reported Building Better Healthcare. The website will include details of what organisations are paying for everything from rubber gloves and stitches to hip replacement implants and even building developments. To coincide with the creation of the site, the Government has also announced the post of procurement champion, whose job it will be to improve overall purchasing systems within the health service. They will work with a team of advisers drawn from the NHS and private business who will help scrutinise and spread best practice. The move follows the publication, in February 2011, of a National Audit Office report which concluded that better procurement could save the NHS half a billion pounds a year. This was followed by a study by Ernst and Young, which highlighted that approximately £500m a year is being lost due to poor procurement processes and decisions. Announcing the plan this week, Health minister Dr Dan Poulter said the ‘scandalous situation’ must end. “When our NHS is the single biggest organisation in the UK, hospitals must wake up to the potential to make big savings and radically change the way they buy supplies, goods, services and how they manage their estates,” he added. The Department of Health believes savings of £1.5billion could be made out of a total spend of just over £20billion.
NHS mental health care in ‘crisis’ due to lack of beds, leading psychiatrist warn: NHS services for mental health patients are in “crisis” and unsafe, according to one of the UK’s most senior psychiatrists. The number of beds available in specialist units has been reduced by 9% since April 2011 – a loss of more than 1,500 – preventing vulnerable people from getting the care they need, reported The Independent. In an investigation by the BBC News and Community Care magazine, 46 of England’s 58 mental health trusts responded to Freedom of Information requests looking into ward occupancy levels and cuts to available beds. It found that three-quarters of the 1,711 bed closures were in acute adult wards, older people’s wards and psychiatric intensive care units. Dr Martin Baggaley, the medical director for the South London and Maudsley NHS Trust, said: “We are in a real crisis at the moment. I think currently the system is inefficient, unsafe. We’re certainly feeling it on the front line, it’s very pressured, and we spend a lot of our time struggling to find beds, sending people across the country which is really not what I want to do.” The average occupancy level of beds in acute adult and psychiatric wards was 100%, and all were above the 85% limit recommended by the Royal College of Psychiatrists. The care minister Norman Lamb told the BBC the current “unacceptable” situation came as a result of the NHS’s “institutional bias” against mental health issues.
Dorset hospital trusts merger plan blocked: Two NHS hospital trusts in Dorset will not merge, the Competition Commission (CC) has decided, reported the BBC. The Royal Bournemouth and Christchurch Hospitals and Poole Hospital Trusts wanted to become one to save money. It is the first time the CC, which normally rules on companies and commercial markets, has intervened in the NHS in England. The trusts said the decision was “fundamentally wrong” and that they would “explore alternative options”. In a statement, the trusts added they were “deeply disappointed” and felt the merger was the best option to ensure “high-quality hospital services to local people”. “The assessment of the merger was always weighted to put competition ahead of benefits to patients, and we do not believe the NHS is best served in this way.” The merger was referred to the commission by the Office of Fair Trading, amid concerns about allowing two competing trusts to combine. The CC said the merger would “damage patients’ interests by eliminating competition and choice”.
Indian healthcare IT market may zoom to USD 1,454m in 2018: The healthcare information technology market in India is expected to reach USD 1,454.7 million in 2018 from the present USD 381.3 million, mainly due to fast adoption of technology by stake-holders, according to Frost & Sullivan, reported The Indian Express. Healthcare IT is a core component to achieve successful transformative shifts in healthcare. Growth in data, digitisation trends in health information and electronic medical records, improvements in collaborative data exchange, workflows and mobility, and need for better financial management are changing the needs of the hospital enterprise. Additionally, patient demographic changes and chronic disease growth, cost control considerations, and importance of patient safety, have all come together to heighten demand for health information technology (HIT) in India, the report said. “The increase in adoption of electronic health records, mHealth, telemedicine, and web-based services has made electronic patient data expand, necessitating the implementation of robust IT systems in Indian healthcare institutions,” according to analysis carried out by Frost & Sullivan. The technology’s benefits, which include enabling experts from any part of the world to advise patients on medical care, streamlining operations, and helping hospitals achieve performance targets, have popularised IT in healthcare,” it said.
Less than Half of Responsible Officers Positive About Revalidation: A survey of responsible officers (ROs) by the King’s Fund has discovered that 42% of those who responded were positive about their experience of revalidation and 10% were negative, reported Commissioning GP. The remaining 40% reserved their judgment as they thought it was only early days and believed the second year would be trickier, as they would then have to revalidate the “less engaged” and “more challenging” doctors who have performance issues. The King’s Fund questioned 53 of London’s 133 ROs and also interviewed 20 of these, aiming to get a snapshot of what was working so that it could be drawn on for the second year and also what needs to be improved. The ROs felt that further work to capture patient feedback and experience as part of the revalidation process is needed to support the delivery of patient centered care and that a positive experience of revalidation is linked to effective systems, processes and IT that underpin the appraisal and revalidation procedure. They added that an RO network, support from the board, support from human resources and the central Revalidation Support Team were key factors in promoting the successful establishment of revalidation and the ability to respond effectively to concerns that arise. They also believed that ROs and doctors should see revalidation as a restorative process; this will help to underpin revalidation.
Rogue publisher gang jailed for attempted £478K NHS fraud: A Warwickshire gang that attempted to defraud NHS trusts by invoicing them for adverts in non-existent publications has been jailed for a total of 18 and a half years following an investigation by Warwickshire Police and NHS Protect, reported NHS Business Services Authority. The gang operated by contacting NHS Trusts who were advertising vacancies in health magazines and journals. Gang members would pose as employees of bogus publications, which had names similar to genuine publications, and attempt to obtain signed orders reproducing the adverts in their own publications. Forms that requested a signature to approve the advert’s content were faxed to the trusts – but these were in fact booking forms. Once signed and returned, NHS trusts would receive an invoice demanding payment. NHS Protect received information on these activities and so alerted trusts to the threat posed by the gang and issued fraud prevention ‘toolkits’ to local counter fraud specialists; this played a significant part in preventing thousands of pounds worth of fraud. Mick Hayes, Anti Fraud lead, said: “This gang attempted to defraud NHS trusts of thousands of pounds through a sustained campaign of misrepresentation and mis-selling. This was a serious crime and the custodial sentence should act as warning to those who intend to defraud the NHS.”
Opinion
What are the real challenges of NHS finances?
In the Guardian this week, Chris Hopson looks at the possibility that the NHS may not be here in 10 years’ time unless it undergoes rapid and radical reform.
“Over the last year, there have been a quarter of a million more A&E attendances to deal with, translating into a total of five million emergency admissions. Nine million 999 calls have been answered; and an estimated 150million different patient interactions delivered by community services.
“This has all been delivered on top of a 4% efficiency requirement and through the largest reorganisation in the NHS‘s history. Complacency is the enemy of improvement, but NHS staff at all levels should take great pride in these achievements.
“This means that the debate now has to change. We can’t go on pretending that all providers can realise 4% recurrent efficiency savings year on year till 2021 without rapid radical reform. Not when that’s twice the long run average for the UK economy as a whole and four times what the NHS has traditionally achieved.
“The NHS has to stick within its financial envelope. But we need an open and honest, rigorous and evidence-based, debate about what really is possible. We need clarity on what reforms are required to meet this size of challenge and how quickly they can be delivered, particularly because we’re three years late starting this debate.”
Hopson concludes by suggesting the next five years will probably be the most difficult in the history of the NHS. “But I am confident that if local NHS leadership teams can meet their leadership challenge, and if the centre can provide the help and support those teams need, then we will emerge strengthened and renewed.”
A brave NHS can make self-management possible
This week in HSJ (subscription required), Jim Phillips, director at the Quality Institute for Self-Management Education and Training and John Worth, CEO at Know Your Own Health, explain why a fundamental reorientation of how services are commissioned and delivered is required if the NHS is to better empower patients and their carers to manage and make decisions about their own care and treatment.
“Self-management support and personalisation through care planning and shared decision making have become core parts of NHS strategy. NHS England’s objective to ensure the NHS becomes dramatically better at involving patients and their carers, and empowering them to manage and make decisions about their own care and treatment has to be welcomed.
“There is an urgent need for input not from large multinational healthcare corporations but from micro and small businesses and entrepreneurs to make this happen. Often these micro businesses are set up and run by people with significant experience of living with a long term condition and borne out of their frustration with the current status quo.
“The NHS must find ways to better stimulate support for entrepreneurship and involvement in healthcare at localised levels so that micro businesses and small businesses can operate in financially viable ways.
“It involves industrialising the work of programmes such as the Year of Care and Co-Creating Health, building on the learning from initiatives such as Nesta People Powered Health, harnessing the outputs of initiatives that have already trained many thousands of lay people who can readily support other patients.
“These people should be encouraged to work as micro businesses working within national quality standards and to be part of a vibrant self-care ecosystem and healthcare economy.”
Three ways to restore faith in technology among NHS staff
In the Guardian this week, Shane Tickell, IMS MAXIMS CEO, discusses three ways to restore faith in technology among NHS staff.
“When it was launched in 2002, the National Programme for IT (NPfIT) in the NHS was predicted to be the world’s largest civilian IT project. Today, it is deemed to be one of the worst and most expensive contracting fiascos in the history of the public sector. It is no wonder that many of those working in the NHS do not trust technology.
There is a misconception that healthcare professionals who do not engage with technology are from a different generation or are not tech-savvy. But ask those same healthcare professionals whether they have a smartphone, use online banking or social networking sites and I guarantee a huge proportion of them will know how to navigate those systems quickly and efficiently.
“Engaging staff in IT procurement at all levels allows suppliers to understand exactly what healthcare professionals need to deliver better, safer patient care. It also allows them to avoid unnecessary extras that sound like a good idea, but that will actually create extra levels of complexity, effort and cost. Similarly, there is so much to learn from peers. What growing pains have they already gone through in implementing a particular system, and how have they achieved their successes? Can you look to them to demonstrate how they have deployed a successful and working solution that is providing benefits for staff and patients alike?
“National and international conferences provide great opportunities to share experiences, but opinion about past failures should not hinder the voice of those truly inspiring organisations that have actually understood the need, studied the market and taken their organisations on a journey that has resulted in success in the form of tangible benefits to patients, staff and the organisation as a whole.
“Ultimately, like in virtually any other industry, having faith in a product or a system comes from past experiences and referrals from people you trust about what to expect. If the NHS had access to this in an easily digestible and accessible way, perhaps faith in technology would gradually be restored.”
The doctor still knows best
In this week’s HSJ (subscription required), Dr Frankie Anderson, a hospital medicine trainee, gives an interesting perspective on the shift in perception of doctors and why it matters.
Anderson begins by explaining how the role of the doctor has changed: “No longer are doctors prepared to work long hours for the sake of their patients, with the introduction of the European working time directive and working time regulations for junior doctors in 2009 limiting the amount of time on the ward to 48 hours per week. Nor are they prepared to dedicate themselves completely to the job. The increasing feminisation of medicine and the drive for part time working from both male and female doctors has made the elusive life/work balance more tangible.”
Amongst the drivers for the shift in perception are the rise of ‘patient power’ and the lack of leadership within the doctor community, Anderson reveals: “Patient expectations have changed. Patients are more internet savvy, better able to negotiate the healthcare system and almost certainly more sceptical of the doctor in front of them. The rise in patient as consumers and the well worn mantra of “no decision about me, without me” have changed patient perceptions on the healthcare system with more vocal and more “empowered” patients demanding flexible opening hours and Choose and Book hospital appointments.
“But with this rise in patient power there has also been a change in how doctors view themselves. The profession has been unable to stand up for itself. The highly successful campaign led by the Daily Mail against the Liverpool Care Pathway resulted in the bizarre affair of the Palliative Care Association initially calling for a review into its own guidelines, before later defending its own practice. Likewise, the muted and confused initial response to the MMR panic showed a lack of leadership.”
Highland Marketing blog
In this week’s blog, Myriam McLoughlin asks whether NHS England and HSCIC’s publicity campaign will hit the mark.
