News in brief
40 million people now have a summary care record: A record 40 million patients now have an electronic summary care record (SCR), according to new figures published by NHS England. NHS England said the number – almost two thirds of the UK population – was a “milestone” and meant health professionals were using the records to improve and speed up patient care, reported OnMedica. The SCR is an electronic record containing information about patients including allergies, medications, and adverse reactions, which is pulled from GP systems and can be viewed by health professionals involved in a patient’s care. The benefit of having this information stored in one place, says NHS England, is that it makes it easier for healthcare staff to treat patients in an emergency, or when their GP practice is closed. The SCR is one of the key projects of the National Programme for IT in the NHS and despite initial scepticism from the public and health professionals around consent and confidentiality, it is now been proving to be a fast and effective system for patients, said NHS England. Initially, privacy campaigners and medical groups raised concerns that patients were not sufficiently informed about the creation of the first, national database of patient records, and that they should opt-in rather than out. The SCR was approved by the present government on an opt-out basis. Beverley Bryant, director of strategic systems and technology at NHS England, said: “The value of the summary care record is being seen in a number of care settings with viewing volumes now growing quickly on the back of the great progress in making records available. This in turn is driving the main objectives, which are improvements in patient care and efficiencies in the NHS.”
Hospitals to scrutinise integration plans: Hospitals will get the chance to check and challenge plans to cut emergency admissions drawn up for the government’s £3.8bn better care fund, new Department of Health guidance reveals. Guidance published by the Local Government Association and NHS England said councils and clinical commissioning groups would be required to share their forecasts for reductions in emergency hospital admissions with local acute providers. According to Health Service Journal (subscription required), providers would be asked to submit a “commentary” on these forecasts, in which they must “confirm the extent to which they agree with the projections” and say whether they have built the same assumptions into their own two-year plans. These commentaries are expected to prove highly influential when the Department for Communities and Local Government and NHS England decide whether to sign off local plans. Earlier this year, the Foundation Trust Network warned that “not enough providers are being engaged in a meaningful way in their local [better care fund] plans”, adding that its own research found just 54% had been involved in the development of plans and just 2% had been “fully involved”. The new requirement comes weeks after ministers announced a set of restrictions on the use of NHS money from the better care fund. This included a requirement for £1bn of the fund either to be spent on NHS commissioned out of hospital services, or to be paid out based on meeting targets for a reduction in emergency hospital admissions.
Hand hospitals over to their staff, says Francis Maude: More NHS hospitals and youth services should be taken out of public hands and owned by the people who run them as mutuals, Francis Maude, the cabinet office minister, has said. The senior Conservative MP told the Guardian that he was “more and more convinced” this was “the way of the future” for a greater proportion of public services – suggesting the only exceptions from possible spin-offs should be front-line police and the armed forces. Unison has criticised the process as a “Trojan horse for privatisation”, as spun-out services can subsequently be taken over by private firms. It also claims they “frequently mask top-level buyouts without any real input or buy-in from staff”. There are already around 100 former public-service mutuals, including many in the area of community health services, and Maude’s drive for more is now focused on hospitals and youth services, where he said mutualisation could help providers to “find new ways of doing things”. The Tory minister said he had a “missionary fervour” about the idea and pointed to expert estimates that predicted one million out of six million public sector employees could end up working in mutuals. He said youth services was a good area for managers to take over as “in the current environment there’s a tendency for councils to cut their youth services funding, and mutualising is a very powerful way of making the money go much further”. As part of the push, Maude and Norman Lamb, a Liberal Democrat health minister, have written to all leaders of NHS trusts, encouraging them to consider mutualisation, and met chief executives of acute trusts to discuss the concept last month. He said many had “come really sceptical” but gone away saying: “This is now something I really want to look at.”
Burnham calls for halt to NHS ‘privatisation’: The introduction of clinical commissioning groups (CCGs) was an “indefensible” change to the character of the health service made without public consent, shadow health secretary Andy Burnham has argued. The Commissioning Review says, Burnham believes the latest NHS restructuring has led to “privatisation being forced through at pace and scale”. Labour claims the public needs a “proper debate” about the future of the health service. Burnham has written to NHS England chief executive, Simon Stevens, to ask for a pause in privatisation unless patient safety is at risk. However, NHS Clinical Commissioners co-chair Dr Steve Kell said he is “quite clear” that CCGs do not have a privatisation agenda. He said: “CCGs are independent statutory bodies with a clear focus to improve services for our patients – to stop clinical commissioners from signing contracts where a local need has been identified will leave gaps in local clinical services, putting patients at risk.” The government said Burnham’s comments were “pure political posturing” from a party with a record of privatisation when in power.
Princess Alexandra live with Cosmic EPR: Princess Alexandra Hospital NHS Trust has become the first UK trust to deploy the Cosmic electronic patient record system (EPR) from Cambio. The 489-bed hospital, which signed a ten year contract with the Swedish supplier in April last year, went live with the EPR last week. It had aimed to go-live before March this year, when its McKesson Totalcare patient administration system contract was due to expire, but decided to delay the go-live until it was completely ready. Speaking to eHealth Insider, the trust’s chief information officer, Anthony Lundrigan, said that going live within 17 months of signing the contract was a great achievement. He added that while there are “challenges” with deploying a ‘first of type’ system, it has been a success so far, with 2,000 users trained and using the system. “We went live on the 20 July with our emergency department, maternity and inpatients, and then on the 21 July in outpatients. It went really well and we’ve had some very positive feedback from staff,” he said. The trust has gone for a partnership approach with Cambio, working closely with the supplier to get the system “just right” for its staff. “One of the challenges has been to describe our clinical processes, set out what we want to achieve, articulate that to the supplier, develop the Cosmic EPR to fit with that, and then work out the elements with data migration, testing, user training, and dress rehearsals.” Lundrigan said success to date has been down to having people from all areas of the trust, from executives to clinicians, “rolling up their sleeves” and working together.
Telecare “not magic bullet” – WSD study: Policy makers have been warned to avoid describing telecare as a “magic bullet” in the latest study to cast serious doubt on the cost effectiveness of remote monitoring and intervention, eHealth Insider has reported. The Whole System Demonstrator (WSD) projects in Newham, Kent and Cornwall were set up by the Department of Health in 2008, with the explicit aim of finding an evidence base for telehealth and telecare. A single paragraph of ‘headline findings’ were used in December 2011 to justify the launch of the 3millionlives programme to try and kick-start the industry. At the time, Prime Minister David Cameron claimed the NHS would spend £750m implementing the technology, but save £1.2bn a year; helping individuals and driving innovation in the process. However, since then, more detailed results from the evaluation of the telehealth elements of the WSD programme have found they are not cost effective and may not be of much benefit to patients. The new study looked at telecare, and compared a group of patients who received ‘second generation’ packages of sensors, monitoring devices, and call centre support, with a control group that did not receive the same interventions. In a discussion, the authors acknowledge that the extra, ‘traditional’ services received by telecare recipients could well have benefited them, and that some other benefits of the technology – for example for carers – may not have been captured by the study. “However,” they conclude, “we found that a package of second-generation telecare equipment [and monitoring services] did not constitute a cost-effective alternative to usual care, assuming a commonly accepted willingness to pay for QALYs [quality adjusted life year]. “For the present… policy makers should avoid characterising the technology as a ‘magic bullet’.”
New portal keeps track of NHS procurement spend: Hospitals across the country will now be able to compare prices paid for everyday items such as catheters, gloves, and needles as part of the government’s response to criticism over poor procurement practices within the NHS, reported Building Better Healthcare. The newly unveiled NHS Procurement Atlas of Variation is effectively a league table of trusts, showing differences in the amount hospitals pay, enabling them to compare prices and identify where they need to drive down costs so they can re-invest in frontline services. Announcing the launch, health minister Dr Dan Poulter, said, “The NHS budget has been increased but the reality of an ageing population, rising patient demand and more-expensive treatments means our NHS needs to spend money wisely in order to direct every penny into frontline patient care. We are delivering on our promise to improve the way our NHS buys goods, equipment and services to make sure taxpayers’ money is spent efficiently and more money is available to look after patients. Our new league tables will make the NHS a more open and better place in which to do business for small and medium sized businesses. Improving procurement practices is about making sure that money is going where it needs to – on patients – and not down the drain.” The NHS Procurement Atlas of Variation is a key component of the government’s drive to make £20bn worth of efficiency savings within the NHS by 2015 while continuing to improve and enhance services.
TDA investigates why winter pressures have continued into summer: The NHS Trust Development Authority (TDA) is undertaking “urgent work” to investigate the “unexpectedly high” demand for acute services that has seen winter pressures continue into the summer, according to Health Service Journal (subscription required). A report to its board last week said the work would examine what was behind the apparent surge in demand and support providers in their response. The board heard trusts had missed all national accident and emergency and ambulance targets and a number of elective care and cancer standards in May. During that month 93.9% of patients waited less than four hours at A&E departments, missing the 95% target. Trusts also fell short of a target demanding 90% of admitted patients are treated within 18 weeks of referral, with performance at 88.2%. Dale Bywater, the TDA’s director of delivery and development for the Midlands and the East, said the pressure on A&E departments had not abated from last winter. “At this time of year we generally expect some recovery after the winter period,” he said. “That hasn’t been the case this year; there seems to be an increasing pressure on A&E departments… admissions and attendances are fairly significantly up on this time last year. This feels less now like a winter/summer service, [and] much more of a norm that’s facing organisations.” Bywater said one of the reasons pressure had continued was because of the increasing frailty of patients attending A&E departments.
NHS England issues genomics tender: NHS England has issued an invitation to tender for organisations wanting to become genomic centres for its project to sequence 100,000 genomes. The project, which was launched by health secretary Jeremy Hunt in June last year, will sequence human genomes and link these to electronic patient records. eHealth Insider previously reported that NHS England aims to have the 100,000 genome sequences done by the end of 2017 and expects to select five genomics centres in the first wave of the project. NHS England has now issued its invitation to tender, which says a key criteria will be the ability to “commence delivering services by 1 January 2015.” The first wave is split into two stages, the first is a pre-qualification exercise to allow NHS England to assess the applicants’ previous experience. “In the second stage, applicants will be asked to respond to a draft contract and detailed specification in addition to other relevant information,” says the invitation to tender document. “Based on the results of the second stage of this procurement process, NHS England intends to award contracts for wave one to a minimum of five applicants.” The 100K Genome project is led by a new arm’s length organisation called Genomics England, which is owned and funded by the Department of Health. NHS England is responsible for a number of “deliverables” on the project, including identifying, collecting and supplying high quality samples for the project, ensuring “clinical advocacy” and developing an “effective clinician and patient feedback mechanism.”
England records rise in dementia diagnoses: The number of people in England diagnosed with dementia has risen by 62% over seven years, reported the BBC. In 2013-14, 344,000 people received a diagnosis – up from 213,000 in 2006-07, when statistics were first collected. The provisional figures also suggest an 8% rise in the number of recorded dementia cases since 2012-13. The rise could be due to a number of factors, including an ageing population and improved diagnosis, the Health and Social Care Information Centre (HSCIC) said. Hilary Evans, director of external affairs at Alzheimer’s Research UK, said the figures gave some idea of the scale of the challenge in England. “This report does not set out to investigate the reasons for the rising figures, but it’s likely that recent moves to improve dementia diagnosis rates, along with an ageing population, will have contributed to this increase,” she said. The HSCIC said the data would be used in planning services. “We are all aware of the challenges facing our ageing population, and these figures will be vital for those planning and monitoring the effectiveness of dementia treatments and services,” said chairman Kingsley Manning.
Sharp cuts leave NHS mental health services unable to cope, GPs say: Family doctors have warned of the deteriorating state of mental healthcare in England, after a survey revealed that one in five had seen a patient come to harm because they could not get specialist help, according to the Independent. GPs reported that some patients had committed suicide or been sectioned because of a lack of available community mental health services. More than eight in 10 GPs now believe that their local mental health teams cannot cope with caseloads, and nearly half said that the situation in their area had got even worse in the past 12 months. The survey of 500 GPs, which was carried out by Pulse magazine, represents stark new evidence of the strain on England’s mental health services, which have been disproportionately affected by NHS budget squeezes in recent years. Despite government commitments that mental health would be given “parity of esteem” with physical health, the amount spent on the services has been cut more severely than other sectors. Charities warned earlier this year that NHS England’s decision to cut tariffs for mental health by 1.8% would cost lives, and Pulse’s findings, gathered from GP surgeries around the UK, appear to bear out those fears.
Open source survey launched: The second edition of a survey about open source within the NHS will help to measure how attitudes towards its use are changing following NHS England initiatives, its creator has said. eHealth Insider reports that the survey is being conducted by John Pyle, an open source consultant for NHS England, as part of his MSc thesis at the University of Leeds. “I felt as though open source systems offered more opportunities to align the values we wanted to get out of the software, and yet this wasn’t taking off anywhere in the NHS.” The survey includes questions about people’s personal attitudes to risk and the speed of implementation, the perceived strengths and weaknesses of open source and proprietary solutions, and their overall preference regarding open source. Pyle initially ran the survey in the summer of 2013, receiving 134 responses. However, he decided to re-run the survey following the launch of NHS England’s open source programme and technology fund, due to their emphasis on open source solutions. Pyle said the results of the survey will be written up for his master’s thesis, and he plans to submit an article on his findings for publication in an academic journal. He also plans to share his findings with NHS England, with the hope of providing suggestions on how concerns about open source can be addressed more effectively.
‘Healthy app’ event to stimulate innovation: A workshop designed to stimulate innovation and collaboration in digital healthcare recently took place in Liverpool. The first ‘healthy app’ workshop brought together key policy makers across the NHS to emphasise how important sharing knowledge and learning is between the NHS, local government, and other key stakeholders, reported Integrated Care Today. The event, hosted by the North West Coast Academic Health Science Network (NWCAHSN), assessed how far apps could influence the NHS. The event also examined what is already occurring in the marketplace and how the established healthcare framework can foster the development of future healthcare apps. Dr Liz Mear, CEO of the NWCAHSN, said: “Apps are now a part of everyday life and the event was a great way to examine how they are now incorporated into healthcare. The NHS already has a number of apps available and we were able to begin a discussion into what works and what needs to be resolved in the use of apps.” The event was the first of two to be held across the North West, with others set to take place in Lancashire and Cumbria.
Opinion
Burnham’s politics will have an instant impact on CCGs’ policy
Alastair McLellan, the editor of Health Service Journal (subscription required) discusses the potential impact that the shadow health secretary, Andy Burnham’s powerful speech is likely to have on local decisions in the NHS.
“By formally asking NHS England chief executive Simon Stevens to place a moratorium on the tendering of “clinical contracts”, Mr Burnham is doing two things: he is attempting to politicise the position of the erstwhile commissioning board, and he is putting a shot across the bows both of commissioners keen on using competition and their potential private sector suppliers.
“The shadow health secretary is working hard to demonstrate causation between the NHS’s problems and the use of the private sector, though he will know most of his “evidence” is actually correlation.
“The impact Mr Burnham’s speech will have on local decisions being considered today will be significant. It will fire up local opposition – but more importantly it will embolden those resisting use of competition from within.
“The double impact of Mr Burnham’s move will be that: these major contracts are likely (as admittedly they always were) to be won by NHS providers; and that private sector suppliers will withdraw from competition of their own volition or, as result, of the inability to raise funds from concerned investors. So, Mr Burnham has already, though perhaps only temporarily, put the brakes on the NHS’s use of the private sector long before the election result is known.
“They also need to consider how this policy affects the party’s desire to allow smaller businesses more access to state funded work – much recent growth in the health sector has come from NHS community services contracts being won by locally based private suppliers.”
The husky that came back to bite
eHealth Insider’s editor, Jon Hoeksma, says transparency is needed on how Fujitsu came to exit NPfIT and then win £700m if we are to avoid such an epic waste of taxpayers’ money in the future.
“The architects of the NHS National Programme for IT were fond of boasting that they had negotiated eye-wateringly tough contracts with suppliers that would punish failure and reward success. Yet this week it emerged that the Department of Health will have to pay Fujitsu more than £700m in damages at the end of a long legal dispute over the company’s departure from NPfIT in 2008.
“This shows just how completely those in charge of the programme failed by trying to manage digitisation and service reform by contract and penalties. How did we get into such mess?
“Famously, Richard Granger, the original director general of NHS IT, promised he would manage suppliers to the national programme by shooting “huskies” that failed to deliver. The idea was that the weaker dogs would be shot and fed to the rest, in order to sustain them and to encourage them to pull harder. But now, as in the second reel of a horror movie, the Japanese husky that was cut loose and taken out into the snow has come back to bite with a vengeance.
“Since 2008, we’ve had a global economic crisis of such a scale that £700m has almost become devalued and debased. But let’s not forget just how much benefit £700m could have bought the NHS if spent on clinical IT alone.
“It’s a greater sum than all the IT investment the government has made available in the past two years through the two technology funds – of £240m and £260m – and the Nursing Technology Fund of £100m.
“Even those legal fees of £31.5m are an awful lot of money for claret and wigs that could have been invested in NHS digitisation – they’re about a quarter of the cost of primary care IT annually.
“Transparency is needed on the decisions taken in 2008 and on the arbitrator’s 2014 settlement if we are to make sure that such a failure is learned from and not repeated. There really is a compelling matter of public interest.”
We bean counters need to speak out about NHS cuts
Finance staff could make a stand without any direct impact on patient care, so why don’t we, asks Jonathan Allsopp.
“Pen pushers, bean counters, faceless bureaucrats, stuffed shirts, spreadsheet monkeys, grey suits… are all terms that I have heard applied to the national health service’s finance staff. I am one of the “bean counters” and until recently it was largely a case of sticks and stones for me. We are an easy target for vote-hungry politicians keen to show how they can save a few bob for the public purse. But peer beyond the lazy rhetoric and it is possible to appreciate that, although we might not be the ones caring for patients, we have a crucial part to play in ensuring that a vast organisation faced with rising demand and a finite level of funding uses its resources wisely. It can be the difference between whether some patients get the care they need or not.
“The NHS is in the final year of a four-year challenge to save £20bn. This is dressed up as “efficiency savings” and “cost improvement programmes” but in reality it means cuts to services, staff pay freezes and pensions “reform”. That’s not enough for NHS England, though, which estimates that the NHS needs to find a further £30bn of savings by 2020-21. In the meantime, the government has the cheek to pretend that NHS funding has somehow been ring-fenced.
“The Health and Social Care Act of 2012 has made it so the NHS can be chopped up and packaged off to private health companies. Between April and December 2013 over £5bn worth of NHS services were put out to tender with 70% of the 400 contracts awarded to a private sector provider; from cancer services in the east Midlands to psychological therapies in Barnet. Yet finance managers appear reluctant to speak out about the changes. The NHS is “unaffordable” is the oft-repeated justification for these cuts. It is not though. Nowhere do I hear one of the NHS’s highly paid finance directors speaking out about the damage done by these financially driven reforms.
“There is the real prospect of austerity stretching way beyond 2020. It is time our profession found its voice on the state of NHS finances and what it means for patients and services. We cannot go on pretending that taking £20bn and more out of the NHS will have no impact on the quality of the service that it provides. In a recent interview, Margaret Hodge, the chair of the public accounts committee said of the NHS: “It’s the public service most under threat, yet everyone’s in denial.”
“I do not want to be part of a fragmented health service that places financial considerations above the needs of patients. Let us show that we are capable of more than pushing pens and counting beans. Let us show that we really care about our health service and the patients who use it. Let us demonstrate some social solidarity and join the doctors, nurses, therapists, other healthcare workers and members of the public fighting to save our NHS.”
Highland Marketing blog
In this week’s blog, Gregor MacKenzie explains how open source solutions benefit both the end-user and the supplier, and why the vendors should reveal their ‘secrets’.
