News in brief
Integration pioneers leading the way for health and care reform: Fourteen pioneering initiatives are transforming the way health and care is being delivered to patients by bringing services closer together than ever before, reported The Department of Health. The pioneers are showcasing innovative ways of creating change in the health service, which the government and national partners want to see spread across the country, Care and Support Minister Norman Lamb announced this week. The 14 ambitious initiatives are blazing a trail for change by pioneering new ways of delivering coordinated care. They have been selected by a renowned panel of experts, including international experts drawing together global expertise and experience of how good joined up care works in practice. The aim is to make health and social care services work together to provide better support at home and earlier treatment in the community to prevent people needing emergency care in hospital or care homes. Results from these approaches in the pioneer areas include: Two thousand fewer patient admissions over a two and a half year period, achieved through teams of nurses, social workers, occupational therapists and physiotherapists working together to prevent crises and setting up a crisis house where people who suffer mental health problems can get intensive support.
2015 records access promise scaled back: The government’s pledge for patients to have online access to their GP record by March 2015 will only require access to the brief information held on their Summary Care Record (SCR), reported eHealth Insider (EHI). Kathy Mason, NHS England’s Patient Online programme lead told EHI that providing access to the same information as held in the SCR is the minimum that GPs must do by March 2015. NHS England will identify and evaluate a series of “accelerator sites” to build a case for providing full records access in the future and will release guidance in April 2014 for practices to make progress towards this goal. “We want to get everybody at least to a minimum level by 2015 then work with accelerator sites to really push the boundaries,” Mason added. The SCR contains a core set of clinical data, including allergies, medications and adverse reactions, but there is work going on to enrich it. The government has made a commitment that by 2015, all patients will have secure online access to their GP record if they want it. All practices must also make transactional services available online such as booking appointments, ordering repeat prescriptions and e-consultations. Mason acknowledged to EHI that some patients will be disappointed with the level of records access on offer by 2015, but said the government has not rolled back on its promise.
GP and hospital records to be ‘linked’ by June: NHS England has announced that the flagship patient data service, care.data, will be able to “link” data from patients’ GP records to their hospital records by June next year, reported Health Service Journal (subscription required). Linking up the data across different care settings will allow the NHS to have “a full picture of all the care that is going on across England” and facilitate smarter commissioning and improve patient outcomes, NHS England said. Patient data from other care settings, such as community and social care, will be incorporated in the future but the first iteration will see GP records linked with hospital episode statistics data. NHS England revealed last month it had pushed back its timetable to begin extracting patient data from GP records, a move that has sparked concern among privacy campaigners. This will now take place in March 2014 instead of this autumn, as it had previously stated. Tim Kelsey, NHS England’s national director for patients and information, said: “Sharing and linking information from all the different places where care is received such as GP surgeries, hospitals and community services will help the NHS to have a full picture of all the care that is going on across England. This will help the NHS and the life sciences sector to see what care and treatments have worked best and will lead to improvements in the health service for everyone.”
Lewisham cuts ‘unlawful’ – Hunt loses appeal case: The Court of Appeal has upheld a High Court ruling that the health secretary, Jeremy Hunt, acted outside of his powers when he cut services at Lewisham Hospital earlier this year, reported National Health Executive. The cuts to maternity and emergency services had been recommended by a Trust Special Administrator to the neighbouring South London Healthcare Trust. Campaign group Save Lewisham Hospital and the London Borough of Lewisham brought the challenge against the government. Rosa Curling, who represented the campaign group, said: “We are absolutely delighted with the Court of Appeal’s decision. This expensive waste of time for the government should serve as a wake-up call that they cannot ride roughshod over the needs of the people. The decision to dismiss the appeal also reaffirms the need for judicial review, a legal process by which the unlawful decisions of public bodies, including the government, can be challenged by the public.” Hunt said: “I completely understand why the residents of Lewisham did not want any change in their A&E services, but my job as health secretary is to protect patients across south London – and doctors said these proposals would save lives. We are now looking at the law to make sure that at a time of great challenge the NHS is able to change and innovate when local doctors believe it is in the interests of patients.”
HSCIC to support open source: The Health and Social Care Information Centre (HSCIC) will extend its support for NHS organisations and providers using open source, open interfaces and cloud technology to increase integration across health and social care, reported eHealth Insider. A draft of the HSCIC’s strategy for 2013-2015 presented at the centre’s latest board meeting says it will focus heavily on supporting interoperability, open source software and the use of application programming interfaces. “By March 2015, we will develop and publish for consultation a 10-year strategic technology futures framework that majors on integration across social care into healthcare services, ensures that there is greater use of cloud technologies, open source, and other new developments, as well as increased use of standards for interoperability,” says the strategy. It adds that the HSCIC will work with the market to support the new requirements this will create, “particularly in regard to the use of open source software and the development and use of APIs (application programming interface). This will have implications for the operating model that is used to manage and develop the national infrastructure in the future,” it says. The HSCIC will focus on engaging small to medium enterprises to create competition in the market and open it up to a larger number of suppliers.
Higher death rate NHS trusts named: Seven NHS trusts have higher than expected death rates for patients who die in hospital or within 30 days of discharge, according to new data, reported Health Service Journal (subscription required). Three of the trusts have had higher than expected rates for the last two years, according to figures from the Health and Social Care Information Centre. The report covers all deaths of patients who were admitted to non-specialist acute trusts in England and either died while in hospital or within 30 days of discharge. It comes after a report from the Care Quality Commission (CQC) last week revealed 44 trusts out of 161 were highest risk, including having higher than expected death rates across their hospitals. In total, the CQC looked at 150 indicators of how trusts were doing, including incidents involving patient safety, whistleblowing staff and patient satisfaction with care. The CQC put England’s trusts into six bands, with band one being the highest risk and band six the lowest. It said the banding was not a final judgment on the trusts but would help inspectors work out where they needed to focus their attention. The data showed seven trusts had higher than expected death rates, including several placed in band one by the CQC and some labelled as much lower risk by the regulator. They are Basildon and Thurrock University Hospitals Foundation Trust, Aintree University Hospital Foundation Trust and Northampton General Hospital Trust, all placed in band one by the CQC.
SMEs key to redefining 3millionlives: NHS England wants more input from small and medium-size enterprises as it works on redefining the 3millionlives programme, reported eHealth Insider (EHI). An announcement on a new direction for the programme, originally due to deliver telehealth and telecare to 3m people by 2017, is due next month. During the April shake-up of the NHS, NHS England took over responsibility for 3millionlives. One of the first things it did was to scrap the 3millionlives industry group, set up to promote the government’s effort to recruit patients. It has been replaced by the ‘Integrated Care for 3millionlives Stakeholder Forum’, which NHS England’s head of collaboration for excellence, Rachel Cashman, describes as a step towards getting rid of the silos the programme previously operated in. “The old industry group was a ‘pay to play’ group,” she added, referring to the significant funding industry organisations had to commit to join. “We decided that if we were going to put in a new model, that wouldn’t be feasible moving forward.” Cashman told EHI that after undertaking an initial review of the programme, the organisation decided that 3millionlives needed to become more of a partnership project to support integrated care.
Watchdog criticises ‘avoidable’ hospital admissions: There are too many emergency admissions to hospitals in England, according to a government spending watchdog. The National Audit Office (NAO) says there were 5.3m such admissions in the last financial year – a 47% rise in 15 years – and many of these patients stayed in hospital for longer than necessary, reported the BBC. It says it is “critical” for the NHS to do better in dealing with these issues to cope with rising winter pressures. NHS England says “big decisions” are needed to develop alternatives. The NAO report looks at how well emergency admissions to hospital are managed. These are admissions that are not planned, and happen at short notice because of the perceived clinical need. The report points out that, although admissions per head of population are lower in England than in Scotland and Wales, the rate of increase over the past decade has been much higher. A big factor is the growing proportion of patients attending major A&E departments who are admitted. Ten years ago it was fewer than one in five. Now it is more than one in four. However, the NAO estimates that at least a fifth of patients admitted as emergencies could be managed outside hospital. It concludes that going to A&E and then being admitted has become the “default route” for urgent and emergency care.
Telehealth has ‘little impact’ on GP workload, study reports: The long-term success of telehealth services depends on the NHS redesigning the way it delivers care, a new study warns. Analysis of the government-backed Whole Systems Demonstrator study by the Nuffield Trust shows no change in the number of times patients using telehealth systems contact healthcare professionals, reported Building Better Healthcare. The findings appear to go some way to allaying fears that assistive technologies could increase demands on primary care, but they also fail to support the government’s claim that the widespread rollout of systems will lead to a significant cut in GPs’ workloads. However, the authors of the research, which was published in Biomedcentral Health Services Research, did note that telehealth could have a different effect on workload if current systems were designed differently. They said the findings showed ‘fears that the widespread increase in the use of this technology may increase the burden on primary care are unfounded’. However they added: “Conversely, we did not find evidence that telehealth led to a significant reduction in GP workload.” The study looked at data from 179 practices and found no change in contact frequency between patients being remotely monitored through telehealth technologies and those receiving standard care.
Scotland’s new Digital Health Institute unveiled: Scotland’s pioneering Digital Health Institute (DHI) was officially launched in Edinburgh to an audience of leading figures in the global healthcare sector and multi-national technology companies, reported eHealthNewsEU. Portal. The DHI, a collaborative partnership between public and private organisations, brings together the country’s leading health and care operators and engages technology businesses across Europe, the United States and Asia to speed up research and development in order to produce innovative new technologies that will transform the quality of people’s lives and help Scotland become an exporter of world-leading products and services. The DHI, which is a consortium partnership between the University of Edinburgh, The Institute of Design innovation at The Glasgow School of Art and NHS 24, is supported by an £11 million five-year investment from the Scottish Funding Council. Its long-term goal is to use digital technology to tackle the increasing demands on the health and care system in Scotland caused by an ageing population, while at the same time producing a direct economic benefit by securing a share of the global digital health marketplace. By 2018 the DHI aims to establish Scotland as a world-leading centre of excellence in the field and help produce up to 140 new commercial products and services that will benefit society.
More than half of CCGs considering plans for GP extended hours: More than half of England’s Clinical Commissioning Groups (CCGs) are already considering plans for extended opening in GP practices above and beyond the current incentivised service, with more than a quarter at the stage of actively planning such schemes, Pulse has revealed. Figures obtained from 129 CCGs under the Freedom of Information Act reveal that 57% of CCGs are either actively planning commissioning of extended hours – above and beyond NHS England’s extended hours DES and the central pilot scheme announced by the Prime Minister – or are considering doing so. The schemes being actively planned are a variety of extended services funded by CCG money and, in some cases, approved bids from the central ‘winter monies’ pot, the £500m the government is giving to certain areas to deal with urgent care pressures this winter. As previously reported by Pulse, practices around Greater Manchester will be taking part in a £2m scheme to improve services to patients, including access, while three practices in Westminster in central London will open a weekend walk-in service to registered and non-registered patients. A total of 129 CCGs responded to Pulse’s request. Of these, 57% said they were planning or considering extended hours schemes, with only 9% saying they were not planning any such scheme. The remaining 34% said they did not hold any information. Of the 129, 26% were actively planning these schemes, with 31% considering plans at this stage. The news comes after the government announced a £50m ‘pioneer’ scheme across England, which GPs will be able to bid for from December in return for providing improved access in weekends and evenings as well as via new technology.
Give hospital patients pen and paper to report bad care, report says: Hospital patients should all be given a pen and paper by their bedside allowing them to record and raise examples of bad care, a damning report has recommended. Prof Tricia Hart and the Rt Hon Ann Clwyd MP said a “revolution” is needed to end the “delay, deny and defend” attitude with which the NHS handles complaints, reported The Telegraph. Many patients are deterred from raising issues about their care because they are too confused by the complex complaints procedure, they said, while doctors and nurses are often dismissive and rude about those that are reported leading to fears of reprisals. This often leads to “minor concerns” which could have been easily resolved being neglected until they become “major problems or lead to formal complaints”. The review of the NHS complaints process was commissioned by the Department of Health following the Francis Report into the Mid Staffordshire scandal, which highlighted that complaints are a warning sign of a hospital’s problems. Anna Bradley, chair of Healthwatch England, added: “People simply don’t know where to go if they have a problem. They just want their complaints dealt with quickly, efficiently and to see that it has made some practical difference for the future. Today’s report is another indication of how far there is still to go before people get the complaints system they deserve.
Milton Keynes’ A&E is ready for 2013 winter pressures with new technology: Following reports that A&E departments have become “like warzones,” and are “out of control”, Milton Keynes Hospital NHS Foundation Trust, now has new technology to support the hospital’s A&E department, reported MK WEB. The winter of 2012 was a challenging period for the Milton Keynes A&E team so the new software aims to improve hospital services and patient care. The use of Caradigm’s intelligence platform has resulted in doctors spending less than one minute at the computer, compared to about eight minutes in the past – giving them more time to spend with patients. Since the changes, patients have reported improvements in the care they have received. A&E consultant Dr Vimal Desai said: “The imperatives were to develop a system that the team could use quickly, simply and that we could develop with practice – and without lots of time consuming IT problems. Above all, our team greatly appreciate being able to spend more time with patients and less on mentally exhausting administrative work.”
Graphnet commissions Shearwater portals: The two founders of System C have launched a new company and announced that it has been commissioned by Graphnet Health to create portals for its electronic health record, reported eHealth Insider. Markus Bolton and Dr Ian Denley announced a year ago that they were setting up Shearwater Healthcare Solutions as a health IT accelerator. They have now launched Shearwater Systems, with £2.2m of initial funding from private investors and Kent County Council to develop a range of healthcare IT products, including two portals. They have also announced that Graphnet Health, in which Shearwater Healthcare invested earlier this year, has commissioned the company to adapt the portals for its CareCentric shared care record. CareCentric is used by a number of healthcare communities to hold and share information from multiple care settings. It holds half a billion health and social care documents for 17m patients across 42 NHS organisations. These include GP surgeries, acute trusts and other bodies in Hampshire, where the technology underpins the Hampshire Health Record. The Shearwater Systems portals will be used to make this information accessible to clinicians on tablets and mobile phones, and to patients on mobile devices and PCs.
Bristol Community Health CIC is now mobile: Following on from a successful pilot, social enterprise and NHS healthcare provider Bristol Community Health CIC has gone live with the TotalMobile App Platform across three of its community healthcare teams and its citywide phlebotomy service, reported eHealthNewsEU. Portal. The TotalMobile App, a mobile workflow management solution, allows healthcare professionals to spend less time on administration and travel, and more with patients. Healthcare professionals within Bristol Community Health such as community matrons, district nurses, phlebotomists, and community nurses for older people are able to view patient demographic and clinical records, update patient information and record clinical activities at the point of patient contact by working with mobile devices such as tablets. Hannah Burge, community nurse at Bristol Community Health said: “I love mobile working – I feel less stressed and more organised because I am able to do all documentation for that patient while I am with them before I move onto the next patient. This also means that my clinical documentation now is bound to be more accurate.” Bristol Community Health is the provider of NHS-funded Community Healthcare in Bristol and its surrounding areas and has 30,000 interactions with patients every month. The TotalMobile App has been deployed to over 60 clinicians for proof of concept during the pilot.
NHS England to join IMS MAXIMS at EHI Live to talk open source: NHS England will be joining IMS MAXIMS on stand A44 at this year’s annual EHI Live conference and exhibition on November 5-6 at the NEC, Birmingham, reported eHealthNewsEU. Portal. IMS MAXIMS is one of the first suppliers in the UK to discuss an open source package for patient administration systems and electronic patient records. Delegates are invited to the stand to find out more about open source and what it could mean for them. Shane Tickell, IMS MAXIMS CEO, said: “As covered in the press, we have recently been discussing the possibilities and advantages of making some of our software open source with NHS England. NHS England is leading the way in creating a “vibrant market” of national solutions and products that are available under open source licensing arrangements. Having a representative on our stand will give delegates, from IT directors to clinicians, an opportunity to ask any questions they may have on open source and its benefits, in an informal setting.” In addition to discussing open source, IMS MAXIMS will be demonstrating solutions that are proven to assist in meeting CQUIN targets. These include the MAXIMS Dementia Module and the MAXIMS VTE Module.
Highland Marketing ‘Live at EHI Live’: NHS leaders including Tim Kelsey will join healthcare industry experts at EHI Live next week to discuss critical challenges facing the health service. Highland Marketing will be streaming a live blog direct from the event, bringing you the latest key announcements and reports from the conference and rich content live from the exhibition floor. To stay informed throughout follow the blog at highland-marketing.com/live.
Opinion
Pathway to privacy – rebuilding trust in patient records
In this weeks’ Public Servant Daily Tim Dunn, general manager at FairWarning UK, discusses that in the wake of the government’s response to Caldicott2, the need to take NHS services into the digital age and the importance of taking ownership of the process in order to improve patients’ trust in the use of electronic records is key.
“The government has finally published its long-awaited response to the Caldicott 2 review of information sharing in the NHS – and, as many of us had hoped, has accepted all of its recommendations.
“The government response reaffirms the belief that better information sharing can help the NHS meet many of its strategic goals, and lead to more effective and efficient healthcare services, enhanced care pathways and improved patient outcomes. But a critical success factor for sharing health information will be ensuring that it is done in such a way that it reassures patients that their privacy will be protected.
“SIROs have been in existence within trusts for a number of years, but the significance of the role has been reinforced by the Department of Health (DH) response to Caldicott 2.
“The SIRO’s key purpose is to lead and implement information governance risk assessment and management processes, and provide assurance to the CEO and board of the effectiveness of the trust’s information risk management.
“Caldicott 2 represents a significant milestone in the UK’s ambitions to harness the power of information. To seize the opportunity, SIROs should redouble their efforts to drive collective responsibility across the organisation, and set up an appropriate information risk framework that focuses the trust on the importance of data transparency.
“The secure, timely and effective sharing of patient information can transform healthcare services in the UK. But it will only succeed if patients’ personal data is treated with propriety and respect.”
Can telehealth reduce demand on GPs?
Dr Martin Bardsley from the Nuffield Trust, asks whether telehealth can change the frequency with which people use GPs and practice nurses.
“Many people believe that telehealth can radically change the way we use health services, and it is often given the tag of a disruptive technology – something that doesn’t necessarily fit with our traditional ways of doing things. Yet the evidence of the benefits of these technologies on the management of chronic disease is irritatingly ambiguous.
“The impacts of telehealth are often assessed in terms of reduction in hospital admissions and few studies look at the changes in use of GPs that arises from home based monitoring. Yet GPs should be an important group in promoting and exploiting the use of these technologies. We considered that telehealth could impact on GPs in two ways.
“We actually found no differences between intervention and control during the course of the trial – patterns of GP contacts appeared unaltered – so not disruptive at all. We also noted that the technology used in this trial did not allow routine sharing of information between the telehealth technology and GP records – something that should probably happen in an ideal world of integrated information systems.”
Concluding, Bardsley suggests that: “The results should reassure those GPs who fear telehealth may lead to greater demands on their time – yet it is disappointing that we could not detect a significant reduction in the use of GPs.”
Digital reform within the NHS is not a choice, but a necessity
In The Guardian this week, Orlando Agrippa, associate director of business informatics at Colchester Hospital University NHS trust, discusses one of Professor Bruce Keogh’s ambitions for the NHS to have the leadership using data competently.
“The recent publication of the Keogh review looking into 14 hospital trusts has sent shockwaves at a national level to the quality of healthcare in the NHS. In many cases, the problems are also financial, with nearly a quarter of clinical commissioning groups struggling each financial year.
“One of Professor Keogh’s ambitions for the NHS in his recent report is to have the boards and leadership of provider and commissioning organisations using data competently. As an example, NHS Tayside, the largest teaching hospital in Europe, uses a business discovery provider called QlikView to understand demand and capacity in its hospitals and outpatient clinics. The trust has complete visibility of where they can deploy resources and as a result can manage queues in several of its departments.
“Similarly, Colchester hospital University foundation trust (CHUFT) also uses data to help manage queues in A&E. Only recently CHUFT remained only one of 18 trusts that was meeting the emergency department four hour standard and this was largely due to technological innovation. Elsewhere in the trust, the stroke department has moved from the bottom quartile to upper quartile of the national standard in just under two years; or from when its data started being analysed.
“It doesn’t have to stop here. Procuring and deploying these technologies and applications shouldn’t be a pipedream for trusts wanting to improve their processes. Earlier this year I made a promise to my healthcare organisation. My 2013 new year’s resolution was to help them drive down the cost of healthcare business intelligence.”
‘Sometimes you have to take the clinic to the person’
This week, Eileen Shepherd, deputy practice editor at Nursing Times, reflects on spending the morning with a community matron for the homeless from Staffordshire and Stoke-on-Trent Partnership.
Community Matron, Jane Morton set up her service in 2010 when she noticed that people with no fixed address were frequently admitted to hospital and Shepard this difficult situation: “Intuitively we know that homeless people have chaotic lives. They may be coping with financial problems, misuse drugs and/or alcohol and often have fractured family lives. However, the way we deliver health care does not meet these complex needs and standard pathways of care do not work for these patients.
“As Jane says, sometimes you have to take the clinic to the person rather than expect them to turn up and it is this flexibility that helps them engage. Jane’s model of care is truly holistic, encompassing the health, social and emotional needs of her patients.
“She knows and understands the community that homeless people live in. She works early mornings and at night, meeting the homeless and engaging with them. But most of all she has the experience and knowledge to know how to respond to their needs. Jane’s service has been successful in reducing hospital admissions but its real success is improving the lives of her patients through care, empathy, humanity and kindness.”
Highland Marketing blog
In this week’s blog Alex Leyton asks about the wider impact that blame culture may have on patient responsibility.
