News in brief
Stafford hospital set to be taken over and lose several of its key services: Trust special administrators say Mid Staffordshire NHS trust is financially and clinically unviable and has staffing problems according to The Guardian. The hospital where the NHS’s biggest scandal in years occurred is set to lose many of its key services and be taken over by a nearby hospital and may change its name in a bid to put its past behind it. Stafford Hospital will see its consultant-led obstetric maternity unit replaced with a midwife-led unit and lose all of its acute surgical services, while the reduction of its A&E unit to operating from 8am to 10pm and handling less serious cases only will be made permanent. Trust special administrators (TSAs) appointed to resolve the future of the loss-making Mid Staffordshire NHS Trust said the big changes were necessary because it was “financially and clinically unviable” and faced major staffing problems. The TSAs said they had listened to pleas from local people to retain a maternity service and services for children through a paediatric assessment unit, which will be open for 14 hours a day, though seriously-ill cases will go to other nearby hospitals. The shadow health secretary, Andy Burnham, said the TSAs’ plans were a kick in the teeth for local campaigners. The Department of Health said the review of the trust’s viability would ensure local people continued to have access to high-quality services.
Treasury approves e-referrals spend: The Choose and Book contract with Atos has been extended for another year while InTechnology builds the new NHS e-referral service infrastructure according to eHealth Insider. The contract with Atos expires this month, but the Treasury only recently approved the contract extension and funding for the replacement service. The Health and Social Care Information Centre (HSCIC) said that it has finalised arrangements for the current e-booking service to continue whilst development of and transition to the new e-referral service is completed. “The incumbent supplier, Atos, will continue to maintain and run the Choose and Book service for up to one year, which will include supporting the transition to the new service and decommissioning the old service when the NHS e-referral service has gone live,” a statement says. The Atos service is built around Cerner Millennium functionality and the contract is worth more than £30m a year. The HSCIC also revealed that it has identified InTechnology as the preferred supplier for the new e-referral service infrastructure following a procurement involving the Cabinet Office G-Cloud framework. “The infrastructure service is a critical element of the new NHS e-referral service, which is due to go live in 2014 and replace the existing Choose and Book service,” an HSCIC statement says. A national programme for IT benefits statement produced by the Department of Health and released earlier this year says that the cost of Choose and Book was £280m by March 2012. Benefits realised at that date totalled more than £820m.
Performance measures will impact on integration funding: NHS England has announced factors, including delayed transfers of care and levels of emergency admissions, and how much money each area will receive from the new £3.8bn integration fund. Health Service Journal (subscription required) reports that planning guidance published by NHS England confirms that £1bn of the total will be paid depending on local performance and how well arrangements are put in place with the intention of safeguarding integrated services. The performance related element will apply from 2015-16, when the “better care fund” – formerly known as the integration transformation fund – takes full effect. NHS England has also said further legislation is needed to ensure the better care fund can legally be set up from 2015-16. “Legislation is needed to ring-fence NHS contributions to the fund at national and local levels, to give NHS England powers to assure local plans and performance, and to ensure that local authorities not party to the pooled budget can be paid from it,” the planning guidance says. A Department of Health spokeswoman said: “As we confirmed in yesterday’s second reading debate on the Care Bill, we intend to amend the bill in the New Year to add provisions that will facilitate the new better care fund.”
NHS Confederation calls for clarity on seven-day care: According to the National Health Executive, the NHS Confederation has urged that a whole-system approach is needed to introduce seven-day care. The organisation is calling for reform to ensure patients with multiple, long-term and complex conditions are given appropriate care and greater use of local and community services. The Keogh Report set out how seven-day care should be introduced, but the NHS Confederation stated that trusts will be coping with winter demand and need better coordination and strong leadership to implement these changes safely. Dr Johnny Marshall, policy director, said that there is still “some uncertainty” over how this will happen. Marshall said: “The pressure on A&E services is increasing, in particular during winter, when patients attending A&Es present more acute symptoms and a number of complex conditions. As a consequence, trusts are finding it harder to meet waiting time targets, with an impact in terms of increased admissions and reduced capacity for swift discharges. Marshall added: “With all of this comes increased costs, and it is unclear how these will be met. Financial sustainability is of particular concern to smaller acute providers, such as district general hospitals, who are struggling more than larger trusts to implement the required financial and operational changes. If in some trusts implementing seven-day care causes significant difficulties then it seems counterproductive to be imposing financial penalties on hospitals that are already struggling. We urge NHS England to take this into consideration, and clarify which support measures will be put in place for all providers who will need assistance in their transition to seven-day services.”
Commissioners get new PCD powers: Commissioners have been given new powers to process ‘necessary’ patient confidential data (PCD) for invoice validation, following a decision by health secretary Jeremy Hunt, reports eHealth Insider. Clinical commissioning groups have been unable to do monthly invoice reconciliation since April because of rules regarding access to PCD. New guidance issued by NHS England says that the result of these changes has been that CCGs and NHS England are “finding it difficult to satisfy their statutory duties for fiscal probity and to demonstrate scrutiny for public expenditure.” Hunt has now approved NHS England’s application for Section 251 support to allow CCGs and commissioning support units to process PCD for invoice validation, though this is subject to a range of conditions. The exemption lasts for a year, until 31st October 2014. The validation process confirms that providers receive the correct amounts by checking that the correct patient received the correct treatment and that the correct commissioner has been identified. Primary care trusts previously used a S251 exemption to access PCD to do this work. However, these powers were not transferred to commissioners when primary care trusts were disbanded in April this year.
South trusts tender for EDM and portal: A group of three southern acute trusts has gone out to tender for an electronic document management system and a clinical portal reports eHealth Insider. The five-year contract will have an option to extend for a further three years and is worth £5m – £12m. Western Sussex Hospitals NHS Foundation Trust, East Sussex Healthcare NHS Trust and Queen Victoria NHS Foundation Trust have gone to tender as the SAcP Sussex Collaborative Programme. They make up one of six collaborative groups of acute trusts in the south, formed to invest in a variety of new IT systems. The 23 trusts involved received nothing from the National Programme for IT and together have secured £80m in central funding for the new systems, with another £100m due to be invested locally. The tender says that each of the Sussex trusts is looking to procure a managed service for the provision of an electronic document management system and a clinical portal and each will award separate but similar contracts to the selected supplier or suppliers. Western Sussex deputy director of informatics, Simon Sturgeon, said that the trusts expected to free up a lot of clinical and administrative time, making important efficiency and financial savings with the new systems. Requests to participate in the tender process are due by 31st January 2014.
Care recipients fall by a quarter in four years: The number of people getting social care support in England has fallen by a quarter in four years, figures show. The BBC reports that the drop comes despite the ageing population placing more pressure on the health and care system. In 2008-09, the number of elderly and younger people with disabilities being cared for was 1.78m but by 2012-2013 it was 1.32m, Health and Social Care Information Centre data showed. The fall has been blamed on budget cuts to councils, which provide social care. By 2015, local government will have lost a third of its budget this Parliament. And while the government has tried to protect social care – £1bn of NHS funding each year is ring-fenced for social care – these figures make it clear services have been hit. The data covers both care provided in people’s homes and the community as well as care home and nursing home places. A spokeswoman for the Local Government Association said councils were struggling to protect services. “Unless adult social care funding is put on a sustainable footing, social care services will remain substantially underfunded and will suffer as a result,” she added. But care minister Norman Lamb said social care remained a “priority” for the government. He said as well as the extra money being provided now from the NHS, from 2015 a new pooled budget of £3.8bn would be established between the NHS and local government. “Councils are best placed to decide what services are needed in their area but we are clear that they must use resources effectively to ensure that the care people receive meets their needs and gives them more control over their daily lives,” he added. However, shadow care minister Liz Kendall said ministers “were out of touch with the scale of the crisis”.
New funding formula approved: NHS England has rejected a proposal that would have seen more than 100 clinical commissioning groups (CCGs) facing real-terms cuts next year so additional funds could be directed to their most underfunded peers according to Health Service Journal (subscription required). The NHS England board instead approved plans to give all CCGs allocations that are at least flat in real terms for the next two financial years, with £180m available for above-inflation increases for the most underfunded CCGs in 2014-2015. The move came as the board approved a new formula for CCG allocations that will distribute 10% of available funding according to a measure of “unmet need” for healthcare linked to deprivation. The decision to introduce a weighting for unmet need in the formula is liable to reignite a debate on NHS allocations that has raged since the board rejected a previous CCG funding formula on grounds that it would have moved funds from areas with worse health to those with the best. Paul Baumann, the body’s chief financial officer, said 31 of the 37 CCGs at risk of deficit this year were underfunded according to the new formula, with more than half being underfunded by more than 5%. The new formula will use the under-75s’ standardised mortality ratio as its measure of unmet need linked to deprivation, a change from the old primary care trust formula that used disability free life expectancy for this purpose. A board paper explained that the ratio was frequently updated and was available for small areas, allowing the formula to more precisely target “deprived communities within otherwise affluent areas”.
Northern Ireland Health and Social Care awards HP £100m ICT deal: Business Services Organisation (BSO), a provider of support and services to health and social care trusts in Northern Ireland, has named HP as the supplier of its £100 million Technology Partnership framework agreement according to ComputerWorldUK. HP will be responsible for providing trusts with a range of IT products and services including hardware, storage, network infrastructure, software, support, application development, service management and systems integration services. BSO’s contract notice for the deal states that the framework will last for four years. Georgina O’Toole, director at analyst house TechMarketView, said that the deal was ‘significant’ for HP and that the company has recently been making a considerable push to do business in Northern Ireland. “HP has been investing in Northern Ireland over the last few years. Towards the end of 2012, for example, it announced investment in new office premises in Belfast city centre designed to strengthen its business in the region and facilitate the completion of its regional job creation project,” said O’Toole. “In addition, the company already works with health and social care organisations; under a £66 million contract let in 2009 by NI’s Department of Health, Social Services and Public Safety, HP has updated the technology behind the country’s hospital patient administration systems.”
£90.5m investment agreed for new Royal Liverpool: The European Investment Bank has agreed to provide £90.5m to support construction of the new Royal Liverpool University Hospital reports Building Better Healthcare. The scheme, costing a total of £429m, includes the construction of the new hospital, demolition of the current buildings, and landscaping works. Construction of the new facility, at a cost of £335m, will begin early next year after the plans were signed off by the Royal Liverpool and Broadgreen University Hospitals Trust and developer, Carillion. Alongside the European Investment Bank support, a further £118m will be provided by the hospital trust and the Department of Health. The remaining funds will come from private lenders including Legal and General Investment Management Lloyds TSB and Scottish Widows Investment Group. Jonathan Taylor, European Investment Bank vice president, said: “The new Royal Liverpool Hospital will transform healthcare in the city, providing the most-advanced medical treatment and ensuring the highest standards of privacy and dignity for the thousands of patients using the hospital each year.” The new hospital will be one of the ‘greenest’ in the country, with renewable energy systems, low-carbon technology, use of water meters and leak detection systems. During the four-year construction it is expected that 750 full-time jobs will be created, with 60% of jobs going to local people. Construction will contribute about £240m to the local economy as well as providing 75 to 100 apprenticeships.
County Durham and Darlington NHS Trust deploys EDM to go ‘paperless’: County Durham and Darlington NHS Foundation Trust has brought in outsourcer Civica to implement the next stage of its “paperless NHS” strategy reports ComputerWorldUK. The deal will see the trust use Civica’s electronic document management system to digitise the records of its patients, transforming the way that information is audited and governed, and ultimately improving patient care, the trust said. The trust has 890,000 active patient records. As a result of the deal clinical and administrative staff will have faster access to vital patient information, which will better inform clinical decisions and free up valuable time. The trust will use Civica’s WinDIP technology, which is currently being used by 50 other NHS trusts nationwide. The technology ensures that patient information is accurate, up-to-date and easily accessible from any location, whist being stored in a completely secure environment. Diane Murphy, clinical director of service transformation and project sponsor at the trust, said: “We’re aiming to have paperless clinical record management by 2015 and this is the next step in our strategy to get there. Being able to provide our clinicians and administrative staff with the information they need at the touch of a button will transform the way patients are treated, and help us make huge savings in the years to come.”
Wales launches £9.5m health tech fund: Health boards and trusts in Wales have until 28 February 2014 to submit applications for a new £9.5 Health Technology and Telehealth Fund to support the introduction of new technologies in non-hospital settings. Health minister Mark Drakeford, who announced the fund, said that the money will help provide access to technology to assist the transformation of health and care services in Wales reports eHealth Insider. “Investment in innovation is essential if we are to achieve our aim of safe, sustainable and high quality health services for Wales,” he said. The fund is part of the service transformation plan set out in ‘Together for Health’, the Welsh government’s five year plan for the NHS to deliver “high quality and sustainable services and improved patient benefits.”
Hospital reforms rushed through, warn doctors: Doctors have accused ministers of rushing legislation that could allow changes to local hospitals to be forced through without proper consideration of patients’ needs, according to Nursing Times. The BMA called on health secretary Jeremy Hunt to backtrack on plans to give greater powers to a trust special administrator (TSA). The changes form part of the Care Bill, which faces its first test in the Commons on Monday, and follow the legal battle over the future of Lewisham Hospital in south-east London. Ministers were defeated in the High Court over their attempt to cut A&E and maternity services at the hospital and had an appeal rejected in October. The courts ruled the special administrator brought in to deal with problems at the neighbouring South London Healthcare Trust did not have the power to suggest changes at other trusts. But under amendments added to the Care Bill in the House of Lords, the British Medical Association (BMA) said TSAs will be empowered to also make changes in neighbouring trusts without consulting patients, clinicians, or the public. Ministers have said the change is a clarification of the present policy but the BMA warned it would allow the health secretary to “force changes through the back door”. Dr Mark Porter, chair of the BMA Council, said: “With the NHS under financial strain there is immense pressure to make changes to the way services are delivered. We need a full debate on the best model for providing sustainable, high quality services, taking on board the views of clinicians, politicians and, crucially, the public.”
One-in-five redundant NHS staff rehired: MPs have heard that thousands of NHS managers and other staff have been rehired by the health service after receiving payoffs – with more than 400 back on the payroll within weeks of taking redundancy, according to the Telegraph. Figures disclosed to the Commons Health Select committee reveal that 19,000 staff were given redundancy payments under the government’s reorganisation of the NHS – and almost one in five of them has since returned. Under the terms, at least 2,300 managers received six figure exit packages. The highest sum of £605,000 went to an NHS executive whose husband also received a pay-off, of £345,000 in March, before both were then hired elsewhere in the health service. Department of Health evidence to the MPs committee disclosed that 19,126 staff were made redundant under the reorganisation. Of those, 3,261 of have since been rehired by the NHS – the vast majority in the past 12 months. Dr Dan Poulter, health minister, said: “These one-off redundancy bills were a direct result of the last government’s ridiculously lax rules negotiated in 2006, which frustratingly left the NHS with excessive liabilities when we dismantled Labour’s bloated management bureaucracy and put doctors in charge. We have overhauled their system with tough new rules that will make sure this can never happen again.”
GPs under pressure after district nurse cuts: Practices face rising pressure because of a sharp drop in district nurse numbers, GP leaders have warned. GPOnline reports that district nurse numbers in the NHS have slumped by 2,000 since the coalition government took office in 2010, according to data collected by the Labour party under the Freedom of Information Act. In 2010 there were 7,813 district nurses in England, the data show, but this has fallen by 2,020 since that time. Derbyshire Local Medical Committee secretary Dr John Grenville said: “I think it does mean additional pressure on GPs. Managers with fewer staff become much more focused on the boundaries between what a district nurse does and what a practice nurse does.” Dr Grenville said the move in the NHS in recent years away from a practice-based model of district nursing to teams covering larger geographical areas had also affected practices workload. Grenville said: “It means communications with the nurses looking after your patients is much more difficult”. He added that general practice was already under huge pressure from rising workload and falling resources, and that despite changes to the GP contract from 2014/15, practices would continue to struggle to cope.
Two-thirds of healthcare regulations to be scrapped: Hundreds of health and social care regulations will be scrapped, the government has announced. The National Health Executive reports that the proposals cover public health, quality of care, mental health, NHS and professional standards, and seek to remove unnecessary red tape and bureaucracy. Of 555 regulations currently covering the sector, 128 will be removed and another 252 will be ‘improved’. These include removing rules banning the sale of HIV home-testing kits, a simplification of professional standards regulations, and working with the Department for Communities and Local Government to reduce duplication of care home inspections by the Care Quality Commission and local authorities. Deprivation of liberty forms will be reviewed and the Department of Health will seek to make paper vouchers for the Healthy Start scheme easier to handle. The changes form part of the government’s wider Red Tape Challenge, which seeks to remove regulation unless there is a good reason to keep them. Public health minister, Jane Ellison said in a ministerial written statement: “Of the 555 regulations considered, the Department is proposing to abolish 128 regulations and improve 252 others. This means that 68% of the regulations under the healthy living and social care theme will either be abolished or improved.” She added: “The Department is committed to continue to look at how it can minimise burdens on both business and health care professionals. The Department is currently looking at opportunities to reduce burdens for those on the front line of healthcare and is engaging with relevant organisations and health professionals to progress this.”
HETT Expo will be held in September next year: The Healthcare Efficiency Through Technology Expo has for the past few years been held in October at the Olympia in London. Next year the date has been changed to 24th September 2014, with the event continuing to be held at Olympia.
Opinion
Will new integration fund be a catalyst or catastrophe?
This week in the Guardian Healthcare Network, Chris Hopson, chief executive of the Foundation Trust Network, identifies the risks associated with the integration transformation fund and explains how these can be overcome.
Hopson describes his concerns over the fund, which include the lack of ‘new’ money available, and the scale and speed of the change to public sector delivery. Hopson provides the following advice to ensure the fund is a catalyst for the health and social care system:
- “Honesty on the scale of challenge – The fund can’t compensate for social care funding cuts; investment in new models of integrated care; and a different way of the NHS spending its health allocation. Central government is asking local health and social care economies to balance these competing priorities and provide better, more integrated, services with less money. This is a significant challenge and pretending that it doesn’t exist isn’t helpful.
- “Support for a collaborative, partnership, planning process – Some local health and social care economies are well integrated, have strong collaborative relationships and are used to planning together. Possible reactions to this process include denial, division and disintegration: denial that it’s going to happen; division as health and social care fight over scarce funds; and disintegration as threatened service deliverers seek to protect their corner.
- “Identifying the risk to NHS service delivery – Taking £2.1bn out of mainstream NHS service delivery brings a very significant risk. Sir David Nicholson told CCGs the fund will “require savings of over £2bn in existing spending … implying an extra productivity gain of 2-3% across the NHS as a whole in 2015/16 … reflected in the tariff”. Given the well known difficulties in realising 4% savings a year, leaping to 6-7% is heroic.”
New CCG allocations: Straw men laid to rest but deeper questions remain?
David Buck, senior fellow, Public Health and Inequalities, discusses in The King’s Fund blog this week, how the bulk of NHS money will get to where it needs to be, and on what basis, through allocations to clinical commissioning groups (CCGs).
“Like many people we have eagerly awaited [Tuesday’s] NHS England board meeting. Before getting to the detail, we should recognise two very important changes in the decision-making process. First, this is the first time the public has ever been party to how these decisions are made, bringing welcome transparency to a hitherto obscure process. Second, it is the first time that these decisions have been taken independently of government.
“As we predicted in August, the questions about which CCGs gets what – and why – have become more contentious as funding gets tighter. A lot of the debate has centred on analysis of what implementing the Advisory Committee on Resource Allocation’s (ACRA) recommendations from last year would mean for the distribution of resources between CCGs. In short, that a stronger focus on the needs of older populations would come at the expense of younger, more deprived communities.
“However, this is only the start of the story, not the end. The fundamental review continues and it needs to tackle deeper questions, including whether the current approach to allocating resources is fit for purpose in the new NHS – as we argued in our report on the allocation of health resources earlier this year. CCGs – as a whole – may be pleased with the slight increase in real terms that they have received. But, as John Appleby has recently shown, the leeway that the NHS – and therefore CCGs – have over how they spend their budgets has narrowed significantly.”
Concluding, Buck says that it’s clear NHS England has shown it takes health inequalities seriously “but CCGs will clearly have little room for manoeuvre”.
Summary Care Record
Hard-wired GP, Luke Koupparis asks in OnMedica this week, whether or not Summary Care Records are achievable in the timescales required by the new contract?
“The new contract has released guidance on patients having access to their medical record. It states that GP practices will be required to promote and offer the facility for patients to gain online access to the data in their Summary Care Record (SCR) only; i.e. medications, allergies, adverse reactions and any additional information they have explicitly consented to from April 2014, or as soon as practicable thereafter, and by all practices by 31 March 2015.
“Despite this headline description there is still confusion about the details of what this actually means. Mr Hunt has recently claimed that care homes would have access to GPs records and would be required to update them daily under the named GP role planned from April 2014. It is unclear as to whether this would come under the same remit of having access to the medical record. Clearly, being able to write to a GP record has a number of implications. Would this also mean that patients could add data to their medical record as well, adding allergies or problems if missing? I doubt it very much.
“GPs have used electronic clinical systems now for many years and in the main have high quality information stored within their practices. However, hospitals tend to have very poor uptake of electronic systems and in most cases still record clinical encounters on paper notes that need to be carried around at a snail’s pace. There needs to be pressure on hospitals to start delivering electronic information back to practices at a very basic level.
“So, the detail of a national summary care record in the head of Mr Hunt needs much more work before GPs can commit to a timetable. There are many consent and confidentiality hurdles to cross which may slow down the implementation of a truly integrated record. However, there are some real benefits to both patient care and primary/secondary care communication that can be achieved at the end of this electronic amalgamation of organisations.”
We are moving swiftly and thoughtfully to fairer allocations
This week in Health Service Journal (subscription required) Paul Baumann, chief financial officer at NHS England, says that NHS England will make difficult choices with profound consequences for the future of the health service.
“To start by stating the basics: we are committed to using the nearly £100bn entrusted to us to ensure that every local health economy has the funding to deliver equal access to services for equal need, while reducing inequalities in access to and outcomes from healthcare.
“This is our legal duty, of course, but more importantly it is fundamental to our stated mission to “secure high quality care for all, now and for future generations.”
“The five-year planning process for local health economies, which we are just about to launch with Monitor, the NHS Trust Development Authority and local government partners provides the ideal opportunity for each community to plan the adjustments required in the medium term, in the light of a clear level of target funding and certainty of funding levels for the next two years.
“The conundrum facing it is how much differentiation in funding growth for individual organisations to make over the next couple of years − and in particular whether to use some of the very limited growth money otherwise available for the most underfunded CCGs to ensure that all CCGs, irrespective of their funding status, receive real terms growth in their allocations.
“These are difficult choices with profound consequences for the future of the NHS at a critical time in its history. The board will take them seriously.
“We will make our decisions in public, in line with our commitment to transparency, and we will support local health economies to work through the consequences as they develop their strategies for the future.”
Highland Marketing blog
In this weeks’ Highland Marketing blog, Mark Venables talks about ‘unleashing the power of NHS technology into 2014 and beyond’.
