News in brief
Commonwealth Fund says NHS world’s ‘best’: The NHS is the “best” and most efficient healthcare system in the world, partly due to its adoption of information technology, says an international study, according to eHealth Insider. The report by the Commonwealth Fund compares the US healthcare system to those in 10 other countries based on their quality, efficiency, cost, and performance. In the report, entitled ‘Mirror, Mirror on the Wall’, the NHS comes out on top in first place, followed closely by Switzerland in second and Sweden in third. When it comes to “effective care”, the UK again comes first, due to its use of health information technology. “The widespread and effective use of health information technology in the UK plays a large role in the country’s high score on the chronic care management indicators, as well as its performance on system aspects of preventive care delivery,” says the report. “All countries, however, have room for improvement to ensure patients uniformly receive effective care.” As well as the US, the countries included in the report are: UK; Switzerland; Sweden; Norway; New Zealand; Canada; France; the Netherlands; Germany; and Australia. The UK also comes out on top when it comes to having medical practices with “multifunctional clinical information technology,” which the report defines as having an electronic patient record system with “two or more functions for ordering, patient information, panel information, and decision support.”
NHS ‘facing funding gap of up to £2bn’ in England: The NHS in England faces a funding gap of up to £2bn, about 2% of its budget, for the next financial year, the BBC understands. Senior health sources told the BBC, growing costs would outstrip the money the NHS received from April 2015. Health secretary Jeremy Hunt is involved in Whitehall talks on how to plug the gap. The Department of Health (DH) said it was “confident” it would “make the savings necessary to meet rising demand”. The NHS’s budget in England for 2015 has been set at about £100bn. The NHS has experienced a prolonged budget freeze as part of the government’s plan to reduce the UK deficit. Its budget has been protected from cuts which have affected most other government departments, but spending has risen only at the rate of inflation. Factors including population growth have led to increasing demand on NHS services and higher NHS pension costs have added to the financial pressure. In a statement, the DH said: “The NHS is on track to make £20bn savings this parliament and we are confident that it will continue to make the savings necessary to meet rising demand.” Speaking this week the health secretary said he was confident in the sustainability of the NHS. He cited a report from the US-based Commonwealth Fund think-tank, which ranked the NHS top in 2013 out of a list of healthcare systems in 11 leading countries around the world for effective, safe, co-ordinated and patient-centred care, access, and efficiency.
TechUK sets out view on EPRs: NHS England should provide trusts with a “consistent outcomes-focused” guidance to make sure they take strategic decisions when buying electronic patient record systems (EPR), TechUK has said. The supplier’s body issued a report outlining its view of the best way to support the EPR market as NHS England launched an investigation into the benefits and weaknesses of introducing a national accreditation system for EPR suppliers, according to eHealth Insider. TechUK believes there is a place for EPR accreditation that provides value both to suppliers and the NHS. However, it argues that it must follow “a key set of principles” that include setting clearly defined business goals, not acting as a barrier to market entry for innovative systems, and consistent application. It adds that it would support looking to countries like the US, where the accreditation policies include incentive based payments, but where excessive accreditation has also involved high costs for suppliers. The organisation also argues that accreditation can only be part of the picture. Whether it goes ahead or not, its report argues there must be consistent, outcomes-focused guidance for provider organisations to make sure strategic buying decisions are made using government funding. “This guidance should be based on predefined usage criteria for collecting, using, and sharing digital data using EPRs to the levels required to achieve the aims of the Integrated Digital Care Record [the ultimate aim of NHS England’s guidance for trusts applying to the two technology funds],” it says.
NHS CIO says National IT programme killed IT recruitment: CIO reports that the NHS National Programme for IT (NPfIT), set up under the government of Tony Blair, has caused a technology recruitment nightmare for CIOs in the health sector, says James Thomas, CIO at one of the UK’s leading hospitals, University College London Hospitals (UCLH). “The stigma of the NHS National Programme for IT is the worst thing for recruiting experts into the NHS,” James Thomas, number one in the 2013 CIO 100, told the Harvey Nash CIO Survey event this week. “Also the roles in the NHS didn’t fit in with industry, so at UCLH we have been normalising our roles and job titles so we have been able to improve our skills base. The NHS is an incredibly complex organisation with lots of organisations that should work together that are not incentivised to do so,” he said of the organisational challenge a CIO faces in healthcare. “We are also creating professional development plans with the BCS and we are creating data scientists with the UCLH,” Thomas said of the skills gap strategy he is pursuing. Thomas has been with the NHS for 10 years now and is widely recognised for his achievements at UCLH. “When I joined the NHS 10 years ago they were 20 years behind anyone else in the use of technology. I was told one day, not long after starting, that the datacentre was being shut down again. This was a non-secure datacentre that anyone could walk into, and the bucket collecting water from the racks air-conditioning had been knocked over onto the electrics,” he said of the scale of transformation he has had to lead at UCLH.
NHS should be run like Tesco, claims Reform think tank: Most of the work the NHS could be carried out by private or voluntary providers within a decade, a right wing think tank has predicted. In a sweeping report authored by a former advisor to Tony Blair, Reform said that the health service should not rely on extra funding to survive into the 21st century, but should allow independent companies and charities to work with the NHS to change the way care is delivered, reported the Independent. Reform, which receives funding from a number of private healthcare organisations, recently said that £1.2bn could be raised for the NHS by charging for GP appointments. The latest report, by Professor Paul Corrigan, who was a special advisor to Labour health secretaries Alan Milburn and Dr John Reid and later a policy advisor to Mr Blair, claims that “political conservatism” has stifled market-driven improvement of services. It adds that the health service should learn from supermarket chains such as Tesco, by mirroring its business model of large superstores and smaller local shops, with a smaller number of large specialist hospitals, supported by small-scale community hospitals. And in recommendations which will raise eyebrows with health professionals, it says lessons on the care of patients can be learned from Mazda, Volkswagen and BMW which have a “zero error” approach to quality assurance.
NHS IT leaders consider limiting parents’ access to online records: GPs will not have to provide parents of children over the age of 12 with online access to their children’s records, under new proposals being formulated by the Health and Social Information Centre (HSCIC). Dr Masood Nazir, a GP in Birmingham and clinical informatics advisor at the HSCIC, said that the information centre is currently formulating guidance for GPs in carrying out their new contractual requirement to provide patients with online access to their records. Speaking to Pulse after his presentation to delegates at the Pulse Live conference in Manchester, Dr Nazir said the HSCIC discussed limiting parents’ access to children’s records last week, with a series of upcoming meetings set to discuss how to protect patients from unintended consequences from granting online access to records. He said: “We met with the Information Commissioner last week and this was discussed. We will be having a number of meetings to discuss guidance for how to protect vulnerable patients, with guidance to be published around September, after being signed off by the RCGP.” However he added that GPs would need to use their own judgement on following the guidance, for example basing decisions on their perceived maturity of the child in question, or refusing to set up online access to vulnerable adults ‘if they knew, for example, that they are at risk of domestic abuse’. However, he added: “Sometimes the problem is that you don’t know.” Because of this, all patients should be warned not to sign up to online records access if they fear they could be vulnerable to ‘coercion’ to release details, he said. It comes after patient watchdogs, as well as the General Practitioners Committee, have warned of unintended consequences of allowing patients to have access to their Summary Care Record ‘as a minimum’ before April 2015, which is now a contractual requirement.
£20m on open source in ‘tech fund 2’: NHS England has a £20m target for open source systems in the second round of its technology fund, although the money is not “ring-fenced” for use, reported eHealth Insider (EHI). The role of open source in the second round of the tech fund, now known as the Integrated Digital Care Fund, was discussed at NHS England’s Open Source Open Day in London with suppliers and developers last week. The prospectus for the fund says NHS England wants to encourage the development of open source software and create a community of “developers, implementers and users” to improve the solutions. EHI previously reported that £20m earmarked for open source projects in the first round of the tech fund would be rolled over due to the timescales for spending. However, following the launch of the second round, NHS England told EHI that there was no “specific ring-fenced amount of funding” for open source within the overall £240m budget. Despite this, Rob Parker, NHS England’s Integrated Digital Care Fund programme manager, told attendees at the open day there is still a £20m goal for open source solutions. “It’s not so much that there’s £20m ring-fenced and it has to be that amount, but we want to hit £20m. That would be a good investment, so that’s what our target is.” Parker said trusts applying for funding for open source software still need to meet the same requirements as proprietary applications on value for money, matching funding and other criteria. “What we’re trying to do is assess each application on its merits…all applications will be treated the same in terms of what they have to supply, and once we get a list of viable projects we will go from there.”
NHS patient information in data breach by Diagnostic Health: As many as 10,000 NHS patients may have been affected by a series of data protection breaches by a private firm, reported the BBC. A leaked report from the Information Commissioner’s Office (ICO) revealed patient data was stored unencrypted by Birmingham company Diagnostic Health. The company, which carries out ultrasound scans for the NHS, said it had voluntarily suspended services. Diagnostic Health added it had now completed an action plan that had been agreed with the ICO. Jonathan Leonard, chief executive of Diagnostic Health Systems Ltd, based on Birmingham Research Park, said the company was planning to resume services for Clinical Commissioning Groups (CCGs). The data protection breaches date back to June 2013. The Care Quality Commission watchdog was alerted to the breaches last year by a whistle-blower and passed them on to the Stafford and Surrounds CCG, which commissioned services from the firm. The CCG’s chief executive Andy Donald said: “We conducted our own investigation. There were concerns of a serious nature so we informed the information commissioner.” While the ICO refused to show the BBC its report, a leaked copy showed Diagnostic Health was aware it was breaching data protection guidelines by 26 June 2013, but continued adding to the database until 22 July. The ICO audit prepared in the summer revealed a company laptop stolen from a member of staff’s home had not been originally reported to the information commissioner. It also showed staff at the company shared the same password to access files on a web-based storage account. GP referrals, meanwhile, were being emailed directly to staff inboxes, while there was no audit trail of who accessed the system and when. At the time of the ICO report, Diagnostic Health was also unable to delete personal data from an ex consultant’s laptop and had no control as to how it was being used.
Winter pressures continue into spring: Hospital trusts across England reported higher than planned deficits in the first month of the financial year, linked to winter pressures dragging on into the spring, Health Service Journal (subscription required) analysis has revealed. Four out of 10 trusts with published financial figures for April have experienced increased cost pressures in that month because of unplanned demand on emergency departments or because they kept beds open, which were previously paid for by the national winter pressure fund. This funding, distributed to trusts to help them cope with increased pressures on accident and emergency departments during winter, finished at the end of March. The unexpected pressure hit a significant minority of trusts, the analysis revealed. Almost 30% of the 99 trusts examined reported higher than planned deficits, which were partly due to winter pressure costs. The remaining 42 of the 141 non-specialist acute trusts in England were yet to report financial figures for April. The analysis showed a wide geographical spread in the trusts reporting increased deficits linked to winter pressures. This group includes six trusts in London and four in Yorkshire and the West Midlands. Croydon Health Services NHS Trust’s April deficit was £2.6m over its planned amount – the largest increase in cash terms in all 99 trusts examined. Almost £250,000 of this was spent on staff costs to cover winter pressure beds that stayed open in April. This increased financial pressure reported by trusts in April corresponds to a reversal in the usual decline in demand in A&Es during April. Official figures showed that emergency admissions inched up from 306,288 in March to 306,500 in April, compared with last year’s 6,000 drop in admissions over the same period.
Millions of patients’ NHS data sold to private companies: Millions of patients’ NHS data has been sold to private companies over the last decade, according to an internal review by the NHS Information Centre (NHS IC). The NHS IC, which has since been replaced by Health and Social Care Information Centre (HSCIC), reviewed data handling and concluded that the NHS had made “significant lapses” in recording the release of the data, reported Computing. The ‘Data Release Review’ led by HSCIC’s non-executive director, Sir Nick Partridge, found that much of the data released by the NHS was to universities and the Department of Health for research purposes. However, between 2005 and 2012, 588 data releases were made to 178 private-sector organisations excluding charities, for the purpose of “analytics, benchmarking and research”, according to NHS IC. The organisations included technology companies, healthcare consultancies, insurance firms, and pharmaceutical giants AstraZeneca and GlaxoSmithKline. Partridge claimed that the HSCIC should “learn the lessons from the loosely recorded processes of its predecessor organisation”. “The public simply will not tolerate vagueness about medical records that may be intensely private to them. We exist to guard their data and we have to earn their trust by demonstrating scrupulous care with which we handle their personal information,” he said.
NHS Trusts that misuse patient records must be penalised, says report: Electronic health records are essential to good care, according to a report by the Sowerby Commission led by Imperial College London. Four out of five doctors surveyed said sharing electronic records among those responsible for a patient’s treatment improves care and two out of three said it would enhance their ability to compare treatment with best practice. However, medical records are currently separated in siloes – hospital, GP, and clinic – and there are technical and cultural barriers to sharing them, including a reluctance by doctors to give up control. After a year long investigation, the Sowerby Commission, a group of experts established by the Institute of Global Health Innovation at Imperial College London with a grant from the Peter Sowerby Foundation, has concluded that there are major benefits to health from sharing records, first by ensuring all staff caring for a patient have access to details of their condition, medication, and test results, and secondly to improve care for the whole population through audit and research – the results of which should be advertised to bolster public support. But there are also risks. Creating population level databases of records such as care.data is essential to improve care but patient confidentiality must be vigorously protected and only NHS or accredited academic organisations should be given access to them. The greatest benefits are likely to come from local and regional schemes, the report says. In addition, NHS trusts that cannot show evidence of extensive use of electronic records should be forced to pay higher insurance premiums, be marked down by the CQC and lose their training accreditation.
Hunt: Desperate need for investment in dementia research: There is a “desperate need” for more investment in dementia research, the health secretary has said. The economic and social reasons to find a cure, or disease-modifying therapy, cannot be ignored, Jeremy Hunt said. Speaking to more than 300 health and finance experts gathered in London to discuss the burden of dementia around the world, the health secretary said more must be done to dispel the myth that dementia is an “inevitable” part of ageing, reported The Telegraph. “This is a condition that we can defeat and that is what we chose to do at the G8 summit in December,” Hunt said. “In December we set ourselves some very ambitious targets and today we are here to find concrete ways in how we deliver those, including how we find a cure or disease-modifying therapy by 2025, how we encourage investment in dementia research, and how we attempt new sources of finance to support global dementia innovation. The UK Government is doing what we can. Since 2009 we have increased investment in dementia research from £28 million to £52 million and we are on target to increase research spending to £66 million by 2015. But globally we desperately need to see new investment flowing into dementia research.”
Trusts exodus from Capita HR contract: Trusts across Liverpool are pulling out of a “landmark” £27m deal to buy their payroll and recruitment services from outsourcing giant Capita, fewer than three years into the seven-year contract. At least five out of eight North Merseyside providers that transferred services to Capita in 2012 will have brought them back into the NHS, or moved to other providers by 1st August, according to statements given to Health Service Journal (HSJ, subscription required). The premature exodus of trusts from the contract follows reports of widespread concerns about the quality of the service Capita HR Solutions provided. Two providers – Royal Liverpool and Broadgreen University Hospitals Trust and neurosciences specialist Walton Centre Foundation Trust – confirmed they had already ceased to receive any services under the Capita contract. Mersey Care Trust, Liverpool Community Health Trust and Aintree University Hospital FT will pull out of the deal by 1st August, according to trust statements. Alder Hey Children’s FT said it was “currently reviewing its deal with Capita”, while Liverpool Heart and Chest Hospital FT said it was “in discussions with Capita about performance”. Board papers published by Royal Liverpool in February stated that an initial “informal letter of concern” about the Capita services was sent collectively by the North Merseyside trusts in March last year, but “no significant improvements were seen within three months”. After receiving a formal letter of concern in June 2013, Capita produced a “further service improvement plan”. A Capita spokeswoman told HSJ this week: “Following a joint review of recruitment, payroll and HR processes, Capita and a number of trusts in North Merseyside have mutually agreed that Capita will no longer provide these services.” She added that “Capita remains committed to providing its broad range of services to the NHS.”
Cerner launches cloud EPR for NHS trusts: Cerner has launched a software as a service (SaaS) option for its Millennium electronic patient record (EPR) system, targeted at smaller trusts who lack the capital for a full deployment. The Cerner SaaS is the first “comprehensive” subscription-based EPR available to NHS acute trusts, according to the company. Under the model, trusts who take a subscription will receive the core elements of the EPR, including the patient administration system and modules for A&E, order communications, nursing and clinical documentation, medicines management, and a data warehouse reporting solution. Cerner says the model is intended “exclusively” for trusts with fewer than 500 beds, and will be a fully-hosted service with a shared domain using a UK data centre. The SaaS option will be fully managed by Cerner, including management of the applications themselves, while the standard Millennium system allows trusts to undertake more of the application management in-house. Emil Peters, Cerner’s vice president and managing director, told eHealth Insider the launch of the SaaS version is intended to provide a “competitively priced” option for trusts that cannot afford the standard Millennium system. “Trusts are under immense financial pressure but they’re still trying to meet some pretty aggressive targets, and it shouldn’t be just the large trusts who can give their clinicians access to these systems.”
54 miles in 24 hours – two marathons back to back and the vertical equivalent of climbing Ben Nevis, twice.
This is the Caledonian Challenge. An event which tests you, both individually and as a team; physically, mentally and at points emotionally. It pushes your body and your mind to its limits over 24 hours, all without sleep!
Highland Marketing’s own Gregor MacKenzie competed with his team this year fundraising for Yorkhill Children’s Charity and Foundation Scotland. The team were humbled along the way but after 23 hours and 43 minutes the team crossed the finish line as one and conquered the challenge together.
“We shared an experience like no other that I have seen or done before. The intensity of this challenge tested each of us” said team member Euan MacKenzie.
Each member had their highs and lows at different points, but with support from their team members each pulled through and went on to return the ‘shoulder to lean on’ further down the line.
So far the team are in the top 10% of all teams in terms of fundraising, their total currently stands just short of £4,500.00, for which the team would like to sincerely thank all their sponsors.
If you still would like to sponsor Gregor’s team the fundraising site is still accepting donations for a short time – it would be an incredibly rewarding feeling for all involved to tip their total over £4,500.00!
Opinion
Technology can give nurses a voice for safer staffing levels
With much publicity and debate around the nursing shortages, Steve Jessop, chief nursing information officer at Hull and East Yorkshire Hospitals Trust, talks to Nursing Times about a unique IT project which supports nurses in allocating resources in real-time for each ward to deliver the safest possible care.
“A major issue in the way the NHS manages nurses is the lack of up-to-date information for making decisions on safe ward staffing. Staffing levels are predicted using a ratio of the number and condition of patients. This ratio, called patient acuity, is typically analysed by trusts just two or three times per year.
In an effort to reduce administration effort associated with calculating staff resource, Jessop has set out to provide nurses with quick access to hard evidence that illustrates when wards are being underserved: “This vision is why I am leading a project to measure real-time patient acuity to support around 3,000 nurses in 52 wards at Hull and East Yorkshire Hospitals Trust and their patients – and I believe we are the first trust to take such an approach. We have invested in technology by Cayder that shows nurses where patients are. With each of the 45 wards using large electronic whiteboards, patient flow technology allows nurses to manage patient admissions more safely. We are extending the software to include management of patient acuity, allowing us to ensure that the nursing resource matches the clinical requirements for every ward on every shift.
“This could be a game changer for safety briefings. We are developing a reporting tool and, when it is complete, we will be able to assess areas of high acuity and move resources, whether from medical, surgical, oncology, or haematology wards. The initial reaction from nurses is extremely encouraging: 95% of wards now measure acuity as part of their daily routine and, thanks to the technology being in place, there is no additional paperwork.
“We are aiming to answer common questions such as “is the ward able to support patients with a high acuity?” or “have I got enough resources?”, removing any uncertainty and ensuring staffing levels are as safe as possible at all times. One of my main aims as chief nursing information officer is to spread the use of technology to support clinical staff and empower them to focus on the essential: caring for their patients.”
How do we solve the problem in Liverpool?
A guest blogger for NHS England, Dr Nadim Fazlani, Chair of Liverpool Clinical Commissioning Group and the NHS Commissioning Assembly Clinical Commissioning Group Development Working Group asks the question: how do we solve the complex problem of poor healthcare in Liverpool?
“I often hear the phrase ‘it is complex’ and on asking what is complex? I am told it is a complex problem. So I ask myself what is a complex problem and how do we solve it?
“The problem in Liverpool is: How do we improve poor health outcomes in the face of good hospital process outcomes and positive patient experience indicators when the available resources are unlikely to increase?”
Together with the chief officer of Liverpool Clinical Commissioning Group, Dr Nadim Fazlani has visited the boards of all eight providers and asked: “How will you attack the problem? How will you tackle the issue? How will you get on top of it?
“In Liverpool we all agreed that we needed to act as one and organisational imperatives should not be a barrier. This is now being tested out in reality and regulators have been supportive of this approach. There will be number of solutions – some of which will be translational. We are all connecting and scrutinising data. ‘Big data’ as a term has been banned in Liverpool – we need good information based on analysis of what we already have.
“This year the LMC conference debated co-payments. Perhaps we will have to debate whether the NHS has to be totally dependent on central funding or whether mixed economy is part of the solution.
“There are – I am afraid – no straight forward answers for the Liverpool problem but then complex problems don’t have simple solutions.”
Health and care integration could prove too costly for the NHS
Despite government promises, the Better Care Fund won’t help balance the NHS budget or bring about a revolution in care, says Mike Broad, programme director of Health+Care 2014.
“It’s not a question of if the NHS will run out of money, but when. That’s the conclusion of a King’s Fund review, amid concerns the NHS will face a £30bn funding gap by the end of the decade. Ironically, it could be the government’s big plan to integrate health and social care services and drive efficiencies that pushes the NHS over the edge.
“Joining up health and social care has the potential to reduce complexity, tailor services around the individual and encourage a more preventative approach to health and wellbeing. The government’s main vehicle for delivering this is the £3.8bn Better Care Fund, due to be launched in April next year.
“The fund will reward those councils and health organisations that co-ordinate their work and grow community-based services, reduce hospital admissions and improve local outcomes.
“It has sound aspirations. However, many fear – against a backdrop of spiralling demand – the transfer of NHS funds to local government to integrate services will hasten the former’s demise.”
“Some trailblazers are edging towards whole system integration. Their hallmarks are great leadership and multi-disciplinary buy-in. These pockets of innovation appear in all sectors – from commissioners to clinicians, social workers to residential and domiciliary care managers.
“They need to be celebrated and the learning points shared because only they can lead the paradigm shift. Failure to do so will see the end of the NHS and social care as we know it.”
Highland Marketing blog
In this week’s blog, Mark Venables, the CEO of Highland Marketing, talks about the rise of advisory and consultancy services in the healthcare technology and IT industry.
