News in brief
NHS IT system one of ‘worst fiascos ever’, say MPs: Taxpayers face a rising, multi-billion pound bill for a failed government IT project, MPs have said. A report by the influential Public Accounts Committee (PAC) concluded an attempt to upgrade NHS computer systems in England ended up becoming one of the “worst and most expensive contracting fiascos” in public sector history, reported the BBC. The committee said that the final bill for abandoning the plan is still uncertain. Ministers initially put the costs of the NHS scheme’s failure at £6.4bn. Officials later revised the total to £9.8bn, however, the PAC said this latest estimate failed to include a price for terminating a contract with Fujitsu to provide care records systems and other future costs. The project was launched in 2002, with the aim of revolutionising the way technology is used in the health service by paving the way for electronic records, digital scanning and integrated IT systems across hospitals and community care. Hit by technical problems and contractual wrangling, it was effectively disbanded by the government two years ago. MPs on the PAC said some outstanding costs remain and committee member Richard Bacon said: “The taxpayer is continuing to pay the price for the ill-fated National Programme for IT in the NHS.”
Cambridge takes out £50m loan to fund IT project: Cambridge University Hospitals NHS Foundation Trust has taken out a £50m loan to partly fund its ambitious new electronic patient records system, Health Service Journal (subscription required) revealed. The loan will contribute a quarter of the finance required for the £200m “eHospital” programme contract, which it awarded in April to the American IT firms HP and Epic. The trust’s integrated performance report, discussed at its annual meeting, said: “The first £15m installment of the eHospital loan (£50m) in total was drawn down at the end May.” A spokesperson for the trust said the loan was secured through the Foundation Trust Financing Facility (FTFF), which is overseen by an advisory committee within the Department of Health. He added: “FTFF interest rates are based on national loans fund rates. The interest rate on this loan is fixed at 2.4% per annum for the term of the loan which is 15 years. Repayments are due to be made in equal six monthly installments commencing six months after the final drawdown. Finance experts said other trusts could also opt to take out loans, as well as pursuing other financial routes, in order to fund new IT systems.
NHS will struggle to meet £20bn productivity challenge, shows survey: The NHS is struggling to meet the so-called ‘Nicholson Challenge’, with one in ten trusts and Clinical Commissioning Groups (CCGs) predicting they will be in deficit by the end of the financial year, according to a new survey, reported Pulse. The King’s Fund’s latest Quarterly Monitoring Report says only one in ten NHS finance directors believe their chances of meeting the target as better than 50/50. Most – 56% – identified a high or very high risk that the target will not be met. The survey – which for the first time includes finance leads from CCGs as well as trust finance directors – shows that 72% of CCG finance leads expect to meet their organisation’s targets for 2013/14. In contrast, only 33% of trusts expect to meet their cost improvement targets this year – a sharp fall on the same quarter last year when nearly three-quarters were confident of meeting their targets. Amongst others the survey also found the vast majority of trusts and CCGs – 89% – expect their organisation to be in surplus or to break even in 2013/14, with 11% expecting to be in deficit and nearly three-quarters – 72% – were pessimistic about the prospects for their local health economy over the next 12 months and only 10% were optimistic. Professor John Appleby, chief economist at The King’s Fund said: “The findings from our survey of finance directors have become significantly more pessimistic over the past 12 months, reflecting the growing pressures on the NHS. Now just over half way through the so-called Nicholson Challenge, it is clear the NHS will struggle to meet its £20 billion productivity target, with potentially serious consequences for patient care.”
Hunt sets out tough new approach to turn around NHS hospitals: Health secretary, Jeremy Hunt has set out the government’s plans to help prevent future failures of care and safety at NHS hospitals, announced the Department of Health. In the wake of the scandal over standards at Mid Staffordshire NHS Foundation Trust and subsequent Keogh Review which looked at 14 NHS trusts with high mortality rates, 11 of those trusts have already been placed in ‘special measures’. The health secretary has set out a new approach to ensure progress at those NHS trusts, which could be applied to any trust that is placed in special measures under a new, tougher inspection regime, which includes in future, NHS hospitals with the highest standards of patient care and safety will help those with problems. Each of the 11 trusts will be partnered with one of the best NHS trusts in the country in innovative improvement contracts, the high performing hospitals will enter into contracts with the NHS Trust Development Authority or Monitor to support the special measures trusts. They will be reimbursed for their time, and will have access to a special incentive fund, through which, where appropriate, they could be paid extra – if their help produces real results. Hunt said: “Turning special measures hospitals round is my top priority as health secretary. For too long, patients have had to put up with poor care because it was inconvenient to expose and tackle failure. So today I am committing to total transparency on progress in these hospitals, and to leave no stone unturned in our mission to turn them round.”
MPs ‘sceptical’ about DH’s vision for a paperless NHS: It is doubtful the Department of Health (DH) can deliver on its ‘paperless NHS’ pledge by 2018 given it has not even set aside a specific budget, a committee of MPs has said, reported Pulse. The report from the House of Commons Committee of Public Accounts, an influential group of MPs, called into question the DH’s ability to meet their target of a paperless NHS by 2018 following the failures of the National Programme for IT. It was found that most of the benefits of the programme are yet to be delivered, and there is a risk that some of these benefits may never materialise. The report said given the failures of the previous IT programme, and the DH’s failure to put aside a clear plan, estimate costs and a budget, MPs were ‘sceptical’ this could be achieved. GP practices have been charged with allowing patients to view their medical record, book an appointment, offer email access and order a prescription online by 2015, and have a vision for a ‘paperless NHS’ by 2018. NHS England are also introducing a new e-referrals service to replace Choose and Book, which they want 100% of practices to use, but have said they will not make compulsory. The report said: “After the sorry history of the National Programme, we are sceptical that the Department can deliver its vision of a paperless NHS by 2018.”
NHS wards should publish their staffing numbers daily, MPs say: MPs have said hospitals should post the figures on wards so patients and families are aware of staffing levels, and that the information should be analysed by experts to ensure levels are safe, reported The Telegraph. The government has said guidance will be drawn up in future setting out safe minimum staffing levels, and that NHS trust boards should publish the figures twice a year. However MPs suggested that hospitals should go further, and provide the public with real-time information which would alert patients to any staff shortages. The system would follow an approach pioneered by Salford Royal NHS Foundation Trust, which has one of the best patient safety records in the country. MPs said transparency needed to become the norm within the NHS, allowing staff to freely raise everyday concerns, not just major wrongdoing. Committee chairman Stephen Dorrell said: “Openness ought to be part of the routine culture of the health and care system.”
UK-wide GP contract to end next year as devolved nations go it alone in 2014 talks: The GP contract will no longer be negotiated on a UK-wide basis, with the devolved nations conducting separate talks with their respective governments on the 2014 contract deal, Pulse has learnt. For the first time NHS Employers will not conduct UK-wide negotiations with the General Practice Council (GPC), and will instead only negotiate terms for English GPs, as well as Quality and Outcomes Framework terms for GPs in Wales. Entirely separate deals will be negotiated for Scottish and Northern Irish GPs. The landmark decision follows an increasing divergence in the four nations’ contract settlements, but still comes as a surprise given the GPC’s determination to continue with UK-wide negotiations. The devolved nations have traditionally only made subsequent tweaks to a concluded UK-wide deal, and Scottish Local Medical Committees rubberstamped a policy to continue UK-wide negotiations at their annual conference earlier this year. GPC chair Dr Chaand Nagpaul said: “It is not a UK negotiation as usual.” An NHS Employers spokesperson said: “From April 2013, NHS Employers negotiates changes to the GMS contract on behalf of NHS England. In previous years such discussions have been conducted at a UK level for the majority of changes.”
Liverpool aims for 1,000 on telehealth: Liverpool Community Health NHS Trust aims to have 1,000 telehealth patients within the next two years. As part of the ‘More independent’ – or simply ‘Mi’ scheme – piloted across four regions in the UK, the trust aims to support people with long-term conditions, reported eHealth Insider. It recently launched a telehealth service using a box which connects to the TV and the Motiva Personal Healthcare Channel, allowing nurses to send messages, feedback and reminders to patients. Patients can also use a blood pressure monitor and scales to send data directly to the nurse via a secure network. The Liverpool programme has enrolled more than 50 patients so far and the trust hopes to get at least 1,000 patients enrolled in the next two years. Helen Locklett, director of operations and executive nurse, said that there were different tools for people’s different health needs. “Mi is all about harnessing potential to empower people to live more independently in their own homes and lead healthier lives,” she said. The Mi service is a partnership between charities, the NHS and supplier organisations and offers a range of telehealth and telecare products.
Launch of healthcare competition: A new competition, ‘Little Touches, Big Difference’, has been launched with the aim of recognising and sharing great productivity ideas within care settings throughout the UK, reported Midwives Magazine. It is open to clinical staff from UK public and private healthcare settings, who can enter as individuals or as teams. A public judging process will decide the winning idea. The prize is an electronic whiteboard with Patient Flow Manager software from Cayder. The software helps care professionals across multiple settings to manage the progress of patients through treatment. Chief executive of Cayder, Stuart Rankin said: “We hope these ideas will then get reused across the country. Anything that makes the lives of our healthcare workers that little bit easier is what’s needed right now and we know there are great ideas to help improve productivity and efficiency that are going unnoticed. Furthermore, it is these ideas that can contribute to organisations achieving the Department of Health’s QIPP (Quality, Innovation, Productivity and Prevention) targets, such as Releasing Time to Care.” To enter the competition, submit your productivity idea in no more than 300 words at www.cayder.co.uk. Closing date for entries is midnight on Monday 7 October.
Eight in ten NHS desktops still on XP: Microsoft’s decision to end support for Windows XP in April next year looks set to cause significant problems for the NHS, which still has 85% of its desktops running on the obsolete operating system (OS). The scale of the XP challenge is revealed in a report from eHealth Insider’s (EHI) research arm, EHI Intelligence, which calculates that there are 677,000 computers across the health service that work on the OS, which was launched in October 2001. By contrast, just 14% of the computers covered by the research (or 110,000) are running the Windows 7 OS that Microsoft introduced in October 2009, and just 1% (10,600) are using the newer Windows 8. The report, which examines servers, networks, hardware, and mobile devices, finds that the NHS has a generally dated infrastructure, and a surprisingly large fleet of PCs for an organisation whose staff need to work on wards and across the community. But it has a particularly large problem with XP. Senior analyst SA Mathieson suggested that this could be attributed to trusts investing in hardware in the early years of the National Programme for IT, the support provided by Microsoft’s Enterprise-wide Agreement with the NHS until 2010, and the large number of health applications that only run on the OS. “This report shows that most NHS organisations invest in infrastructure and devices when times are good or they have a specific reason to do so, such as a new building or electronic patient record project,” he said.
New £429m Royal Liverpool University Hospital given the green light: Plans for the new £429m “world class” Royal Liverpool University Hospital development have been approved, reported the BBC. The city hospital will be built next to the current site after Liverpool City Council planning chiefs gave the project the green light. Hospital chief executive Aidan Kehoe said the new facility would provide the “most advanced” treatment for patients. The part government and private finance initiative funded building is scheduled to open in 2017. Mayor of Liverpool, Joe Anderson said: “It is now all systems go for the new hospital, which is fantastic news for the city. “This world class facility will bring massive health, education and economic benefits.” Royal Liverpool and Broadgreen University Hospitals NHS Trust said it would be the largest hospital in the country. The hospital building alone will cost £335m and will include 18 theatres, 23 wards and 646 single bedrooms. Aidan Kehoe, chief executive of the trust, said: “We are creating a new kind of hospital designed to meet the needs of the people of Liverpool and Merseyside and dealing with the health challenges we face. It will provide both the most advanced treatment and the highest standards of comfort, privacy and dignity for patients.”
Scotland gets HANDI: The Scottish cluster of the Healthcare App Network for Development and Innovation (HANDI) has been launched at the Health Informatics Scotland conference in Edinburgh, reported eHealth Insider (EHI). HANDI is a not for profit organisation that holds workshops to discuss how the app approach can be used to improve health and care for staff and patients. Clusters are already in place across England. Richard Brady, a surgeon at NHS Lothian and one of the facilitators of HANDI Scotland, told EHI it provides a platform for those looking to advance the mobile health agenda. “It provides a community for people, especially young physicians who have ideas, but don’t necessarily have the tools or the ability to take that forward,” he said. Brady recognises the need for apps, but also that a good idea can be difficult to get off the ground, especially when dealing with the NHS.
World Alzheimer Report: Global number of dependent older people will nearly treble to 277m by 2050 – with almost half suffering from dementia: The number of dependent older people in the world will nearly treble to 277m by 2050, according to a new report, with almost half of those suffering from dementia, reported The Independent. Globally, the burden of dementia will spread to rapidly developing middle-income countries like China and Brazil, where populations are ageing at historically unprecedented rates, according to Alzheimer’s Disease International. In their latest World Alzheimer Report, the organisation warns that the cost of the disease, currently more than £395bn, or around 1% of global gross domestic product (GDP), will rise to more than £690bn by 2050. In high income countries, which currently have the greatest proportion of Alzheimer’s disease, the costs of long-term care are set to double over the next 50 years as a proportion of GDP – from 1.2% to 2.5% for the 27 EU countries. Jeremy Hughes, chief executive of the Alzheimer’s Society said that the report was a “wake up call to governments across the world”.
Swedish company wins ambulance bid: A Swedish company is the preferred bidder for a £19m contract to provide IT systems for three southern ambulance trusts. eHealth Insider reported in July that the procurement was on hold due to a legal challenge from one of the bidders involved, but it is now progressing again. A Department of Health spokesperson said: “There was a legal challenge to the procurement but this has now been withdrawn. Commercial activities with Ortivus, the preferred bidder subject to contract, have now resumed.” Ortivus is a Swedish company specialising in mobile systems for emergency medical care. The company website says it has 20 employees in Sweden and the UK and more than 1300 ambulances using an Ortivus system called MobiMed Smart, which allows ambulance staff to handle documentation and monitoring while in the field. The ambulance project is part of the Southern Local Clinical Systems programme for the 60% of providers in the South that otherwise got nothing from the National Programme for IT.
Opinion
Health and social care integration: how do we make it work?
This week in the Guardian Healthcare Network Chris Hopson, chief executive of the Foundation Trust Network, discusses how we can make health and social care integration work.
“While our health and social care system often divides and separates us – think organisational structure, payment mechanisms and performance targets, for example – we are all in this to improve care for patients. We are at our best when we focus on that, and at our worst when we forget it. Integration is a perfect example of this truism.
“When some people talk about integration they actually mean organisational and provider integration – creating single accountable care organisations or lead providers. Others mean integrating commissioning – bringing local authority and health commissioning together into a single place.
“Some mean improving collaboration and co-ordination with the voluntary and other sectors. Yet others mean integrating governance – for example, creating health and wellbeing boards.
“That’s why if we are to use the i-word and concept (and some are wondering aloud if we should drop its use altogether, given the confusion), we should get the right definition. The Integrated Care and Support Collaborative’s definition, for example, carries a strong and welcome emphasis on patient leadership and patient outcomes: “My care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes.
“But let’s please ensure that the move to integration improves patient outcomes and doesn’t just end up making organisational, governance, budgetary or structural changes that do little to change patient pathways. In a phrase, integration: it’s the patient, stupid.”
Strong medical leaders: the key to high-quality care in these austere times?
Chris Ham, chief executive of The King’s Fund, asks whether medical leadership is the key to improving care when money is tight.
“Health care systems around the world will not survive in austere times – let alone deliver high performance – without exceptional medical leadership. This is because the most important opportunities to improve productivity are to be found in unwarranted variations in clinical practice, such as prescribing, the use of diagnostic tests, and lengths of stay in hospital.
“Tackling these variations cannot be done by politicians or managers. Rather, it requires every clinical team to take responsibility for reviewing its use of resources with the aim of improving the quality of care and reducing costs.”
Ham gives the example of the how Intermountain Healthcare in Utah, USA have made a sustained effort to support their clinical staff with significant results. “One example is the reduction in deaths from sepsis from 18 per cent in 2004/05 to 10 per cent in 2008/09. The drop came three years after committing to the goal of treating more patients with a recommended ‘bundle’ of strategies, resulting in identification and treatment at a much earlier stage than at most hospitals. A key message is that resources are wasted when the quality of care is compromised. At Intermountain Healthcare, they tackle this by engaging clinicians in developing guidelines on best practice and reviewing performance against these guidelines. Medical leaders at all levels use performance data to challenge their peers in order to drive continuous improvements in quality and outcomes.”
Ham concludes by suggesting that not only should the profile and status of medical leaders in the NHS be raised, but also: “The lesson for the NHS is to redouble efforts to involve doctors in leading work to improve performance and to do so as a matter of urgency.”
Idealism can be the enemy of culture change in the NHS
This week, Dean Royles, chief executive of NHS Employers, delivers a rallying call to stop blaming the NHS’ culture as the only source of its problems.
Royles explains that following the Berwick, Keogh and Francis reports, the healthcare industry seems to accept that the solutions are not in funding, structure and integration of services: “Every time there is a problem – a staffing issue, a complaint, a quality concern, a bullying allegation, a system failure, or a whistleblower – the shout goes out, “That’s why we need to change the culture”. It’s as though culture change, which is often ill defined, will solve the ails of the NHS and nothing will ever go wrong. Furthermore, it seems the culture we currently have is responsible for the failings in the NHS, but that the millions of people receiving exceptional care and treatment every week receive it by chance.
“An idealistic view that ‘culture change’ will solve all the problems in the NHS will leave us all disappointed. Worse than that, it will prevent progress and lead to more blame. Let’s not confuse culture (expressed as behaviours expected in a given environment) with cult (expressed as behaviours demanded by the environment). The latter will lead to inevitable destruction.”
Royles goes on to make comparisons with the aviation industry and believes that context is key when seeking solutions for cultural issues in the NHS.
Online consultations can save valuable time for both patients and doctors
In the Guardian this week, Mohammad Al-Ubaydli, chief executive and founder of Patients Know Best, explains why he thinks online consultations could reduce the need for face-to-face appointments with GPs by 40%.
“In my opinion, it’s important to offer online consultations when they are appropriate. But for the best of reasons, many in the NHS remain deeply sceptical about consulting online. Time-pressed doctors and GPs are not sure what an online consultation actually is. They fear it might take up even more of their time.
“Many doctors believe online consultation means sending emails – but we already know this doesn’t work well. The back-and-forth nature of email means that getting detailed answers is slow and frustrating for doctor and patient alike. But we do know the right way to do online consultations: asynchronously, where a patient fills out a structured online questionnaire that the doctor checks at a later date; and synchronously, where both parties talk to each other at the same time, using video technology such as Skype.
“No patient should be forced into using online consultations – but many want to be offered the option. Moving just a small proportion of these face-to-face consultations online can make a big difference for patients. Furthermore, online consultations allow more efficient and frequent interaction with a specialist and the advice received is available for sharing with the local GP. This completes the circle of care and means patients can access the best care wherever they live.
“GPs and doctors must move away from thinking they are too busy to consult online – indeed, it is precisely because they are so busy that they need online consultations.”
Highland Marketing blog
In this week’s blog Mark Venables considers if there could be a better way of knowing whether an IT solution does exactly what it says on the tin.
