News in brief
More NHS IT investment on the way, despite austerity: NHS acute trusts will be ramping up their investment into new IT infrastructure over the next year, despite continued financial difficulties, reported Public Technology. The news has come from the latest EHI Intelligence survey, and also shows increased interest in EPRs and portals, and more influence of trust boards on IT strategy and procurement. The report, which produced figures based on the survey, found as many as 70% of acute trusts stating their main IT priority is to deliver new infrastructure over the next 12 months. The figure is up from just 40% last year. Lindsay Bell the report author said “The report shows increased optimism among respondents compared with last year.”
NHS CB promises new quality data: The NHS Commissioning Board has published its first planning guidance for the NHS, putting a new focus on outcomes and promising that far more consultant-level outcome data will be published, reported eHealth Insider. The guidance, published this week, replaces the Operating Framework for the NHS in England that is published by the Department of Health each December. While the framework was a “to do” list for NHS management, the new guidance says it will support a new principle of “assumed liberty” for the organisations set up by the ‘Liberating the NHS’ reforms.
‘Tough choices’ ahead for commissioners: Health professionals and organisations have responded positively to the plans published this week by the NHS CB, reported National Health Executive. The plans cover the amount of funding Clinical Commissioning Groups (CCGs) will receive in 2013/14, and the financial incentives that will be in place to achieve certain outcomes. Jo Webber, interim director of policy at the NHS Confederation, called for local commissioners to take advantage of the opportunities in the report skill to deliver improvements in their local areas.
GPs face patient spending curbs: Family doctors will be forced to limit spending increases to below-inflation levels next year as the government launches its contentious plan to put doctors in charge of the NHS budget, reported The Financial Times. The budget squeeze surprised GPs who had been expecting an above-inflation rise in line with the government’s pledge to maintain real-term increases in health spending. The NHS CB will tell new CCGs that their budgets for buying NHS care for patients will increase by 2.3% in 2013-14. The sum is marginally over the Treasury’s forecast for economy-wide inflation for 2013-14 of 2%.
Financial squeeze on NHS providers to continue in 2013-14: NHS hospital trusts and other providers face another tough financial year in 2013-14 with the NHS CB unveiling plans for further cuts to tariff income and the introduction of new contractual penalties, reported HSJ (subscription required). The board’s planning guidance for the coming year confirmed that tariff prices for NHS services would be cut by a further 1.3% in cash terms. The guidance explained that providers were facing estimated cost inflation of 2.7%, so the cut would impose an “efficiency requirement” on providers of 4%. It added that the 1.3% reduction should also be the “base assumption for discussions on price for services outside the scope of the mandatory tariff”. The cut follows similar reductions in tariff prices in 2011-12 and 2012-13.
Commissioning Board pledges paperless referrals by 2015: HSJ (subscription required) has reported that the NHS CB has announced the health service will move to paperless referrals by March 2015. The pledge, made in the board’s first ever planning blueprint, appears to fall short of promising to totally rid the NHS of paper by 2015 – an ambition outlined by the board’s information chief Tim Kelsey in October. The document, Everyone counts: planning for patients 2013-14, published this week, says: “We will support commissioners to provide patients with access to digital tools to help them manage health and care as they choose and shall also support a move to paperless referrals in the NHS by March 2015 so that patients and carers can easily book appointments in primary and secondary care.”
Cautious support for data publication: Doctors’ leaders have backed plans to publish outcome data for most surgeons in England; as long as the information is “meaningful” for patients, reported eHealth Insider. In its first planning guidance, issued this week, the NHS CB says the health service needs to put a new focus on outcomes, and promises a number of new data services for commissioners and patients. Chair of the BMA Council, Dr Mark Porter, described the move as an “extremely ambitious plan”, and expressed some concern about how the data would be presented.
NHS trusts are enmeshed in private provision – as buyers and suppliers: NHS hospitals deal with private firms to buy and sell patient care and treatment services worth more than £500m, creating a marketplace for commercial healthcare companies in the English health service, an analysis by the Guardian reveals. Freedom of information requests to more than 100 NHS trusts revealed hospitals were spending millions of pounds buying beds in private hospitals, often to bring down long waiting lists. A review of these trusts’ finances identified at least £300m generated in hospital income from patients who pay. Many trusts admit they seek to profit from private patients and use the money to fund public healthcare.
NHS staff ‘felt pressure’ to meet waiting times targets: Some NHS staff in Scotland said they felt under pressure to say patients were “unavailable” for appointments in order to meet waiting times targets, reported the BBC. The finding appeared in an NHS Tayside report sparked by allegations of fiddled waiting times figures. All 14 Scottish health boards had been asked to review their practices in light of the accusations. In a statement to parliament, Health Secretary Alex Neil said the reports showed no evidence of deliberate manipulation of the figures, but there were improvements in waiting times management that could be put in place.
Chesterfield issues PAS tender: Chesterfield Royal Hospital NHS Foundation Trust has published a tender notice for a patient administration system to replace its current system, which is reaching “end of life” in March 2014, reported eHealth Insider. The tender, published in the Official Journal of the European Union, says the trust wishes to procure a system that will be fully implemented by the time its contract for its McKesson PAS runs out. Chesterfield’s annual plan 2011-2012 says that one of its main goals is to go and procure a new PAS. It underlines that new systems are needed not just because of the imminent end of the support contract, but to secure “further improvements to clinical care and business efficiency.”
NHS Direct chief to stand down: The chief executive of NHS Direct has announced he will step down next year, reported HSJ (subscription required). Nick Chapman joined NHS Direct in 2009. The last couple of years have been turbulent for the organisation following the announcement that its core service, an 0845 number, was to be decommissioned and replaced by the non-emergency NHS 111 telephone number. In a statement released this morning Chapman said he would be leaving once the decommissioning of the 0845 service was complete. The board has appointed finance and performance director Trevor Smith as his replacement. In future the role will carry the title managing director, not chief executive.
Opinion
Clinical commissioning groups – what do we know so far?
The King’s Fund’s Chris Naylor (fellow, health policy) gives his first impressions on the progress of CCGs as they move several steps closer to taking control of £65 billion of NHS spending, following the results of the authorisation process so far.
“First, there are some grounds for optimism. All of the 34 CCGs completing the process in the first wave have been authorised, in some cases unconditionally, but more often with specified conditions attached. So far, the NHS Commissioning Board has not found it necessary to use the more punitive measures and sanctions available to it.”
However, Naylor identifies a lack of clear planning as a key weakness, with significant challenges ahead:
“Only 50 per cent of the first wave of CCGs were able to meet the first of these important requirements. One interpretation is that while CCGs have made significant progress in putting the basics in place and preparing to accept their new powers, some do not yet have a clear plan for how they will use these powers once authorised.
“The core challenge they face is to commission improved services for patients in a time of financial stringency, and there is still some distance to go before we can be confident that CCGs will be able to rise consistently to this challenge.
“We also know that many CCGs are grappling with the tricky question of what it means to be a membership organisation…Many smaller CCGs are working hard to be seen as being owned by their members, whereas in larger CCGs, the conceptualisation is often that the role of members is to select the governing body and grant them authority to act on their behalf.”
Getting it right for dementia
With dementia now a high priority on the government’s agenda, the BBC has been driving awareness of the condition. In an analysis, Nick Triggle, moves away from the negative coverage that has highlighted frequently appalling treatment of dementia patients and praises those NHS hospitals that are getting it right and implementing simple measures, such as staff training to give staff the confidence and skills to deal with patients, to make a difference.
“In the three elderly care wards at St Thomas’s Hospital, doors to toilets and washrooms have been colour-coded with bays to give patients visual prompts in finding their way round. Padded flooring has also been laid to help soften falls, which are more likely among dementia patients.
“A number of other measures have been introduced trust-wide. These include a print of a forget-me-not which is placed above the bed of all dementia patients to alert staff to their condition. Dementia patients are also given blue wristbands to wear.
“This has proved particularly useful if patients have wandered away from their wards… Red trays and beakers are also used to signify which patients need help with nutrition.”
Better access to patient records is essential to make the NHS a safer place
Writing in the Guardian this week Peter Dawson tells readers why the paternalistic dogma that regards patient records as the property of doctors and institutions must be discarded to make way for shared personal health records.
“Two weeks ago one of our patients, a 59-year-old woman with a diagnosis of vascular dementia and epilepsy, living alone with the daily support of carers, had been treated in hospital after an apparent fall. She was back home, but required further supplies of her new medications.
“Wynn, her domiciliary carer, came to the pharmacy to collect the customised monthly dosette trays, and she told us how much better her client was on the new tablets after coming out of hospital. The alarm bells sounded. The pharmacy technician, who had painstakingly prepared the trays, cursed. Once again, we had been unaware of alterations to treatment.
Dawson goes on to say that new prescriptions were requested from the GP surgery, but they knew nothing of the hospital admission, and they had not received a discharge summary. The hospital was contacted, and the following day a discharge summary was faxed, but it did not indicate which medications had been stopped or changed.
“Historically, patient records have been regarded as the property of doctors and their institutions. The riddance of such paternalistic dogma could be the very paradigm shift required to introduce the seamless integrated care that patients and health professionals alike would welcome. A British Medical Journal survey revealed 58% of respondents in favour of such changes.
“Without Wynn, one of the lowest-paid workers in the NHS, our patient would probably have been readmitted to hospital. In the pharmacy, and not just on a Saturday morning with the rest of primary care apparently closed for the weekend, access to PHRs would make the NHS a safer place.”
Highland Marketing Blog
In this week’s blog Myriam McLoughlin questions whether health literacy is something the government should include in its Information Strategy.
Merry Christmas
Highland Marketing would like to wish all of our Healthcare Roundup readers a very happy Christmas and a prosperous 2013. The Healthcare Roundup will resume on Friday 4th January 2013.
