News in brief
Giant NHS database rollout delayed: The start of the new NHS data-sharing scheme in England involving medical records is being delayed by six months, reports the BBC. Work to start compiling the largely anonymised records on to the care.data database was meant to start from April. However, NHS England has now decided that will not now happen until the autumn. The organisation has accepted the communications campaign, which gives people the chance to opt out, needs to be improved. An NHS England spokesman said: “To ensure that the concerns are met, NHS England will begin collecting data from GP surgeries in the autumn, instead of April, to allow more time to build understanding of the benefits of using the information, what safeguards are in place, and how people can opt out if they choose to.” It has not yet been decided how the communications campaign should be built on – some have suggested there should be a high-profile TV and radio advertising campaign. The BBC reported that Patients4Data, an umbrella group for more than 70 bodies, warned that opponents of the plan to share medical records are “peddling scaremongering myths” and risked preventing patients benefiting from a revolution in modern medicine. However privacy campaigners maintain their concerns are justified. Care.data involves extracting a new monthly dataset from GP practices and linking this with other datasets, such as the Hospital Episode Statistics, within the ‘safe haven’ of the Health and Social Care Information Centre. NHS England’s director of patients and information, Tim Kelsey, says ‘pseudonymisation at source’ technology is not ready for use on the care.data programme. However, experts spoken to by eHealth Insider reveal that the technique is already used for large-scale research projects and they believe it could be applied to care.data.
NHS trusts ranked on their clinical IT: The first national table ranking all NHS hospital trusts on their clinical IT systems has been launched by EHI Intelligence, in partnership with NHS England. The Clinical Digital Maturity Index (CDMI) provides a complete picture of the clinical information systems in use at all 160 English acute trusts. The new CDMI service, which is provided as a searchable online database and national baseline report, has been licensed by NHS England so that all NHS staff can see how their trust ranks on its use of IT and where it is on its digital journey. King’s College Hospital, Liverpool Heart and Chest Hospital and Newcastle Upon Tyne Hospitals NHS Foundation Trusts, are ranked top in the national table, which is published for the first time this week. Colin Sweeney, director of ICT at King’s, said the trust regards itself as an innovative organisation and at the forefront of healthcare in the NHS. EHI Intelligence recently completed a refresh of the rankings after trusts were given the chance to update their profiles online. Trusts can access and update their profile at any time and another rankings refresh will take place in six-months.
Children with mental illness admitted to adult wards amid bed shortage: Acutely ill children as young as 12 years old are being admitted to adult wards due to bed shortages at specialist child services, a Community Care/ BBC investigation has found. The Information Daily reported that 350 minors were admitted to adult mental health wards in the first nine months of the period 2013/14, up from 242 in 2011/12, data obtained under the Freedom of Information Act has revealed. Of these minors, 12 were aged under 16 and one was just 12 years old, a situation NHS England admits is “totally unacceptable in the majority of cases”. The investigation also found that many children were being uprooted from their communities and sent to mental health wards up to 150 miles away from home. One child was sent a record 275 miles away, leaving their Sussex home to stay in Greater Manchester. Sussex Partnership NHS Foundation Trust has responded to this shocking revelation, claiming that they “simply couldn’t find anywhere nearer” to deliver the specialist care the child required. The bed shortage as it stands risks flouting the Mental Health Act 2007, which states that “age appropriate care” must be given to those under 18.
E-referrals to be mandatory – Nicholson: Use of the new NHS e-referrals service could become mandatory for GPs, NHS England’s chief executive, Sir David Nicholson, has said. The NHS e-referrals service, being developed by BJSS, is due to be in place by the end of this year and NHS England’s aim is to hit 100% paperless referrals in 2017. In June last year, NHS England’s director of strategic systems and technology, Beverley Bryant, said that use of the e-referrals service would not be mandatory because the centre wants GPs to, “want to use it”. However, speaking at a Public Accounts Committee meeting last week, Nicholson signaled a turnaround on the issue. “I think we are getting to the point, with what we have understood from the implementation of e-referrals, where we want to get a system where we can make it mandatory as we go forward,” he said. The question we have to ask, and to get as wide a support for it as we can, is what incentive or penalty system do we need to put in place to ensure that it works?” Choose and Book went live in 2004 after the then-Labour government promised to introduce “airline-style booking” to the NHS. Use of the system reached an all-time high of 57% in early 2010, but has since leveled off at 50% usage for a number of years. Nicholson acknowledged that the system has not been as well used as originally planned.
Information centre should audit waiting times data, say health leaders: Health leaders have called for an Audit Commission-style body to perform spot checks and external monitoring of waiting times data to ensure its accuracy, revealed Health Service Journal (subscription required). At a Public Accounts Committee hearing last week the Department of Health’s permanent secretary, Una O’Brien, said that the Health and Social Care Information Centre (HSCIC) should take on the old role of the Audit Committee in monitoring the accuracy of the data. The government announced in August 2010 that the public sector auditing body was to be abolished. The hearing focused on the findings of the National Audit Office’s elective care waiting times report published in January which found that more than half of the waiting times of 650 orthopaedic patients across seven trusts were incorrectly recorded. Chief executive of NHS England, Sir David Nicholson, said the introduction of a quality premium was a “significant incentive” to encourage commissioners to ensure trusts provide accurate data. The quality premium will be paid at the beginning of the 2014-15 financial year to any clinical commissioning groups that have seen improvements to the quality of the service they commission during 2013-14.
Dominance of small GP practices undermines push for extended providers: General practice remains overwhelmingly dominated by providers on single sites with small lists, providing little beyond “core” services, Health Service Journal (HSJ. subscription required) analysis reveals. The findings highlight the scale of the challenge involved in cultivating the landscape of large and extended GP provider models, which is currently being sought by national officials and policy experts. However, analysis of the GP provider sector also identifies about a dozen emerging large scale operations working over multiple sites and with the biggest operator’s practice list stretching to more than 170,000 people. A small number provide services significantly beyond core GP work, such as specialist clinics, proactive community health services, diagnostics and urgent care. The research is the most comprehensive analysis of the current landscape of GP and linked providers publicly available, and is based on the Care Quality Commission’s database of registered providers and sites. HSJ’s analysis found that, of about 7,580 distinct providers registered in general practice and associated services, around 5,700 offered care at only one site. This group had an average registered patient list population of 6,500. The analysis comes as national policymakers and commentators push for bigger GP providers covering a wide range of out of hospital services.
GP practices face crackdown on walk-in centre attendances: Pulse reports that GP practices with high numbers of registered patients who attend walk-in centres face tougher scrutiny of their opening hours, under proposals from Monitor. The patient watchdog has recommended that managers should ‘identify and correct any access or other problems’ in GP practices that may be contributing to high attendance levels at walk-in centres. Monitor also suggested – in the final version of its review of walk-in centre closures published this week – that practices could be incentivised financially to ensure their registered population attends the practice over walk-in centres. In a previous ‘interim’ report, Monitor concluded that GPs may be encouraged to ‘raise their game’ by increasing competition for funding between GPs and walk-in centres. In the final report, Monitor said: “We recommend that commissioners work with any GP practices that have a high number of their patients using a walk-in centre to identify and correct any access or other problems.” Monitor also said there was ‘confusion’ over commissioning responsibility of walk-in centres, especially in those that were GP-led and also kept a registered list. The report said: “Current payment mechanisms for GP practices and walk-in centres discourage commissioners from offering walk-in centres, even where these may represent a high quality, cost-effective model for delivering services. In addition, the payment mechanisms do not strengthen incentives for GP practices to improve the quality and efficiency of their services so that their patients are more likely to choose the GP’s services rather than a walk-in centre.” It comes as Monitor is already involved in a review of payment systems which it is jointly overseeing with NHS England.
Bristol Community Health counting the benefits of mobile technology: Bristol Community Health has reported improvements in staff satisfaction, patient experience, in addition to increased patient contact time, following the introduction of a community health mobile workflow management solution provided by TotalMobile, reported eHealthNewsEU.Portal. Speaking at the Annual Mobile Healthcare Summit in Toronto recently, Julia Clarke, chief executive of Bristol Community Health, reported that clinicians surveyed as part of the pilot are 35% more positive about their ability to do their job to a standard they are satisfied with and respondents feel 31% more able to manage caseload demands better. Clinicians using the solution are saving significant time on every shift through the elimination of paperwork, unnecessary travel and data entry to patient record systems, for example, they are saving at least 30 minutes per shift on data entry in to just one system. The TotalMobile solution was deployed during a pilot to over 60 clinicians across three community nursing teams and a citywide phlebotomy service. Following this success, Bristol Community Health is now rolling the solution out to other areas of the organisation. Colin Reid, CEO of TotalMobile, said: “The community landscape is changing dramatically throughout healthcare, with increasing demands on out-of-hospital care. Bristol Community Health has recognised how mobile technology can support this change and their staff are now seeing the benefits – spending as much time with their patients as possible by reducing their administrative and travel burdens.”
Trusts trim transfer times: East Yorkshire Hospitals NHS Trust and Lincolnshire Community Health Services NHS Trust have reduced transfer times by implementing a patient flow management system from Cayder, reports eHealth Insider. The roll out of the system at Hull and East Yorkshire began last winter and is now in use on 39 wards with 45 electronic whiteboards deployed across the trust’s two hospital sites. The trust’s chief nursing information officer, Steve Jessop, said that staff would previously write with coloured marker pens on whiteboards to record patient details and bed availability would be recorded manually six times a day. Patients can now be transferred electronically across wards, reducing transfer times to less than five minutes down from 22. “Electronic transfers mean that at least an hour of clinical time is saved on each and every ward in the organisation every time a patient is transferred,” Jessop said. “A nurse can also now discharge a patient at the touch of button, or by just marking their finger across a screen to place a patient into a discharge box – much more quickly than the five or 10 minutes that the paper-based system used to take.” He added that the trust’s local authority partners are planning to procure their own electronic whiteboards, which will integrate with the trust’s boards.
Over 95% of practices have risks relating to prescribing system: Prescribing continues to be one of the top five risks in general practice based on Clinical Risk Self Assessments (CRSAs) conducted by the Medical Protection Society (MPS), reported Commissioning GP. Data from assessments of 153 practices in the UK and Ireland conducted in 2013 revealed that 95.4% of practices visited had risks relating to the prescribing system. Common specific examples include uncollected scripts, repeat prescribing systems, and administrative staff changing medications on the computer. Julie Price, clinical risk manager at MPS, said: “We found that a number of practices did not have a robust system in place to alert the prescribing doctor to uncollected prescriptions. Clinicians should be able to review uncollected scripts to check whether any further actions are needed as a consequence of non-compliance, this is particularly important when dealing with vulnerable patients.” MPS advises practices to consider making a note on patients’ records when they have not collected their prescription. This would alert the doctor to possible non-compliance and highlight to patients that a control mechanism is in place. Price added: “The CQC will be looking to see whether a practice has suitable arrangements to ensure that patients have their medicines when they need them, and in a safe way.”
CCG tenders for £3m-£4m GP IT support: NHS Dorset Clinical Commissioning Group (CCG) has gone out to tender for a GP IT support service worth £3m-£4m, reports eHealth Insider (EHI). The three-year contract, with an option to extend for another two years, will replace the IT support service currently provided by two suppliers, neither of which is a commissioning support unit. It will cover IT maintenance and a service desk, GP clinical systems, national systems implementation and information governance management. The tender is significant as a signal that CCGs are taking control of the funding and responsibility for procuring their GP IT after NHS England announced it was devolving responsibility for this to the groups in June 2012. EHI established in February last year that the total allocation for CCGs across England would be £186m in this financial year, based on previous reported spend by primary care trusts on GP IT. The funding landed with local area teams, which were working with commissioners to verify local budgets. However, there were concerns raised that the money was never finding its way to CCGs, but rather going directly to CSUs to provide GP IT support. Commenting on the release of the Dorset tender, chair of the BMA’s General Practitioners Committee, Dr Chaand Nagpaul, said: “CCGs have delegated authority to commission GP IT support services. “It is encouraging that CCGs are beginning to exercise their entitlement to procure services that are fit for purpose, and the most appropriate and responsive to the needs of GP practices.” Requests to participate are due by 3 March.
Opinion
Community services have been neglected
In HSJ this week (subscription required), Nigel Edwards, senior fellow at the King’s Fund and soon to be chief executive of the Nuffield Trust, explains that community services make up a large part of NHS activity but years of initiatives and ideas have left a legacy of highly complex, poorly coordinated care.
“Launched by the government in 2008, the Transforming Community Services programme [was] mostly concerned with structural changes rather than with service improvement, the programme led to some community services being privatised – and often set up to fail against hugely onerous procurement processes – with others transferred to whichever acute or mental health provider was available.
“In the services themselves there has been a loss of direction and, more worryingly, a loss of staff from what is already an ageing workforce. Mergers and reorganisations have left hospitals and GPs confused about who to refer to, while community services often do not respond quickly enough when patients are discharged.
“The ambition to move care closer to home is not new – it has been the agreed direction for years – but further significant changes are needed in the way care is delivered to achieve it. So it’s interesting to reflect on why community services have received more rhetorical support than actual support which is what we explore in the King’s Fund’s new paper on transforming community services, published on 13 February.”
“Some providers are delivering fantastic and innovative care against the odds and new thinking and models are emerging. It will now be important that the mistakes of the past are not repeated and the opportunity to transform community services is seized.”
Care.data: a media.disaster
This week in eHealth Insider, Lyn Whitfield says that whatever the rights and wrongs of the care.data scheme, the leaflet campaign put together by NHS England and the Health and Social Care Information Centre, and their response to increasingly adverse media coverage, have been disastrous.
“Over the past couple of weeks, the number of articles, think-pieces and slots on satirical radio programmes about care.data have exploded; and “slammed” has been one of the milder words in their headlines. The Mail Online described Gordon Gancz, who has decided to opt-out all his Oxford patients from care.data unless they decide to opt-in, as the “hero GP” who “won’t give in to the NHS thought police.”
“Both the Mail and the Guardian have received huge responses to their coverage of care.data, with comments running well past the 1,000 mark on almost every item they have published. Many of these responses, it has to be said, have focused on the idea that drug and insurance companies will be able to buy care.data information – either because this was the initial focus of much of the newspaper coverage, or because people just don’t trust the present government not to do it.
“One YouGov poll for consumer group SumOfUs found that 65% of respondents “oppose the sale of their medical history.” An ICM Research poll, reported by the BBC, found that only 29% of the 860 people contacted recalled getting a leaflet, and 45% were unaware of the scheme. And a further YouGov poll for the Medical Protection Society said that 77% of GPs do not feel NHS England has given them the information they need to help patients make an informed choice.
“This alone will keep the row running, push care.data proponents even further onto the back-foot and, by the look of it, make heroes of some very unlikely family doctors.”
‘More resources to the frontline’ slogan damages the NHS
This week in the Guardian Healthcare Network, Dr Stephen Black, health management expert at PA Consulting Group, comments on an NHS slogan which he describes as ‘naïve’.
Black argues that the slogan fails to communicate the intricacies of how a hospital system works, and the actual resources required to deliver a complex health service: “The slogan [‘more resources to the frontline’] effectively captures the public mood. When a UKIP politician on BBC Question Time claimed that the NHS has two managers for every nurse, he was overestimating the manager count by a factor larger than 20 (see useful analysis of the real numbers here and here).
“The slogan reinforces beliefs about the NHS that are simplistic, naive and probably incorrect. But the slogan is so attractive almost nobody looks beyond it.
“This wouldn’t be a problem if the people running the system didn’t share the belief. But the slogan was written into the health bill. Despite the whole thrust of the bill being to free up local NHS organisations from central control to help them decide how to run the system, a centrally imposed target on how much could be spent on management has been built in. This target was derived from the idea that we should move more resources to the frontline, even though the best evidence available at the time suggested the system was undermanaged before the changes.”
Engaging with 10,000
Jane Cummings, NHS England’s chief nursing officer, has reached a milestone number of followers to her Twitter account. Here she talks about why social media is so important.
“Everywhere we look in the healthcare system there are numbers. It seems we are always measuring data and figures to ascertain the worth, the value or the efficiency. Some of the numbers we collate are valuable and some we attribute more importance than they are worth.
“I recently reached 10,000 Twitter followers which is a significant number, although it’s important to remember that this isn’t about numbers but about individuals. Each and every follower creates the opportunity for positive and valuable engagement that enables me to communicate, listen, learn and share within an energetic community of nurses, other professions and a much wider community.
“To be a nurse in such a visible and open forum such as Twitter takes not only courage but also a high degree of professionalism. We are using Twitter to connect and support each other in so many ways; the exchange of nursing experience, ideas and expertise is commonplace but it is the celebration of nursing that makes our Twitter community so very special.
“Twitter has given us the opportunity to communicate beyond hierarchies and geographical locations. It is the tweeting community that has actually made this happen, each and every individual and their commitment has created this space for sharing.
“Twitter allows me to communicate and engage with so many different people, to understand their perspectives and to be a part of the community. 10,000 is a number but it’s the 10,000 individuals that matter, the 10,000 opportunities to connect, the 10,000 opportunities to share and the 10,000 opportunities to learn.”
Highland Marketing blog
In this week’s blog, Gemma Thomson looks at whether people are complaining more or whether we are just more aware of the issues in light of all the negative publicity the NHS is getting.
