News in brief
The silent scandal of patient safety: “If we are to improve the silent scandal of patient safety across the NHS we need a new culture of openness, transparency and accountability,” according to the health secretary Jeremy Hunt. During his speech he said: “Florence Nightingale said: “The very first requirement in a hospital is that it should do the sick no harm.” The many dedicated doctors and nurses I have met as health secretary would all agree. Thanks to their commitment, the Commonwealth Fund consistently rates safety in the NHS ahead of France, Germany, Sweden, Norway and the US. But is it as good as it should be? Julie Bailey, James Titcombe and other brave campaigners who have lost their loved ones know the answer to that question is unequivocally “No.” In the wake of Mid Staffs, Morecambe Bay and many other shocking lapses in care, we must ask ourselves whether we, along with other countries, have become so numbed to the inevitability of patient harm that we accept the unacceptable. That grim fatalism about the statistics has blunted the anger that we should feel about every single individual we let down, anger that should be the fuel of an uncompromising determination to put things right. It is time for a major rethink.” Click here to read Hunts full speech.
Tech fund to ‘catalyse’ NHS IT – Bryant: The £260m fund announced by the Department of Health (DH) as a boost for e-prescribing will be linked to NHS England’s guidance on electronic patient records to “catalyse” the adoption of IT in the NHS. Beverley Bryant, the director of strategic systems and technology at NHS England, told eHealth Insider’s ‘The Big EPR Debate’ roundtable that linking the two would give the guidance traction. “Call me an old cynic, but I think there is more chance of people reading it [the guidance] if there is an application form at the back to get hold of the money,” she told the event in central London this week. The DH announced in May that a ‘Digital Challenge’ fund would be available to hospitals that wanted to introduce e-prescribing, with health secretary Jeremy Hunt promoting this as a patient safety initiative. It subsequently emerged that NHS England’s strategic systems and technology directorate will be responsible for the fund, now called the ‘Safer Hospitals, Safer Wards Technology Fund’. NHS England’s website says this will be used to support a wider shift away from “outdated paper-based record keeping” to paper-lite and paperless working.
CQC ‘failed fundamental duty’ – Hunt: CQC chairman David Prior is to report back to the health secretary Jeremy Hunt on the actions the regulator will take in response to a review that was covered-up to hide the CQC’s failings at the University Hospitals Morecambe Bay NHS Foundation Trust, reported National Health Executive. This will include internal disciplinary procedures and may involve the naming of individuals involved in the suppression of the original report, as demanded by a number of national newspapers this week. In a statement, Hunt said: “What happened at Morecambe Bay Hospital is, above all, a terrible personal tragedy for all of the families involved. As we saw with Mid Staffs, a culture in the NHS had been allowed to develop where defensiveness and secrecy were put ahead of patient safety and care. The role of the regulator is to be a champion for patients, to expose poor care and make sure steps are taken to root it out. It must do this without fear or favour. It is clear that at Morecambe Bay the CQC failed this fundamental duty. We now have new leadership at the CQC and we should recognise their role in turning things around. David Behan was appointed chief executive in July 2012. One of his very first acts was to commission the report we are now debating. David Prior was appointed the new chairman in January this year. He has rightly insisted this report be published as soon as possible.”
Health and wellbeing boards may control £1bn under integration plan: Health and wellbeing boards could be given control of more than £1bn funding from the Department of Health (DH) budget under plans being considered by ministers and local government leaders, reported HSJ (subscription required). The proposal is being considered as part of discussion about the comprehensive spending review for 2015-16, due to be published on 26 June. Talks are also believed to be ongoing about whether there will be a significant increase in funding transferred from the health budget to councils. Rising sums have been paid by the DH to local authorities each year since 2011-12, under an initiative aimed at supporting integration between the NHS and social care, introduced in the autumn 2010 comprehensive spending review. It has so far been intended to be “ringfenced” to be spent only on joint working with the NHS, and in 2013-14 local authorities are required to seek the approval of clinical commissioning groups for how they use it. However, HSJ understands the DH, the Department for Communities and Local Government and the Local Government Association are working on a different approach to be used from 2015-16.
Trusts warned to get procurement right: Bidders are becoming more likely to challenge procurement decisions they don’t like, UKRC heard last week. Andrew Daly, a partner specialising in procurement for Hempson’s law firm, told delegates that it was becoming more common for bidders to question decisions during the standstill period, reported eHealth Insider. This is the period that falls after the procurer tells the market who has won and before they sign the contract. Some suppliers, Daly told the radiology event in Liverpool, are employing people to look for flaws in the procurement process so they can make a legal challenge. “We went through a stage last year of getting about two or three challenges a week from disgruntled bidders, looking at challenging the robustness of the process,” he said. Daly urged trusts about to embark on procuring new picture archiving and communications systems and radiology information systems to comply closely with the rules on procurement. He talked through the requirements of the two main procurement routes for PACS and RIS; placing an ad in OJEU and using a framework contract drawn up by NHS Supply Chain.
NHS urged to use IT safety standards: Trusts should adhere to patient safety standards when implementing new IT systems, a patient safety expert has argued, reported eHealth Insider. Maureen Baker, clinical director of patient safety at the Health and Social Care Information Centre, told last week’s UKRC that although the last 20 years had seen an increasing awareness of the importance of patient safety, there was still much to be done. In the US, for example, an estimated 98,000 people a year die from medical errors occurring in hospital. “We need to start thinking more critically about when things go wrong. We need to get better at stopping things going wrong in the first place,” she said. Although human error was inevitable, well-designed systems and processes could minimise the capacity for human error, Baker added. She also urged the NHS to learn from other industries such as aviation, which had extensive safety management systems in place. While the adoption of IT systems in healthcare had removed some major causes of error (such as illegible handwritten prescriptions), it had introduced others, Baker told delegates at the congress in Liverpool.
Hospitals to be given Ofsted-style ratings: Hospitals will be told to make urgent improvements if any department is providing poor care, under new Ofsted-style ratings prompted by the Mid Staffordshire NHS scandal, reported The Guardian. The “tough and rigorous” ratings will go further than Ofsted’s single overall ranking for schools in England by giving an official assessment, from “inadequate” to “outstanding”, based on inspections of every department of every hospital. The Care Quality Commission (CQC), which regulates NHS care, hopes the ratings will drive up standards and give patients and families a better insight into the quality of treatment they can expect from particular hospital services. Under CQC plans being unveiled on Monday, inspectors will rate every department, as well as each hospital and hospital trust, as inadequate, requires improvement, good or outstanding. The changes will begin in October, with the first ratings published in December.
Managing director resigns as NHS Direct losing more than £1m a month: NHS Direct is losing £1.5m a month and is likely to exit the NHS 111 market by the end of the year, reported HSJ (subscription required). The director charged with leading its 111 work has resigned following disciplinary action being initiated. The NHS trust’s most recent board papers reveal it has overspent on staff for its 111 contracts despite only delivering 30% of contracted call volumes. A revised budget for 2013-14 is expected to be submitted to the NHS Direct board for approval on 1 July, following discussions with the NHS Trust Development Authority and commissioners. It is widely expected this will set out plans for a managed exit from its nine NHS 111 contracts over the remainder of the year, most likely involving the transfer of contracts to ambulance trusts. NHS Direct won nine contracts to provide NHS 111 in about a third of the country including the West Midlands, North West, South East London, East London and the City, Buckinghamshire, North Essex, Somerset and Cornwall and the Isles of Scilly.
Risk stratification IG rules clarified: Clinical commissioners can use only pseudonymised patient data in risk stratification tools for commissioning purposes, new guidance says, reported eHealth Insider. NHS England has released guidance on risk stratification, setting out the circumstances in which patient-identifiable data can be used by GPs and clinical commissioning groups. It says that GPs using risk stratification for identifying high-risk patients should also use pseudonymised data where possible, or weakly pseudonymised data in an Accredited Safe Haven. If neither of these options is feasible, they must find a legal basis for using confidential patient information. Patients must be informed about how their data will be used and any objections respected. Risk stratification tools use relationships in historic population data to estimate the use of health care services by individual patients. They can be used for planning services across a population or identifying high-risk patients who could benefit from targeted support.
Senior NHS Direct leaders warned 111 was unsafe but were overruled: Senior directors at NHS Direct warned it was not safe to go live with one of its biggest NHS 111 contracts but were overruled, HSJ (subscription required) has learned. It comes as further revelations have emerged about the fallout for the organisation following its failure to fully deliver the urgent care phone service. A series of emails, seen by HSJ, reveal discussions between senior NHS Direct figures and commissioners in the run-up to the disastrous launch of 111 in the West Midlands. The services began failing within hours of launch at the end of March, and GP out of hours and ambulance service providers were drafted in to provide support. Across its nine contracts, of which the West Midlands is one of the biggest, NHS Direct is still only handling 30% of the calls it was originally contracted for. The emails, about the decision to go live in the West Midlands, show it was taken despite warnings from NHS Direct’s chief nurse Tricia Hamilton and NHS Direct’s director of service delivery for 111, Laurin McDonald. NHS Direct is one of two major national providers of NHS 111.
Increased interest in video conferencing from UK health trusts: With healthcare budgets being squeezed and the NHS charged with making services more accessible and more efficient, video conferencing technology is fast being adopted by forward-thinking trusts, reported Building Better Healthcare (BBH). It can be used by community nurses to liaise with consultants and GPs to decide on the best course of treatment for a patient; it can be used by doctors looking for advice from more senior or specialist medics; and it can be used for conferencing between different medical teams. Starleaf is at the forefront of this revolution, providing healthcare operators with cloud-based technology charged by usage and with no upfront capital costs. The solutions enable multi-person video conference calls to be undertaken from various devices including desktop computers, PCs, Macs and iPads. Speaking to BBH, Michelle Durban, marketing director at Starleaf, explained: “Rather than going into nursing or care homes, the health service is keen to help people to stay in their own homes for as long as possible, supported by health and care services.”
Earlier medical advice to underpin revamped NHS 111 service, claims NHS England chief: NHS managers are considering a major change to the way calls are dealt with by the troubled NHS 111 service, with advice from a medically trained professional introduced at a much earlier stage, Pulse has revealed. The helpline has been heavily criticised by the medical profession for unnecessarily referring patients to GPs and A&E services, and the General Practitioner’s Committee has repeatedly called for more clinical input in the service. The algorithm is operated by non-medically trained call handlers – with some clinical input if the caller does not accept the call handler’s recommendation, or they have complex medical needs – and was signed off by the NHS Pathways group, which included representatives from the Royal College of General Practitioners. It is currently used across all NHS 111 sites. However, Pulse has learnt that NHS England is considering major changes to this algorithm after numerous problems with the service, including commissioners in the North West and the West Midlands having to reinstate triage services from out-of-hours providers, calls going unanswered and 22 serious incidents in its first month of operation.
Monitor and NHS England seek views on first National Tariff for NHS services: National prices for hospital services will be broadly set at present levels next year while a new payment system for NHS-funded healthcare providers is established. Rules for making local payments will also remain largely unchanged. This commitment to maintain stability for 2014/15 subject to inflation and efficiency gains, is made jointly by Monitor, the sector regulator, and NHS England, the commissioning board, who are together taking over the payment system from the Department of Health. Under the Health and Social Care Act 2012, Monitor will set prices for groups of health services that are determined by NHS England. Ahead of a formal consultation in the autumn, both organisations are seeking views from providers and commissioners about the key principles underpinning the new National Tariff that comes into effect in April 2014. Paul Baumann, chief financial officer for NHS England said: “We are working to develop and design a new payment system that does more for patients. It is very important that we get the views of practitioners and so we are asking for feedback in any areas where they have ideas or concerns. We urge the sector to engage fully with our proposals.”
NHS cash-for-access: personal details of thousands of newborns sold under NHS deals: The personal details of newborn babies and their mothers are being collected in wards through photography offers and goodie bags offered by Bounty, the National Childbirth Trust (NCT), reported The Telegraph. The details are then resold over and over again as the child increases in age. Birth dates in particular are noted. Often patients, some of whom claimed they were targeted just minutes after major operations, are unaware their details are being sold to marketing companies, the NCT added. Concerns were also raised about mothers handing over details after mistaking sales representatives for medical staff. The names and addresses are estimated to be worth up to £1 each time they are sold, the NCT said.
Opinion
A chase with no thrill: in search of perfect healthcare
In HSJ this week, Dr Mark Goldman, a consultant in healthcare management, compares the journey of the NHS to a story and discusses what is really important and whether it is achievable.
“The Health and Social Care Act 2012, it is said, would have been received as wisdom from the outset if only Andrew Lansley had been a better storyteller – better able to fashion the horrible hotchpotch it became into a cogent and compelling tale.
“As we approach summer 2013, a new chapter in the story of healthcare opens, with another review. Unfortunately, looking after the health of the nation has no beginning, can never fully overcome the complexities it faces and the end is always stubbornly beyond reach.
“We have learned that people want excellent individual care built around them. Most do not care too much whether it is delivered by the public or private sector. They will be content if we can conjure for them the unique combinations of professional contacts and interventions they need, when they need them, and do so willingly and kindly.
“At age 65, the NHS enters a new era. As the financial situation continues to bear down, providers will feel the pain. Clinical commissioning groups will struggle, the NHS Commissioning Board will overplay its hand, the system that is not really a system will clunk along – and ministers will do what ministers have always done, then move on.”
Goldman concludes by stating: “Health professionals, politicians and the general public all want the same thing from the NHS – for it to provide the right care at the right time.”
From suitcases to systems – striving for electronic healthcare
The Clatterbridge Cancer Centre NHS Foundation Trust is striving to become one of the world’s leading cancer treatment centres, Thomas Poulter, head of IM&T says this ambition can only be achieved with the right technology in place.
“Many patients would be surprised to know the lengths that our staff go to in order to look after and provide their medical records at the point of care. If we showed them where their case notes are securely stored before the lengthy process of allocating them and transporting them to the correct healthcare professional begins, they simply wouldn’t believe it.
“Our aim is to embed fully electronic systems and processes into clinical practice before the doors of our new world-class cancer treatment centre in Liverpool City Centre open in 2018. This seems a long way off but there is a lot to do and the strategy is made up of several different projects, with the vision remaining the same for each; enhance clinical safety, efficiency and improve access to information.
“The system from IMS MAXIMS that we have in place has set us some way on our journey by providing the single front door to all electronic patient information, including the flexibility to act as a type of portal to provide access to third party applications.
“One of our biggest issues in becoming paperless is our dependency on the other partner organisations that we work with, as all of our patients are referred through to us from district general hospitals and acute teaching hospitals. What we can say is that the electronic systems we have in place are enabling us to deal with the large increase in activity levels we are seeing across the organisation more effectively with the same, if not less resource, which in itself is a huge achievement.”
What next for health and social care in England?
This week The King’s Fund chief executive Chris Ham asks what is next for health and social care in England?
“The King’s Fund is today launching a major review of health and social care under the leadership of an independent commission chaired by Kate Barker. The context for the review is a population in which people are living longer but often with long-term conditions, such as diabetes, heart failure and dementia. An increasing number of people have both health and social care needs, and the division between the NHS and social care that was established in 1948 means it is not always possible to meet these needs in an effective way.
“We have therefore asked the Commission on the Future of Health and Social Care in England to consider whether the boundary between health and social care should be redrawn by revisiting the post-war settlement and asking fundamental questions about whether it is still fit for purpose. This includes examining how the NHS and social care are funded and organised, and what the alternatives might be to current arrangements. We have also asked the Commission to consider the different entitlements to these services, and whether now is the time for these to be changed. This includes addressing the thorny question of the role of the state and individuals in paying for health and social care.
Ham concludes “The financial and service pressures currently affecting health and social care add urgency to the Commission’s work. With the prospect of several years without growth in the NHS budget and further cuts in the funding of adult social care, it is essential that all options for using scarce public resources more effectively are considered. This includes looking beyond health and social care to ask whether other forms of public spending could be drawn on to meet growing needs for support, as well as reviewing the balance between public and private funding of care. The experience of other countries will be used to inform the Commission’s thinking on this.
Bank on the internet to save the NHS
This week, NHS Confederation chief executive, Mike Farrar, explains that the NHS needs to radically review and change its approach to cost-saving to survive, and should look at the internet banking model as a way of generating more value out of current resources.
Reflecting on internet banking, Farrar said: “…nearly 20 million people now use internet banking – managing their own money in their own time in ways that had previously been done by others. Of course, customers do not do this on their own: the infrastructure to make online banking possible requires a very complex web of organisation that encourages people to use their time and expertise to multiply the value that is being invested from the industry.
“In the next decade healthcare is going to have to develop a similar approach to improving the capacity and knowledge of people to self-manage their conditions. A third of the UK population currently lives with a long-term condition, accounting for half of all GP appointments and two-thirds of outpatient appointments.”
Farrar believes the NHS will have to “change and evolve” in order to ensure a consistent quality of care: “This dilemma is not unique to our population or our health service. The need to innovate and change has been recognised in the NHS Confederation’s work with the World Economic Forum, which is currently highlighting the need for countries to reorient their healthcare delivery to wellness support models based on supported health maintenance and enhanced self-care. But changing the DNA of the NHS to genuinely see people as “assets” rather than “needs” is challenging, to say the least.”
Highland Marketing’s news
This week Highland Marketing announces its appointment by TotalMobile to develop and deliver a strategic communications campaign.
