News in brief
Department of Health forecasts tightest financial year end since 2006: This week’s Budget revealed that the Department of Health (DH) was forecasting a zero underspend on its revenue budget for 2013-2014, in what one expert said was a sign of how “finances are deteriorating very quickly across the NHS” reports Health Service Journal (subscription required). According to the Budget statement, the DH is forecasting revenue spending of £105.6bn for the current financial year. Although last year’s Budget Book said that the planned spend for the year was £106.9bn, the difference is entirely accounted for by the transfer of a £1.4bn learning disabilities grant to the Department for Communities and Local Government. A DH spokeswoman confirmed that the DH’s expected year-end position was “full spend against £105.6bn budget”. She added that for capital expenditure, the department was predicting a “£0.1bn underspend against £4.4bn budget”. The Budget figures do not represent the DH’s final year-end position – that is expected to be published in July. However, if forecasts turn out to be accurate, 2013-2014 would be the first year that the DH has not achieved a revenue surplus since 2006-2007. Anita Charlesworth, chief economist at the Nuffield Trust, said that the lack of a surplus was “a sign of just how phenomenally difficult this year is”. She added: “The DH normally underspends by one per cent. If there’s zero underspend in 2013-2014 it shows how difficult providers and commissioners are finding it to deliver their financial targets. What this shows is how the finances are deteriorating very quickly across the NHS, and sooner than we all thought they would. After this, it is really difficult to say how the NHS will get through 2014-2015, and 2015-2016 does not look doable.”
Kelsey admits care.data use unclear: NHS England delayed the care.data programme because it could not give guarantees on how the data would be used, reports eHealth Insider. Speaking at HC2014 in Manchester this week Tim Kelsey, NHS England’s director of patients and information, said that a reason for delaying the controversial programme was because there was no legislation to prevent the data being sold for commercial reasons. “We got caught in a very healthy debate about the guarantees we were offering the public about the safety of their data. Not so much that the public don’t recognise the risks of living in a digital world where hackers exist and where jigsaw identification is a possibility, but actually; could we guarantee that this data would be used for the purposes of improving healthcare? One of the reasons why we chose to delay the programme was so we could have more time to have these conversations as it turned out we could not give those guarantees.” Originally planned to begin this month, care.data extractions have been delayed until the autumn and health secretary Jeremy Hunt has announced that he will legislate to prevent the Health and Social Care Information Centre (HSCIC) from selling data for commercial use by insurers and other companies. Following this announcement eHealth Insider has further reported that NHS England has set up an independent advisory group to improve governance around the care.data programme. The group will be chaired by Ciaran Devane, chief executive of Macmillan Cancer Support and non-executive director of NHS England. NHS England has also hired a new communications manager, Tim Carter, whose role is to ensure communications and public awareness of the programme.
Confed chief: NHS leaders must look ‘beyond their own organisations’: Provider chief executives must be “system leaders” beyond their own organisations, the new chief executive of the NHS Confederation has told Health Service Journal (subscription required). Rob Webster, who joined the confederation a month ago from Leeds Community Healthcare Trust, also highlighted the intense challenges senior figures now face. Webster said all local NHS leaders need to look beyond their own trust in order to be successful. “Before coming into this job I was a frontline chief executive and one of the things that was clear to me from my daily work was that everything that was crossing my desk was about the system, not just my organisation,” he said. “It’s pretty clear to me that chief execs in the NHS now need to be system leaders as well as leaders of their own organisation.” Webster also stressed the major challenges currently facing NHS leaders attempting to change services. He said they were likely to be “vilified publicly”. Webster said the confederation would “be lobbying for the changes that will make [members’] lives easier”, and seek to ensure “frontline leaders are given the headroom they need” from the government and national bodies. Webster also wants the confederation to highlight the role of clinical leaders. “The idea NHS leaders are grey suited bureaucrats has had its day in many ways,” he said.
Informatics profession gets a federation: BCS, the Chartered Institute for IT, the UK Council of Health Informatics Professions and the Institute of Health Records and Information Management (IHRIM) are working together to create a new federation for the informatics profession reports eHealth Insider. The collaboration, announced at the HC2014 conference in Manchester, aims to ensure that UK health informatics is recognised as a valued profession. BCS Health chair Justin Whatling said technology has an “immense and profound impact” on people’s health and wellbeing and it is time for the profession to mature to meet the increasing demand on its skills and capability. Whatling said: “We want health to be an attractive place for informatics professionals from other sectors to come and work, and we want to provide a clear career path and professional development opportunities to retain those already working in health. The federation will help us to achieve this.” The federation will be open to all other informatics professional bodies, the private sector, the home countries and lay representation. Isabel Chevis, IHRIM chief executive, said that the three bodies together will have a louder collective voice “that will be heard and heeded”. “To do this, we need to know what health informatics professionals want and think; this is the beginning of our consultation period where we are very much looking for feedback from across the entire informatics profession beginning at BCS’ health computing conference HC2014,” Chevis said.
Additional £1.4bn boost for care integration: Councils and NHS commissioners will share more than £5bn under the better care fund after agreeing to pool over a third more money than they are required to according to Local Government Chronicle (subscription required). Early indications show the total fund for 2015-2016 will be worth £5.2bn after an extra £1.4bn is understood to have been pooled by councils and clinical commissioning groups. The minimum fund for 2015-2016 is £3.8bn, £3.4bn of which comes from the NHS. The Department of Health has not yet completed its analysis of where the additional £1.4bn is coming from or how it will be spent. Health and wellbeing boards sent draft plans for the fund to NHS England in February setting out how the money would be spent and final plans are due to be submitted in April. Care and support minister Norman Lamb confirmed the £5.2bn figure and said it could rise further as some health and wellbeing boards were late in confirming how much money they would pool, or were looking to extend their joint budgets. Lamb said: “I’m delighted there is that sense of ambition in lots of areas to go well beyond the minimum. The better care fund is acting as a real catalyst for some really dynamic thinking.” Lamb added that the plans submitted last month exhibited a “range of quality”. “There’s inevitably variability. Some are brilliant, some are less well developed,” he said.
Paperless NHS by 2018 target could be missed without ‘step-up in activity’: The government’s bid for a ‘paperless NHS’ by 2018 requires a ‘step-up in activity’ if the scheme is to recover from recent delays and deliver on time reports Pulse Today. The ‘Digitising the NHS by 2018 – One Year On’ report, published this week by the technology think-tank, techUK, said that “progress is underway”, but warned that projects are being scaled down, such as the commitment to have full online patient records. It suggested the government should ensure digital systems are compatible with one another, better engage healthcare professionals and the public in developing digital products and services, and investing more in raising awareness of the benefits of technology. The last two points come almost a month after NHS England announced a six month delay of its flagship electronic record sharing scheme, care.data, to build patient awareness of the benefits. The report adds: “The complexity of the initiative has meant there has not been universal uptake just yet, as NHS organisations vary in their skills, resource, and readiness to make progress. We have also seen timescales for some individual projects slip and/or the deliverables be scaled down to meet deadlines. For example, the ambition to have patient records accessible online by March 2015 has been amended to just include information in the Summary Care Record.” techUK’s head of health and social care, Natalie Bateman, said: “Good progress has been made in regards to planning and allocating the necessary funding for a digital health service; however more is needed in the coming year.’ ‘Whilst it is clear that some NHS providers are well underway in terms of implementing the paperless agenda, the majority are only just starting out on their digital health journey.”
Data archiving project underway at UK NHS trust: The recently merged Lewisham and Greenwich NHS Trust is working with Stalis, specialists in integrated care records, to conduct a large-scale data migration and archive project to ensure only accurate, valid and complete data is fed into the trust’s new electronic patient record (EPR) system for University Hospital Lewisham. According to ProHealthServiceZone, the programme is planned to be delivered in three phases, which will incorporate the Queen Elizabeth Hospital, and will aim to reduce clinical risk associated with transferring confidential and sensitive patient information across the trust’s disparate systems. Once complete it will provide healthcare professionals with up-to-date accurate information at the point of patient care from a single EPR system. Elisa Steele, director of IT for Lewisham and Greenwich NHS Trust said: “Merging many systems into a centralised platform comes with its complexities. We recognised that the data migration was an integral part of our IT strategy in helping us to reduce data duplication within the local healthcare economy and improving access to patient records.” Christine Whitehouse, managing director at Stalis said: “Working with Lewisham and Greenwich NHS Trust demonstrates our leadership in data migration, cleansing and integration. Our core objective for this project is to ensure good data quality to support healthcare professionals in their day-to-day work as they make decisions about how to deliver the best care for patients.”
London NHS trust digitising legacy records as part of NHS-wide roll out: One London NHS trust has got a head-start on its counterparts by digitising its legacy patient records in what will be a regular occurrence among the country’s medical organisations over the coming years according to ITProPortal.com. The Royal Free London NHS Foundation Trust is bringing in an information management system that allows it to take all traditional paper patient records and case notes, and access them in a digitised format. Will Smart, director of information management & technology at the Royal Free said: “For a complex hospital environment like ours, managing patient care using paper case-notes has been logistically very challenging. Tracking and moving paper case notes across a large physical estate has made it difficult to ensure that these are available where and when they are needed and has required a large administrative team. By digitising these case notes we have the opportunity to improve the quality of the services we provide whilst reducing costs.” OpenText is providing the new platform that will be integrated with the Cerner-based electronic patient records system already in place and it’s designed to help doctors and various members of medical staff get a rounded view of each patient’s medical condition. The system will be deployed hospital-wide in the summer and is part of the wider NHS Digital Health Strategy that aims to make it paperless by 2018, thus many other NHS trusts will be making the same move in the coming months.
Technology fund supports first stage of “Connecting Care” in Bristol, North Somerset and South Gloucestershire: IT Analysis reports that the first stage of a programme to deliver a detailed, local shared patient record in parts of the South West of England has gone live and subsequently been rewarded with a successful application for NHS England’s Safer Hospitals, Safer Wards technology funding to support the second stage. Bristol, North Somerset and South Gloucestershire (BNSSG) Health Community was recently named an exemplar Integrated Digital Care Record (IDCR) site by NHS England and will receive funding to support its aim of joining up silos of information across different organisations to improve care delivery. BNSSG selected Orion Health’s Cross Community Care Record to deliver the ‘Connecting Care’ programme and has now gone live with the first stage, focusing on urgent and unscheduled care. Andy Kinnear, director of informatics and business intelligence at South West Commissioning Support, and Connecting Care programme chair said: “This is an important first step in connecting care across our community and working towards a vision for better patient experience, quality of clinical care and efficiency of our services.” Colin Henderson, managing director, UK and Ireland for Orion Health concluded: “Given the scale of this programme covering many diverse organisations, we are very proud to be the selected IT partner to BNSSG ahead of 40 other suppliers. Our portal technology is now set up to pull information from 11 different systems allowing medical information to ‘follow’ the patient to any care setting throughout Bristol, North Somerset and South Gloucestershire, helping authorised users to make safer, faster more informed decisions.”
Nurse tech trusts rush to spend £30m: More than a third of the £30m awarded in the first round of the Nursing Technology Fund is for observations projects, which trusts and suppliers are scrambling to get off the ground before April, reports eHealth Insider. The winners of the fund were formally announced on 4th March. Two successful projects are extensions of existing implementations of electronic vital signs monitoring at King’s College Hospital and Luton and Dunstable NHS Foundation Trusts, which use open source software Wardware, and three have already named their supplier as VitalPac. The first £30m awarded from the fund is capital expenditure which must be spent in this financial year. Client engagement director at VitalPac, Nick Elliott said it expects to win between six and ten Nursing Technology Fund projects, all of which are new deployments. The company estimated how many contracts it would win and is geared up to deliver them. More than half are already in early deployment phase. Elliott said: “The fund was announced many months ago so we have been working with trusts all the way through that and have done due diligence way in advance. We took the view that it would be worth it to expend the effort and start working with them before the announcement was made. It’s an exciting time for all the companies that have won. It can be a challenge, but we feel confident that trusts will get the money and spend the money this year.”
Bristol clinicians to gain easier access to radiology images: Clinicians across Bristol are set to share radiology images far more effectively and improve patient care following the implementation of the Connect and Share registry reports eHealthNews.EU Portal. As an extension to the Image Exchange Portal (IEP) used across every NHS trust, Connect and Share has successfully completed extensive testing at University Hospitals Bristol NHS Foundation Trust. It is now entering the final stages of a pilot programme, before benefiting thousands of clinicians and their patients, with at least two other trusts in the region due to come on board. Connect and Share is a web-based patient registry built on the XDS data-sharing standard. Paolo Zanoni, Picture Archiving and Communications System (PACS) manager at University Hospitals Bristol NHS Foundation Trust said: “Connect and Share will free clinicians from having to chase to find information they require. It is simple to use and tells the clinician’s browser where to find images and information, even if it is held by another participating trust. Clinicians can then access that information directly.” Steve Jessop, product marketing manager at Sectra, said: “There is a lot of interest nationally in this solution. Clinicians can see the potential for improving clinical care from sharing radiology images and bringing them closer to the point of care. Connect and Share provides a means of doing that in a cost effective way by linking existing radiology systems through an easy to use and powerful solution.”
MAXIMS code to be released on GitHub: IMS MAXIMS will release the source code for its electronic patient record system on GitHub, reports eHealth Insider. Speaking in the open source pavilion at the HC2014 conference in Manchester Paul Cooper, IMS MAXIMS’ head of research, said the company has been in talks for several months about how best to go about open sourcing parts of its MAXIMS EPR. Cooper said: “We are now at the stage where we will be putting the MAXIMS source code on GitHub. We’re making the product itself open source. The toolset will be made available using a free license model.” GitHub is an open source collaboration review and code management platform. The announcement comes as Taunton and Somerset NHS Foundation Trust picked IMS MAXIMS as preferred bidder to supply its EPR earlier this month. The trust is likely to become the first acute NHS trust to implement an open source EPR. Cooper said he hopes making the software open source means more NHS trusts will be interested in taking the system. Cooper added that IMS MAXIMS will be offering implementation and support services to anyone that takes the system. The system includes modules such as a patient administration system, A&E, theatres and reporting modules, but does not have maternity, e-prescribing, patient portal and bedside observations. Cooper added that the company is “very keen” to work with other open source providers. He said: “By making MAXIMS available to a wider audience there will be a greater community of users that can contribute in partnership to make the system better.”
Project to measure integrated care from user perspective: A coordinated 18-month project will document elderly peoples’ experiences of integrated care to help develop a tool to measure its success reports Integrated Care Today. The programme called ‘Developing a patient reported measure of care coordination’ and funded by US-based Aetna Foundation, is designed to help health and care providers to improve the coordination of care. Five leading independent healthcare organisations have joined-up for the project. The participating organisations are the Nuffield Trust, Picker Institute Europe, The King’s Fund, International Foundation for Integrated Care and National Voices, a national coalition of health and social care charities. In order to gather reliable data the project will construct a survey tool to measure service users’ experience of care when it’s delivered through multiple channels. Ruth Thorlby, senior policy fellow at the Nuffield Trust said: “Better joined up health and social care services is a priority for most modern healthcare systems and the English NHS is no exception. With a series of government and locally-led initiatives currently underway to encourage more co-ordinated care, this work will provide us with a robust way of establishing baselines and measuring progress from the perspective of patients and service users themselves.” The study will focus on the perspectives of people aged 65 and over. Don Redding, director of policy at National Voices said: “When care is fragmented it affects patients and carers and can have a detrimental impact on their quality of life. But we currently have no way to assess the experience of service users with regard to care coordination. This is a major gap both here and in other countries, which this tool will help to fill.” If successful, it will support improvements in the commissioning and delivery of well-coordinated, integrated care in the UK, and potentially be of relevance to other user groups and for quality improvement efforts on the international stage.
Opinion
Health data boom heralds new era of personalised medicine
In a feature on the BBC, Wayne Parslow, MedeAnalytics’ general manager for EMEA describes how we are moving from a world where we treat illnesses to one where we predict and prevent them.
Parslow writes: “As more and more information is known about us, the more tailored our treatments will become” he writes. “And the more hard evidence we have, the better the decisions we can make,” he adds.
Combining public health records with all the new sources of health data generated by wearable devices, wi-fi enabled scales, smartphones and low-cost diagnostic kit, could provide a far more accurate picture of our health and the treatments we receive. “Soon we’ll be carrying our own personalised health plans around with us,” he says.
Parslow adds that access to huge amounts of data is enabling companies to develop predictive algorithms that can forecast which demographics are likely to cost the most to treat in future, for conditions like diabetes and asthma.
“This will help healthcare providers intervene earlier and redesign their services to cope with the expected massive increase in healthcare demand,” he says.
Are the wheels finally coming off the NHS’ finances?
Anita Charlesworth explains to the Nuffield Trust that while this week’s Budget contained no new announcements on health spending, it shone a harsh light on just how tough the financial challenge is proving for the English NHS.
“While the NHS’ long-term financial challenges are well-known, the presence of annual surpluses in recent years suggested it was coping with the short-term pressures. But, unless the Department of Health finds quite a bit of cash stuck down the sofa at the end of the year, 2013/14 will signal a marked deterioration in its finances.
“The latest data from Monitor and the NHS Trust Development Authority (TDA) shows that at the turn of the year, almost half of all acute hospitals were in deficit. The second is the specialised services (like chemotherapy and cystic fibrosis care) commissioned by NHS England, which according to their March board reports, have overspent by £366 million or (3.8 per cent) in the first nine months of the year.
“With productivity unable to fill the financial gap, the NHS has been coping by living off some big one-off savings: wage restraint, administrative cost reductions and falling drug costs for GP prescribing. As the Health Select Committee recently highlighted, progress in making the transformative change so widely trumpeted as a possible answer has been slow. Hospitals are finding it increasingly difficult to identify and deliver their cost improvement programmes.
“In the end, if we want to maintain the current NHS with a growing and aging population, and tackle concerns about quality, we will have to pay for it one day. It looks increasingly like that day will come sooner rather than later. There is now a serious chance that the NHS will hit the financial buffers before and not after the next election. Even if it limps on, there can be little doubt that the position for 2015-16 is not sustainable. Watch this space.”
Open access to data can break down barriers and empower patients
Projects that use patient data collaboratively and develop new technologies are helping tackle the impending NHS crisis, says Zahid Latif in the Guardian this week.
“Without a technological shift to a new care model based on the open use of data, public health and social services will struggle to keep up with the needs of those with long-term health conditions and the looming problem of our ageing population. Despite recent pledges to bring patient power to the NHS, the idea that public services can work smarter with patient data has actually been on the table for some time, with the latest changes to NHS data policy merely a recent topic in the debate.
“Without an analysis of search trends or buying habits, private enterprise as we know it wouldn’t exist: Google, Amazon or the world’s largest supermarket chains couldn’t predict what we want. This is a well-known example of empowerment through the use of big data, albeit a bit one-sided. Nevertheless, the old maxim ‘knowledge is power’ could not be more appropriate for our public service leaders today. We live in a time when sophisticated activity monitors can be downloaded to our smartphones and their operating systems can track our every moment. It is therefore remarkable that our personal health data can’t be accessed in the same way, or that technology has not been adapted for the needs of older people, or those with diabetes, heart disease or other long-term illnesses.”
“By turning its development focus to patient data nationally, the NHS can combat the policy of localism prevalent within the sector. Without this, there is a risk that in the rush toward technological advancement, the wheel is going to be reinvented hundreds of times across the country without a thought for how data can be shared securely, and still remain the property of an NHS patient. This could leave the NHS with incompatible technology systems which do not advance the common goal of improving the collaboration across health and social care organisations.”
“These projects show that access to data works to empower those who have it to improve health and social care; in reality this is only a few steps away. Our own participation in managing our health data will bring a new depth to the concept of self-care.”
Budget could be catastrophic for GP morale and patient safety
This week on GPOnline Dr Kailash Chand, deputy chairman of the British Medical Association, says that the budget does nothing to address the crippling funding shortfall in the NHS.
“It is ‘another blow’ to general practice that could be catastrophic for the profession’s morale and patient safety.
“Most NHS staff and GPs in particular have been carrying the NHS through austerity for the last three years. Last week’s decision by the governments in England not to award in full the already meagre independent recommendation of a one per cent pay rise and now ignoring resourcing and funding of the NHS sends a clear message what this coalition thinks of the NHS and patients.
“With growth forecasts rising, it is even more shameful that the government won’t uplift the NHS budget.
“While the government claims the NHS budget is protected, in reality it has suffered £20bn of cuts – billions of which have come from a sustained attack on staff pay. The cost of living crisis is hitting the NHS family the hardest.
“The NHS reforms have neither improved patient safety nor quality, but basically outsourced the NHS at turbo speed. Public resources have been allocated to the private sector.
“The morale of the profession has sunk to rock-bottom in the last three years. The NHS has not faced this level of challenge in its history. The universal healthcare provided by the NHS is in serious danger of becoming unsustainable. David Cameron, who pledged his loyalty to the NHS before the general election, now appears to have committed more of a betrayal.
“We have an infinite demand for healthcare and a finite budget. A rapidly ageing population, escalating obesity and alcohol-related illnesses, and growing health inequalities will continue to put increasing pressures on the health service. The government should be considering additional investment in primary care which deals with 90 per cent of NHS contacts, to meet rising patient demand and put the NHS on a sustainable financial footing. Without it, the reality is that patient care – and indeed the very future of the NHS – will be at risk.”
