Guest interview
Reasons to be cheerful: Andy Kinnear on UK digital health
Shared care record pioneer Andy Kinnear believes that UK digital health has many reasons to be cheerful at the moment – and suppliers that take the right approach to sharing information and working together are central to making the most of this opportunity.
News in brief
Hunt refuses BMA olive branch to cancel strikes: Health secretary Jeremy Hunt has again refused to resume negotiations with junior doctors over an unpopular new contract, saying that halting the contract’s introduction at this point would create “unacceptable disruption” for the NHS, reported National Health Executive. Dr Johann Malawana, chair of the British Medical Association (BMA) junior doctors’ committee, wrote to Hunt saying the BMA will call off the planned strikes on the 26th and 27th of April if Hunt called off a decision to impose the contract, which features a reduction in the times eligible for antisocial hours pay, after previous strikes failed to reach an agreement. Hunt replied that the BMA’s refusal to compromise on Saturday pay has made settlement impossible, and that the strikes, which include an unprecedented withdrawal of emergency care, will put patients in danger. Hunt wrote: “If you had been willing to discuss this during the negotiation process with Sir David [Dalton] then we would have a negotiated outcome by now. Because you were not, we were left with no choice but to introduce a new contract which more than 500 doctors have already signed up to. It is not now possible to change or delay the introduction of this contract without creating unacceptable disruption for the NHS. It is clear that the industrial action you plan will put patients in harm’s way. The first step to averting this must be serious recognition of the offer that Sir David made, so that we can have talks about the many other areas where training and quality of life can be improved for junior doctors.”
GP shake-up will bring extra £2.4bn a year funding and see patients urged to ‘self-manage’ conditions on the Internet: Patients will be urged to “self-manage” conditions on the Internet and see nurses and pharmacists instead of doctors as part of a major shake-up of GP practices, reported the Independent. NHS England laid out a five-year plan to put general practice “back on its feet”, with an extra £2.4bn a year in funding by the end of the decade. The funding comes from existing budgets and is likely to mean cut backs in other areas of the NHS. However health leaders hope it will lead to a reduction in demand for hospital services saving the NHS money in the long term. Under the plan announced by NHS England boss Simon Stevens, GP surgeries will work together to manage patient demand, increase their opening hours on week nights and weekends, and encourage patients to see professionals other than GPs. Dr Maureen Baker, chairwoman of the Royal College of GPs, welcomed the move. She said: “For too long GPs – and our members – have been undervalued, underfunded, and not recognised for the essential role we play in keeping the health service sustainable and safe for patients. We genuinely hope that the news marks a turning point for general practice.”
CQC’s budget cut further: The Care Quality Commission’s (CQC) budget has been reduced by an additional £9m compared to what it was expecting to receive this year, reported Health Service Journal (subscription required). The regulator’s budget for 2016-17 is due to be £236m, rather than the £245m it had expected only a few months ago. The budget is £13m lower than the £249m made available to the CQC last year. The new figures appeared in the regulator’s draft business plan for the coming year. In the plan, the CQC said its “focus will be on regulating for quality in a time of straitened public finances”, and that it will “need to become more efficient and effective to stay relevant and sustainable for the future”. The regulator set out four priorities for the year: completing its much delayed inspection programme; updating its approach to inspection; developing its internal capabilities; and evaluating its impact and value for money. David Behan, the CQC’s chief executive, said the lower budget would be “sufficient for us to discharge our responsibilities”. He said the figure was achievable because the CQC was likely to have ended 2015-16 having spent £237m – a £12m underspend.
Government warned mental health targets could be missed: Mental health improvement targets risk being missed owing to the fragmented nature of health services, the National Audit Office (NAO) has warned, reported National Health Executive. The NAO report said that implementing the government’s commitment to improve access and waiting times for mental health treatment will be made more difficult because mental health service provision varies by clinical commissioning group (CCG), and because the £120m additional funding the NHS and Department of Health (DH) have provided to CCGs in the past two years is not ring-fenced. The report also said that the cost of improving services may be more than current estimates. For example, the DH estimated that providing adequate access to early intervention in psychosis services will cost £137m more every year, but the NHS only provided £40m last year. Sir Amyas Morse, head of the NAO, said: “The Department of Health has recognised that mental health has been treated as a poor relation relative to other health needs for many years. This recognition, the goal of ‘parity of esteem’ and the setting of new standards for access and waiting times are all bold and impressive steps forward. It is important that these steps are supported by implementation in a reasonable timescale if they are not to be a cause for disillusionment, and this looks challenging in current conditions.” The report also said that there was a lack of data measuring how well NHS England was meeting its targets, and that this varied between CCGs.
‘Radical changes’ needed for NHS Wales to cope – confederation: The Welsh NHS needs to make “radical changes” in order to cope with ever increasing demand, said the new boss of the body representing health boards, reported the BBC. Vanessa Young, director of the NHS Confederation in Wales, wants a “shift in focus” with resources moving from hospitals to the community. Shortages of staff needed to be tackled and the NHS has to be set up to cope with the needs of an ageing population. She wants the incoming Welsh Government to set out a “10-year vision”. Ms Young took up her post on Monday at the body which represents the seven health boards in Wales. She wants the public to be fully aware of what lies ahead – as well as taking more responsibility for their own health. The background to it is that the number of over 65s will increase by 50% in the next 20 years. “The debate needs to involve patients and the public. It’s very much about engaging the public in understanding the scale of the challenge and the health needs of the population,” she said. Dr Phil White, of the British Medical Association, said: “All the uncertainty and the bad press has probably adversely affected recruitment within the hospital sector and primary care.”
Southern trusts to get £50m central funds before March 2019: More than £50m in central government money is yet to be paid to southern NHS trusts to deploy new clinical IT systems before March 2019, reported DigitalHealth.net. A Freedom of Information (FOI) request to the Health and Social Care Information Centre (HSCIC) revealed that, to date, £35m of payments have been authorised and paid to 21 NHS provider organisations under the South Local Clinical Systems programme, which was set up for trusts that received little or nothing from the National Programme for IT in the NHS. This is made up of: £8.3m paid to two ambulance trusts to implement the Ortivus electronic patient record; £13.4m to nine community and child health providers to implement TPP’s SystmOne; and £13.6m to ten acute organisations, which have invested in a range of systems. The anticipated remaining funding for the programme between now and March 2019 is just over £50m. “Funding will be released to NHS provider organisations at point of need in line with approved business cases, contracts and agreed implementation plans,” the FOI response said.
Western Sussex Hospitals NHS Trust rated outstanding: An NHS trust has become just the third to be judged outstanding since the present system of inspections for hospitals and other health services was introduced in England more than two years ago, reported The Guardian. The Western Sussex Hospitals NHS Foundation Trust, which serves a population of more than 450,000 people, a relatively high proportion of them over 65, was particularly praised for its A&E, medical and end of life care, as well as its maternity, gynaecology and children’s services. The Care Quality Commission said two of the trust’s three hospitals – St Richard’s in Chichester, and Worthing – were outstanding, while the smaller Southlands hospital in Shoreham was said to be good. Only two other trusts – Salford Royal NHS foundation trust and Frimley Health NHS Foundation Trust in Surrey – have had a similar rating among more than 160 trusts on which reports have so far been published. Western Sussex, inspected over four days last December, was among only a handful of trusts to meet waiting time targets for emergency treatment, inspectors said. “Overwhelmingly and almost exclusively positive” feedback from patients and their families was unprecedented, while there was a sense of pride and being valued among staff. Mike Richards, the chief inspector of hospitals, said: “Staff we spoke with were exceptionally compassionate when talking about patients and we observed kindness, not only towards patients, but to each other whilst on site.”
One million patients have opted out of Care.data: More than one million patient opt-outs have been implemented for the controversial Care.data scheme, the HSCIC announced at UK e-Health Week. The Register reported that those patients have opted out of having information that identifies them “being shared outside of the HSCIC for purposes beyond direct care”. The major controversy over Care.data – first announced three years ago – has been the lack of patient consultation over personal data being shared with the private sector bodies. Phil Booth, coordinator of MedConfidential, an independent organisation that campaigns for confidentiality and consent in health and social care, said: “After over two years, HSCIC has been allowed to do what NHS England should have ensured was in place before trying to sneak Care.data past the public. Some 1.2m people noticed and objected – hopefully the Department of Health will keep this in mind in the future. We welcome [health secretary] Jeremy Hunt eventually keeping his promise to patients, but that promise needs to continue into the future.”
HSCIC changing its name to NHS Digital: NHS Digital will be the new name for the HSCIC, the Department of Health has announced, also revealing the new chair for the organisation. From July 2016, the HSCIC will change its name to NHS Digital, in a move said to reflect the role the organisation plays in directly supporting the NHS and social care services. Noel Gordon, currently non-executive director and chair of the specialised services commissioning committee at NHS England, has been appointed as the new chair for NHS Digital. Speaking at the National Information Board’s Leadership Summit, life sciences minister George Freeman explained that NHS Digital would continue to produce high quality information, IT systems and services for health and social care. “Healthcare in the 21st century is going digital with improved treatment and care, and with huge benefits for patient safety,” he said. “The newly named NHS Digital will provide important information and IT services to ensure better care for patients.”
First free NHS wi-fi targets outlined at NIB meeting: The National Information Board (NIB) has started to lay out the timetable for delivering on health secretary Jeremy Hunt’s promise that free wi-fi for patients will be rolled out across the NHS, reported DigitalHealth.net. At the public meeting that it scheduled to coincide with e-Health Week 2016 in London, the NIB was given an update on the work being done to take forward the recommendations of Martha Lane-Fox’s report on tackling digital exclusion, one of which was to roll-out free wi-fi across the NHS estate. Tom Denwood, the national provider support and integration director at the HSCIC said the aim was to make sure that wi-fi was seen as a “utility” for healthcare. He said GPs were due a refresh of their NHS broadband provision, and “wi-fi will be rolled out with that”. He said delivering wi-fi to hospitals was “more difficult” but issues of funding would be “worked through this summer”. He said that by March 2018, there would be a firm target in place to meet the commitment, with GPs having free wi-fi in place by March 2019.
Hillingdon Hospitals give clinicians mobile access to care records: The Hillingdon Hospitals NHS Foundation Trust has deployed a mobile app platform, giving staff access to a range of patient information, reported Computer Weekly. The trust has worked with CommonTime, using an application platform to develop a mobile Hillingdon Care Record, which holds information from a series of the trust’s systems, such as its Silverlink Patient Administration System, discharge summaries, pathology and radiology results and order communications. Clinicians can view patient letters, clinical documents, palliative care records and GP summary care records through the app. Matthew Kybert, systems development and integration manager at the trust, said the project has been “completely clinically driven”. Doctors and nurses treating patients now have a full picture of the patient, which is particularly useful in A&E, he said. “We don’t have doctors queuing up at the nursing station waiting to look up the patients’ information anymore,” he added. The trust has deployed 50-60 iPads and iPad Mini’s to specialist nurses, junior doctors and consultants so far, but as the trust – like every other NHS organisation – faces significant financial pressures, it can’t afford to buy everyone an iPad.
Kelsey replacement to have “wider impact”: The NHS’ new chief information and technology officer (CITO) will report to NHS England, NHS Improvement and also to Matthew Swindells, the new national director for commissioning operations and information, reported DigitalHealth.net. Beverley Bryant, director of digital technology at NHS England, said the role – which has not been filled since the departure of previous incumbent Tim Kelsey in December 2015 – will have a wider impact. She said: “It will be a far reaching role that builds on what Tim did, but linked to operations.” NHS England advertised in November last year for a CITO to chair the National Information Board, deliver on national IT programmes, “embed core digital standards” in services, and deliver new public and data services. However, Bryant, who was responding to a question at e-Health Week 2016, shed no light on when – or by whom – the role might be filled.
New study reveals a ‘20% fall in new cases of dementia’ in past two decades: Over the past two decades, there has been a 20% fall in new cases of dementia, equivalent to a reduction of 40,000 cases per year, according to a study led by scientists at the University of Cambridge, reported ITV News. Though the overall number of people with dementia in the UK is still rising, better lifestyles in the latter half of the 20th century seem to be contributing to better brain health as people get older. But dementia remains one of the biggest public health challenges for the UK’s future. As healthcare and medicine has improved in recent decades, more people are living longer than ever before. In our ageing population, doctors would expect to see more cases of dementia such as Alzheimer’s disease. Previous studies had predicted that we should see around 250,000 cases of dementia every year by now. But the new study – published in Nature Communications – revised that prediction down to 210,000 new cases per year, made up of 74,000 men and 135,000 women. (There are more cases in women simply because many more of them live to the older ages where dementia becomes more prevalent.) Dr James Pickett, head of research at the Alzheimer’s Society said that it was encouraging to see the latest research but warned: “However, people are living for longer and with other risk factors such as diabetes and obesity on the rise, there will still be over 200,000 new cases of dementia each year.”
Barts Health unifies its lab information systems: Barts Health NHS Trust is moving to unify its laboratory information management systems (LIMS), reported DigitalHealth.net. The trust, which was formed out of a merger of three organisations using different instances of the WinPath LIMS, has appointed its supplier, CliniSys, to implement WinPath Enterprise. This will give it a single system, encourage the adoption of standardised processes, and give laboratory technicians access to patient information wherever they are working. In a statement from the company, Professor Finbarr Cotter, clinical director for pathology, said: “A single LIMS will expedite open access to data for all physicians and is supportive of ‘shared care’. Having one system covering the whole of the East End of London has got to lead to an enhanced patient experience and to improve service quality.” The new system will enable pathology services across the four major hospitals run by the trust to work together in a more collaborative fashion. Professor Cotter added that this should enable Barts Health to deliver a “superior NHS pathology service” without consolidation or outsourcing.
LMC wants to stage massive paper patient record bonfire: A Local Medical Committee (LMC) has called for NHS England to permit GP practices to burn their paper patient records, or store them in an underground bunker, to create more room in practices for consultations, reported Pulse. Devon LMC’s newsletter to local colleagues suggested it would be ‘bizarre’ for NHS funds to be spent on building additional space in practices ‘when practical space already exists in most practices but is simply filled with paper’. LMC vice chair Dr Anthony O’Brien argued there were companies ‘queuing up to do the scanning required’ to get all of the records onto just ‘one disc’. He said: “Space would be created quicker and at a fraction of the cost of paying builders to lay bricks. All that paper [could be put] onto one disc [for] easy download of individual notes into the practice system when required. However a decision at a high level within the NHS would have to be made about whether the current paper record can be burnt or perhaps stored in an enormous medico-legal underground bunker.”
Views from those that headlined at e-Health Week
There was plenty of discussion points at the recent e-Health Week event in London this week. Here are a few headliners main points and views from Health IT Central.
Kicking the ‘Five Year Forward View’ into action: The challenge of making the Five Year Forward View action rather than rhetoric, was up for debate in a panel session. Mike Macdonnell, director of strategy at NHS England, said that since the plan was published in 2014, there had been some progress in creating new care models through the vanguard sites, but there was much more to do. He said that the establishment of a £2.1bn ‘Sustainability and Transformation Fund’ would help the provider sector back to a point of sustainability and invest in transformation. Peter Counter, chief technology officer at NHS Digital said the vision set out in the plan was “completely reliant on technology to achieve it”. Dr Justin Whatling, vice president of population health at Cerner said: “As networks come together with new care models to take on new responsibilities, often with new financial incentives around them, we will need the informatics to step up to help with that. It’s going to move beyond information sharing portals out to citizens.” Dr Amir Mehrkar, chief clinical information officer, EMEA at Orion Health said: “With efficient new data like genomics, this ushers in a new era of personalised services. These new models of care need our care information to be set free and put to work with no silos.”
Interoperability is key to a paperless NHS, says digital lead: Beverley Bryant, director of digital technology at NHS England, emphasised the need to drive everybody towards the same goal in order to deliver a paper free NHS by 2020. Bryant said: “If everyone doesn’t pull together, such as the government and system leaders, it will keep falling down the to-do list of chief executives.” She explained that there was still plenty of work to do in terms of moving into a digital era, although they were further ahead in primary care. “We have 100% digitisation in primary care, but there is still loads to do in general practice and other areas to ensure we meet the 2020 deadline,” added Bryant.
The future of e-Health is huge responsibility, says Lord Victor Adebowale: The chief executive of Turning Point, Lord Victor Adebowale, said the future of young people is in the hands of e-Health and will vastly improve, with a warning not to fail the next generation. He said: “Technology is about engagement, connectivity and relationships. At the moment, those people who need health and social care the most tend to get it least. The main point of e-Health is it should be an important tool for these three aspects, not a substitute for it.” Adebowale warned what will happen if the technology isn’t used in the right way. He said: “Technology that removes relationships is no use in health care. There will be challenges. We need to use tech and we need to co-produce the means of enhancing relationships and communication. We need to engage the citizens in health and social care. How do we build in the use of technology for the young? These all need to be addressed urgently.”
Opinion
Calculating the cost of switching to open source
The adoption of open source clinical information systems in the NHS is gaining momentum, but there remains some common misconceptions for NHS providers. Leesa Ewing of IMS MAXIMS helps to demystify some of the myths of open source in the NHS.
On the move from a proprietary to open source healthcare software vendor, Ewing writes: “It is fair to say, however, that our journey to get to this point has not been an easy one. Along the way, those that aren’t familiar with open source have raised concerns about whether the code would lead to incomplete or incoherent software, while others have queried its clinical safety. But, by far the most-common concern has been about cost – will we try and compensate for the source code being open by increasing costs elsewhere?”
Ewing cites total cost of ownership as a topic of confusion for NHS providers considering their options for clinical IT systems: “When debating the cost of open source it’s important to consider that the software is only one element of any transformational change programme that the NHS adopts. It has to be considered in the wider context of the total cost of ownership of the programme. This will include, not only the hardware and services required to successfully deploy and support the open source software throughout its life cycle, but also the investment required from the trust to make the project a success, for example through education and training.
“While we will not be increasing our support fees to compensate for the open source code, there will still be costs to the NHS to implement the software. However, in the longer term the service transformation will be significantly more economical. We purposefully chose to disrupt the marketplace with this unique offering because we believe wholeheartedly that there is another way to develop code for the wider benefit of the NHS. By changing our business model from a proprietary software vendor, to that of delivering an implementation and support service, we can fulfil our development aspirations and roadmap for openMAXIMS a lot quicker, and with significant clinical engagement.”
If the government had stuck to its plans, catastrophic care costs would be a thing of the past
The Care Act was meant to introduce a cap on the cost of care. Delaying it means some older people face losing their life’s savings, writes Janet Morrison on the Guardian’s social care network.
Morrison, chief executive of Independent Age, says: “Last year, just before the Care Act came into force, I took part in a BBC broadcast explaining its effect. I told viewers that one of the most important and positive changes was a cap on the cost of care, which the government would introduce in April 2016. What I didn’t know was that a few months later, the government would announce that this reform would be kicked into the long-grass.
“If all had gone to plan, self-funders – who frequently get the worst deal paying for quality care – would now be able to start a care account with their local council. They could add up what they were spending on essential care costs, so that when they reached the £72,000 cap, the state would step in to pay.
“According to the government’s 2015 impact assessment, the reforms would have offered protection and peace of mind to the estimated 16% of older people who will have lifetime care costs exceeding £72,000. A total of 37,000 people would have reached the cap by 2020. An estimated 23,000 people would have benefited in the first year alone as a result of lower thresholds for state support. It would also have brought many self-funders into contact with their local authority for the first time, making them aware of their right to a care assessment and information and advice.
“The government said the decision to postpone the cap until at least 2020 reflected fears that local councils, already under huge financial pressure, would not be able to cope with the increased demand. It also said the benefit of the cap was hard to explain to the public and didn’t justify the extra cost to the Treasury.
“But when it first proposed a care cap, the government said it would protect older people from ‘catastrophic care costs’ and ‘end the unfairness and fear caused by unlimited care costs’. This was needed because ‘there is currently no safety net to protect people from losing almost everything’.
“With the postponement of the cap, older people and their families are again left without a safety net against catastrophic care costs.”
Separating the noise of contract negotiations from the signal of STPs
Chris Ham, chief executive of The King’s Fund, considers the progress made so far on sustainability and transformation plans, and whether they really have the potential to be a game-changer for the NHS.
“NHS leaders across England are working with local government leaders and other partners to prepare sustainability and transformation plans (STPs). A total of 44 areas of the country have been identified for planning purposes with populations ranging from 300,000 to 2.8m. STPs have the potential to be a real game-changer by shifting the focus from organisations to place-based systems of care in which decisions are taken collectively about the common pool of resources available.
“Work on STPs is taking place in parallel with negotiations between commissioners and providers on contracts for 2016/17. These negotiations appear to be more difficult than usual, with few contracts yet signed and many issues still to be resolved around activity levels, funding and payment systems. I’ve also come across examples of providers being put under pressure to hold out for agreements that will address their performance challenges. Worryingly, this creates a real risk that conflicts over contracts will undermine efforts to collaborate on STPs.
“Not for the first time, the fault lines between commissioners and providers have been exposed in an NHS that is struggling to deal with the competitive legacy of Andrew Lansley’s 2012 Act. All the more important, therefore, that national bodies are consistent in their commitment to STPs as the main hope for the NHS and its partners to overcome the unprecedented pressures they face. As well, the commitment of leaders of national bodies must be reflected in the actions of their staff at all levels if the noise around contract negotiations is not to drown out the signal around STPs.
“If this is to happen, then the yawning chasm in planning at a national level should be filled by the development of a 45th STP, covering the whole of England and setting out how national bodies plan to sustain and transform care. Based on the NHS five year forward view, the national STP should spell out how organisational performance, particularly among providers in difficulty, will be tackled without derailing nascent efforts to collaborate and establish system leadership. A good start would be to require system-wide recovery plans in which organisations are held to account collectively, in place of organisational recovery plans.”
