News in brief
Better care on track despite tough climate, new chief claims: The government’s ambitious plan to integrate health and social care is on track to go live next April despite the “tough” financial climate, the health chief overseeing the project has said. In an exclusive interview with Health Service Journal (HSJ, subscription required), Andrew Ridley admitted the health and local authority commissioners expected to collaborate on the £3.8bn better care fund were “hard up” and should brace for a further five “tough” years. However, he still expected all 151 integration plans drawn up by local areas to be approved by next year’s April deadline: “It is my intention that everybody is approved by then,” he told HSJ. “That is the intention of the legislation – so we will work really hard to make sure everything gets approved.” He admitted some areas were finding it tough to draw up coherent plans but said he was “not getting signals from any areas that this is impossible”. Ridley, who has been seconded to the role from the North East London Commissioning Support Unit, said plans would be formally checked from next month. They will be rated as either – approved, approved with support or approved with conditions. A similar system is applied by NHS England to clinical commissioning groups. However, Ridley said that he did not expect every plan to be signed off by the Department of Health’s November deadline.
NHS England looks at expanding care.data extractions to include ‘sensitive’ patient information: NHS England wants to expand its care.data extraction scheme to also include ‘sensitive’ patient information, despite initially saying these conditions would be excluded. Currently, diagnoses such as HIV or AIDS, sexually transmitted infections and medical history mentioning abortions, IVF treatment, convictions or abuse have been classed as ‘sensitive’ and are set to be excluded when the government’s flagship record-sharing scheme goes live. However Pulse has revealed that NHS England is preparing to consult on expanding the scheme to include some or all of this information in the extract, as well as who has access to the database. Information extracted to care.data can only be used for the ‘benefit of health and care’ after new legislation was enacted in the wake of revelations that records had been sold to insurance organisations. An NHS England spokesperson said: “The care.data advisory group has agreed that it will look at methods for future scoping around inclusion of sensitive data, highlighted in the notes from the meeting in June. In the meantime there will not be any change to the original plans for the data extract.”
Private hospitals ‘must provide more safety data’: Private hospitals should release the same levels of data about patient safety incidents as NHS providers, a report says. The organisation behind the report says it is difficult for the public to judge the safety of private hospitals. Private hospitals now receive 28% of their income from treating NHS patients, reported the BBC. Independent hospitals say they are working hard to provide better data. Private hospitals are required to report all serious incidents to regulators at the Care Quality Commission (CQC) and Monitor, and additionally to commissioners if NHS-funded patients are involved. However it is not possible to compare data side-by-side from NHS and private hospitals for death rates or complications such as infections. A think tank scrutinising the role of markets and competition in the NHS, the Centre for Health and the Public Interest (CHPI), says figures obtained from the CQC show just over 800 patients died unexpectedly in private hospitals in England between October 2010 and April 2014 – and there were more than 900 serious injuries. The report says: “It is not possible to state whether these rates of death and serious injury are significant, as we do not know in which hospitals they occurred, the health status of the patients concerned, nor the types of treatments that were being provided. It is also not possible to state whether the rates are unusually high or to be expected.” Private hospitals’ representatives say those figures need to be examined against comparable NHS data. The report also says there were 2,622 emergency admissions to the NHS from the private sector in 2012-13. CHPI is calling on the government to review the nature and costs of these admissions.
Nine CSUs reach final stage of framework: All nine commissioning support unit (CSU) alliances have got a place on the final stage of assessment for NHS England’s lead provider framework. The framework, worth between £3 bn-£5 bn, will allow clinical commissioning groups (CCGs) to purchase services on a ‘call-off’ basis, according to eHealth Insider. The final stage assessment suggests that they will be able to choose from CSUs, charities and private companies. The new set-up is due to launch in January 2015. The lead provider framework has three lots. Lot one is end-to-end commissioning support services and includes IT support and business intelligence. Lot two is further divided into two sub lots; medicines management and optimisation and individual funding request case management. NHS England announced earlier this month that 16 bidders successfully met the criteria for lot one and have been invited to progress to the final invitation to tender, including seven non-NHS organisations. Bidders have until 29 October to respond to the tender. NHS England says the response from bidders means commissioners, CCGs and NHS England will have a “wide choice of excellent, affordable commissioning support services” when the framework opens. “It will cut bureaucracy, helping CCGs and other commissioners by providing an additional, simpler and easier route by which they can access high quality support of their choice, avoiding lengthy delays and full Official Journal of the European Community procurement,” says NHS England. “CCGs have complete flexibility over whether to use the framework and whether they want to use it for some or all of their commissioning support.”
Hospital trust sector deficit could breach £750m this year: The NHS acute sector is expecting to record a net deficit in excess of £750m for the current financial year, exclusive Health Service Journal (subscription required) research shows. The findings are based on the latest available figures from all but six of England’s 140 hospital trusts. They have prompted warnings that financial problems facing the sector are no longer confined to a few poor performers, instead appearing to be “systemic”. Nearly half the sector (66 trusts) is currently planning or forecasting a deficit for 2014-15. The gross deficit projected by those organisations is £940m. In contrast, the gross surplus projected by the 68 trusts planning to finish the year in the black is just £167m. This would mean an overall deficit of £773m for the acute sector – a steep decline on the already grim financial circumstances of the last financial year, in which the sector recorded a net deficit of £421m. Financial problems are spread across the country’s hospital trusts, with an overall deficit expected in a large majority of health economies. This analysis provides the most comprehensive picture to date of the scale of the financial challenge facing the NHS this year.
Urgent care change pilots started: NHS England has established a series of pilots for a “system-wide transformation” of emergency services, including restructuring A&Es and enhancing the NHS 111 service, reports eHealth Insider. Its medical director, Sir Bruce Keogh, was tasked to review urgent and emergency care services and ease pressure on the services. NHS England has now issued a progress update on the work that has been done since the first report on the first stage of the review that was published in November last year. The progress update says that over the last six months, the centre has worked to set out more specific guidelines for how this will work and has begun pilots and evaluation projects to test out the new initiatives. This includes an enhanced NHS 111 service as a single point of contact where patients can speak directly to nurses, doctors and other healthcare professionals who have access to the patients’ medical history. “Clinicians within the NHS 111 service have access to relevant aspects of a patient’s medical and care information (where the patient has consented to this being available), including knowledge about contact history and medical problems; so that the service can help patients make the best decisions,” says the update. The 111 telephone triage service, which had a rocky start after its launch in Easter 2013 and faced significant problems with staff shortages, treatment delays and ambulances called unnecessary, will become “enhanced” and “the smart call to make” as a 24-hour personalised service.
NHS complaint records made public: The Parliamentary and Health Service Ombudsman has released the details of a number of NHS complaints, which highlight a raft of serious failures in spotting serious illnesses, according to National Health Executive. Members of the public and services providers, for the first time ever, will be able to go online to see the various types of complaints. In particular, details of 81 investigations the Ombudsman has completed are now being made available for the public to search online. University Hospitals Birmingham NHS Foundation Trust misdiagnosed a man as having a blood clot when he actually had a tear in the blood vessel from his heart to his body. This resulted in his death. The Ombudsman found there had been a number of missed opportunities in the care provided to the man. Julie Mellor, the Parliamentary and Health Service Ombudsman, said: “Our investigations highlight the devastating impact that failures in public services can have on the lives of individuals and their families. For the first time MPs, members of the public and service providers will be able to go online and see the types of complaints we have investigated. This will help MPs to see what complaints have been made about public services in their constituency and will help provide confidence to people to complain when they see what happened to other people.” Of the 81 accessible cases, 23 involved Parliamentary cases and 58 involved healthcare cases. A Department of Health spokeswoman said: “Listening to patients is one of the best ways to improve standards and we welcome this increased transparency around complaints. Hospitals should make sure patients, their families and carers know how to complain – including displaying information on the complaints system in every ward.”
Records access may reduce GP pressures: Giving patients access to their GP records can reduce demand for traditional appointments and telephone calls to practices, a research study has suggested. The government has set a target of giving all patients who want it, access to their GP record – or the elements included in the Summary Care Record – by 2015, reports eHealth Insider. Caroline Fitton in her study estimated that if 30% of its patients used records access at least twice a year, the average 10,000 patient practice would save 4,747 appointments a year and 8,020 telephone calls. In a discussion, Fitton said: “The effects in our study are likely to be the result of people doing things for themselves; which is typical of online experience.” The study acknowledges that access has a cost; but suggests this can be reduced to around £5 a year per patient by using admin staff to manage it.
London trusts on track for PACS exit: London trusts are exiting their national digital imaging contracts on schedule, a bulletin from the Health and Social Care Information Centre (HSCIC) has suggested. The capital is the last area of the country to exit the picture archiving and communications (PACS) and radiology information systems contracts that were placed by the National PACS Programme in 2004, reports eHealth Insider (EHI). To manage the transition, the PACS Transformation Programme, which is hosted by the HSCIC, put trusts into one of three groups: early exit; exit on expiry, and continuation of service. Trusts in the early exit group were due to leave their contracts by the end of June this year, and the bulletin says that seven trusts duly moved onto replacement supplier contracts in June and July. The London PACS contract officially came to an end at the same time. However, the programme has negotiated a thirteen-month transition period with BT that will end in July 2015. All trusts in London must have moved their PACS data out of the BT central store, known as MIA, by this point. Trusts in the next two waves will be able to exit their contracts and terminate their LSP services. In January, Professor Erika Denton, the senior responsible owner and medical director for the National PACS Programme, told EHI that trusts needed to focus on the deadline for repatriating data. “Any trust that has not already commenced data repatriation activity, particularly those with more than 20 terabytes of data, is advised to commence this work as a priority,” she said.
Stockport NHS trust deploys Kainos electronic medical records system to cut costs: Stockport NHS Foundation Trust has deployed the Kainos Evolve electronic medical records platform to help get a tighter grip on its data and cut costs, according to ComputerWorldUK. Since initiating the rollout the trust has extended the software to paediatricians who see patients in outpatient clinics and in the community, and to paediatric sub-specialities including paediatric cardiology and paediatric trauma, and to orthopaedic, obstetrics and gynaecology areas. During the summer Stockport also introduced Evolve right across the trust for all brand new patients not previously seen at the trust. The trust decided to implement Kainos Evolve to address the high costs and inefficiency of managing patient records on paper. It is now projecting savings of tens of thousands of pounds on storage costs alone. “We have around 900,000 sets of case notes stored on site, as well as high volumes stored off site,” said Judith Riley, clinical service lead and project manager for Evolve at Stockport NHS Foundation Trust. “We also have around 40,000 sets of notes in various secretaries’ offices, so there is a high churn of notes travelling around sites.” Transport costs are considerable too. “If we have to urgently get a file to the Buxton Cottage Hospital in Derbyshire, which is 30 minutes away, it means sending them via the courier service,” said Riley. As well as reducing costs Evolve brings other benefits to the trust, such as providing secure and immediate access to electronic medical records for authorised staff.
Discharge summaries ‘illegible and lack information’: Hospital discharge summaries frequently fail to provide GPs with crucial clinical information and are often illegibly scrawled, a study has found, in what has been described as symptomatic of a system “pushed to the limit”, reported Pulse. The audit of more than 3,400 discharge summaries found 33% of handwritten and 26% of electronic summaries fell short of NICE’s minimum standards for clinical communication. Worryingly, more than half neglected to tell the GP about changes to the patients’ medication, while nearly 43% of handwritten summaries were deemed ‘partially illegible’ and 9% ‘mostly illegible’. “It’s not surprising given the huge workload and workforce pressures that both primary and secondary care are experiencing”, said Dr Tim Morton, chairman of the Norfolk and Waveney LMC, where the study took place. “There needs to be a continued dialogue about what is actually useful in primary care – not just regurgitating a load of meaningless investigations. We need to know quite clearly: what is the plan of action? What’s expected of primary care? What are the medication changes?”, he added. The University of East Anglia-led study appraised 3,444 discharge summaries sent to GPs in the NHS Norfolk Primary Care Trust between January and March 2011. These were scored against 14 key clinical criteria, developed from 2008 guidance from the National Prescribing Centre, now part of NICE.
Millions needlessly clogging up A&E: Millions of people are needlessly attending overstretched A&E units, an investigation has suggested, with up to 70% of casualty patients in some areas leaving with nothing more than a few words of advice, according to The Telegraph. If the pattern were the same across England it would mean that 12 million patients a year attend A&E only to be given advice and sent away. The analysis, by Channel 4’s Dispatches programme, found that in 46 hospital trusts in England, half of patients attending A&E left without receiving any treatment, while in a further 21 trusts, this figure was 70%. In four hospital trusts, 90% of patients left A&E with just advice. The investigation, to be aired next week, follows stark warnings about the growing pressures on the NHS, particularly A&E units, under the weight of demand from patients. A&E waiting time targets have been missed, patients are increasingly been held in ambulances queued up outside emergency departments and calls to 999 and 111, the non-emergency number, have risen steadily. The problem has been blamed on GPs, with the difficulty in getting an appointment with a family doctor often cited as reason for why more people are being driven to A&E. However, an ageing population is also putting more pressure on hospitals.
Opinion
Another view of savings
In eHealth Insider this week, GP Neil Paul points to a few examples where technology has been used to meet patient demand and save the NHS money, and also where it hasn’t.
In one case Paul describes a needless visit to the GP to change a prescription after being seen by an ophthalmology department, where both time and money could be saved if the hospital could access systems in primary care: “I struggle to understand this concept of every department needing its own system, and then only using it for some of the conditions it is meant to deal with. But if it doesn’t have a system, or can’t or won’t use it effectively, why doesn’t it just get a window into our practice systems?
“As far I as understand it, my patients’ data is stored on a cloud server somewhere. I have a client on my desk that authenticates me as a valid user and allows me to see their data. Why can’t the ophthalmology department have a client that does the same thing, but instead of having its staff the whole GP front end, just give them access to the information that they need; drugs, allergies, significant history, investigations, and so forth.
“Then they could record the pressures and – here’s the miracle – change the medication themselves. They could even issue a prescription at the same time, if needs be, on our drugs budget. In the time it takes them to dictate “please ask GP to change drug a to b” they could do it themselves, print off the script, hand it to the patient – knowing they would walk out of the room with the right thing – and enter the information into the records contemporaneously.”
Private hospitals need to be more transparent about patient safety
This week in Health Service Journal (HSJ, subscription required) Colin Leys, emeritus professor at Queen’s University, Canada, and honorary professor at Goldsmiths, University of London, points out if and why the private hospitals should follow the same requirements as NHS hospitals in regards to patient safety.
“As Jeremy Hunt said in his speech in the US earlier this year, the approach is based on two pillars. […] But the same approach has not been applied to the private hospital sector, which carries out 1.6 million operations each year – a quarter of which are now funded by the NHS.
“[…] because the Health and Social Care Information Centre doesn’t produce standardised hospital mortality indicators for private hospitals it is not possible to interpret the significance of the fact that 802 unexpected deaths and 921 serious incidents have been reported in private hospitals over the past four years.
“As part of the health secretary’s push for greater visibility of patient safety incidents, NHS Choices now lists a wide range of patient safety indicators for NHS hospitals, ranging from bed sores to safe staffing levels, but most of these indicators are not available for the private hospitals listed.
“If the government is right that a culture of patient safety demands transparency and openness, there is no good reason why the same reporting requirements that have been imposed on the NHS should not also apply to private hospitals.”
Can we ignore NHS charges any longer?
On the King’s Fund website this week, Andrew Haldenby, director of the independent think-tank Reform and Cathy Corrie, senior researcher at Reform discusses the future of health financing and how new ideas will be needed to fund the NHS and social care.
“The independent Commission on the Future of Health and Social Care in England has produced an admirable and comprehensive interim report. One of the few things that might be added is the grim fiscal context for the next period of health financing. It can’t be stated often enough that public finances for the next three decades are in a completely different position to when Sir Derek Wanless carried out the last landmark review of NHS financing in 2001/02.
“When Sir Derek reported, the national debt was an entirely manageable 40% of GDP. The country was (too) relaxed about running annual deficits during a time of economic growth across the Western world. Times have changed since then. The coalition government has implemented historic policy changes such as the means-testing of Child Benefit and the cutting of the police budget by 25% in real terms. Even so, the annual deficit on public finances will be around £70bn on the day of the general election.
“The point of all this is to emphasise that new ideas will be needed to finance the NHS and social care. Ideas that are different from the increases in tax-funded spending which Sir Derek Wanless advocated. Taxation is already going to have to stay unusually high to finance the recovery from deficit and debt. It will be extremely difficult to raise new hypothecated income taxes for the NHS and social care on top of this. An extra penny on income tax or National Insurance, which is all that could be imagined, would raise only enough to fund the NHS for a fortnight (around £5bn). It would not be a game changer.”
How care.data could help save lives
Confidentiality is vital, but fear should not jeopardise our ability to coordinate and improve care, says James Mucklow and Peter Bull, healthcare experts, PA Consulting Group.
“A colleague of ours visited his out of hours doctor service because of a painfully swollen knee, a condition he’d had once before. While there, he asked whether they could see any useful information from a previous GP visit for the same condition. They could not access the information. The reason was not technical: GP systems store vast quantities of detail about your health electronically. It is because the information governance hurdles that GPs have to leap over to share the data between services are high and few have the patience or motivation to try.
“If it is too hard to share your records among the various people and organisations who need to treat you, care will be poorly coordinated and more expensive because of wasteful duplication. Most patients assume that data relevant to their healthcare will be shared across the NHS and are frustrated and surprised when it is not.
“Of course, confidentiality is absolutely vital, and should always be protected with strong rules and systems, but it seems unreasonable to let fear of risk jeopardise our ability to coordinate and improve care.
“We need strong, transparent controls on confidentiality that protect individuals. Furthermore, if anyone’s fears about confidentiality are not assuaged by these controls, we need to make it easy for them to opt out. But the risks to confidentiality must be balanced against the potential gains to our health. Trepidation should not prevent us from achieving those gains.”
Highland Marketing blog
In this week’s blog, Highland Marketing’s industry advisor, Simon Rollason reflects on the complexities of implementing change management in healthcare.
