News in brief
DH on course for biggest underspend this parliament: The Department of Health (DH) is this year on course for its biggest annual underspend in the current parliament – with none of the unused budget due to be carried over for future use, reported HSJ (subscription required). Figures published in chancellor George Osborne’s 2013 Budget this week, show that the department is expected to underspend against its 2012-13 expenditure limit by £2.2bn. None of that unused funding is expected to be carried over for use in future financial years under the Treasury’s “budget exchange” scheme. That would make the amount of health budget unused this year greater than in either of the previous two financial years. It would also mean the department’s underspend for this year would be 2%, higher than the 1.5% figure that the DH says is consistent with “prudent financial management” for a department of its size.
Budget “likely to increase pressure on the NHS”: Chancellor George Osborne’s Budget for 2013 has been hit with criticism by NHS organisations, reported Comissioning.GP. The NHS has been protected from any reduction in budget, but staff face salaries which are increasing below the level of inflation until at least 2016. The British Medical Association (BMA) welcomed the protection of the NHS’ budget, but expressed concerns that the NHS has to try to make savings of £20 billion by 2015, arguing that this is causing posts to be cut and the rationing of services in order to make the savings. Dr Mark Porter, chair of the BMA Council, said: “We’re concerned that the chancellor is seeking to meddle in NHS pay processes. As MPs noted this week, pay restraint cannot be seen as a long term savings strategy for the NHS. Efficiency gains will be achieved by focusing on quality, not by suppressing pay. Pay progression is not automatic for most senior doctors.” NHS Confederation chief executive Mike Farrar also expressed concerns that the chancellor’s budget could cause financial problems for the NHS.
NHS is ‘not ready’ for changes, say senior staff: More than three-quarters of senior NHS staff fear the health service is not ready for the major reorganisation that comes into force in less than two weeks. That is a key finding of a survey of NHS professionals, in both clinical and management roles, who belong to the Guardian’s healthcare network. The survey shows that many of those most directly affected by the government’s radical reorganisation of the NHS do not think that the new bodies that come into force next month, including the NHS Commissioning Board and GP-led clinical commissioning groups, are prepared for the mammoth task of running the health service. The 1,100 members of the network who responded to the survey, which was conducted in February and March were asked “How ready do you believe the NHS as a whole is to take on its new role from 1 April? “An emphatic 76% said “not ready”; 16% said “don’t know”; and only 8% said “ready”. Respondents also doubt that any parts of the new system will be geared up for the transfer of responsibilities.
Devon and Somerset issue £35m EPR tender: Taunton and Somerset NHS Foundation Trust and the Royal Devon and Exeter NHS Foundation Trust have gone out to tender for an electronic patient record (EPR) system worth up to £35m, reported eHealth Insider. The notice, published in the Official Journal of the European Union, says the executive teams of the two trusts are “exploring whether closer partnership working has the potential to improve the quality, sustainability and viability of clinical services for the population of Devon and Somerset. IT is widely recognised as an enabler in this process and a shared EPR solution is a major strategic consideration,” it adds. The value of the ten-year contract is £15m-£20m, with an option to extend for an additional five years taking the total value to £25m-£30m.
NHS could charge fee to call out the doctor: Calling out a doctor to your home could cost £8.50 and patients could be charged for meals under radical proposals being outlined by the NHS Confederation to shore up the finances of the NHS, reported The Telegraph. The proposals are being outlined as a way of tackling the financial hole in the accounts of the health service. The moves sparked outrage with claims they amount to a patients’ tax and undermine the “free at point of use” principle of the NHS. The federation said there were no plans to suggest charging but frank discussions were needed. The chief executive Mike Farrar told the Daily Mail: “We need to talk openly and honestly about why our health service needs to change. We cannot risk the wheels coming off and patient care suffering.”
Rotherham spending £40m on EPR: The Rotherham NHS Foundation Trust plans to spend more than £40m on implementing its Meditech V6.0 electronic patient record system which is causing “persistent serious issues” nine months after go-live, reported eHealth Insider. The trust deployed the EPR in June last year, but has hit consistent problems culminating in an intervention by foundation trust regulator Monitor last month. It stopped all further go-lives of the system late last year. The trust’s revised business case dated 28 February and obtained by eHealth Insider via the Freedom of Information Act, reveals it plans to spend £40m on the implementation. Rotherham has spent £21.5m to date including more than £8m on implementation and on-going support costs against a budget of £6.5m, mostly due to a £1.2m over-spend on trainers.
Thousands of NHS deaths were avoidable: Public Service has revealed, close to 20,000 deaths in NHS hospitals could have been avoided if trusts had paid more attention to figures showing extraordinarily high mortality rates, according to Professor Sir Brian Jarman who has been tasked by the government to investigate the performance of 14 NHS trusts. Following the scandal at Stafford Hospital and the damning report by Robert Francis QC, Jarman was told to look into other trusts where death rates were higher than might be expected. His review, he said, revealed that there must be at least tens of thousands of avoidable deaths in those hospitals when the authorities should have been going in and looking at what was happening.
ITK money links PAS to online booking: Heatherwood and Wexham Park Hospitals NHS Foundation Trust is implementing an online booking system to reduce no show appointments and improve patient communication, reported eHealth Insider. The system is being created by DrDoctor and will let patients book, cancel and view outpatient appointments online or on a smartphone app. The trust is using its £49,000 ITK funding to develop an interoperability toolkit compliant interface to the DrDoctor platform. The funding is part of the Department of Health’s £2.2m Information Sharing Challenge Fund awarded to 43 different projects across the NHS. Tom Whicher, one of the founders of DrDoctor, said the aim was to integrate with the trust’s own system.
Patient Opinion website for rating NHS care endorsed: A website which allows patients to rate the care they have received on the NHS is being formally supported by the Scottish government, reported the BBC. Patient Opinion works in the same way as travel review websites, but contributors review the care at hospitals, surgeries and clinics. It hopes that by allowing patients to post opinions, services can be opened up to scrutiny and standards driven up. Recent comments posted on the website range from a complaint from a patient who said she waited five months instead of six weeks for an important clinic appointment, to praise for the new Victoria Hospital in Glasgow from a patient who said they received “a 5 star experience”. The Scottish government said improvements had already been made as a result of comments made on Patient Opinion. Funding has now been awarded for health boards to engage with the service.
Doctors in the fast lane on social media guidance: The first-ever practical guide to help UK doctors navigate their way around the ethical and confidentiality dilemmas of social media has been published this week by the Royal College of General Practitioners (RCGP) in collaboration with Doctors.net.uk and LimeGreen Media. The Social Media Highway Code is a collation of practical and supportive advice based around a 10-point plan. The advice was provided by a range of people with an interest in social media, including doctors, nurses, journalists and patients. It is intended to help and encourage healthcare professionals to communicate effectively using various social media channels, whilst adhering to the conventions that their patients, their colleagues and the public might reasonably expect. Dr James Quekett from Doctors.net.uk said: “The Code is about helping individuals navigate social media and attempts to highlight where doctors need to exercise caution based on past experience. It is not about imposing rules on their online behaviour.”
Delay to 111 go live in third of country: NHS Direct has been asked to provide a contingency service in almost a third of England due to delays in rolling out the government’s flagship 111 urgent care phone number, reported HSJ (subscription required). The new non-emergency telephone number was due to have been rolled out across the country this week, replacing NHS Direct’s 0845 number, under a target set by the Department of Health. However, NHS Direct has been asked to continue to provide the service in 17 areas, including West Midlands and South East Coast, due to concerns about readiness. In most of these areas, NHS 111 has been “soft launched”, so has begun receiving out of hours calls, but will not progress to full launch and taking over calls to NHS Direct’s 0845 number until after Easter. Most commissioners facing delays said it was due to concern about introducing a new service so close to the four day Easter bank holiday weekend which is usually one of the busiest times of year for NHS out of hours and emergency services.
NHS told to do more to ‘reduce health inequalities’: Health secretary Jeremy Hunt has backed a report calling on health professionals to tackle the social and economic causes of ill health – not just the medical, reported the BBC. The report, supported by the British Medical Association, says more needs to be done to reduce the health divide between rich and poor. It contains a commitment to making “social referrals”. Hunt said the NHS had a legal duty to reduce health inequality. It has been calculated that addressing health inequalities in the way the report suggests could save the NHS £5.5bn a year. The report from the Institute of Health Equity points out that eight people a second are seen by the NHS, yet not enough attention is given to social and economic problems underlying poor health.
N3 gets PSN certified: The N3 broadband service, provided by BT, has been certified as a Public Services Network, reported eHealth Insider. N3 has more than 1.3m users across England and Scotland. It provides the foundation for many front-line clinical applications as well as voice, videoconferencing and mobility solutions. BT powers the network and is the fifth provider to be awarded PSN certification in a process that took 11 months. The PSN creates a ‘network of networks’ across the public sector allowing authorised users to access and share data securely. Nick Earl, chief executive of N3 Service Provider, said BT aimed to get accredited before 1 April as the transformation of the NHS would see a number of NHS employees transitioning to local government who would still need access to systems and applications connected by N3.
Opinion
Why a paperless NHS will be great for patients
In this week’s HSJ (subscription required) Eileen Milner, executive director for business strategy at Northgate Public Services, discusses why the push for a paperless NHS can be one of the most meaningful and high-impact policy drivers of the next few years.
“In setting out his vision for promoting the creation and effective use of digital patient records across the country, the secretary of state has brought to the fore the issue of how we can best use the huge amounts of data in the NHS for the benefit of patients, clinicians and commissioners. This represents an opportunity to drive forward new, more open, safer and more cost-effective models of healthcare in the UK.
Eileen continues by saying that a paperless solution can help hospitals save time and money – it is estimated that a saving of 10% of clinical time spent on administration would release £6bn per year, which in turn could be reinvested in patient care.
“As we have seen across public services, better use of digital information can have very positive outcomes for providers and patients.
“While the NHS has many examples of successful data management and informatics use, the next stage of transformation for the service requires that information continues to be not only collected but must be intelligently analysed and targeted for effective use.
“With this in mind, the paperless NHS has the opportunity to be one of the most meaningful and high-impact policy drivers of recent times.”
Another view
Despite negative comments surrounding Tim Kelsey’s suggestion that clinicians and even patients should write apps, GP Neil Paul thinks it should be encouraged.
“I think it’s not that bad an idea. I also worry about complacent IT departments and suspect that the reason these naughty users started to design their own systems was that they weren’t being listened to by them.”
Paul goes onto to say that the possibilities within programming need to be understood and there is a gap for a middle person who can: “…turn your ideas into a tender; get financing; find the programmers and run the project.”
There is an element of risk when backing IT projects, however Paul concludes by likening apps and computer programmes to drugs in the pharma world: “Fund the R&D, most projects fail, a few break even, and a couple make a fortune. Only for the NHS, the payback doesn’t have to be monetary – it could just be better clinical care.”
From the Heart and Chest
A new columnist appears on eHealth Insider this week with Dr Johan Waktare, a consultant cardiac electrophysiologist at Liverpool Heart and Chest Hospital NHS Foundation Trust, giving his account of becoming the first trust in the UK to implement an electronic patient record system (EPR) from Allscripts.
Dr Waktare writes about becoming the trust’s clinical EPR lead and switching from focusing on “decrepit hardware” to becoming involved in something “far bigger than he ever imagined”.
He discusses how after numerous visits to healthcare organisations both in the UK and in the US, very few have a full EPR but rather an element of ‘EPRedness’.
“Having an EPR or an EPR programme is seen as an end in itself, and it isn’t. What I and the rest of my trust’s team are doing is delivering change that will improve care for our patients, processes for our staff, and efficiency for our organisation.
“The fact that it is electronic is secondary. I don’t want to be measured by how electronic we are, but instead by how much improvement we have delivered. The fact that that improvement comes in the guise of “IT enabled healthcare” is a logical choice – a reflection of the times and nothing more.”
Telemedicine: A viable solution to NHS staff shortages?
As more and more pressure is being put on the NHS to meet waiting times targets and improve the quality of service, Andrew Graley, healthcare director at Polycom EMEA asks whether wider adoption of telemedicine offers a viable solution to the problem of limited resources.
“Millions of pounds are currently being spent on agency doctors to help NHS hospitals comply with the European Working Time Directive, which limits the number of hours healthcare professionals can work. With new checks being introduced to ensure that medics from the EU have high proficiency in English, NHS staff shortages are likely to get even worse. There are a number of particular benefits that video conferencing brings to the medical market.
“The most important is of course improved patient experience. Not having to travel to the hospital to receive treatment is particularly useful for elderly patients, people with mobility issues and those who live in remote areas. It also enables patients in hospital to have access to specialists who may not be based in that location. Besides, patients could be seen and treated more quickly, potentially reducing the need for hospital visits.
Graley goes on to say that it’s not only about patients. With fewer doctors available to go around visiting people, telemedicine can help the NHS meet its targets by significantly reducing the time used by doctors and health experts for travel and therefore enabling them to see more patients per day. Video conferencing also enables increased collaboration between specialists who work apart, further improving patient outcomes.
“The Health Secretary’s recent plans to replace face-to-face GP appointments with a new system of “virtual clinics” have been met with a mixed reaction with critics concerned about the less technologically able being left behind. In my opinion, whilst we can’t deny the fact that not everyone is technology savvy, this shouldn’t hold us back.”
Pressure mounts on Clinical Commissioning Group leaders
In an article in the Guardian this week, Richard Vize warns that the imminent deadline for CCGs to take full control of decision making in their locality is “awash with risk”.
“The first is simply: time. With two days probably being the minimum a GP commissioner can wisely spend in their surgery each week, they will be faced with leading their commissioning organisations in no more than three. In practice of course – whatever their intentions – the boundaries between the two will be blurred and the risks of doing neither job well are considerable.”
In addition to this juggling act, they also need to develop and maintain relationships. There are Clinical Support Units, Local Medical Committees, the Commissioning Board and most importantly their patients to keep happy. Tough budgets mean there will be very limited support and so the pressure is on them to keep an appropriate balance.
Then there are additional Government directives to achieve – moving services from the hospitals to the community. What has become clear is that this presents its own dangers.
“Research carried out by the BMJ showed that more than a third of GPs sitting on CCG boards have a financial interest in private health companies.”
This coupled with a lack of understanding on how to manage conflicts of interest in the public domain, could impact on maintaining appropriate clinical governance and give the local and national press enough ammunition to fire at the NHS for the next 10 years.
The hope is that a few CCGs are able to demonstrate the benefits of the new structure in the short term. This will keep the critics at bay and allow other CCGs to catch up. However with less than 10 days to go until the transition is complete, is there enough time to turn the aspirations into reality?
Highland Marketing Blog
In this week’s blog Gemma Thomson discusses how investing in healthcare IT can deliver greater efficiencies and improve patient care.
