News in brief
Tight timescales for Tech Fund: Suppliers and trusts are concerned that timescales are increasingly tight for spending the first £90m of technology fund money by April next year according to eHealth Insider. The £260m ‘Safer Wards, Safer Hospitals: Technology Fund’ was announced by health secretary Jeremy Hunt in May to catalyse the adoption of IT in the NHS. An announcement of the winners was originally due at the end of October, but it has not yet been made. Of the £260m, £90m must be spent in this financial year and £170m in the next and trusts must match any funding they receive. It is understood that the delay is related to gaining Treasury approval. NHS England was also due to announce the opening of the £100m Nursing Technology Fund in late October, however this has been delayed. Bids were due to be awarded by Christmas with the first £30m to be spent by April 2014. Director of Graphnet Markus Bolton said the company has a number of clients with applications in for the tech fund and the majority are anticipating spend in this financial year. “That’s possible because all of the projects are building on existing infrastructure and data that’s already there,” he explained. Jim Chase, managing director of Advanced Health and Care, said delivery of projects within this timescale will be “challenging”. Chase said: “Much of the NHS is going to be preoccupied with winter pressures from now until January, which compresses the timescales further.” However, he believes that if announcements are made early in the New Year, projects can be delivered in time.
A&Es to receive extra £150m to ease winter pressures: A second wave of winter pressure funding is to be made available for all accident and emergency departments, Health Service Journal (subscription required). The Department of Health is this week expected to announce the creation of a new £150m fund, targeted at emergency departments that are not receiving a share of the £250m fund unveiled in September. It is understood that foundation trusts’ receipt of the funds will be linked to an agreement to comply with additional performance management of their A&E departments. NHS England and the NHS Trust Development Authority are already closely monitoring and managing clinical commissioning groups and NHS trusts. Particular attention has been paid to figures relating to cancelled operations and the temporary closures of A&E departments at exceptionally busy times, although the extent of the intervention has led to complaints about a culture of micromanagement. One foundation trust medical director said extra funds would be only a temporary solution, when winter pressures were inevitable without longer term planning. “It’s all going to go completely pear shaped and they know it. It’s entirely predictable,” he said. “It would be much more helpful if they gave [funding] to social services − that’s one of the biggest problems. One of the overwhelming issues for struggling accident and emergency departments is they can’t get people back into long term care.”
Electronic prescribing ‘patchy’ in NHS hospitals: There is wide variation in electronic prescribing in NHS hospitals, putting patient safety at risk through medication errors, research suggests. According to the BBC, a survey of 101 hospitals in England indicated 69% used some form of electronic prescribing, but there was wide variation in the systems used. Only one of the hospitals used a single system in all of its clinical areas, a University College London team said. The Department of Health has promised to spend £1bn to replace paper systems. The study is published in the journal Plos One. Lead researcher Professor Bryony Franklin, of the University College London School of Pharmacy, said within the UK, most GP prescribing was now done by computer, but prescribing for hospital inpatients generally still required pen and paper, in contrast to many other developed countries. A Department of Health official said: “Earlier this year we announced £1bn in funding will become available to replace outdated paper-based systems for patient notes and expand electronic prescribing. This kind of technology can help reduce prescribing errors, enable more efficient administration of medicines and free up staff time to spend with patients – not paperwork.”
Hunt orders hospitals to publish ward staffing levels every month: The Guardian reported that Jeremy Hunt, the health secretary, will introduce monthly mandatory reporting of numbers of staff on hospital wards from next April but will reject a fixed minimum nurse-patient ratio. Hunt’s proposal is in response to the Francis Report commissioned in the wake of the Mid Staffordshire scandal, where hundreds of patients died amid appalling failings in care. He will propose that the National Institute for Health and Care Excellence (NICE) be required to draw up a “toolkit” suggesting minimum staffing levels in wards according to the size of ward, acuteness of patient illness, age profile and other factors. NHS trusts will then be required by law to publish the staffing in each ward – and will be subject to an immediate health inspection by the Care Quality Commission if they are not meeting the guidelines. The Safe Staffing Alliance, which includes the Royal College of Nursing, Unison and the Patients Association, backs the idea of a fixed staff ratio of no more than eight patients to one nurse. The response to the Francis Report also follows a report by Don Berwick, on patient safety in the NHS. Health minister Norman Lamb said: “Professor Berwick’s report showed us that, more than anything, safety is about being open and honest. We are determined to see the NHS become a world leader in patient safety – with a safety ethos and level of transparency that matches the airline industry. The Francis report is already having an effect, with the NHS planning to hire more than 3,700 extra nurses over coming months.”
Fiddling with figures a crime: eHealth Insider reported that it will become a criminal offence for NHS care providers and senior managers to submit misleading data, under plans released by the government in response to the Francis Inquiry. The inquiry, led by Robert Francis QC, was launched in response to failings at Mid Staffordshire NHS Foundation Trust, which had high death rates, but made inaccurate statements about its mortality figures. The government’s response, entitled ‘Hard truths – The journey to putting patients first’, says that Francis’ recommendation to introduce this as a criminal offence has been accepted. The report says: “The government has introduced a new criminal offence applicable to care providers that supply or publish certain types of information that is false or misleading, where that information is required to comply with a statutory or other legal obligation. The offence will also apply to directors and senior managers who have consented or connived in an offence committed by a care provider.” The government will also create a hospital safety website for patients, available by June next year, as part of a ‘patient safety programme’ run by NHS England. Health secretary Jeremy Hunt said: “that this was only the beginning of the transformation of the NHS. Today’s measures are a blueprint for restoring trust in the NHS, reinforcing professional pride in NHS frontline staff and above all giving confidence to patients. I want every patient in every hospital to have confidence that they will be given the best and safest care and the way to do that is to be completely open and transparent.”
New era for patients and NHS as government accepts recommendations of Mid Staffordshire inquiry: More openness, greater accountability and a relentless focus on safety will be the cornerstones of an NHS which puts compassion at its heart, health secretary Jeremy Hunt has announced. Gov.uk reported that the plans, set out in the government’s response to the Inquiry into the failings at Mid Staffordshire NHS Foundation Trust, build on the cultural change already taking place in the wake of the hospital scandal. The government has already instigated a number of changes following the Inquiry’s report published in February, most notably introducing a new hospital inspection regime and legislating for a duty of candour on NHS organisations so they have to be open with families and patients when things go wrong. Hunt said: “I do not simply want to prevent another Mid Staffs. I want our NHS to be a beacon across the world not just for its equity, but its excellence. I want it to offer the safest, most compassionate and most effective care available anywhere – and I believe it can.” In total, the government has accepted 281 out of 290 recommendations, including 57 in principle and 20 in part (meaning the recommendation has been accepted with some differences or new ideas relating to how it will be delivered). Progress against the report as a whole will now be reported to Parliament on an annual basis to ensure rapid progress against delivering the recommendations.
£10 charge for GP appointments would raise the NHS £1.2bn, study finds: Charging patients £10 a time to visit their GP would raise an extra £1.2bn a year in England, a new report has claimed. The think tank Reform’s study of 31 developed countries found that 22 countries require patients to pay for an appointment with a GP, ranging from 85p in France to £17 in Sweden according to Pulse. If the government introduced a £10 fee in England, this would equate to £1.2bn increase in funding, the report concluded. Reform’s calculations are based on adopting fees in the same way that other developed countries do. Its report argues that extra cash could also be raised through increasing prescription prices, charging patients a £10 ‘hotel charge’ for every overnight stay, and £10 for missing a hospital outpatient appointment. Overall, these measures would bring in £3bn for the NHS, it concluded. Thomas Cawston, research director at Reform, said: “Few will want to debate higher NHS charges, but the funding outlook for the service makes it unavoidable. Prescription charges are the easiest route to new revenue, with exemptions for people on low incomes.” The GPC and RCGP have said they are strongly opposed to introducing charges for patients, and ministers have also ruled out the idea.
Commissioners predict growing QIPP shortfall: NHS commissioners are slipping behind on their efficiency plans and becoming more pessimistic about whether they will hit their year-end targets, reported Health Service Journal (subscription required). Figures released under the Freedom of Information Act show performance on the quality, innovation, productivity and prevention programme (QIPP) worsened between quarters one and two of 2013-14. Although QIPP is supposed to be about making the NHS more cost-efficient while improving the quality of services through innovation, NHS England centrally monitors only the programme’s financial performance. Six months into this financial year, the commissioning sector is forecasting a QIPP shortfall of £246.6m, or 12.2% for the end of 2013-14 − more than double the expected shortfall in the first quarter. Much of the deterioration comes from clinical commissioning groups, which are now forecasting a £176.9m shortfall − an increase of more than £100m over the past three months. Steve Kell, co-chair of NHS Clinical Commissioners leadership group, said that on the transformational side CCGs were focusing on improvements to community services and, through their memberships, primary care. He said these innovations would lead to savings over a longer timescale. “Contract work has been the focus of QIPP in the past few years,” he said. “Transformational change takes longer.”
Major new report backs seven day services in hospitals: Seven day services would create a “transformational shift in the way the NHS delivers medical care” according to a major new report by the Academy of Medical Royal Colleges (AoMRC). According to The National Health Executive, the report says hospitals need to move to seven days services where patients in hospital over a weekend or bank holiday would get a daily care review led by a consultant. Weekend patient reviews would often allow earlier discharge, freeing up beds for new admissions, as long as strong links between hospitals and community care are in place. The AoMRC report, ‘Seven day consultant present care: Implementation considerations’, comes after the BMA softened its stance on seven day hospital care, although it still believes there is a lack of resources for elective and routine services on evenings and at weekends. Achieving seven day services will need more consultant appointments and a “reorganisation” of the current workforce, the AoMRC says, plus more integration of primary and social care. It suggests seven day working would require more funding initially, but suggests it could save money in the long run through re-organising services and reducing morbidity. Professor Norman Williams, steering group chair and president of the Royal College of Surgeons, said: “It is not acceptable that over weekends and bank holidays, patients receive a lower standard of care than they would during the week.” NHS Employers chief executive, Dean Royles talked of a “growing consensus” on seven day care, adding: “This gives greater impetus and urgency to the negotiations currently taking place about doctors’ terms and conditions of employment.
South integration funding scrapped: Funding for the integration project that was part of the Southern Local Clinical Systems Programme has been scrapped and trusts must instead apply via the Technology Fund reported eHealth Insider. The ‘integration’ project was the last of four projects that made up the southern programme, which also includes ‘community and child health’, ‘acute’ and ‘ambulance’. The programme is for providers in the South that otherwise got nothing from the National Programme for IT. The three other projects have had business cases approved for central funding totalling £130m. The total central government spend now appears to be around £130m, with at least £100m committed by the trusts involved. When asked what happened to the integration project, NHS England said southern trusts can apply to fund their integration work via the second round of the Technology Fund, recently announced by health secretary Jeremy Hunt. Beverley Bryant, director of strategic systems and technology at NHS England, said: “The £250m extension to the ‘Safer Hospital, Safer Wards’ Technology Fund is available to NHS Trusts to support the widespread adoption of modern, safe electronic record-keeping, replacing outdated paper based systems for patient notes and prescriptions with integrated digital care records. The trusts in the south will be able to fund their integration work via this route.”
NHS ‘resistant to innovation from SMEs’, survey finds: Three-quarters of small to medium-sized enterprises (SMEs) in the health technology sector have rated their experience of working with the NHS as “difficult” or “very difficult” according to Pharma Times. Eighty-five per cent of UK-based SMEs identified overly-long decision-making times and finding the appropriate person in an organisation to speak to, as barriers to working with the NHS, a new survey conducted by Health 2.0 has found. Over 80% of respondents reported that NHS procurement processes are too complicated, while nearly 60% felt that there is a resistance within the service to working with private sector companies. Moreover, only 30% of UK-based respondents said they have worked with Academic Health Science Networks (AHSNs), the organisations set up in April 2013 to work with the NHS, academia and the private sector to encourage innovation. Commenting on the findings, Health 2.0’s international director for health, Pascal Lardier, said: “It’s very tough trying to do business with the NHS – a change of culture is needed from the decision-makers with budgets. There is a need for entrepreneurs to contribute to innovation in health to help health services cope with increasing demand and decreasing funds.” 125 health sector SMEs responded to the survey, of which 82 (67%) were from the UK, 22 (18%) from the rest of Europe, 12 from the US (10%) and six (5%) from the rest of the world. Most sell their innovations to public and private hospitals, followed by clinicians and national health authorities, while 30% sell direct to patients and the public.
NHS England to launch new ‘hospital safety’ website: A dedicated hospital safety website will be launched next year as part of the government’s response to Robert Francis QC’s report, ministers have announced. Health Service Journal (subscription required) reported that the government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry said the website will provide the public with “up to date” information on a range of patient safety metrics. These include staffing levels; pressure ulcers; healthcare associated infections and other key indicators, where appropriate at ward level. It is unclear if the new website will be linked to the already existing and popular patient information website, NHS Choices, which is in the process of a substantial revamp. The report added: “The website will aim to begin publication from June 2014. It will, over time, become a key source of public information, putting the truth about care at the fingertips of patients and updated monthly never events.” Never events are already published at trust level but the report said NHS England will now publish national never event data quarterly before the end of 2013, and then monthly from April 2014. A Department of Health spokeswoman said NHS England was leading on the patient safety response to the inquiry but it had not yet been decided which organisation would develop the new website.
NHS organisations get access to Graphnet CareCentric suite through G-Cloud 4: IT Director reported that Graphnet Health, supplier of electronic health records to the NHS and social care providers, is the latest vendor to team up with Softcat on version 4 of the G-Cloud framework. Softcat’s Partner Alliance team will provide NHS and social care organisations with access to Graphnet’s CareCentric electronic record software running on a cloud infrastructure. CareCentric is designed to support the delivery of integrated care services, whether across whole health economies or individual care settings, by providing access to a single, secure electronic health record. Care professionals can access the record from their remote, mobile or desktop devices, whether at various locations within a hospital or GP practice, at other hospitals, in the community or at home. CareCentric is fully interoperable, connecting to most of the major health and social care IT systems being used in the UK, including EMIS, iSoft, INPS, Microtest, RiO, Ascribe and twenty more. Andy Bratt, managing director of Graphnet, said he was delighted that the company’s bid for inclusion on G-Cloud 4 had been successful. “Our aim is to be as flexible as possible in terms of what we can offer health and social care organisations. A place on the G-Cloud framework through Softcat offers accelerated procurement procedures, and gives customers the option of buying CareCentric applications running on a cloud infrastructure, with all the scalability benefits that implies.”
MedeFest demonstrates NHS transformation using business intelligence: Actionable intelligence is transforming parts of the health service that are effectively using data analytics, delegates at MedeFest 2013 heard this week. The conference, hosted by MedeAnalytics, heard that the NHS could save hundreds of millions of pounds if it better embraced business intelligence. Frontline care could also be dramatically improved by giving medical professionals the information they need, in the right place and at the right time. Healthcare leaders came together from organisations ranging clinical commissioning groups to acute care to share best practice at the event. They were told that cloud technology was the only way forward in delivering the most up-to-date information needed by people across healthcare. Wayne Parslow, MedeAnalytics general manager for Europe, Middle East and Africa (EMEA) said: “Think of the biggest technology companies over the last five years – Twitter, Amazon, Facebook, Ebay, Apple – they are all cloud based. The reason why cloud works is that there’s only one central version of the truth and it can be shared and collaborated when necessary. Nothing else will work strategically, only tactically.”
‘Tremendous interest’ in genome project: Healthcare IT suppliers have shown “tremendous interest” in a government project to sequence 100,000 genomes and link these with electronic patient records reported eHealth Insider. The project involves the DNA codes of up to 100,000 patients being matched to their EPRs over the next five years to create anonymised datasets of the genome sequences and the clinical data. The government has set up a new company, Genomics England, to manage the project contracts for specialist UK companies, hospitals and universities to deliver the necessary services. Genomics England chief data officer, Professor Jim Davies told EHI a procurement will start in the first half of next year. The organisation will need a secure high-performance computing facility and software to provide both clinical and research data services. “We will provide an environment in which users can come and ask questions of the data. All this needs to be procured as a service,” he said. “There’s been a tremendous level of interest and we are going to be looking far and wide for suppliers. The only risk would have been being overwhelmed by it, fortunately we had a lot of help by the Department of Health in terms of organising events where we see a lot of people in one go.” An initial phase will run next year with a full go-live with participating trusts in 2015. The government has pledged up to £100m in funding which will be used to cover the initial DNA sequencing, build the secure NHS data linkage and train scientists and the healthcare community.
Opinion
Encourage staff to see learning as something that happens every day
In Nursing Times this week, Val Dimmock, simulation and clinical skills facilitator at Homerton University Hospital NHS Foundation Trust, explains that easy access to training will help boost standards of care.
“Clinical skills leads must rethink their role – and how their trusts provide clinical training – if the NHS is to implement the recommendations of the Francis report and respond to the call by the Nursing and Midwifery Council to move from renewal to revalidation. Many acute hospitals have appointed clinical skills leads, senior nurses with a wealth of practical and theoretical experience, to lead training and development. Yet the Francis report indicates the NHS is still struggling to ensure staff develop and maintain skills.
“A sea change in the way clinical skills leads approach our role is needed. We need to encourage staff to see learning as something that happens every day in the workplace, not something that takes staff away from it. More than that, we need to provide an environment where clinical staff can quickly and easily access training to meet immediate patient needs as well as for long-term development, without taking too much time away from clinical practice.
“To achieve that, we must create a learning environment that allows staff to access self-study materials at work or at home, so they can learn the theory and move towards certification before they reach the classroom. Classroom sessions can then focus on practical elements – which will both reduce time away from clinical areas while increasing time spent on hands-on practice.
Dimmock concludes by explaining the work done at Homerton University Hospital NHS Foundation Trust: “We have adopted an e-learning programme called Elsevier Clinical Skills. Over the longer term, we expect it to improve staff productivity and allow us to get more from our training budget, while supporting trust-wide objectives around the quality of care and staff development. For patients the benefit is simply safer, higher-quality care from competent, confident nurses.”
The value of volunteering in acute trusts
The Kings Fund’s Amy Galea, senior researcher of health policy, blogs on the importance of the three million volunteers that contribute to their service and play an important part in improving patient experience in acute trusts in England.
Following new research into the average 471 volunteers for each trust, Galea reported: “The variation in numbers between these trusts is considerable, with some reporting as few as 35 volunteers, and others reporting 1,300. Of course this is just the tip of the iceberg and it does not shed light on the scale of volunteering in primary care, mental health trusts or volunteers who offer their time in a governance capacity in trusts. However, it does point out that some trusts may be benefiting more than others from the potential of volunteers. For example, one trust with around 2,000 staff has almost 1,000 volunteers, while one trust has less than half this number of volunteers but staff levels of 13,000.
“Volunteers engage in a wide range of roles, from befriending, signposting and administering patient surveys to providing specific services based on their professional background, like offering reiki, massage and reflexology to patients and carers to help improve their wellbeing. Our survey respondents strongly valued the time volunteers dedicated to patients, as one respondent mentioned: ‘The thing volunteers have got is time, which obviously the staff have not got on wards, so by having those volunteers there, it’s the little extras which are really making the difference – for example, at meal times holding the patients’ hands and reading the menu to them’.”
Barring scheme for directors will do more harm than good
This week in Health Service Journal (subscription required), Alastair McLellan says that using a fit and proper person test to bar directors from the health service will put even more pressure on the Care Quality Commission (CQC), and the government should abandon the idea.
“Some NHS policies receive attention inversely proportional to the good they will achieve. The news the proposed fit and proper test will be used to “bar” directors of health and social care providers from further employment falls into that category.
“The government has decided the Care Quality Commission will be the arbiters of a fit and proper person. Because the test is now linked to potentially depriving someone of their livelihood it is bound to involve significant effort on behalf of the overstretched regulator.
“When the “testing” of directors begins, HSJ predicts very, very few NHS directors will fail. This will disappoint those from a wide range of interest groups who believe disagreeing with them is an indication of unfitness. The CQC will spend most of the time defending its decisions to give a board a clean bill of health and the rest in industrial tribunals. That is the last thing its slowly recovering image needs.
“Last week, the Department of Health’s own leadership standards group urged caution in implementing a barring scheme, suggesting the same result would be achieved by better use of existing disciplinary procedures.”
Hospital complaints review: name and shame trusts that do not comply
Ann Clwyd’s recommendations to make hospitals more accountable must be enforced by patient champions says Dick Vinegar in this week’s Guardian Healthcare Network.
“Last month Ann Clwyd MP published a review of NHS hospitals‘ complaints systems with the subtitle “Putting patients back in the picture”. You will remember that last year she described, in tears, on the floor of the House of Commons, the inhuman treatment her dying husband received in a Welsh hospital. Afterwards, she received 2,500 letters and emails from patients and relatives of those who had received similar treatment in UK hospitals – it’s their stories that form the basis of her subsequent review.
“The final report is a horror story. It shows how lackadaisical some hospital staff can be, and how dysfunctional many complaints procedures are. “I found a confused system, where the NHS was judge and jury, and where the strategic intent seemed to be to destroy the complaint,” writes one respondent. “I tried to attract the attention of the nurses, but found the entire nursing team bidding at the end of an eBay auction,” adds another. When patients do pluck up the courage to raise concerns, the typical hospital reaction is to deny, defend and delay. It’s a terrible situation, and it’s nothing new.
“Clwyd has made some attempts to ensure that these reluctant and defensive bureaucrats do implement her findings, persuading several NHS organisations to sign pledges to act on her recommendations. Most of these are the great and good of the health service: the NHS Confederation, the General Medical Council, Monitor and the Care Quality Commission. But really, she needs pledges not from such august (and rather toothless) bodies, but from the hospital trusts – these are the organisations that have ignored the need for a patient-friendly complaints system in the past.
“I would like to see every local Healthwatch, patient assembly or patient champion across the country investigate the complaints procedures of all the hospital trusts in their area to see whether they are compliant with Clwyd’s recommendations. They should kick up a hell of a fuss if they aren’t. Otherwise, her report will go the way of all the previous complaints procedures reviews – and be totally ignored.”
Highland Marketing blog
In this week’s blog Jeremy Nettle asks ‘is the NHS in crisis’?
