News in brief
NHS England forecasts 13pc savings plan shortfall: NHS England is predicting it will fall short of its efficiency savings target by 13% in this financial year − a much bigger gap than that expected by Clinical Commissioning Groups (CCGs) reported Health Service Journal (HSJ, subscription required). That is despite the national commissioning organisation setting a less ambitious initial savings target than CCGs. An internal report obtained by HSJ reveals NHS England is aiming to make savings of 1.4% through the quality, innovation, productivity and prevention (QIPP) programme this year. CCGs are planning for a 2.6% saving. NHS England collects and collates the information, to track performance on QIPP and other financial indicators, in an internal document called the Non-integrated Single Financial Environment report. As of the end of June, NHS England’s savings plan was 9.2% behind target. The shortfall is forecast to rise to 12.9% by the end of the year – a gap of £48.1m in a £374m savings plan. The main contributor to the gap is primary care, for which NHS England took on responsibility in April. It predicts it will miss its primary care QIPP target by 19%, or £22.5m. It is also predicting a 38% shortfall on public health savings, although these account for a much smaller percentage of the organisation’s budget and QIPP target.
NHS England aims for 100% of practices to use e-referrals service: NHS England is aiming for 100% of GP practices to use its new e-referrals service, in order to make the health secretary’s pledge for a ‘paperless NHS’ by 2018 a reality, reported Pulse. NHS England said it would not mandate the new e-referrals service, or incentivise GPs or Clinical Commissioning Groups (CCGs) to use it, but would instead develop a service with the profession, and encourage them to come on board. NHS England announced plans for a new e-referral service – a revamped version of Choose and Book – which will be based on flight-booking websites, earlier this year. An NHS England spokesperson said: “We want all GP practices to use Choose and Book/NHS e-referral service over time. There will be no mandating, but we will be developing a service that works for the NHS, in conjunction with the NHS, encouraging everyone to come on board.” They added: “Achieving paperless referrals is an important step on the pathway to a paperless NHS by 2018. In terms of timing, there will be a gradual evolution from Choose and Book to the new NHS e-Referral Service. It is clearly inefficient to have dual systems with a mixed economy of paper and electronic referrals and we must ensure that everyone is onboard in making paperless referrals a reality.” Figures from the Health and Social Care Information Centre from April and May this year show that just 52% of practices made all their referrals through Choose and Book, though figures from the first week of August show 91% practices make at least some of their referrals through the service.
Scrapped NHS IT programme to cost taxpayer £10bn: The NHS National Programme for IT (NPfIT) is to cost the taxpayer more than £10bn, a final figure released under the Freedom of Information Act has revealed. The failed programme was dismantled by coalition ministers after the realisation that it would never meet its core objective of delivering an electronic record for every patient in the NHS, reported Public Service. Ministers have been attempting to claw back cash from one major supplier – CSC, which MPs at one point warned had the government “over a barrel”. However it has now emerged that the final cost to the taxpayer is expected to come in at £10.1bn. The figure came in an NPfIT benefits statement that was released in response to a freedom of information request from e-Health Insider. The Department of Health statement, which was released by the National Audit Office, said that £2.6bn of actual benefits had been identified as of March 2011. But £7.3bn had been spent already and £10bn would be spent in total. Organisations across the NHS are now turning to implement local interoperable alternatives after ministers criticised the top down nature of NPfIT.
Nine CCGs planning overspends in first year: Nine clinical commissioning groups (CCGs) are forecasting multi-million pound deficits in their first year, revealed Health Service Journal (HSJ, subscription required). The number of new commissioners planning to overspend in 2013-14 is almost triple the number of primary care trusts (PCT) that planned or recorded deficits in any of the three years up until the government’s NHS reforms took effect in April. Between them, the nine CCGs are forecasting a combined deficit of £86.7m, which is also significantly higher than the gross deficits planned or recorded by PCTs in the past three years. Four CCGs planning overspends of more than £10m include Barnet and Croydon which are well known for having historical financial problems. However others, such as Blackpool, Coastal West Sussex and North Hampshire, do not have predecessor PCTs with a recent history of overspending. An NHS England spokesman told HSJ that because there were “many more” CCGs than there had been PCTs, 211 compared with 151, it was “inevitable that there will be a proportionate increase in those that are reporting financial issues”.
£2.7m telehealth deployment goes ‘live’: Clinical Commissioning Groups (CCGs) are taking part in the largest telehealth deployment in the country, with at least 1,500 patients given touchscreen technology to answer questions about their own health at home, reported Pulse. The £2.7m scheme will see patients – initially with chronic obstructive pulmonary disease and heart failure – relaying information about their blood pressure, weight and blood gases via touchscreen devices. The information will then be analysed and, if necessary, acted on by specialist nurses. The three-year scheme has been commissioned by Surrey County Council and will involve six CCGs. The first telehealth patient in North West Surrey CCG is already ‘live’, with more patients in Surrey Downs CCG following shortly. A joint statement from Surrey County Council and the manufacturer behind the devices, Medvivo, said: “Methods for systematic and careful selection of patients have been worked through at CCG meetings with representatives from a cross section of disciplines including Dr Richard Barnett, North West Surrey’s clinical lead for telehealth and Dr Philippa Woodward as lead GP. Following telehealth training for nurses, which took place during July, the first patient joined the service on 30th July. The intention is to increase numbers progressively over coming weeks and months.”
Jeremy Hunt plans to give anonymised patient medical records to private firms: The new General Practice Extraction Service will consolidate NHS patient records sent to a central database by GPs around the country, reported The Telegraph. The project has been described by campaigners as an “unprecedented threat” to medical confidentiality, and it will be the responsibility of GP practices to inform patients about the changes, and provide them with information on how they can raise an objection to their data being shared. The records will be anonymised but will include details of medical conditions. Private firms such as Bupa are able to purchase the records for research by applying to the Health Service. The project is being driven by NHS England but has been championed by health secretary, Jeremy Hunt. It is hoped that sharing GP records with universities and private companies could give a boost to NHS coffers as well as providing a valuable tool for medical research, monitoring flu outbreaks and screening for common diseases. Hunt also believes that providing easier access to health information will attract pharmaceutical companies and life sciences firms to the UK. However, privacy campaigners have expressed reservations over the data sharing plans. Shami Chakrabarti, director of Liberty, said: “The more people who have access to sensitive data, the greater the risk that it will not be protected properly. We’ve seen that on umpteen occasions in the past. And when there’s a financial element involved, it introduces all sorts of incentives that are not necessarily about protecting privacy.”
Gloucestershire NHS trust leads tender for clinical system: Gloucestershire Hospitals NHS Foundation Trust is going out to tender for an integrated clinical information system, reported Government Computing. The tender, for an eight-year contract with an optional extension of up to two years, is also on behalf of Yeovil District Hospital NHS Foundation Trust and the Northern Devon Healthcare Trust with a contract value between £35m and £60m. According to the minutes of a main board meeting for the Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, Yeovil and Northern Devon shared a common requirement to replace an ageing patient administration system and an aspiration to secure an integrated clinical information system. The grouping became known as the SmartCare Collaborative. In a statement, Gloucestershire Hospitals NHS Foundation Trust said it has embarked on a tendering process for the introduction of an electronic patient record (EPR), which it said, “will underpin improvements in care for years to come.” All three currently have ageing systems that need replacement as the NHS heads towards a ‘paper-light’ future. The project will lead to the installation of an EPR at all three trusts, based on a detailed specification that has been developed jointly since last summer. SmartCare will provide the three trusts with modern information systems for their teams of doctors, nurses, therapists and support staff. The three trusts aim to choose a preferred supplier in the New Year following extensive testing by groups of key staff, from ward clerks to consultants.
IT contractor demand on NHS ‘looks buoyant until 2016’: Demand from the NHS for IT workers will be buoyant for the next two to three years, initially for contractors skilled in Windows 8, reported Contractor UK. Don Tomlinson, managing director of NHS IT recruiters Max20, said that half-year billings of IT contractors have already more than doubled from 174 in 2012 to 398 this year. The opening up of IT opportunities on the NHS to contractors from commercial or other non-healthcare backgrounds is why the forecast of buoyancy for IT workers until 2016 can be made, the recruiter suggested. In fact, as many as half of all new information management and technology contracts on offer from the Department of Health “no longer need experience in the NHS,” contrary to last year when the majority specified it. “There has been a complete shift in the approach to NHS IT recruitment,” added Mr Tomlinson. “[We’re seeing] huge demand for business analysts, technical support and project managers with business backgrounds.”
UK to host G8 dementia summit: The UK is making the fight against dementia global by hosting the first G8 summit dedicated to seeking an ambitious level of international coordination and an effective response to tackling the condition, announced the Department of Health (DH). Prime minister David Cameron and health secretary Jeremy Hunt will use the UK’s 2013 presidency of the G8 to lead coordinated global action against what is fast becoming one of the greatest pressures on families, carers and health systems around the world. In the UK alone, there are likely to be nearly a million people with the condition by the end of 2020. The government has already begun a national programme of action through the prime minister’s Challenge on Dementia, launched in 2011. Now the UK is looking to spark a world-wide effort by inviting health ministers from G8 countries to a high-level summit in London on 11th December to discuss how they can coordinate efforts and shape an effective international solution to dementia. This includes looking for effective therapies and responses to slow dementia’s impact. The summit will aim to identify and agree a new international approach to dementia research, to help break down barriers within and between companies, researchers and clinicians and secure a new level of cooperation needed to reach shared goals faster than nations acting alone.
Patient feedback hub launched but 2015 target reconsidered: NHS England has “soft launched” a flagship transparency project which allows patients to give real time feedback on their hospital experience, reported Health Service Journal (HSJ, subscription required). Care Connect allows patients to send feedback to trusts via a website, free phone hotline, email, text or social media. The comments then appear on a public website. However in order not to over burden the service, and avoid a rushed implementation, it has dropped plans to have every trust signed up by 2015. Jane Barnacle, NHS England’s senior responsible officer for Care Connect, said the early results from the pilots, which have been running for two weeks, were “very positive”. Barnacle said: “We have soft launched Care Connect and are taking it quite slowly because it’s a significant culture shift.” Asked if NHS England had been mindful of the problems surrounding the go-live of 111, which had a strict and tight timetable, she said: “Absolutely, we want to do this properly [before it gets rolled out nationally].” Care Connect is being piloted by 18 trusts in London and the North East including Moorfields Eye Hospital Foundation Trust and Great Ormond Street Children’s Hospital Trust.
Cambridge goes for Epic big bang: Cambridge University Hospitals NHS Foundation Trust is taking a ‘big bang’ approach to its Epic electronic patient record (EPR) implementation, on a scale rarely seen in the NHS, reported eHealth Insider. Carrie Armitage, the director of the eHospital programme that will cover the trust and neighbouring Papworth Hospital, told eHealth Insider that Cambridge will implement a complete EPR, including specialist modules and e-prescribing, in one go in October next year. “We are rolling out the core [patient administration system] functionality, clinical documentation, A&E, maternity, e-prescribing, pharmacy, radiology, oncology, cardiology, theatre, pathology, orders – which includes all the observations and clinical decision support – and transplants,” she said. Armitage acknowledged that the move will be challenging, but argued that it had very little “good IT” in place, and very little worth retaining. “We haven’t really done an awful lot here at Cambridge. We have some really old systems, some home-grown systems, really nothing worth keeping. We really had to start from scratch,” she said. The ambitious eHospital programme will see Cambridge and Papworth spend in the region of £200m over the next ten years; with much of the money going on an infrastructure and hardware contract with HP.
Government to consider prison sentences for data breaches: The government is to consider introducing custodial sentences for people who have committed serious offences under the Data Protection Act, according to Public Service. The revelation follows repeated calls from the Information Commissioner to introduce tougher penalties. His latest appeal for the government to act came last week after a probation officer received a minor fine of just £150 after she leaked the new address of a domestic abuse victim to the alleged perpetrator. Commenting on the case, Information Commissioner Christopher Graham said: “This is not just a criminal breach of the Data Protection Act, but it also led to a police investigation of alleged domestic abuse being dropped. The government must act now to introduce tougher penalties for individuals who illegally access and disclose personal information.” Concerns about inadequate penalties for recklessly mistreating personal data have been voiced for years. But in what is believed to be the first public sign of the government acting on the area, a Ministry of Justice spokesperson said that the introduction of stronger penalties would now be considered as part of a wider consultation into data protection proposals made by Lord Justice Leveson.
Managers claim telemedicine ‘helped cut admissions by 45%: NHS hospital managers have claimed that a telemedicine system has enabled them to cut admission rates by 45% and lengths of stay by 30% for care home residents with long term conditions, reported Pulse. Health leaders at Airedale Hospital in West Yorkshire argue that reductions on this scale among these patients – who have conditions such as chronic heart failure, chronic obstructive pulmonary disease and diabetes – can bring savings of about £2m a year. However, GP leaders have said that, although telemedicine can work well in certain cases, it should not be regarded as a ‘panacea’ or a ‘political tool’. The system at Airedale Hospital allows more than 1,000 patients in 33 residential and nursing homes to have face-to-face consultations with nurses and doctors round-the-clock using mobile video technology. The improvements were calculated by comparing two 12-month periods, before and after the telemedicine system was introduced. Dr Richard Pope, a consultant in telehealth at Airedale, presented the results at a King’s Fund’s conference on telehealth and telecare. He said: “These results are really positive and show that using teleconsultation has huge benefits for managers of care homes and carers, who feel reassured they can quickly get expert help. But more importantly for patients, who would prefer to be cared for in their own environment than taken into hospital.”
Humber and Hull to share Lorenzo record: Humber NHS Foundation Trust and Hull and East Yorkshire Hospitals NHS Trust plan to create a unified Lorenzo electronic patient record (EPR) across both trusts, reported eHealth Insider. Humber went live with the Lorenzo EPR from CSC in May last year as the first mental health ‘early adopter’ under CSC’s local service provider contract for the North Midlands and East of England. Its neighbouring acute trust, Hull and East Yorkshire, is due to go live with the same system in September 2014 under the new deal agreed between the Department of Health and CSC a year ago. Martyn Smith, the trust’s director of IT and innovation, told eHealth Insider that part of the Lorenzo programme is to bring together the trust’s patient database with that of Humber in a single record for both acute and mental health. “This allows for a unified patient record, capturing the totality of a patient’s treatment across both trusts,” he said. “The clinical benefits of this approach are clear: staff will have better information about the patients they are treating.”
GPs predict longer waiting times – survey: The BBC reports that patients will find it more difficult to see a GP in the future as budgets get squeezed, doctors are predicting. A Royal College of General Practitioners (RCGP) poll of 206 UK GPs found that more than 70% were forecasting longer waiting times within two years. Eight in ten also said they did not have enough resources to provide high-quality care, the survey showed. A Patients Association report this year suggested that people were already having to wait longer. Six in ten of those polled by the royal college said patients in England were waiting longer than the recommended 48 hours. Primary care, which includes GP services, has been one of the worst hit by the funding squeeze in the health service. Spending has effectively been frozen for the past six years in England, and while there have been rises in funding elsewhere in the UK, they have been smaller compared with those given to other parts of the health service such as hospitals. The RCGP said this situation was beginning to have an impact. Chairman Dr Clare Gerada said: “GPs are grappling with a double whammy of spiralling workloads and dwindling resources, and big cracks are starting to appear in the care and services that we can deliver for our patients. We are particularly concerned about the effect this is having, and will continue to have, on waiting times for GP appointments. The profession is now at breaking point and we do not have the capacity to take on any more work without extra funding and resources to back it up.”
Opinion
Department of Health report reveals NHS value for money failures
In the Guardian this week, Colin Cram explains how NHS trusts pay over the odds for products and services due to a lack of collaboration.
“On 5th August 2013, the Department of Health (DoH) announced an ambitious programme to deliver cost reductions of £1.5bn by 2015-16 and to install a framework for world-class procurement. To put the statement in context, £1.5bn is equivalent to about 20,000 nurses – a valuable prize.
“So why has the NHS failed to secure value for money? Firstly, inadequate collaboration between trusts is to blame. Secondly, a reluctance to standardise clinical products. Finally, many trusts have only limited procurement capability and capacity, and the procurement staff may have insufficient authority. The DoH has tried various approaches to resolve these issues and collaboration is increasing through the use of procurement partners, collaborative hubs, the government procurement service and the DoH commercial medicines unit. Together, about £6bn of expenditure is channelled through them.
“The report sets out several remedies. Poor data remains a problem, so the DoH will mandate a common coding system to ensure good quality data is available to take strategic procurement decisions and identify areas for savings. There will be a programme for managing key suppliers. The initial focus will be to release cash quickly, but then work together to take waste out of the system and smooth the pathway for innovation. There will also be a price comparison database and the NHS will work with NHS Supply Chain.”
Cram concludes: “A national centre of expertise for major and complex contracts and management of certain markets could provide much benefit. The risk – ever present in the public sector – of investment in personnel resulting in a shift from delivering value to job preservation must be avoided. Overall, however, the new strategy should provide the foundation for the transformation that is needed and deserves strong support.”
On the money? NHS England gets serious about allocations
This week David Buck, senior fellow, Public Health and Inequalities tells The King’s Fund that in times of austerity it is particularly important that money gets to the areas within the NHS that need it most. And in the health care system, it is the arcane – but vital – process of resource allocation that tries to do that.
“Amidst the complexity of the reforms, there were some changes announced to allocations; with the biggest ones being the new allocations to local authorities for public health, and NHS England being given responsibility for allocating the NHS budget, something that had previously been the Secretary of State’s responsibility.
“One of the first things NHS England did was to announce a fundamental review of resource allocation, following concerns that the current formula favoured healthier areas over less healthy ones, and underplayed unmet need. Last week – after a hiatus – it published more details of the terms of reference for that review, and trust me, they make fascinating reading.
“We argued in April that the most important thing for NHS England to define was whether resource allocation was simply a fair way to get money from the centre to where it was needed or whether it was a powerful and active policy tool. A lack of clarity on this has always been the Achilles heel of NHS resource allocation; with much of the work locked up in the dusty corridors of the Department of Health’s finance department, in isolation from wider policy goals. The refreshing focus on inequalities is welcome, but NHS England has the opportunity to transform resource allocation by aligning the money transparently with its wider policy objectives. In our review of the allocations process, we speculated how resource allocation could be designed to promote wider goals such as a clinically led NHS; an outcomes driven one; or an NHS more integrated and aligned with wider public services.
“This review is more encompassing than anyone assumed when it was announced last year. Hopefully, given the ambitions on transparency we won’t have to wait until its end-date, this time next year, to get the chance to see if it’s really on the money.”
Why doesn’t the NHS know how many patients have chemotherapy?
NHS director of patients and information, Tim Kelsey, tells the Guardian Healthcare Network, he believes the health service needs to invest in data to transform patient services.
Kelsey says that healthcare professionals have the skills to adopt technology, accustomed by activities such as online shopping in their personal lives: “It still shocks and surprises me that doctors – a group of extremely intelligent professionals – will do all this online stuff, be among the most vigilant users of TripAdvisor, and then turn up at the NHS and nothing is there.”
Technology will play a key part in addressing the future funding gap for the NHS and Kelsey believes there are lessons to be learnt from other industries in managing data to improve customer satisfaction. Kelsey said: “I think over the next five to 10 years – which is the sort of time period we are talking about for the £30bn deficit – I would be betting we will be targeting about half of that through savings generated by technology productivity.”
Kelsey continued: “I think the quality of data is fundamentally linked to the quality of health services,” he said. “And although a lot of people can’t quite see the connection, essentially it goes back to the basic reality that if you can’t measure it, how the hell can you manage it?”
NHS procurement: put in the frame
It is no secret that NHS procurement is more often than not a complex and slow process. In Public Technology this week, Helen Parslow, director of business development EMEA at Harris Healthcare talks of her recent experiences and says that it does not have to be that way.
“It’s not only difficult for suppliers to find and manage the resource and expense required to take a procurement process from start to finish but it is equally as painful for NHS organisations trying to ensure they get what they need, when they need it and for an investment that fits budgets and business case requirements.
“With the London 2015 framework, for example, seven trusts realised that if they were each to go out to the market individually and assess what was available, not only would they be duplicating each other’s efforts but it would be a hugely time consuming, resource intensive, lengthy and expensive process. The trusts teamed up with Nautilus Consulting, a specialist organisation made up of experienced clinicians and technologists, to manage the procurement and spread the cost.
“The trusts had monthly chief information officer (CIO) meetings and staff from the consultancy attended each session to ensure they were kept up to date on requirements and activities. As responses to the Official Journal of the European Union (OJEU) came in, the trusts would review each solution, providing scores around each area of functionality on offer. Often, they would do this separately and the responses would be collated offline.
“At a time when resources are limited for the NHS and numerous suppliers are wanting and willing to show trusts what they can help them achieve, the rise of the framework should be something that NHS trusts can embrace across the country to get the best possible outcome for all.”
Highland Marketing blog
In this week’s blog, Jeremy Nettle looks at the engagement in social media and asks whether the NHS’ culture of reluctantly accepting blame will take the risk.
