News in brief
Half of UK citizens say they do not trust NHS with personal data: Computing reports that half of UK citizens say they do not trust the NHS with their personal data, according to a survey conducted by IT services and software provider Unisys. The Unisys Security Index survey found that there are varying levels of trust in the NHS from different age groups; only 44% of UK respondents over 50 reported that they trust the NHS with their personal data, in contrast to 55% of 18 to 49 year olds. The findings may alarm the government, as NHS England prepares to roll out its care.data programme. The programme has already been at the sharp end of stinging criticism from patients, doctors and privacy groups over plans to extract patient record information from GPs’ surgeries to a centralised database, where they say it could be sold on to pharmaceutical companies, researchers and other organisations. This led to the NHS delaying the programme for at least six months, with the organisation’s new chief executive, Simon Stevens, telling MPs that the programme’s “artificial start date” should not be set in stone. Dr Gerhard Knecht, head of global security services and compliance, Unisys Enterprise Services, urged the NHS to work on reassuring a large number of UK citizens that it can safely handle their personal data. “The government must focus on educating the public on how their data will be treated and what security measures will be taken before its second attempt to launch the programme,” he said.
Jeremy Hunt calls for better incident reporting: Health secretary Jeremy Hunt has used a keynote speech at the Patient Safety Congress to call for increased reporting of concerns about the safety and quality of patient care, reported Health Service Journal (subscription required). Hunt highlighted the example of Virginia Mason Hospital in the US, which he visited earlier this year. This had seen a 75% fall in the number of litigation claims it received between 2004-05 and 2012-13. The health secretary said this was “hard evidence” that it was not “too expensive” to improve patient safety. “One of the key metrics we need to measure ourselves on is the number of staff raised safety concerns because that’s probably one of the best ways of really measuring whether we have a safe and open reporting culture,” he said. According to data from the National Reporting and Learning System, medium-sized NHS acute providers report around 5,700 incidents a year on average. Hunt said the NHS could learn from the airline and nuclear industries which have transparent reporting systems. “When we started the NHS 60 years ago we turned heads across the world… I want us to turn heads again. I want our NHS to be the first system in the world that starts introducing airline [industry] levels of safety and nuclear [industry] levels of transparency. I think if we do that we can turn the tragedy of Mid Staffs into a turning point that many years later we can look back on and say: ‘that was when it changed’.”
NHS trust sector ends year £241m in deficit: The NHS trust sector finished 2013-14 £241m in deficit, the NHS Trust Development Authority (TDA) has confirmed. The year-end position is substantially worse than the £76m net deficit planned at the start of the year, revealed Health Service Journal (subscription required). In a paper presented to the TDA board last week, chief executive David Flory said that plans received from trusts for 2014-15 indicated its overall position for the sector was “likely to deteriorate further” this year. Flory cited “a squeeze on income as commissioning budgets tighten, and pressure on expenditure given the need to maintain and invest in the quality of services” as factors likely to cause the deterioration. While the 26 trusts finishing last year in deficit was in line with the number the TDA predicted, six trusts with unplanned deficits largely accounted for the £165m variance from the forecast shortfall. The combined value of the gross deficits of the 26 trusts was £460m. However, 76 trusts were able to break even or deliver a surplus, recording a combined gross surplus of £218m. The financial strain was most evident among acute trusts, with 40% ending the year in deficit while all community, mental health and ambulance trusts managed to break even or achieve a surplus. The TDA attributed the deterioration in acute finances to an “unplanned reduction in total operating income”. The end-of-year financial position for the foundation trust sector will not be known until Monitor publishes its final quarterly report for 2013-14, which is expected to be early this summer.
Trusts should look to open source EPRs: Trusts looking for electronic patient record (EPR) systems should consider open source alternatives, as they offer “the biggest bang for buck”, an NHS England representative has said. Speaking at eHealth Insider’s CCIO open source conference, held as part of the Digital Health Festival, NHS England’s head of business systems Richard Jefferson, said the organisation’s immediate focus is on encouraging a move to open source EPRs due to the greater value for money they offer trusts. “We are prioritising the EPR space because that’s where we see [open source] as having the biggest bang for buck, but there is a wide spectrum of possibilities.” The higher software licence cost for EPRs is one of the main reasons why trusts should consider a move to open source, he said. “If you don’t mind the fact that you’re paying £50 a year for some commodity software, that’s fine. But why put off using it in a clinical setting where you can save hundreds of thousands a year?” He said the chance for greater clinical engagement and flexibility to make software changes are also important benefits, and should be considered as valuable as potential financial savings. Jefferson said the focus on open source in the second round of the technology fund will allow NHS England to help providers access the market and speak to trusts, while also developing clinical engagement groups and ‘communities of interest’ to share innovation and examples of best practice. He said 10 to 15 trusts have expressed an interest in using Moorfields Eye Hospital NHS Foundation Trust’s open source EPR Open Eyes, while another four are looking at using another large open source EPR provider. NHS England is also talking with IMS MAXIMS and another EPR provider about releasing the code for their products, he said.
Trust must prove benefits in £240m IT bidding competition: Trusts bidding for a share of NHS England’s latest £240m tranche of its technology fund will come under increased pressure to prove proposals deliver significant economic benefits, reported Health Service Journal (HSJ, subscription required). This emphasis on outcomes follows the loss of a £60m chunk of the £260m originally earmarked for its first funding round had been clawed back by the Treasury. NHS England sees the creation of a strong evidence base as critical to the future of the fund. The health agency’s director of strategic systems and technology Beverley Bryant stressed the need to show delivery on outcomes as she unveiled a prospectus for the second funding round last week. “Historically, [health IT projects] have been criticised by the Public Accounts Committee for not having enough emphasis on benefits so that is the lens through which we are defining everything that we are doing,” she added. Paul Rice, head of technology strategy at NHS England said it expected to be able to set out “in concrete terms” what first round bidders had achieved in the autumn. Under Treasury rules, bidders will be expected to generate a £2.40 return for every £1 of funding they receive. The second round has been rebranded the Integrated Digital Care Fund and will for the first time accept applications from local authorities and community health trusts to encourage projects that aim to integrate patient records across different providers. Bids must be submitted by 14 July 2014. Some £160m will be available in 2014-15 and a further £80m in 2015-16.
GPC chair calls for 2.5% increase in funding with warnings that NHS is in ‘danger of collapse’: The leader of the General Practitioners Committee, Dr Nagpaul, has taken the fight to the government in the opening speech of the Local Medical Committees Conference, warning that the NHS is in danger of ‘collapsing’ unless there is at least a 2.5% increase in funding for general practice. In a passionate speech to delegates in York, he said GPs are facing a ‘quadruple whammy’ of a crisis in workload, workforce, premises and morale. He also criticised the failure of clinical commissioning groups to commit funding to support GPs in delivering care for elderly patients, and launched a fresh assault on NHS 111, saying it was a ‘disgrace’ that patients have to endure a ‘litany’ of questions from a computer algorithm, reported Pulse. He said: “After years of devaluing our worth, the crux of my argument to government since I took office, is for politicians to grasp that general practice is the solution, not the problem. That increasing the proportion of NHS spend into general practice by just an initial 2.5%, will translate to a one third increase in our resources and which could transform our ability to provide care that patients need, and reap huge cost efficiencies in a cash-strapped NHS.” Dr Nagpaul added: “Let me warn those that continue in their quest to denigrate us. Continue to put off younger doctors into becoming GPs, continue to accelerate those leaving the profession, and you certainly won’t have the last laugh when you won’t have a GP to turn to in times of need, and when the NHS collapses because it’s very building blocks have imploded. But we won’t just roll over and let this happen. General practice matters too much to you and me, but more importantly to our patients who fundamentally depend on us.”
Most patients ‘right to go to A&E’: Efforts to redirect patients away from busy A&E departments will not work, doctors have said – as a new study shows most need to be seen there. The College of Emergency Medicine review of more than 3,000 patients found only 15% could have been treated in the community, according to the BBC. Last year NHS England suggested 25% could – and used that to justify a major shake-up of A&E units. The difference amounts to 1.4 million patients, the college said. The college is not opposed to NHS England’s proposed creation of a two-tier system involving major and minor units. But it said the expectation that large numbers of visits to A&E could be saved was likely to be wrong, and it was important to take other steps to relieve pressures. One of these includes locating GPs in or alongside A&E units to filter out the less urgent cases – something which is already happening in a number of hospitals. The review, carried out by consultancy Candesic, looked at what was happening in 12 A&E units over a 24-hour period in March. It found 85% of patients needed to be seen in A&E – although 22% could have been dealt with by a GP on site if there had been one. College president Dr Clifford Mann said: “The fact that only 15% of attendees at emergency departments could be safely redirected to a primary care clinician without the need for emergency department assessment is a statistic that must be heeded by those who wish to reconfigure services.”
Ambulance trust tenders for EPR: West Midlands Ambulance Service NHS Foundation Trust (WMAS) has gone out to tender for an electronic patient record system (EPR). The tender says the ambulance trust wants a system which supports integrated care and can be rolled out across the region. “The EPR will equip the trust with a system that enables the West Midlands Ambulance Service to capture the clinical care given to patients, transfer this data to appropriate stakeholders and to learn from the data captured,” says the tender. The trust does not specify which modules it wants the EPR to have, but the tender is classed as a document creation, drawing, imaging, scheduling and productivity software package, which a trust spokesperson said may or may not be required as additional IT provision for the EPR. The contract will last three years, and a spokesperson from the trust told eHealth Insider that the estimated value of the contract has not been set. “The tender opportunity has been published through Official Journal of the European Union (OJEU) as the value of the contract is expected to exceed the OJEU threshold, the actual value of the contract is not known because WMAS is still in the ‘invitation to tender’ stage,” said the spokesperson. West Midlands Ambulance is also a part of 16 other organisations across Birmingham, Sandwell and Sollihull working on a joint care record project. The trust spokesperson added that in the future, it may allow other ambulance trusts in the country to use the contract managed by West Midlands Ambulance Service if they so wish at any time during the contract once it has been awarded.
NHS trusts given staffing guidance: NHS trusts in England have been issued with guidance on how to publish monthly data on ward-level nursing and care staff numbers as part of plans to increase transparency, reported Public Finance. On June 24, data on staffing fill rates for nurses, midwives and care staff will be presented on the NHS Choices website to allow patients and the public to view easily accessible information on how hospitals are performing. The template requires trusts to enter information on registered nurse and midwife numbers and care staff, such as health care assistants and auxiliary nurses working each day and night shift on each ward. Trusts also need to say how many staff hours they planned to provide each month and how many actual staff hours were worked. Trusts are also required to publish actual versus planned staffing rates on a ward-by-ward basis on their own websites. A letter sent on May 16 to trust chief executives and nursing directors from chief nursing officer Jane Cummings confirmed that data relating to the month of May needs to be entered and uploaded by noon on June 10. Trusts failing to comply with this deadline will have a red flag placed on their NHS Choices webpage, the letter said. Cummings said: “I fully appreciate the amount of work involved in enabling this significant step forward in our strive for openness and transparency and I am grateful for your support in delivering what is a first both in England and much further afield.”
Two-week wait for GP appointments to become the norm in many practices ‘within a year’: Four in ten GPs predict the average waiting time for appointments at their practice will exceed two weeks from next April, as they struggle to cope with unprecedented levels of workload, revealed Pulse. The survey of nearly 500 GPs shows that they expect average waiting times for an appointment to increase from nine days in April 2014 to 13 days from April 2015. Only a fifth of GPs said that the average wait for a non-urgent appointment at their surgery was more than two weeks currently. However, this proportion doubled to 40% when they were asked for their prediction of waiting times in 12 months’ time. GP leaders said that this is indicative of increasing workloads and reductions in resources, with GPs receiving a funding uplift way below inflation this year. The results also showed that less than half of GPs – 43% – said that the average waiting time for a non-urgent appointment is currently less than a week. However, only one-quarter of GPs said they would be able to offer less than one week average waiting times from April next year. The results follow a Labour Party pledge earlier this month to consider a contractual change that GPs would see patients offered an appointment within 48 hours. It also chimes with analysis by the Royal College of General Practictioners, which estimated that 34 million patients in England will fail to get an appointment with their GP in 2014, because of reductions in funding for general practice over the last decade.
Dr Mark Davies joins MedeAnalytics: Dr Mark Davies, former medical director at the Health and Social Care Information Centre (HSCIC), has joined health analytics firm MedeAnalytics as European medical director. Dr Davies was medical director and one of the most high profile figures at the HSCIC, as well as its predecessor body, the NHS Information Centre (IC), often representing the organisation at national events. Speaking to eHealth Insider, Dr Davies said that after ten years with HSCIC and the IC, the bodies responsible for collecting and publishing NHS data sets, he is looking forward to a new challenge working for a health analytics firm. “It’s an interesting change in direction,” said Dr Davies. “I was clear I wanted to do an analytics job, not work for an electronic patient record system supplier. I think big challenges in health informatics will be off the back of analytics, particularly measuring outcomes and financials.” He said that MedeAnalytics has what he believes to be a “compelling vision” and the technical capabilities to deliver it. “I believe the combination of sophisticated predictive analytics and data driven population segmentation will herald a new age of understanding for those making decisions in the planning and delivery of care.” Dr Davies said that the big analytics challenge in healthcare information is around joining data together in ways that provide insights that can be acted on. Asked what he would bring to the new role Dr Davies said: “There is a lot of complexity, which my previous experience means I do understand. And the fact that I am a clinician means I have a good understanding of what the clinical priorities are and drive the whole engagement with clinicians with data flows.”
NHS England to spend £33m on 111 tech: NHS England will spend £33m on re-procuring technical elements of NHS 111, reported eHealth Insider. The organisation needs to procure the telephony elements for 111, which provides the infrastructure for the 111 triage service. The procurement has to be completed by April 2015, which the organisation says will be difficult. “The timeline to achieve this re-procurement is challenging, and any slippage will impact on the set up and test phase and create a significant risk of loss of business continuity for the NHS 111 service,” says the board paper. The NHS 111 service had a troubled start, as the telephone triage service faced significant problems with staff shortages, treatment delays and ambulances being summoned unnecessarily, since being launched in Easter 2013. In July NHS Direct announced it would withdraw from all its 111 contracts as they were “financially unsustainable”. NHS England and local commissioners then had to appoint a range of step-in providers to take over the services, most of which were ambulance trust and GP out-of-hours providers. The contracts with the new providers are in place until April 2015. Clinical commissioning groups were told in October last year not to agree any NHS 111 contracts to start before April next year, while NHS England considers its options for the future of the service. NHS England’s chief operating officer Dame Barbara Hakin said earlier this year that NHS 111 is now stable and improving, there are still issues around the service that need to be addressed.
IMS MAXIMS named as only EPR and PAS open source supplier in Technology Fund Two catalogue: IMS MAXIMS has been named as one of 11 open source suppliers in a ‘catalogue’ designed to support NHS England’s technology fund two, officially called the Integrated Digital Care Fund, which opened for applications last week. The catalogue is part of a prospectus on the fund, which aims to provide NHS trusts and local authorities with more information on how they can apply for the fund and the types of technology that will be supported, reported eHealthNews.EU Portal. It places a strong focus on open source software, stating that “applications from organisations intending to deploy open source solutions are particularly welcome” to meet the aim of encouraging “the creation of a community of developers, implementers and users supported by a vibrant market of commercial organisations using open source methods”. With applicants working towards a submission by 14 July 2014, the interest in open source solutions is strengthening; a sentiment that was reflected at a recent IMS MAXIMS-hosted event, attended by 17 representatives across eight NHS trusts. Shane Tickell, chief executive of IMS MAXIMS explained the next steps in the company’s open source journey: “The continued focus on open source in the Tech Fund two prospectus together with on-going interest in clinical assurance and maintaining the integrity of the code at recent events demonstrates the demand for open source solutions. We have considered for a long time how best to release our code, which has been built over nearly three decades of clinical input. Using a free license model, we will soon be announcing that we have made our code available to trusts through [open source collaboration review and code management platform] GitHub. We are working closely with NHS England in the creation of a community interest company (CIC) to ensure MAXIMS enhancements are safe, secure and validated.”
Pilot set to test GP tool for patients with long-term conditions: An assessment tool that could help GPs deal with long-term conditions is to be piloted in England, according to OnMedica. NHS England has announced a pilot scheme that is designed to help GPs assess the care and support needs of people with long-term conditions. The assessment tool, known as patient activation measure, is intended to help GPs put people with long-term conditions at the centre of the care and support that they receive. The tool measures the knowledge, skills and confidence these patients have to manage their own health, and highlights where they need extra support. The pilot, which will cover 150,000 people, is being launched in partnership with The King’s Fund, The Health Foundation, five clinical commissioning groups across the country (Somerset, Islington, NHS Horsham and mid Sussex, Tower Hamlets and Sheffield) and The Renal Registry. It follows the publication of a recent report from The King’s Fund, Supporting people to manage their own health: an introduction to patient activation, which introduced the concept of patient activation and its potential for application in the UK. NHS England said previous research had shown that people with long-term conditions with higher activation levels – more knowledge, skills and confidence – had better health outcomes and that people with lower activation levels led to higher health care costs. Clinicians will be asked to work with the 10% of people who have low levels of activation because studies have shown that when the right services and support are put in place, their activation and health improves as they are able to make changes which improve their well-being. The Health Foundation will evaluate the pilot which runs for two years, but results will start to be looked at after the first year.
Imperial live with Cerner PAS: Imperial College Healthcare NHS Trust has finally deployed its Cerner Millennium patient administration system and maternity module, following a series of delays. The trust went live with the patient administration system (PAS) and maternity module on April 22, roughly one year later than initially planned. An Imperial spokesperson told eHealth Insider that the go-live date was designed to take advantage of the four days of lower planned activity over the Easter bank holiday weekend. “This follows on from our implementation of the Cerner order communications module for ordering and viewing pathology and radiology tests in 2011. The preparation and cutover involved a team effort from staff across the organisation. The focus for the implementation programme now is supporting staff as they get used to the new processes, and making sure that the new system operates smoothly.” The trust is one of the largest in the country, with an annual turnover of more than £970m in the 2012/13 financial year. It was formed following the merger of the St Mary’s and Hammersmith Hospitals Trusts and integration with the faculty of medicine at Imperial College London. The roll-out of the PAS and maternity module was initially meant to take place in spring 2013, but it was pushed back to August 2013 and then again to 2014. At the time of the delay, a trust spokesperson told EHI it was “taking a rigorous approach” to ensure the system was ready to go live and staff were well prepared.
Shane Tickell, CEO of IMS MAXIMS has walked an epic 212 miles in 8 days, the equivalent of a marathon a day, to raise awareness of the early signs of cancer. Tickell made it to the finish line in Milton Keynes, complete with plasters, paracetamol and a stick, on Friday afternoon. Although the walk is complete, there is still time to show your support by congratulating Shane on Twitter @BigWalktoWork or making a donation here.
Opinion
Social media drove the heart and soul of NHS Change Day 2014
NHS Change Day in 2014 saw a massive expansion of social media platforms and channels used to engage the frontline and support the social movement, with as many as 1.3 million impressions in just one day on Twitter and 32,000 video views across YouTube, Vimeo, Podbean and iTunes, Joe McCrea, social media lead for NHS Change Day said this week.
Writing in an NHS England blog, he said that key to success was the move to a “communitarian” as opposed to a “broadcast” approach, which he said was vital for the social movement environment.
“A communitarian approach is needed to deliver truly groundbreaking results,” he said. ”Under a communitarian approach, the widest possible range of social media channels and tools are deployed to underpin a change and improvement programme built upon a rich mix of engaging, listening, responding, supporting, facilitating and participating in communities of individuals and organisations.
“That is precisely the approach adopted for Change Day 2014. Rather than using social media simply to tell the NHS, social care and the wider world what we were doing and what we were thinking, we used social media to give frontline staff, carers, patients and families their voice and their spaces to interact with each other and inform each other. And a very powerful voice it proved to be.
“And, of course, social media uniquely provides an economical and easy way to share the richest quality and depth material and content. An iPhone becomes a movie camera. A tablet becomes a novel or journal. A webcam becomes a live TV station. All of them provide spaces to interact, mutually discover and share.”
Beyond the official data: a different picture of A&E attendances
Dr Clifford Mann and Dr Michelle Tempest tell HSJ this week that The College of Emergency Medicine and Candesic has found discrepancies around data on A&E attendances that should be viewed an opportunity to design services fit for the future.
Mann and Tempest write: “And so it was decreed: 40 per cent of people who attend accident and emergency could be treated closer to home. As a result of this statement, sways of policy documents and even a new blueprint for urgent and emergency care across England were published.
“These well intentioned reports aimed to encourage extensive services outside the hospital, making services more personalised and expanding the roll of pharmacies. There is little doubt that community care needs to increase and improve, and the NHS needs to evolve to reflect demographic needs.
“However, new healthcare systems must be built on solid foundations and accurate data.”
Can technology improve patient safety?
The advantage of technology is that it obeys instructions and behaves consistently, says Dr Mark Ryan, consultant anaesthetist and clinical safety officer at Rotherham NHS foundation trust on the Guardian Healthcare Network.
“Technology must be seen as part of the team of carers that contribute to patient care. The advantage of this team member is it obeys a rigid set of instructions and behaves consistently. Electronic prescribing has been shown to make prescription errors 50% less likely compared to handwritten ones. However, a recent survey of acute hospitals in England showed that although 69% had some form of e-prescribing, the vast majority of these were for discharge medication or chemotherapy, and only 13% are using it for general ward-based prescribing.
“Prescriptions can be checked to conform to sensible drug quantities, interactions with other medication, patient allergies and even clinical conditions (eg kidney or liver problems) in fully working electronic records, improving safety further still. Scanning patient wristbands and matching them to that prescription helps ensure patients receive the correct medication. Computerised physician order entry (Cpoe) can be used to group investigations, and treatments, to standardise the level of care. In doing so, any patient presenting with a particular problem can follow a set, best practice, pathway of care at the click of a button.
“But, how do you stop someone heading down the wrong pathway? Here too, IT can aid clinicians in making the right diagnosis, and re-evaluate care by making effective use of information about us. Technology has the ability to look for that information for us, retrieve it and display it in a way that makes the logical diagnosis or conclusion obvious. Achieving the correct diagnosis at the first attempt has been reported to be wrong in 10 to 50% of consultations. Errors in diagnostic thinking are not easy to assess, as harm that results may be categorised as due to a different source, eg caused by (the wrong) treatment, or a delay to the right one. In my view, they contribute an important source of occult risk.
“Finally, the process of introducing technology as part of the health team should force a full review of the causes of risks, roles and responsibilities of the other members of the team, the existing processes, and the overall environment that it has employed. Although technology behaves consistently, it and the rest of the team can behave poorly if this is not done. Its biggest strength is also its weakness. Technology has no capacity to think for itself and symbiotically needs the very thing that it helps make safe, to make it safe too. Failure to do this just trades one risk for another.”
Five things the NHS must learn about empowering patients
In the Guardian, Meg Hillier, MP for Hackney South and Shoreditch points out five ways to empower patients and gives examples from around the world where they’ve been proven effective
She writes: “Knowledge is power. In Denmark, everyone has the ability to see and interact with their medical records online. This gives people the power to really understand their health and treatment. Giving British patients this ability needn’t mean another huge national IT project.”
Shared decision making is an “easy choice” for clinicians, she adds. “Partnership with patients needs to be the easy choice, which means making consultations smarter rather than longer. Massachusetts general allows doctors in the hospital and community to prescribe decision support tools for patients to use at home to decide which treatment is best for them.”
She also says there is a need to invest in supporting carers. “A chain of hospitals in India has come up with a great solution – when vulnerable patients are admitted, their main carer can go on a short course at the hospital to learn the skills to look after them at home. They then get to practise these skills on the ward before the patient is discharged.”
Groups of patients could also be powerful. “We’ve seen what peer support and education can do in the UK for years through the work of networks like Alcoholics Anonymous and Weight Watchers. What other problems could be tackled by people power in this way?”
And listening to patient stories has enormous power to challenge the status quo, says Hillier: “We can’t directly cut and paste any of these overseas examples into the NHS. Nonetheless, they do help us to think bigger and bolder about making real change happen at long last.”
Highland Marketing blog
In this week’s blog, Jeremy Nettle looks at the similarities and differences between Tech Fund one Tech Fund two.
