With everything from electronic records, to online GP services, genomics and flagship programmes like care.data on NHS England’s agenda, Tim Kelsey tells Highland Marketing about progress and responsibilities.
A man with a vision
Tim Kelsey has a reputation as a visionary in the NHS. A man who has dedicated his professional life to the sharing of information, Kelsey has certainly been making his mark on the health service.
Since taking on the mantle of NHS England’s national director for patients and information back in 2012, he has set about bringing technology and data to the fore, with the aim of radically transforming how health services are delivered.
“This is no less than an industrial revolution we are witnessing,” he says. “Industrial revolutions are about the way in which man, through ingenuity and enterprise, scales new heights of knowledge. We are entering a period of human history where we are about to experience an extraordinary and profound knowledge revolution, particularly focussed on the kinds of data that are about us.”
The fact that the health service is now moving into this era is crucial. Kelsey tells Highland Marketing that the NHS is now starting to gain a foothold on the exponential curve of the data and technology revolution. And with an impending 2018 deadline for a paperless NHS and an even closer deadline looming for patient access to information by 2015, big strides are already being taken to accelerate change.
Read the full interview here, which explores how technology is empowering patients; the responsibility people have to share data safely; and how the NHS must change to become more accessible to industry.
News in brief
Patients to add to medical record online: Patients will be able to contribute to their own medical record and switch GP practice online, NHS England’s director of patients and information Tim Kelsey has said. Kelsey’s ‘Patient and Public Voice’ report to NHS England’s board this week describes the vision to “unleash the power of people to manage their own conditions.” According to eHealth Insider, NHS England will do this by “providing them with applications that allow them to monitor their lifestyles, for example activity and diet – but with the added ability to view, merge and enhance their full NHS medical record with the information they are recording about themselves.” As well as contributing to their own medical records, people will be able to transact directly with the NHS online. This will involve “technologies that allow them to book and rearrange appointments, order repeat prescriptions, track the progress of test results, contact their GP or hospital electronically with a query, provide electronic feedback and even switch GP provider.” The report says there will be safeguards in place, including that the patient’s doctor or carer also has access to this information and can “intervene and support as required”. Under the new GP contract, which comes into force on 1 April, GPs must provide online transactional services to patients, such as booking appointments and ordering repeat prescriptions. They must also allow patients to access information held in their Summary Care Record online by March 2015.
Patients’ data ‘can’t be used for marketing or selling insurance premiums’, says NHS: Patients’ NHS data that private companies could get access to under the controversial Care.data programme, will not be able to use such data for marketing purposes or to raise insurance premiums as claimed. The NHS has said that the scheme will allow primary care data from GP practices to be shared with the new Health and Social Care Information Centre (HSCIC) and clinical care groups, and eventually matched with secondary care data, anonymised and shared with clinical researchers. Under the programme, the NHS claims that researchers will only be able to access non-identifiable data collected from health records. However, Phil Booth, co-ordinator at patient pressure group Medconfidential claims that the data is not just for the benefit of patient care, but will be used for secondary uses, including potential access by research bodies, information intermediaries, companies, charities and others. “Patients need to be told who is going to have access to their medical information and what for,” Booth told Computing. “Broad promises about research benefits are all very well, but the Care.data programme hasn’t even received approval to pass data to researchers yet, and you don’t see NHS England explaining to patients that it wants all sorts of others – including private companies, think tanks and ‘information intermediaries’ – to have access as well,” he added. Pulse reported that an MP has tabled a Parliamentary motion calling for the care.data scheme to be ‘indefinitely’ delayed until further consultation takes place and patients are asked to opt into rather than opt out of the programme. It comes as HSCIC revealed that a phone line set up to answer queries from patients regarding the data-sharing scheme has received almost 2,400 calls in the first few weeks of a national publicity campaign.
Health Committee warn that A&E departments in England are under pressure: The Health Committee took evidence on NHS England’s Urgent and Emergency Care Review and the performance of urgent and emergency care services over the winter months, reported the BBC. There have been a number of warnings that A&E departments in England are under increasing and unsustainable pressure. Last week the NHS failed to hit its target of seeing 95% of patients within four hours. Over the two-week Christmas period, NHS hospitals did succeed in meeting this standard. However, England’s major A&E centres have not hit the 95% target since mid-July 2013. The problems in A&E are being blamed on a number of factors. These include a lack of access to GP surgeries and walk in centres for out of hours care, a “workforce crisis” in A&E units, some of which have had only 50% of senior positions filled in the last three years and financial problems caused by a funding mechanism which makes it cheaper for GPs to send patients to A&E rather than treating them in a primary care setting. The committee heard evidence from: Professor Sir Bruce Keogh KBE, NHS England medical director, Professor Keith Willett, national director for acute episodes of care and Emma O’Donnell, deputy director for acute episodes of care.
NHS waiting time data for elective surgery ‘unreliable’: Patients in England cannot rely on information on waiting times for non-emergency operations, such as knee and hip replacements, according to The National Audit Office (NAO). The NAO found wrong and inconsistent recording after reviewing 650 cases in seven trusts, reported the BBC. The watchdog said it was unable to discern whether this was deliberate, but overall the practices concealed delays rather than over-recorded waits. The government said the issue would be investigated. The NAO said that the lack of reliability, whatever the causes, was harmful to patients because it hampered their ability to make informed choices about where to choose to have their treatment. It also called into question whether the NHS was actually meeting its waiting-time targets. There are more than 19 million referrals for elective operations each year. Patients are meant to be treated within 18 weeks of a referral and the NHS is currently meeting its targets on this – but only just and the report noted there was growing pressure on waiting times. The waits are monitored and recorded by hospitals themselves. However they have the power to pause the clock if a patient is unavailable for appointments for personal or social reasons. In response to The NAO report, health secretary, Jeremy Hunt has insisted that inaccuracies in hospital waiting time figures are not the result of deliberate manipulation, reported The Telegraph. Hunt said that although the report identifies “inconsistencies”, hospitals are not “deliberately misrepresenting”, but he warned any hospitals that do falsify figures in the future will face criminal charges.
NHS to tackle early deaths in mental health patients: NHS England is pledging to tackle early deaths in mental health patients in England, given that they have the same life expectancy as people living back in the 1950s, reports PharmaTimes. Patients with serious mental health conditions such as schizophrenia and bipolar disorder are dying earlier from illnesses such as cardiovascular disease, cancer, lung disease and liver disease, largely because they are “missing out on vital health interventions,” it says. The organisation believes that more than 40,000 deaths among people with serious mental illness could be reduced if they get the same healthcare checks and interventions as the general population. “Patients with schizophrenia will on average die 14.6 years earlier, bipolar 10.1 and patients with schizoaffective disorder eight years earlier than the general population,” noted Geraldine Strathdee, NHS England’s national clinical director for mental health. To paint a better picture for mental health patients NHS England has set out an action plan and a package of supporting measures to address these stark health inequalities and generally improve the care of patients, through better access to therapies, improved medicines management, and more targeted education, for example. “This needs a co-ordinated effort so that some organisations which traditionally solely address the patient’s psychological problem, also now arrange treatment of the physical health aspects,” Strathdee said.
US-UK sign healthcare IT MoU: NHS England and the Health and Social Care Information Centre have signed a healthcare IT memorandum of understanding with the US Department for Health and Social Services this week, according to eHealth Insider. The memorandum of understanding (MoU) focuses on sharing common values around healthcare informatics and making it easier for small and medium-sized enterprises (SMEs) to get a foot in the door on both sides of the Atlantic. At the Information Services Commissioning Group board meeting earlier this week, Tim Kelsey, NHS England’s director of patients and information, said the agreement would be signed “to try and make access to both markets easier for SMEs”. He added that he expected some substantive bilateral announcements to be made in June and said: “We hope we can announce some really exciting things for SMEs and patients in general.” The MoU says that potential future sharing activities include sharing quality indicators, and “identify alignments across existing UK and US repositories and topics with the potential for further collaboration and harmonisation, particularly in the area of longitudinal patient indicators.” It also includes exploring ways to maximise the adoption of electronic patient records and working to remove barriers to innovations and discuss app regulations.
CCG backs down in patient involvement procurement row: A clinical commissioning group (CCG) leading one of the most high profile procurements in the NHS has agreed to publish commercially sensitive documents following a threat of legal action. A law firm acting for campaign group ‘Stop the NHS Sell Off’ in Cambridgeshire accused Cambridgeshire and Peterborough CCG of acting unlawfully by failing to allow opportunities for meaningful public engagement in the tender of a multi-million pound contract for older people’s services. In a letter before action sent on 10 December, Leigh Day said the CCG had been “preventing proper patient involvement” by refusing to let the public see tender documents that had been shared with bidders. The firm argued that the CCG was in breach of its legal obligations to engage with the public, as set out by the 2012 Health Act. It gave the CCG seven days to either share the documents or put the tender on hold – or face the prospect of judicial review proceedings being initiated. Health Service Journal (HSJ, subscription required), understands the CCG has not conceded that it acted unlawfully. However it has agreed to publish the documents in question. David Lock QC, who was instructed by the group, but who normally advises NHS bodies, told HSJ the case showed CCGs face conflict between commercial confidentiality and public engagement. He said: “This tension must be resolved in favour of openness because those are clear legal obligations which have been imposed on the CCG by Parliament.”
1 in 8 CCGs expect to end the financial year in deficit: A survey by the King’s Fund has revealed that commissioners are optimistic they will meet their productivity targets, with 61% of finance leads expecting to reach their target, reported Commissioning GP. However, the survey “How is the health and social care system performing?”, also highlights that one in eight (13%) expect their clinical commissioning group (CCG) to be in deficit at the end of the year. Additionally, the new quarterly monitoring report found less optimism among hospital trust finance directors, with more than one in five (22%) expecting their hospital to end the financial year in deficit. The findings highlight the growing pressures on hospitals as the NHS continues to manage the biggest financial squeeze in its history. The survey suggests the NHS will struggle to meet its target of delivering £20 billion in efficiency savings by 2015, with less than half (47%) of finance directors expecting to meet their productivity targets for the current financial year. Worryingly, the survey also found that staff morale now tops the list of concerns identified by hospital finance directors. Professor John Appleby, chief economist at The King’s Fund said: “Despite warnings about a potential crisis in A&E, most hospitals are coping with winter pressures so far – a tribute to the hard work of staff in A&E departments. However, the growing number of hospitals set to overspend their budgets shows that for some, it is no longer possible both to maintain the quality of services and balance their books. The emerging concerns about staff morale in hospitals are very worrying as there is a proven relationship between staff satisfaction and the quality of care provided to patients.”
Northumbria live with Silverlink: Northumbria Healthcare NHS Foundation Trust has gone live with its Silverlink patient administration system (PAS), reported eHealth Insider. The system, which was deployed at the beginning of the year, replaces the trust’s legacy McKesson Totalcare PAS, which the trust has used for 17 years. Along with the implementation of the PAS, the trust has introduced new trust-wide data standards to ensure all aspects of patient activity are coded accurately. Northumbria claims these standards go beyond the national requirements and play an “essential role in ensuring appropriate patient care”. Northumbria selected the Silverlink PAS from Stalis in 2011 and Mark Thomas, director of health informatics at the trust, said that the project had demanded a lot of work. “The implementation involved a lot of planning and represented a significant change for many staff, especially those who have been using the old system since it was put in place,” he said. “We pride ourselves on the quality of our data and have been recognised nationally for our work in this area. High quality data is an essential part of delivering high quality and safe patient care and we place great emphasis on making sure we capture robust data so that we can continuously review and improve our services for patients.”
Ministers support CCIO 12-point plan: Ministers have issued a message of support in response to the new vision and 12-point plan for chief clinical information officers (CCIOs), issued by the CCIO Leaders Network. The Department of Health (DH) has requested a meeting with CCIO leaders to discuss the plan, which recommends actions to accelerate the appointment and development of CCIOs and to give them greater responsibility for clinical data quality, reports eHealth Insider. The day after the plan was published, a DH spokesperson said: “Ministers very much welcome the CCIO Leaders Network’s drive to engage professions in the need for information and IT as core elements in delivering safe, high-quality, person-focused health and social care.” The representative said local clinical leadership will be vital to ensure information underpins NHS modernisation. “This is an important area of work for the department, and we are clear that with the move toward local decision-making in health and care IT systems, this kind of local professional leadership will be essential.” They added that such leadership needs to support innovative and integrated solutions and local decision-making “within a framework of national standards that ensure information can move freely, safely, and securely around the system.” The DH recommended that the CCIO Leaders Network should also give attention to integrated health and social care.
Drop in attendances at A&E departments: Health Service Journal (subscription required), reports that attendances to accident and emergency departments have fallen over the course of the past year, according to NHS England data. Between October and December attendances dropped to 5,289,000, down from 5,351,000 in the same period the previous year − a fall of 1.2 %. The number of patients presenting at major consultant led A&Es decreased further, by 2.1% to 3,473,000. Performance against the target to treat, admit or discharge 95% of patients within four hours has dropped slightly, by 0.1% points to 95.6% over the quarter. However, admissions to major A&E departments increased by just over 2% to 959,000 year on year. The Foundation Trust Network’s head of analysis Sivakumar Anandaciva said the key to A&E performance was admissions rather than attendances because “whole system working” was required to ensure a flow of patients through the department. He added: “You can get the same number or even fewer admissions, but if the case mix or acuity of those admissions changes then that affects four hour performance. For example, more complex comorbid cases means more complex care and slower throughput through the emergency department and hospital.” An analysis of the 10 trusts performing worst against the four-hour target shows that admissions decreased slightly compared to the same period last year, from 81,701 to 81,351. The 10 best performing trusts against the target have also seen admissions ease slightly, with a drop of just over 3,500 since last year from 66,075 to 62,522.
NHS 24 wants ICT services to support elderly care: NHS 24, a telehealth advice and information service provided by NHS Scotland, is seeking ICT services to support the redesign of services to support people aged 50 and over. In particular, the service helps those who are at risk of falling or who have fallen and need support to recover. The technology to be procured includes web-based applications and apps for mobile devices that can be used on PCs, laptops, tablets and mobile phones, according to Government Computing. The services need to securely manage user accounts and sensitive personal information and integrate with statutory systems. Bidders will also need to offer service providers the ability to analyse data, and may need to provide apps for professionals to support the assessment process. The service is part of a European Commission project called ‘SmartCare’, which aims to promote a more integrated and effective approach to providing health and social care to older people across Europe, by embedding an open ICT platform which supports the delivery of integrated care to older citizens. A total of ten regions across Europe, including Scotland, are piloting the scheme, which is jointly funded by the European Commission and the Scottish Government. The SmartCare programme, started in March 2013, is due to finish in February 2016 and will operate in seven local health and care partnerships in Scotland. Suppliers have until mid-February to respond to the notice, with the procurement due to formally start at the end of March 2014, once NHS 24 has conducted initial market engagement. There will be a ‘Show and Tell’ event for suppliers and developers interested in participating on 29 January at Hampden Park Stadium in Glasgow.
Opinion
“Innovation must never trump patient safety”
As part of a British Journal of Healthcare Computing’s ‘voxpop’, Dr Maureen Baker, the new chair of The Royal College of GPs, talks about the regulation of medical apps and ensuring they are used safely and effectively.
Do you think apps are a valuable tool for today′s medical professionals?
“Absolutely. We are living in a digital age and people are looking for accessible information and guidance quickly and conveniently. Medical apps can be used for both information and communication – and when used appropriately can be valuable tools for both GPs and their patients, especially as we emphasise the importance of self-care.
“It is essential that GPs keep up-to-date with the latest clinical research and guidance but as demands on general practice increase, this is often very difficult. Therefore, we are always looking for new ways to communicate with each other to share ideas and expertise and medical apps can provide pragmatic, convenient, and cost-effective platforms to do this.”
Is there an argument that any regulation of medical apps may stifle innovation? Where do you stand on this point?
“Innovation and regulation aren′t mutually exclusive. In my opinion, some of the cleverest and most useful ‘new′ ideas simply tweak and modernise tried and tested traditional practices and this is the kind of innovation that we need to promote further. Innovation must never trump patient safety.
“Any worthwhile medical app should be designed with the intention of being used and everyone who uses it, or is directly or indirectly affected by its use, must be confident that they are doing so safely.”
The debate about the OFT’s role is a sideshow
In Health Service Journal (subscription required) this week, Bill Morgan, founding partner of Incisive Health and a former special adviser to Andrew Lansley, discusses the myths circulating on the role of the Office of Fair Trading in relation to the NHS.
“These myths are harmful in the short term because, propagated by commentators on the NHS − and even its leaders − they risk becoming self-fulfilling. They are harmful in the longer term because they obscure significant policy debates about the future of the NHS.
“The first and most important myth to bust is that the powers and functions of the OFT over the NHS are granted by the Health and Social Care Act 2012. This is wrong.
“This first myth gives rise to the second myth − and the one most harmful to the NHS in the short term. The second myth is that the 2012 act changed the way in which competition law applies to the NHS.
“The first myth also gives rise to a third: that the Health Act, in granting the OFT powers and functions in relation to the NHS, must be repealed. It is self-evident that, if the act gave the OFT no new powers or functions, then repealing it would make no difference to its role in relation to the NHS.”
Morgan continues, “the OFT is not involved in the NHS by virtue of the 2012 act but by virtue of the purchaser-provider split, foundation trusts, independent sector provision, patient choice and a “money follows the patient” payment system.”
Concluding Morgans explains, “The debate over the role of the OFT is yet another discussion about competition in the NHS. We should debate the latter, rather than allow the organisation to be used as a fig leaf by politicians unwilling to retrench NHS competition. The OFT is a sideshow in a broader debate about the principles that govern the NHS and it is too important to be distracted by it.”
Are clinical commissioners improving patient services?
This week in the British Medical Journal, Richard Vize, a journalist and communications consultant specialising in health and local government, asks if clinical commissioners are really improving patient services.
“The health reforms were intended to put clinical commissioners at the heart of the drive to improve quality and reconfigure services. But since they took over from primary care trusts in April, clinical commissioners have not fitted in with the political direction being pursued either by health secretary Jeremy Hunt, or the shadow health secretary, Andy Burnham.
“Hunt’s determination not to mention the health reforms means clinical commissioners have rarely been part of his narrative about improving the NHS. Meanwhile Burnham has been developing a plan to move commissioning to local government, with clinical commissioning groups being reduced to an advisory role.
“But CCGs have an ally in Stephen Dorrell, chair of the Commons’ Health Select Committee. Last year he challenged NHS Clinical Commissioners, the representative body for clinical commissioning groups (CCGs), to provide evidence of where clinical commissioning was making a practical difference. The result is their report, Taking the Lead, giving examples of where they are working with providers in “changing the face of the NHS.”
“The emphasis is on pulling together and interrogating clinical data from across whole systems, asking searching questions of everyone involved, and taking action. Key to making that work is commissioners as far as possible leaving their managers to do the management while focusing their own efforts on building relationships with hospital consultants and others. It is the insights gleaned from those relationships, and the trust that develops, that act as the catalyst for change.
“Clinical commissioners need to push hard to ensure that the central importance of the local clinical voice in improving services is grasped by national and local politicians and local people, and their role in securing changes such as seven day working and lower demand for emergency services is understood. After a year of relentless criticism of the NHS, good stories need telling.”
Will 2014 be the year telehealth comes of age?
The NHS will see a more agile workforce progress toward going paperless and the end of an outdated operating system says David Furniss, portfolio and practice director at BT Global Health, in the Guardian this week.
“Just as we get used to writing 2013, 2014 is with us. But rather than looking back at a year that brought huge reform, huge headlines and huge change, I thought I’d look forward to what the coming 12 months may bring. We know the current model of healthcare isn’t sustainable. As we recently heard from one customer, there is no such thing as “winter” pressure. The pressure is constant and year-round – and it will just get worse if the healthcare system doesn’t do something to transform the way care is delivered.
“With the strain on acute hospitals – be it in overstretched A&E units, cancelled operations, bed blockers or hospital-acquired infections, top of the wish list for many will be telehealth and telecare. Yes, we’ve heard it all before, but perhaps this truly will be the year that telehealth comes of age.
“Of course, keeping patients in their homes does mean additional pressures on community-based services, including social care, health, private and third sector providers. I predict that 2014 will be the year of the agile worker – this means giving staff access to data and information on the move, helping them spend more time with patients and less time travelling or in the office. It’s a culture change that needs careful consideration and detailed planning and implementation in order to reap the rewards, but the benefits are there.
“Interoperability is the term on the tip of everyone’s tongue. I expect to see real traction here – especially to support the paperless challenge, as the health secretary’s goal that everyone who wishes will be able to get online access to their own health records held by their GP by March 2015 is now only 14 months away.
“Will 2014 be the year we create a new world of care where the patient is at the heart of the model? I don’t think so, but I think there will be some leaps forward toward that goal.”
Highland Marketing blog
In this week’s blog Myriam McLoughlin looks at the Care.data debate and asks “what price will you pay for our NHS?”
