Please note that next week’s healthcare roundup will be distributed on Monday 3rd June.
News in brief
NHS boss set to retire next year: Chief executive of NHS England, Sir David Nicholson, will retire next year, reported the BBC. Sir David has announced he will step down in March 2014 after seven years in charge of the NHS. In recent months Nicholson has faced repeated calls to resign over his role in the Stafford Hospital scandal. In March, Sir David, whose career in the NHS spans 35 years, told MPs on the Health Select Committee he was determined to carry on despite the furore over his involvement, however in his letter to bosses announcing his retirement from the £211,000 a-year-post, he said “recent events continue to show that on occasion the NHS can still sometimes fail patients, their families and carers.” He went on to say “this continues to be a matter of profound regret to me”. He also said by giving such notice he hoped to give NHS England time to recruit a high calibre successor while continuing to give stability while the changes, which came into force in April, bed in.”
GP contract set to change as Hunt hands responsibility for out-of-hours care back to general practice: Health Secretary Jeremy Hunt has announced that the GP contract is set to be rewritten as part of reforms to out-of-hours care, which will see general practice handed back responsibility for the care of patients around the clock, reported Pulse. Speaking at a King’s Fund conference this week, Hunt said that GPs will not ‘personally’ have to be on call at all times but that they should have ‘sign-off’ to say they are happy with their patients’ care out-of-hours. He did not explain exactly how this would be designed but in response to a question from Pulse, he said that the GP contract would ‘need to change’. He also admitted that an expansion of the GP workforce would be necessary to achieve the reform. The Health Secretary said in his speech: “We have allowed ourselves to lose sense of the family doctor – the GP being a champion of our health not just the gateway to the system. Out-of-hours services are perhaps the prime example of where things have gone wrong.”
NHS England gives green light on £70m innovation networks project: NHS England has licensed 15 academic health science networks (AHSNs) which it hopes will improve the uptake of innovative treatments by trusts and generate economic growth, reported HSJ (subscription required). The 15 networks including Greater Manchester, South London and Yorkshire and Humber, will bring together commissioners, providers, academia and industry. They will share £70m of NHS England funding in the first year but are expected to be self-sufficient in the longer-term. AHSNs are designed to drive collaboration, connect state organisations with local industry and co-ordinate specific projects, which have been selected on the basis of the needs of local populations and capabilities of partners. HSJ understands eight AHSNs have received full licences, which last five years, while seven have been given conditions to fulfil, including submitting more robust business plans.
‘All trusts’ to get some of £260m fund: NHS England has said that all acute trusts are expected to get “some money” from a new £260m e-prescribing fund, but will have to match the investment, reported eHealth Insider. Health Secretary Jeremy Hunt announced last week that £260m would be made available for hospitals to increase their use of e-prescribing and electronic patient records. An NHS England spokesperson confirmed to eHealth Insider that trusts would be expected to match any money they received. Also, that the fund was planned on the basis of making “some money available to all trusts”. “Further details of how to apply for the fund will be made available shortly, but we do not want to exclude trusts that have already started work on this important agenda,” the spokesperson said.
NHS holds ‘risk summits’ over A&E concern: Pressures in accident and emergency have been the largest single trigger for “risk summit” meetings which are being called to address quality, safety and performance concerns under the new NHS system, HSJ (subscription required) research revealed. Under guidance settings from the Department of Health on how quality and safety would be sustained during the commissioning reorganisation and in the reformed NHS, a summit is called when “there are concerns that a provider is potentially or actually experiencing serious quality failure”. These can be highlighted by regulators or commissioners. Of those held so far, the largest single reason was emergency care problems at hospital providers, which has been the subject of nine summits. There has been a high level of concern about A&E performance in recent months, and many providers have failed to meet the four hour waiting time target. Other reasons for summits range from the sustainability of obstetric services to the training of surgeons.
Patients in hospitals are not being put first, healthcare professionals say: The study, by influential think tank The King’s Fund, paints a devastating picture of a health service culture in which the needs of the sick come second to management targets and ministers’ priorities, reported The Telegraph. It says NHS reforms which were introduced last month have increased the risks to patients – and the likelihood that a scandal like that at Mid Staffordshire Hospital is repeated. The report, based on a survey of more than 900 healthcare professionals which was undertaken before the head of the NHS, Sir David Nicholson, announced plans to retire, found little confidence among frontline staff and managers about those in charge of the service. Just 1% of those polled thought the leadership of the NHS was very good, with 13% rating it as good – compared with 40% who said it was poor or very poor. The report found that 73% of those surveyed said quality of care is not given enough priority in the NHS, and warns that those in charge of the health service need to ensure patients are put first.
Kingsley Manning confirmed as the new chair of the Health and Social Care Information Centre: Health Secretary Jeremy Hunt has announced this week that Kingsley Manning has been confirmed as the new chair of the Health and Social Care Information Centre (HSCIC), reported the Department of Health. The HSCIC has a pivotal new role as the focal point for data and for core IT infrastructure and expertise across the health and care system. It will play a fundamental role in driving better care, better services and better outcomes as part of the government’s reforms under the Health and Social Care Act 2012. The Health Secretary said: “Kingsley brings a great wealth of experience and expertise and his leadership will be essential at such a crucial time for the new HSCIC. I am sure he will lead it to become the leading centre of expertise and innovation in information management, right at the forefront of driving technological change in the NHS.”
Cumbria trust takes new step towards becoming paperless: Cumbria Partnership NHS Foundation Trust has selected FairWarning’s Patient Privacy Monitoring solution as part of its strategy to become a leader in meeting the government’s target for a ‘paperless NHS’ by 2018, reported Building Better Healthcare. The trust, which provides community, mental health and learning disability services to half a million people throughout Cumbria and employs around 4,000 staff, will deploy the solution to protect current patient records. It will use the experience gained during the initial deployment to establish a ‘privacy by design’ approach into the more comprehensive EPRs being developed at the trust. Yvonne Salkeld, head of information governance at the trust, said: “Following a review to ensure that we had in place a model for information sharing, we saw privacy as being key to developing our reputation as a trusted provider of healthcare services to the public. This requirement has since been reinforced by the findings and recommendations in the recent Caldicott2 Review.”
Top A&E doctors warn: ‘We cannot guarantee safe care for patients anymore’: The Accident & Emergency (A&E) crisis is now so severe that doctors can no longer guarantee safe care for patients, NHS officials have warned in a leaked letter seen by The Independent. A combination of “toxic overcrowding” and “institutional exhaustion” is putting lives at risk, according to the letter to senior NHS managers from the leaders of 18 emergency departments. They warn that the rising number of patients presenting themselves for treatment has created a “state of crisis” in casualty departments. In a chilling warning, they write: “What is entirely unacceptable is the delivery of unsafe care, but that is now the prospect we find ourselves facing on too frequent a basis.” The 20 emergency medicine chiefs from the West Midlands tell how A&Es in the area – which serve a population of 5.3 million and have more than 1.5 million patient attendances a year – are being overwhelmed by “unprecedented and relentless pressures”.
City Health Care Partnership deploys Cayder PFM (Patient Flow Management) solution: Healthcare staff at City Health Care Partnership CIC (CHCP CIC) will be able to manage patient care more effectively across multiple community sites, following an implementation of a patient flow management solution (PFM) developed by Cayder, reported Healthcare IT News. With patients due to experience improvements in their care pathway, including more contact time with health care professionals, Cayder PFM is supporting the Partnership’s aims to deliver better, safer patient-centred joined-up, pro-active care services. Toni Yel, business development manager at CHCP CIC said: “The patient flow management solution is already providing benefits for both our patients and staff in the testing stage. The reduced volume of administration, including regular phone calls to co-ordinate discharge from acute care, means our staff can manage our care services more effectively and efficiently.”
Huge support for CCIOs in EPR Debate: An overwhelming 93% of respondents to The Big EPR Survey say that every NHS trust should have a chief clinical information officer (CCIO), reported eHealth Insider. The figure for support that every trust should have a board level chief information officer was 83%. Many trusts do not have board level IT directors or CIOs, with information often being a responsibility of the finance director. Asked what steps should be taken to accelerate the adoption and use of electronic patient records, there was a strong call for greater clinical leadership, engagement and involvement at both a national and local level. At a national level there was a call for leadership from the Royal Medical Colleges. eHealth Insider launched the EHI CCIO Campaign in the summer of 2011. It called for NHS organisations to consider appointing a chief clinical information officer to lead on IT and information projects.
Calls for hospital patients to be given Wi-Fi access: Recent research has revealed that only a third of hospital inpatients have access to Wi-Fi during their stay, reported Building Better Healthcare. Despite a considerable number of people using the internet from smartphones and tablet devices in their everyday life, hospitals are lagging behind when it comes to providing services for patients when they are in hospital. The figures were revealed following a Freedom of Information request by Enterasys Networks, which found that 64% of NHS trusts did not offer Wi-Fi to patients. Instead, most patients still have to rely on expensive outsourced bedside TV, internet and phone systems, which often cost £10 or more a day. Commenting on the research, Harley Street psychotherapist, Jennifer Dew, argued that patients who can regularly converse with family and friends using personal devices, while they recuperate, suffer less from isolation and loneliness and are more likely to make a speedier recovery.
Most leaders would leave if groups’ budgets were given to councils, survey finds: Large numbers of clinical commissioning group (CCG) leaders would leave their roles if the groups’ budgets were given to local authorities, as has been proposed by the shadow health secretary, reported HSJ (subscription required). Respondents were asked about the likely effects of transferring their budgets and making CCGs advisory bodies to councils. Andy Burnham suggested the change in January as part of proposals aimed at better integrating care. He said it would be tested in discussion with the health service and councils. Asked if “you personally would leave your CCG position”, 63% of respondents said they were likely or very likely to do so. 85% said it was likely or very likely “some of the CCG’s GP leaders would leave”. In relation to the effect of the policy, 42% of respondents said it was likely or very likely the policy would mean “health and care services would be less well integrated around individuals”.
Reporting to reduce avoidable harm: Increased reporting of incidents in the NHS will significantly boost patient safety, Dr Mike Durkin told the Patient Safety Congress at the ICC in Birmingham, reported National Health Executive. He told the conference: “There is a lot to do and a lot of levels to do it at. We have collected reports in an open but confidential nature. We are determined to create a system that will be an exemplar of good practice in reducing avoidable harm. It must matter to everyone in healthcare that we do not walk past when we see a harmful, or potentially harmful, event. Information must be acted upon. I would expect organisations to be fully scrutinising their patient safety incidents.” Dr Durkin added: “We have put in place a number of initiatives to significantly reduce incidents of patient harm. Firstly, a three-year strategy for nursing, midwifery and care staff will contribute to high quality, compassionate and excellent health and wellbeing outcomes for patients. Secondly, professor Donald Berwick is chairing a National Advisory Group on the Safety of Patients in England. The group includes world-leading experts in all aspects of the culture and processes of minimising patient harm, and lastly professor Sir Bruce Keogh will lead an investigation into fourteen hospitals that are persistent outliers on mortality indicators.”
Opinion
Is the NHS going to blow a gasket?
Nick Triggle, BBC Health correspondent asks why we think of NHS services in isolation?
“Take the current debate over A&E. The focus has been on what is happening in these units rather than how it fits in with the entire system. In many ways the NHS is like an engine. It is made up of many different parts. If a problem develops in one area, it is likely to have an impact on the whole.”
Triggle continues by saying that in order to get a full picture, you need to look at the whole system.
“Rises in demand are being seen everywhere in England. The ageing population has meant there are more people with multiple conditions, such as heart disease, dementia and respiratory problems. These patients need careful managing and more help.”
In addition demand continues to rise at the ‘front-door’ with “the NHS is finding it difficult to get patients out the other end.
“Cuts to council budgets have meant they have had to ration social care, which affects the ability of hospitals to discharge frail and elderly patients as quickly as they should.
Research carried out last year by Dr Foster, suggests that hospitals are running at 90% capacity. Triggle goes on to suggest the NHS is “full”.
“This, of course, has an impact on the ability of A&E units to admit patients and get their treatment under way – hence the long waits that were experienced in many parts of the county this winter.
“It may also ultimately drive up waiting times for non-emergency operations as hospitals struggle to fit in their routine patients around the emergency cases – a point made by NHS Confederation chief executive Mike Farrar when he appeared before MPs on the Health Select Committee this week.”
Concluding Triggle suggests that whilst from the outside, all appears well, on the inside it still needs fixing.
Why market research is important for the NHS
In this week’s Guardian Healthcare Network, Jane Frost, CEO of the Market Research Society (MRS) explains why the health service needs evidence-based decision making rather than being reactive to perceived need.
Frost cites good examples of market research in the NHS, but a recklessness in keeping the results and subsequent analysis accessible throughout recent reorganisation.
“A relentless focus on understanding people – patients, their relatives or carers and staff – should be the central pillar around which the NHS focuses its decisions in this period of change. This is the operational side of evidence-based decision making that has long been a clinical mantra. Research is critical to that focus, allowing the service to identify actual needs and effective solutions rather than being reactive to perceived need (or, on occasion, organisational myth).
“Research is a critical tool to help the NHS and its hospitals and doctors understand the changes taking place and the impact this will have on the service. Critically, it will also help everyone to understand not only what patients need and want but how they feel.
“Research can drive better care, increase patient engagement and help the NHS understand how patients respond to diseases and treatments. In defining what patients value, it can frequently help reduce costs as well as assist in prioritising increasingly scarce resource. I have personally seen how market research has been used to do both in the justice and tax systems. I believe it has a crucial role to play in ensuring that the NHS is transformed for the better.”
Why DH civil servants will spend a month on the front line
In this week’s HSJ Una O’Brien, permanent secretary for the Department of Health, says that civil servants are too remote from the reality of life and work in the health service. O’Brien explains that this is why they are being asked to spend four weeks every year on the NHS front line.
“February was a humbling time for everyone in the Department of Health and the NHS. The publication of the Francis inquiry’s report into the horrific events at Mid Staffordshire Foundation Trust was a moment to reflect on some deep and enduring issues – how we all listen to patients and service users, understand the work of staff and truly appreciate the experiences of illness, care and recovery.”
“As Robert Francis QC highlighted, this was not just about hospitals, doctors, nurses, carers and health service managers. It was also about civil servants like me who work in the Department of Health.
“For our decisions on policies to be shaped around the needs of patients and staff – to make us better at what we do – we must nurture this direct connection with the places and people on which they impact. That is why I want every civil servant working for the Department of Health to have frontline experience as part of their professional life.
“I know some will dismiss this commitment as tokenism, as some likely short-lived PR exercise. This will not be the case – this is not just what the Francis inquiry report recommended, but also what we need to do to help us be good at our jobs.
“The Department of Health is an organisation that prizes evidence. Evidence derived from data, analysis and research, such as performance information, surveys and patient insight, is critical to good policy making. But the truth is that in complex systems such as health and care, we need a broad base of real life experiences to be able to better interpret this evidence. I firmly believe our policies will improve further if we collectively have a broader grasp of how things work in practice and how people feel about their health and care.
“That is why, as civil servants prepare to leave their offices to experience life on the front line, I am in no doubt how inspirational, rewarding and above all valuable this programme will be.”
How can telehealth help patients take responsibility for their health?
In this week’s Guardian Ruth Chambers explains why compared with normal care, telehealth can achieve better and faster health outcomes, better adherence to medication, and increased productivity.
“The debate around remote care frequently stalls on the matter of expensive or complicated equipment, but often people have all the technology they need sitting in their pockets. While some healthcare providers use text alerts to remind patients about appointments or about submitting data, little use is made of responsive telehealth – the sending and receiving of linked information.
“Developed by the NHS as a simple telehealth application, Florence (or Flo for short) allows clinicians to engage patients with their own healthcare. This achieves faster health outcomes, better adherence to medication or other treatments, and increased productivity compared with normal care. Harnessing this SMS technology has yielded much better engagement between clinician and patient, too.
Chambers goes on to explain the process which involves a clinician signing a patient up to the programme, after which the patient may begin receiving regular information or prompting messages to remind them to take their medication, for example. However, the communication is two-way. The patient can send in readings – for example, blood pressure, weight or oxygen saturation – to a website that is monitored by a clinician at agreed intervals.
“Flo sends messages only when needed and uses humour in transmitting information and encouragement about lifestyle changes. The interaction requires the patient to be involved as they measure their vital signs or describe their condition. The regular feedback from their overseeing clinician by text reassures them that they’re progressing well. If their condition isn’t improving as expected, they can see their clinician and revise their management plan.
“This approach complements that taken by the 3millionlives initiative, which aims to increase the uptake of telehealth and telecare at scale over the next five years, to improve the lives of at least three million people. Flo is being used in general practice, acute hospital, community and mental health settings, as well as by social care professionals.
“Are there risks with using this type of telehealth? As the equipment is viewed as an aid in clinical management rather than a standalone feature, there shouldn’t be. If the transmission of information and interactive messaging is done alongside an agreed clinical management plan or lifestyle, then remote care should enhance the quality of a patient’s care.
“What is crucial is that the purpose and design of any telehealth approach complements usual clinical care and does not replace it.”
Highland Marketing Blog
In this week’s blog Paul Curran looks at Sir David Nicolson’s ‘good points’.
