News in brief
NHS investing £1.2bn to raise care standards post-Francis: Nearly £1.2bn will be spent across the NHS to improve patient care following the public inquiry into failures at the Mid Staffordshire hospital trust, a survey has found. However the poll of NHS hospital trusts and foundation trusts by the Foundation Trust Network warned the extra costs were likely to push some into deficit for the first time, revealed Public Finance. According to the survey of 50 foundation trusts or aspirant trusts, £712m had been earmarked for care improvements in 2014/15 to implement the recommendations of the Francis report into care failings at Mid Staffs. This follows £450m spent in the previous financial year. At least 90% of this investment is being spent on extra staff, particularly nurses and also comes in response to the new inspection regime introduced by the Care Quality Commission watchdog, the poll found. Foundation Trust Network chief executive, Chris Hopson, said the spending would improve care, but warned some hospitals would run deficits for the first time, as the cost of improvements were not being fully met by government. Hopson called for the Department of Health to adopt a different approach to paying for service improvements in response to the squeeze, including full funding any changes included in the mandate. Higher costs as a direct result of the Francis report should also be reflected in either future service development uplifts or higher tariff prices, and there should also be clear, realistic and detailed plans to realise any projected efficiencies.
DH rolls back GP records access promise: The government’s pledge to give patients online access to their GP records by March 2015 has been scaled back again, with practices now only required to have a plan to provide access by the deadline, reported eHealth Insider (EHI). The Department of Health’s (DH) 2012 NHS information strategy said that all GP practices would be expected to provide electronic booking, cancelling of appointments, online prescriptions and electronic online access to their record to anyone who wants it by 2015. EHI reported last October that the level of proposed patient access had been reduced, with GP practices only required to provide access to the brief details in a patient’s Summary Care Record. In its Transforming Primary Care report, published jointly with NHS England last week, the DH now says that practices must either provide people with access “or have published plans for how they will do so” by March 2015. The requirement for GPs to allow the electronic transfer of records between practices by the same deadline also allows practices to simply have a plan in place by then. Patients will “increasingly” be able to book GP appointments and order repeat prescriptions online from this month, but the DH does not provide a date by which all practices must provide these services. The report also highlights key changes to the new GP Systems of Choice contract which started earlier this month, making clear the need for GPs to securely share records with other services when patients are happy for them to do so.
Care.data to be piloted in GP practices before full rollout: NHS England will launch its flagship patient record-sharing scheme, care.data, with trials at between 100 and 500 GP practices, according to a stakeholder briefing, reported Pulse. In a letter sent out last week, NHS England patients and information director, Tim Kelsey, said these pilots would allow them to ‘trial, test, evaluate and refine the collection process’ before it goes national. He said the decision was informed by discussions held between stakeholders and the independent advisory group on care.data – the group set up since NHS England was forced to postpone the launch for six months. Prior to the delay, NHS England had planned to begin a phased rollout of care.data in March in 1 per cent of GP practices. It comes after health secretary, Jeremy Hunt, said last month that new legislation would be brought in to improve protection of patient data. Kelsey’s letter said: “We have heard common themes emerging over the last number of weeks and as a result, we have been discussing with the BMA, Healthwatch, Royal College of General Practitioners and the independent advisory group, a proposal for a phased roll out of the GP data extraction process to begin in the autumn. This will involve a cohort of between 100 and 500 GP practices to trial, test, evaluate and refine the collection process ahead of a national roll out. In addition, steps have already been taken in making changes to the law. This will increase the protection of confidentiality and ensure there is greater transparency around the release of data by the Health and Social Care Information Centre.” A spokesperson for NHS England said: “We are in discussions and will provide more information in due course.”
Central Eastern CSU to shut its doors: The Central Eastern Commissioning Support Unit (CSU) has decided to close down in October 2014, despite being financially viable for the next two years, according to eHealth Insider. Earlier this year the CSU undertook a review of its customers’ commissioning intentions, which found that most of the clinical commissioning groups (CCGs) it serves intend to take at least some services in-house from October. Following that review, Central Eastern has chosen to not submit its application for a place on the Lead Provider Framework (LPF) as a stand-alone CSU. The framework, created by NHS England, will allow CCGs to purchase commissioning support services on a ‘call-off’ basis. This could lessen the need for the large number of CSUs as organisations look to work together. David Stout, managing director at the CSU, said that talks are in place with Central Southern CSU and North and East London CSU to take over service provision for local CCGs, even though the organisation’s finances could see them through the next two years. “While we will remain financially viable, the reduction in our overall income up to 2016 will weaken the LPF assessment of our medium to long term financial prospects, he said.
Patient safety scheme piloted: A “ground-breaking” scheme which aims to improve patient safety by ensuring better communication between GPs and pharmacists is to be piloted by health boards in Scotland, according to Herald Scotland. The Scottish Patient Safety Programme (SPSP) in Primary Care, run by Healthcare Improvement Scotland (HIS), has been awarded £450,000 over two years to test the scheme. HIS said that the majority of patient consultations are safe but that some hospital admissions are due to the adverse effects of medication. Research has revealed that up to 5% of prescriptions contain an error, HIS said. It is hoped the new scheme will reduce the risk of harm to patients through issues such as prescribing discrepancies, which can happen when patients are discharged from hospital. Jill Gillies, who leads the SPSP in Primary Care team, said: “Our main aim is to improve and bridge the gap in relations between pharmacists and GPs.” She added: “This is a ground-breaking project that aims to strengthen the link between GPs and pharmacists – it clearly demonstrates the commitment of the SPSP in Primary Care team to explore innovative ways to improve patient safety in Scotland.”
E-referrals to go live in November: The NHS e-referral service will go live in November this year, the Health and Social Care Information Centre (HSCIC) has said. At a recent supplier testing open day, the HSCIC gave a presentation on the service which will replace Choose and Book in order to make sure suppliers are prepared for the launch, reported eHealth Insider. The system is based on open source technology and there will be a large focus on open standards, says the presentation. The replacement service has been rewritten and re-developed and should be the same from a functional perspective of Choose and Book compliant systems. Choose and Book was developed a decade ago, after the then-Labour government promised to introduce “airline-style booking” to the NHS. It was intended as one of a number of new, digital services to make the NHS more convenient. However, its roll-out was significantly delayed, and usage has stalled at around 50 per cent of referrals. NHS England is considering making the use of the new e-referrals service mandatory and is also looking at introducing an incentive and penalty system to ensure GP practices and hospitals use the service.
Health atlas allows online search of risk by area: A new online map of England and Wales allows people to enter their postcode and find their community’s risk of developing 14 conditions, such as heart disease and lung cancer, reported the BBC. The map presents population-wide health information for England and Wales. The researchers at Imperial College London pointed out that it could not be used to see an individual’s risk. It indicated an area’s health risk, relative to the average for England and Wales, they stressed. Researchers at Imperial looked at 8,800 wards in England and Wales, each with a population of 6,000 people. They collected data from the Office for National Statistics and from cancer registries for 1985 to 2009. Data was then mapped alongside region-by-region variations in environmental factors such as air pollution, sunshine and pesticides. The data was also adjusted for age, deprivation and to take into account small numbers. Dr Anna Hansell, from the UK Small Area Health Statistics Unit, led the research. She said: “Across all of these areas there are some that have higher risks and some that have lower risks.”
TPP likely to sign GPSoC shortly: The Health and Social Care Information Centre (HSCIC) and TPP are still negotiating, but the company is expected to sign the GP Systems of Choice (GPSoC) contract “in the very near future”, according to eHealth Insider (EHI). EHI reported a few weeks back that sixteen suppliers of GP IT systems had signed up to the new contract, without TPP so far. A spokesperson from the HSCIC told EHI that TPP and the centre are still working out the issues surrounding the contract, but would not share any detail on what those issues are. “They have made good progress on the key outstanding issues and we hope to be in a position to sign in the very near future,” said the spokesperson. The company has been in negotiations with the HSCIC for weeks regarding the terms of the framework, as the previous contract expired on 1 April this year and TPP is the only supplier not to have signed. This has caused a lot of questions and debate, which has prompted the HSCIC to release a guide to the new GSPoC framework. The guide says that the centre has put in place interim arrangements should TPP not sign. “There are some specific contractual issues that must be addressed by TPP before they can join the new GPSoC framework. TPP are working to address these final points and we hope to reach an agreement soon,” it says.
CCG funds digital dictation for 22 practices: Digital dictation software has been provided to 22 general practices by their local Clinical Commissioning Group (CCG) to help meet NHS England’s paperless challenge, reported The Commissioning Review. Sheffield CCG believes the software will improve efficiency, speed up patient referral times and improve patient safety. Hallam and South Locality Commissioning (HASC) is funding the rollout of Lexacom software. Lexacom created a mandatory Choose and Book dropdown menu for HASC, so that GPs have to select the relevant categories at the time of dictation, ensuring secretaries instantly know which clinics to book for which patients. The system will also integrate with the three leading clinical systems, EMIS, Vision and SystmOne, which the company believes will ensure accurate patient data is always included in each dictation. Gordon Osborne, HASC interim locality manager, said: “All GP practices are keen to find reliable ways to improve the service they provide to patients. It’s much easier for secretaries to book the right clinics. They don’t have to check with the GP first and there are fewer cancelled appointments and queries as a result.”
Numbers of elderly needing care will soon outstrip relatives able to help: The scale of the gathering social care crisis has been underlined by new figures showing the number of older people is expected to outstrip the number of family members able to provide informal care for them for the first time in 2017, reported The Guardian. Within four years, it is predicted, 800,000 people may be in need of care, including 20,000 with no family to care for them, according to a report by the centre-left think-tank the IPPR. By 2030 there will be 2 million people aged over 65 without adult children to look after them, up from 1.2 million in 2012, and about 230,000 of them will be in need of more than 20 hours’ care a week and will have no informal support. The average annual cost for an older person who pays for 10 hours of home care and receives five meals on wheels a week has increased to £7,900 a year and nursing homes now cost an average of £36,000. The report will accelerate private discussions under way in the Labour party about how it can integrate social care and health services, and whether this will require any kind of earmarked extra spending. Labour says it has rejected plans for a 1p increase in national insurance contributions, an idea being touted by the former welfare minister Frank Field, however, Ed Miliband is known to want to make the future of the health service a big issue at the next election.
NHS England steps up work on pooling budgets: NHS England has begun detailed work on how to pool its primary care budgets with other commissioners, one of its senior leaders has revealed. Head of primary care commissioning, David Geddes, told Health Service Journal (subscription required) that leaders in its regional and local teams had begun a project to “explore how far” it can develop co-commissioning and pooling. The project is led by NHS England’s operations and delivery director for London, Simon Weldon, who is working with others including other directors of area teams. Since April last year NHS England has held budgets for most primary care and specialised services, local authorities for most public health services, and clinical commissioning groups for community, acute, mental health and other services. The splits between responsibilities have caused problems and NHS England earlier this year said it would explore greater joint-working and pooling, particularly of primary care and community budgets.
Channel 4 interactive documentary to examine cost of treating NHS patients: The cost of treating NHS patients will be examined in a new Channel 4 interactive documentary that the broadcaster says gives viewers the chance to “decide for themselves who should receive the treatment”, reported The Guardian. With the working title of NHS: The Cost of Living, the series has been commissioned as campaigners are currently urging pharmaceutical giant Roche to reduce the price of a pioneering breast cancer treatment after it was rejected for widespread use by the NHS on cost grounds. According to Channel 4, NHS: The Cost of Living will have, “a live presence through the broadcast of the documentaries [and] this innovative format will challenge viewers to decide for themselves who should receive the treatment and how the NHS should spend its rapidly depleting funds”. Exact details are still being worked out of how the programme will work – however, it will not be a kind of Patient Idol or X-ray Factor style-show as viewers will not actually have the final say on who receives the treatment, only register their opinions on either a website or Twitter feed. The four-part series will be followed by a live debate, which is likely to provoke opinion as with the NHS spending on average more than £2bn a week, its costs are rising faster than its budget.
Monitor appoints medical director: Monitor has appointed Hugo Mascie-Taylor as its new medical director and executive director of patient and clinical engagement, Health Service Journal (subscription required) has learned. Dr Mascie-Taylor is the former medical director at Leeds Teaching Hospitals Trust, and has been working as a trust special administrator to determine the future of Mid Staffordshire Foundation Trust. He was also medical director at the NHS Confederation. A Monitor spokesman confirmed that Dr Mascie-Taylor would start work on a part-time basis on 1 May, but would continue his work on the administration of Mid Staffs, “providing as much input as is necessary, until the trust is dissolved”. His role is a new addition within Monitor’s organisational structure. In the role Dr Mascie-Taylor will be responsible for providing clinical advice to the board and executive on a number of issues including reconfigurations, interventions and transactions, and for ensuring Monitor gets input from clinicians and patients when making decisions. Dr Mascie-Taylor said: “I’m pleased to be joining Monitor and will work hard to make it as effective an organisation as possible. My role will include advising the board on clinical issues to ensure that decisions are made in the best interests of patients.”
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Opinion
Could controversial data sharing be good for patient health?
The Snowden NSA leaks have bred public mistrust of data sharing. But the practice could have huge positive benefits for healthcare explains Craig Manson, executive vice-president (international) at Dr Foster Intelligence, in this week’s Guardian.
“Revelations of eavesdropping by US and UK spy agencies has without a doubt contributed to the general public’s sensitivities over how our personal information and data might possibly be harnessed and used by those with less than honourable intentions.
“Care.data, the well-documented proposals for a medical record data-sharing project in the UK, was so badly communicated to the public that its launch has been delayed for six months. Meanwhile, the European Commission’s attempt to bring in new data protection laws, launched two years ago, has been put on fast forward since the Snowden revelations brought the importance of privacy issues to the wider public.
“With so much attention focused on the risks of data sharing and how to manage them, it is easy to lose sight of the huge positive impacts sharing our health data has had on aspects of health, safety and health service quality.
“At the harder end of the debate, access to hospital data has undoubtedly improved patient safety at the very least, if not saved lives. In the UK, mortality statistics have been credited with highlighting issues such as high numbers of unexpected deaths at Mid Staffordshire NHS Trust and, more recently, the fact that more patients are likely to die after surgery performed on or close to the weekend.”
Concluding Manson suggests that: “In conducting the debate about data share, we need to keep sight of the great extent to which data sharing boosts medical and health research and care in ways we should not be expected to live without.”
Mobile technology: switching on community healthcare
This week, Colin Reid, CEO of TotalMobile, writes in Building Better Healthcare about the support modern day community nursing needs, and says the entire workings of primary care can be revolutionised by mobile working technology and points out the pitfalls to avoid.
“…increasing demand from old and frail patients living with complex and chronic long-term diseases is placing a strain on the system and putting frontline staff under enormous pressure. A lack of funding in primary care, a shortage of nursing skills, and a failure to integrate NHS health systems has left many services across the country varying widely in performance and productivity. Frontline workers are also spending more time dealing with paperwork than caring for their patients.
“This must change, and I believe community nurses and the tools of mobile technology are the key to that change. Community nurses are passionate about their job and want to do what is best for their patient. They are frustrated that paperwork, bureaucracy and poor technology are taking them away from what they joined the health service to do.
“The community worker’s job is complex. They often have to deal with large amounts of information, such as their daily appointment schedule, the location of visits, and what tasks need to be completed. Any supporting technology must therefore encompass a frontline worker’s entire workflow. It is about taking the pressure off, creating more capacity so they can get more done. Just as the patient should be at the centre of the health professional’s world, so should the frontline health worker be the focus of a technology support system.”
We can learn more from India than how to cut costs
The King’s Funds, Chris Naylor has been working with the Public Health Foundation of India, and discusses how we can learn more from India than how to cut costs.
“Here’s a puzzle for you. You have a population of one million people, three psychiatrists, and no mental health nurses. How do you go about delivering mental health care? Resource constraints of this order are something we rarely have to contemplate in the UK, but are a daily reality in India and many other countries. Despite the differences in the scale of the resources available, the underlying challenge of improving quality within limited budgets is one shared by health systems across the world, and in the UK there has been increasing interest in the lessons that might be learnt from innovations in lower-income countries.
“Having spent the past few months working at the Public Health Foundation of India in Delhi, several things have struck me about the approach taken here. One is that the health system (or at least the publicly funded part of it) has had to learn to actively involve the local community as a partner in service delivery. A second is that there are some very innovative examples of thinking creatively about human resources, in particular using task-sharing approaches to extend the capabilities of lower-cost staff.
“Back in the UK, we have previously argued that the NHS needs to become much better at strengthening these kinds of links with local communities, building on the success of initiatives such as the ‘community health champions’ programme. This is particularly important in the context of long-term conditions, for which the formal health system can only ever be part of the answer.
“Some of the challenges faced by the health system in India are, of course, very different to those in the UK. Public funding currently amounts to just 1 per cent of GDP, most health care is paid for out-of-pocket, and dramatic economic and social changes are in motion that often create as many difficulties as they solve. Nevertheless, what has struck me most is the commonality of many of the problems we face. Sharing solutions to these common problems can help us all to find ways of improving quality with finite resources.”
Highland Marketing blog
In this week’s blog Myriam McLoughlin explains why social media guidelines are a necessary evil that might just save your reputation.
