News in brief
New NHS England chief executive named: Simon Stevens, the former health adviser to Tony Blair, has been appointed NHS England’s new chief executive, reported Health Service Journal (subscription required). Stevens will take over from Sir David Nicholson on 1 April 2014. He is currently the president of the global health division of UnitedHealth Group, the US-based health giant. Stevens was the prime minister’s health policy adviser from 2001 to 2004 and before that an adviser in the Department of Health from 1997. Prior to this he worked in the NHS for more than 10 years, including as group manager at Guy’s and St Thomas’ Hospitals, a general manager of mental health services in North Tyneside and Northumberland, and a director of primary care in two health authorities. Stevens said in a statement: “The next five years are going to be extremely challenging for the NHS, but compassionate high quality care for all is as vital as ever. It will be a privilege to lead NHS England – at a time when the stakes have never been higher – because I believe in the NHS, and because I believe that a broad new partnership of patients, carers, staff and the public can together chart a successful future for our health service.”
Integrated care budgets ‘to be linked with performance’: Clinical Commissioning Groups (CCGs) will be given part of the £3.8bn shared budget to support the integration of health and social care held back unless they meet targets, revealed Pulse. A letter from NHS England and the Local Government Association sent this month reveals part of the new pooled budget with local authorities will be linked to performance in areas such as emergency admissions and user experience. The money will be reallocated from current budgets and ministers have said that they are looking closely at how it could be used to boost investment in primary care, after a plea from the Royal College of General Practitioners. The letter says that the details are still being looked at, but local authorities and CCGs are likely to be measured on their performance in delayed transfers of care, emergency admissions, the effectiveness of re-ablement, admissions to residential and nursing care, and patient and service user experience. It added: “When levels of ambition are set it will be clear how much money localities will receive for different levels of performance.” The ‘integration transformation fund’ was announced in the government’s June spending review and CCGs and local authorities have until March 2014 to apply for the funding.
HSCIC plans a national tech strategy: The Health and Social Care Information Centre (HSCIC) plans to publish a national technology and data strategy in summer 2015, reported eHealth Insider. The strategy will focus on a number of areas including, minimising barriers to the flow of data between care settings, making data available in appropriate care settings at the lowest cost possible and improving public access to the data. The HSCIC draft strategy for 2013-2015 was presented to an HSCIC board meeting this week. It sets out the centre’s priorities over the next 18-months, setting a number of targets to achieve in 2015. “The capacity for technology to contribute to a transformation of care services will depend on the complementary actions of commissioners, regulators, professional bodies and service providers,” it says. “Our task, with our partners, is to build a data and information eco-system to support these groups and minimise the barriers to the radical changes they need to promote. Over the next 18 months we will therefore develop, with our partners, a national technology and data strategy to inform that long term view.” The strategy focuses on each of the HSCIC’s roles, such as data quality assurance. It says that by March 2015, the centre will publish draft quality standards for the major care sectors and publish the performance of providers against those standards. It also plans to implement a national data quality assurance framework.
A quarter of NHS trusts identified as ‘high risk’: Almost a quarter of NHS trusts have been identified as high risk and may not be offering safe, good-quality care to patients, reported The Telegraph. A new report by the Care Quality Commission (CQC) has found 44 trusts with the most serious level of concern, including higher than expected death rates across their hospitals. Several came to attention after whistleblowing by staff, while others had a higher than expected death rate among patients who should be low risk. A total of 161 acute trusts across England were examined by the CQC against more than 150 indicators. All 161 trusts were divided into six bands, with band one being the highest risk and band six the lowest. There were 44 trusts in the two bands with the highest risk, with 24 trusts in the highest possible band one. Trusts in band one included: Basildon and Thurrock University Hospitals NHS Foundation Trust, Croydon Health Services NHS Trust and Royal Berkshire NHS Foundation Trust. To view the full list Click here. The report will act as a screening tool to identify which trusts need the most rapid CQC inspections and where inspectors need to focus their attention. The second wave of acute trusts are to be inspected by the CQC reports Health Service Journal(subscription required). Nine of the 19 trusts to be inspected in January have been identified as posing the highest risk under the CQC’s new “intelligent monitoring system”.
NHS Direct to close down next year: NHS Direct – one of the most recognisable names in the NHS – will be closed down in England next year, reported the BBC. The organisation, which is an NHS trust, got into financial difficulty after winning a number of the contracts for the 111 phone line. It had already said it was pulling out of those – and this latest decision means its other services will be closed or transferred to other NHS bodies. The service began 15 years ago and ran the national telephone advice line from the late 1990s until April this year, when the 111 service was launched.
The 111 service was split into 46 different contracts and NHS Direct won 11 of them. However, during the summer it announced it wanted to end these deals – nine of which had already started and two of which were yet to be launched – as they were “unsustainable”. Replacement providers have already been found. NHS Direct also runs a number of other services, including an information website, GP appointments booking, phone line and complaints service. Many of these are expected to be transferred to other parts of the health service or put out to tender. NHS Direct chair Joanne Shaw said the organisation should be proud of the innovation it had championed as it had helped pioneer “remote assessment, advice and information”.
NHS Choices re-launched next month: The integrated customer service platform beta launch in November will be a re-launch of NHS Choices, reported eHealth Insider (EHI). The November release will include publication of the general practice high-level indicators in the NHS Choices accountability tool, designed to give people a comprehensive view of practice performance across a range of quality and clinical indicators. NHS England’s planned patient platform, dubbed “the daughter of NHS Choices”, aims to be the new “digital front door” to the NHS. NHS England says it will be, a “new multi-channel information, feedback, transactions and participation customer service programme”, delivered through mobile apps, SMS, phone and online channels. A report presented to the Informatics Services Commissioning Group’s July board meeting said, “the core of the integrated customer service platform (ICSP) will be its application programming interface (API), the ‘black box’ of quality and open data that websites, apps and other services can use to create interactive and useful content”. The report said the November beta-launch was going to include; a symptom checker; GP appointment booking; a health apps library; web chat, ratings of services and ordering online repeat prescriptions. The NHS Choices name will be kept for now, but is being reviewed.
Hunt: Contract reforms next year will mean ‘fundamental change to the role of GPs’: Health secretary Jeremy Hunt has said his planned reforms to the GP contract will result in a ‘really fundamental change to the role of GPs’, reported Pulse. Hunt made the statement at a King’s Fund conference on the care of older people this week, making it clear that the new GP role as ‘named clinician’ will be written into the GP contract. As previously reported by Pulse, Hunt expects GPs to coordinate the care of England’s elderly on a patient-by-patient basis from next April. Speaking at the conference, he said this ‘proactive’ approach would make a big difference to GPs’ working days but that he hoped the changes would ‘simplify rather than complicate’ general practice. The health secretary said: “The first thing is that we have to change primary care from being reactive to being proactive, and that means a really fundamental change to the role of GPs. What I really want to see is a GP who is responsible, via his or her contract, to provide thorough support to the frail, elderly and vulnerable. But it isn’t just about ticking a box… it is about giving the GP autonomy to deliver a care plan. That is a big change.” Justifying his plans, Hunt said that he was aiming to free GPs from bureaucratic targets and let them return to being ‘traditional family doctors’.
NHS praises GPs seizing opportunities to innovate: Innovative GPs are seizing opportunities to transform general practice, according to the deputy medical director of NHS England. Dr Mike Bewick pointed out how some practices are “already tackling the many challenges” that primary care is confronting, reported OnMedica. He said he has heard from health and social care professionals responding to NHS England’s Improving General Practice – Call to Action, setting out their views on what and how primary care should change. However, he added: “As a GP, I understand the call for some space or headroom to think about change; how do we describe what we need to do and how do we then go about trying to deliver it? How do we prioritise the hundred things on the ‘to do’ list and focus on the top three that will really improve the experience of our patients? The day job sometimes just doesn’t give us time to think about innovation.” Bewick insisted that NHS England wants to support GPs and give them the tools they need to “help secure the future of primary care”, rather than tell them what to do.
Royal Liverpool and Broadgreen University Hospitals go for vendor neutral archiving: Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT) has implemented a vendor neutral archive (VNA) to store millions of medical images from its new picture archive and communications system (PACS) to underpin its electronic patient record strategy, reported eHealthNews.EU. The new system will allow clinicians to access and share images and other electronic patient notes from any location or device in a fraction of the time previously taken. In addition, the trust sees its investment in the new VNA as part of an over-arching strategy to improve its IT ahead of the move to its state-of-the-art hospital due to open in 2017. This will include moving to a ‘paper-lite’ model of managing patient records and other content. The trust has already migrated 87 million existing images to the new VNA. Sarah Lomax, project manager for PACS and VNA at RLBUHT said: “We chose a truly open platform since it allows us to go beyond the scope of PACS by storing and managing other content alongside medical images. To maximise the benefits, we decided to integrate our VNA plans with our electronic document and records management strategy using the same infrastructure. Now we will be able to provide better, quicker access to patient data meaning clinicians will be able to see more patients and have more time to explain diagnoses and related treatment plans, thereby improving the quality of care.”
Penine Acute NHS Trusts sign cloud deal: Public Technology reports that Pennine Acute Hospitals NHS Trust has signed a five-year deal with service provider ANS Group to create a private cloud, which will allow staff to access a range of IT systems. The new package is aimed at automating a number of processes through which staff currently access to IT systems by creating an “app store”. Those in charge of running the project intend to open up the new system to other trusts, to help achieve wider efficiency savings. Christine Walters, the trust’s associate director of IM&T, told publictechnology.net: “My trust is a very large organisation – five sites and four hospitals. Clinicians have to be able to go from site to site and see the same desktop and access their systems quickly.” Walters said that the trust had taken a strategic decision to stop updating its old IT platform, partly because of the number of passwords doctors had to remember to be able to access multiple systems. Walters continued: “The new technology provides them with a single sign on and they can get very quickly into their own applications.” The company has already signed deals this year to provide similar services based on the technology to Greater Manchester Commissioning Support Unit (CSU) and Staffordshire County Council.
Homerton Hospital invests in online clinical skills training solution: Homerton University Hospital NHS Foundation Trust is providing its healthcare professionals with access to a new, interactive online training solution from Elsevier that enables staff to improve patient care and record their annual learning, reported Building Better Healthcare. The trust has implemented the online training tool following a needs analysis carried out after the publication of the Francis Report. This recognised a demand for clinical skills teaching, on-going competency assessment and a requirement for trust-wide education programmes following any serious untoward incident. The solution provides more than 3,000 healthcare professionals – medical students, healthcare students, qualified staff and healthcare assistants – access to training modules covering an extensive range of practical and communication skills. Val Dimmock, simulation and clinical skills facilitator at Homerton University Hospital NHS Foundation Trust said: “Elsevier Clinical Skills not only supplements our existing training programme, but also creates an ethos whereby learning becomes something that happens continuously in the workplace. Whether staff are returning to work after a period of time, or simply need to refresh or add to their skills, they now have easily accessible, interactive, learning modules on the ward to meet immediate patient needs.”
NHS is ‘not an international health service’ – Hunt: Health secretary Jeremy Hunt has announced that charging overseas visitors and ‘health tourists’ could save the NHS £500m, reported National Health Executive. The Department of Health has published a study of migrant use of the NHS, which suggests £388m is spent each year on patients who should be paying for their care. Currently only around 16% of these costs are recovered. Relatives of British residents and migrants who come to the UK to try to get free healthcare – a phenomenon known as health tourism – cost the NHS between £70m and £300m, the study states. To tackle these costs, the government is introducing a new ‘health surcharge’ as part of the Immigration Bill. Students will pay £150 a year and other temporary migrants will pay £200. The move will affect approximately 490,000 applicants. Hunt said: “Having a universal health service free at the point of use rightly makes us the envy of the world, but we must make sure the system is fair to the hardworking British taxpayers who fund it. We have one of the most generous systems in the world when it comes to health care for foreign visitors, but it’s time for action to ensure the NHS is a national health service – not an international one.” Other measures include appointing an independent adviser on visitor and migrant cost recovery, establishing a cost recovery unit, looking at incentives for hospitals to report examples of treatment that should be charged, and introducing a simpler registration process to identify who should pay for their care.
Doncaster picks Ascribe: Doncaster and Bassetlaw Hospitals NHS Foundation Trust has awarded a contract to Ascribe for its patient administration (PAS) and A&E systems, reported eHealth Insider (EHI). The trust runs the legacy Totalcare PAS from McKesson, for which a support contract agreed between the company and the Department of Health in the National Programme for IT era, expires in March next year. Doncaster and Bassetlaw’s director of ICT Steve Parsons told EHI that he is excited about implementing Ascribe’s CaMIS PAS and Symphony A&E system, but the trust will not manage to go-live before the McKesson contract expires. “We have a timetable at the moment which takes us into May-June next year, so there will be a couple of months where we will be running the existing PAS ourselves,” explained Parsons. “Obviously there’s a risk, but it’s a manageable risk. We have a fundamental knowledge of the system. We believe it’s achievable.” The trust is focusing on implementing Symphony before grappling with the PAS and has already begun deployment work.
FairWarning announces CloudConnect as first to achieve FairWarning Ready for Identity Management certification: FairWarning, the patent holder of privacy monitoring solutions for electronic health records, has announced that CloudConnect Health IT is the first vendor to achieve certification in the FairWarning Ready for Identity Management program, reported HeraldOnline. Designed to help hospital customers make better use of their existing investment in IT infrastructure, the program enables identity management application vendors to seamlessly integrate with FairWarning patient privacy monitoring to provide customers with advanced privacy monitoring analytics, filtering and workflow capability. John Houston, resident, CloudConnect said: “By integrating CloudConnect’s `CloudIdentity’ identity management solution with FairWarning, they can deliver much richer information to its small to midsized healthcare customers. Better user identity information will help ensure secure and appropriate access to patient information.”
Robot helps Sheffield surgeons: Sheffield Teaching Hospitals NHS Foundation Trust has bought a robot to help surgeons perform complex operations according to eHealth Insider. The £1.8m multi-armed da Vinci robot lets surgeons perform less invasive surgery from a sophisticated robot arm. David Throssell, the trust’s medical director, said that Sheffield hopes to become a centre for robotic surgery training. He said: “The da Vinci robot has an excellent safety record and makes the most of the surgeon’s skills to perform delicate and complex operations. Surgeons using the equipment will be given extensive training in its use.” The robot is operated using joysticks and foot pedals from a console where surgeons can control a 3D camera and specialised instruments attached to the robotic arms. As the camera is ten times more accurate than the human eye and the robot has specially designed instruments, surgeons can perform complex surgery through small, precise incisions, as the machine adjusts itself to compensate for the natural tremor in the human hand. Kirsten Major, director of strategy and operations at the trust, said it will improve surgical outcomes and means patients will spend less time recovering in hospital. The da Vinci robot, developed by American company Intuitive Surgical, is also in use at the Royal Wolverhampton Hospitals NHS Trust where it was used to perform the country’s first ever robotic open-heart surgery last year.
Opinion
There is still hope for trusts seeking to merge
In Health Service Journal this week, Ben Collins, an independent management consultant, discusses that although the Competition Commission’s stance on foundation trust mergers may seem unyielding, there is still promise for NHS organisations wanting to merge.
“After 10 months of agony, the Competition Commission finally put an end to Bournemouth and Poole’s merger plans. The tone of the commission’s final report is uncompromising, rebuking the foundation trusts for failing to provide a detailed rationale for the merger and rejecting any suggestion that it might deliver benefits for patients.
“But did the regulator make a fair assessment of the case? And where does this leave other foundation trusts contemplating the mergers obstacle course?
“Under competition legislation, the authorities are required to make a balanced assessment of the costs and benefits of mergers. Contrary to popular belief, there is no presumption in favour of competition to the exclusion of other considerations. However, there is a nagging suspicion that the authorities may be unwilling or ill equipped to give the benefits of mergers a fair hearing in practice.
“……there is still hope for FTs and NHS trusts contemplating mergers. If your patients have access to three or more alternative hospitals within a reasonable distance, it may be possible to gain rapid clearance on the basis that the merger does not raise competition concerns. Chief executives will need to mobilise their organisations to meet a high analytical standard at the OFT stage.
“If the case raises competition concerns, it will be essential to gain Monitor’s unambiguous support. The competition authorities cannot easily ignore a sector regulator’s expert advice.”
‘Health tourism’ and the China syndrome
Fresh from the remarks health secretary Jeremy Hunt made about learning from China on how to treat our elderly, Michael White, assistant editor at The Guardian, discusses whether cultural attitudes matter in blaming foreigners for the squeeze on NHS funds.
“Health tourism is trickier. Instead of inviting voters to self-criticism (“do we do enough for mum?”), it tempts them to blame foreigners, albeit with the help of inflammatory tabloids. Properly handled, it strikes me as a legitimate target and the British Medical Association’s excuses for inaction (unreliable data, admin costs, dangers to health) like feeble bleating.
“If ineligible users cost the NHS £2bn (obesity costs £5bn), surely it’s worth making better efforts to claw back Hunt’s modest target of £500m. After all, the French do it to us and every euro counts now.
“Pressure on GP surgeries or hospital beds will not be solved by excluding what the BMA’s man called “a child struggling for breath” – and the NHS couldn’t function without immigrants. But taxpayers have to feel they aren’t paying for free riders (bankers or Bulgarians) who haven’t contributed.”
Why the NHS needs a blend of private and public sector managers
In the Guardian this week, Stephen Dangerfield explains that managers from both sectors have their own expertise and can learn from each other.
“In March this year, the secretary of state for health, Jeremy Hunt, launched an initiative to attract managers from the private sector into the NHS, amid fears that health managers have become too institutionalised. This initiative was, and still is, met with some criticism – with many critics suggesting Hunt is trying to privatise the NHS. However, without exploring the benefits of this initiative and what it could bring to the NHS, it is easy to see why many have been critical.
“Managers from both sectors have their own expertise and it is important that we recognise these and use them in the best possible way. This avoids the risk that an NHS trust can become too inward looking by relying on a single management style, delivered by managers from just one sector – private or public.
“At NHS Professionals, the journey we have taken over the past 10 years demonstrates the benefits of adopting a blend of private and public-sector managers. We have turned the organisation around from a £16m operational deficit to an operating surplus within two years with corresponding uplift in quality. Last year our turnover was £311m and we achieved a profit of £4.4m before tax – all of which is retained by the public sector.
“When it comes to management, we need flexible boundaries, otherwise we risk cutting off the fresh vision, skills and experience that come from other sectors of the economy.”
What the integration of health and social care could mean for homecare
If fully integrated services were provided in people’s homes it could help raise the status of homecare, says Richard Humphries, assistant director of policy at the King’s Fund, writing in the Guardian this week.
“Veterans of health and social care integration will recall earnest discussions about what is a health bath as opposed to a social care bath. The former is a free service via the NHS involving a nurse; the latter is a means-tested one via the local authority and a homecare worker. For people who just wanted help to have a bath, the distinction always was, and still is, absurd.
“That homecare services should be at the heart of a joined-up health and social care experience is a no-brainer. There is near-universal agreement that as much care as possible should be provided closer to home, a point on which public expectations and policy aspirations are aligned. The demand for care at home is set to grow rapidly – changing patterns of disease and demography will see more us with long-term conditions and frailty in older age. The King’s Fund’s Time to Think Differently campaign highlighted the importance of the home as the primary hub of care. This will further blur the boundaries between the tasks done by home care and health personnel.
“Integrated care is gaining traction across the country as providers and commissioners seek new solutions for people with complex needs. The King’s Fund recently published a map of UK integrated care sites and related resources, looking at the progress local innovators are making. The government’s plans for integration pioneers and a £3.7bn integration transformation fund to ensure that closer integration between health and social care reflects a fresh approach to joining up services around the needs of individuals.
“Local plans for the use of the fund have to be agreed locally by April next year. These plans offer an important opportunity to reconsider the different ways good home care services can support people to live at home and reduce the use of urgent care, hospitals and care homes. In the meantime, the approach of winter brings fresh anxieties about A&E performance. Financial pressures are growing across the whole system. There is no time to lose.”
Highland Marketing blog
In this week’s blog, Matthew D’Arcy discusses whether a new chief executive in a new NHS means new accountability?
