News in brief
Time running out to make bids to Tech Fund: NHS trusts have expressed concern that there is not enough time to complete applications to the £260m Technology Fund, with less than a week to the deadline. Trusts were given just a month to apply to the ‘Safer Hospitals, Safer Wards Technology Fund’ when NHS England issued its guidance on the hospital part of the integrated digital care record concept on 1 July. The guidance said NHS England was looking for bids to help trusts at the start of their digital journey, to promote e-prescribing and scheduling, and to support information sharing. There is no limit to how many bids a trust can make or how much money they can ask for, but applicants must match any funding received. Beverley Bryant, the director of strategic systems and technology at NHS England, told eHealth Insider that she had received questions from trusts worried about the deadline and the requirement to find match funding. However, she said that if trusts had clinical ownership, board level support for delivery, and “an existing IT or technology strategy” they should apply. Further details may be figured out during the due diligence phase in August and September. Some £90m of the tech fund cash will be available in this financial year and £170m in the next. This funding must be spent before the end of March 2015.
NHS England and the Health and Social Care Information Centre launch consultation on hospital data: NHS England and the Health and Social Care Information Centre (HSCIC) this week published NHS Hospital Data and Datasets: A Consultation to explore how better extraction of information from hospitals’ data systems could help raise standards, improve safety, and reduce inequalities in patient care. The consultation asks for views on what information should be extracted to support the commissioners of healthcare services, and how to minimise any extra burden on hospitals. The potential new data requirements being consulted upon include extracting information about tests and investigations performed, nursing care delivered, and medicines prescribed. High quality data will underpin the transformation of the NHS, ensuring that it becomes truly patient centred and clinically led. Collecting and sharing accurate information with providers, commissioners, patients and the public will help to assess safety issues and identify areas where outcomes and patient experience can be improved.
Grant signals global search for ‘fresh’ chief to replace Sir David Nicholson: The chair of NHS England has underlined his determination to consider people from outside the UK and with no health service experience as candidates to be the organisation’s chief executive. In an interview with Health Service Journal (subscription required), Sir Malcolm Grant also revealed all of NHS England’s current national directors had ruled themselves out of replacing Sir David Nicholson. He emphasised he was beginning a “genuinely open and global search” and saw the appointment as an “opportunity to break from the past and to consider candidates who may not have had any NHS or health related experience”. Sir Malcolm suggested leaders without NHS experience could be successful if they appointed the right staff: “Great leaders delegate quite a lot, keep their eyes on the big picture [and] trust others to have the immediate grip.” He emphasised the role was different to that of NHS chief executive, to which Sir David was appointed in 2007. “What we’re doing is recruiting somebody to lead NHS England, the commissioning side,” he said.
Launch of pioneering dementia care pilot projects: Over a hundred hospitals and care homes across England have been awarded a share of a £50m fund to create pioneering care environments designed with the needs of people with dementia in mind, reported the Department of Health. Health secretary Jeremy Hunt announced details of the 116 successful projects as part of a visit to the award winning dementia ward at Guy’s and St Thomas’ NHS Foundation Trust. Guy’s and St Thomas’ were selected to receive £955,490 to fund their project ‘Designing the Dementia Journey’ – a holistic approach to the environment for people with dementia, which will support the hospital’s existing care provision for dementia patients. The older person’s unit features a specially designed ward environment, with colour-coded bays and symbols to help patients remember their way back to their bed. The funding will enable these successful initiatives to be rolled out to other high priority wards across the trust. Hunt said: “There is little doubt that our home and work environment has an important impact upon our day to day lives – and our care environment is no exception. Funding was awarded to projects that demonstrate how practical changes to the environment within which people with dementia are treated in will make a tangible improvement to their condition.”
NHS trusts tender for electronic patient record system: West Suffolk NHS Foundation Trust and Shropshire Community Health NHS Trust have both issued separate tenders for electronic patient record (EPR) systems in the last week, adding to a growing number of NHS bodies migrating from paper-based patient notes and prescriptions to a digital format, partly in response to the push for a paperless NHS by 2018, reported Government Computing. Last week, West Suffolk published a tender worth an estimated £12.5m over 10 years in the Official Journal of the European Union (OJEU). Shropshire has since also issued a tender, but for a five-year contract, estimated to be worth between £1.5m and £3m over its lifetime. West Suffolk is seeking to buy not only an EPR, but also associated systems such as patient administration, medicine administration, e-prescribing, patient portal and care pathway management. In addition the trust is procuring a maternity system, a clinical portal including GP and community access, and systems for order communications, results reporting, clinical noting, assessments and observations. The OJEU notice explains that West Suffolk is seeking a single integrated solution from a single ‘strategic partner’ to provide clinicians with access to a growing set of clinical information over time. Shropshire, on the other hand, is looking to buy an EPR and integrated digital care record system to support the delivery of community health services.
EPRs essential for HES expansion plans: Hospitals will need electronic patient record (EPR) systems to meet NHS England’s “ambitious” plans for extracting a hugely expanded hospital dataset from April 2014, reported eHealth Insider. A consultation started this week on the commissioning board’s proposal to require a much larger dataset to be electronically provided by hospitals from the start of the next financial year. NHS England proposes to extract data including all tests and results, investigations performed and medications prescribed, as well as nursing observations. The expanded Hospital Episode Statistics dataset will ultimately be linked with a primary care dataset due to start being extracted from GP systems later this year, to create new Care Episode Statistics. NHS England acknowledges that the majority of trusts do not have the IT systems necessary for the planned extractions, but says trusts will have to work with commissioners to get the technology in place. NHS England chief data officer Geraint Lewis told eHealth Insider that current HES data is incomplete. “Within NHS England we have quite an ambitious plan about what kind of hospital data we think should start flowing so commissioners know much more about what’s happening in hospitals,” he said.
Some commissioners setting ‘unachievable’ targets, NHS England admits: NHS England is floating the possibility of scrapping the complex array of financial penalties and incentives currently imposed on NHS providers and replacing them, from 2015-16, with a single pay-for-performance premium, reported Health Service Journal (subscription required). An NHS England discussion paper currently being circulated to clinical commissioning groups and other bodies admits that the current system of “incentives, rewards and sanctions” is “often not used as intended”. It cites examples including “commissioners setting targets that cannot be achieved in order to avoid paying Commissioning for Quality and Innovation (CQUIN) monies”. Under the CQUIN scheme, providers can theoretically earn a premium worth 2.5% of their contract for meeting quality improvement targets. In other cases, it admits sanctions are “not being implemented in the event of performance failures”, or commissioners and providers have agreed block contracts which effectively “guarantee” the combined impact of all sanctions and incentives.
TPP MIG integration axed: Healthcare Gateway’s agreement with TPP to enable information sharing via its Medical Interoperability Gateway (MIG) has broken down and a pilot of the integration has been axed, reported eHealth Insider. The companies have different versions of events regarding who is to blame, but agree that they have failed to sign a contract to allow sharing of data held on SystmOne via the MIG. TPP announced in January that it would integrate with the MIG, meaning that more than 99% of GPs across the UK could share patient data securely. Healthcare Gateway, jointly owned by EMIS and INPS, released a statement this week saying it has been unable to agree terms with TPP for a contract, which was due to be signed this week. Managing director Peter Anderson said this means that a London pilot of the integration, due to start this month, will not go ahead. Anderson said the proposed terms of engagement for the interoperability project have remained the same since the beginning of the negotiations and that Healthcare Gateway has repeatedly extended signing deadlines. eHealth Insider also reported this week that the an agreement to work on direct sharing of information between TPP and EMIS users has collapsed.
NHS faces chronic shortage of staff, warns King’s Fund: A report has warned that the NHS is facing such chronic shortages of GPs, nurses and specialists in elderly care in the next few years that patients may not get the care they need, reported The Guardian. Deepening gaps in the service’s workforce are so serious that bosses may have to rip up longstanding national pay agreements in order to attract key staff, risking confrontation with the health unions, according to the King’s Fund think-tank. In an assessment of the NHS’s 1.4 million labour force, it concludes that while it will soon have too many hospital doctors, there will also be too few psychiatrists and emergency care doctors. It comes after the Commons Health Select Committee highlighted the fact that more than 80% of A&E units cannot provide coverage by an on-duty consultant for the 16 hours a day needed to guarantee the best possible care. “The potential shortages in the formal and informal workforce faced by the health and social care system are breath taking and will pose challenges to the implementation of new models of care. The scale and urgency of the task is immense,” said co-authors Candace Imison, the King’s Fund’s acting head of policy, and Richard Bohmer.
Nurses still struggling to influence IT: The Royal College of Nursing (RCN) has called for more nursing input into IT and more IT training for nurses after a survey uncovered a lack of confidence in clinical systems, reported eHealth Insider. The survey of 1,000 RCN members found the majority of nurses had no influence on the way technology was used in their workplace. Just under half (46%) said they had not been consulted at all about the introduction of IT systems and 54% said they had not been able to influence their use, even though 85% used a variety of systems on a daily basis. In addition, the survey found that many nurses are still struggling to share PCs, instead of using more modern technology at the bedside. A report on the survey says: “35% stated they had insufficient access to ICT equipment, or that the type of ICT tools they used were inadequate for their roles.” Dr Peter Carter, chief executive and general secretary of the RCN, said: “We would like to see nursing staff more involved in the implementation of e-health to ensure the focus of new technology is always on how it can improve care for patients.” The RCN report – ‘Positioning nursing in a digital world’ – suggests that nurses should have influence on trust boards and clinical commissioning groups “to promote nursing input to service transformations facilitated by e-health.”
NHS books £2.1bn surplus, but pressures growing: The National Health Service has booked a financial surplus of £2.1bn for 2012-13, remaining flat with that last year, reported Pharma Times. According to the National Audit Office (NAO), the figures show that there was sufficient money in the health service “to make ends meet”. However, it also highlights “a substantial gap” between those trusts with the largest surpluses and those with the largest deficits. This variation was also seen between local health economies, with differences most marked in London, where primary care trust clusters in parts of west London had some of the largest surpluses and outer north-east London one of the largest deficits. At first glance, the number of foundation trusts and NHS trusts reporting a deficit dropped from 31 at the end of 2011-12 to 25 at the end of 2012-13. However, a closer look reveals that trusts may be balancing their books only because they are getting extra local cash from health authorities; without this, 43 trusts would have been in the red in 2011/12 and 44 this year, the NAO said.
Health data access for just £1: NHS England wants to reduce the cost for researchers to access expanded healthcare datasets from around £30,000 to £1, reported eHealth Insider. The NHS England’s chief data officer Geraint Lewis said that it wants to reduce barriers to accessing the new datasets being created by the care.data programme. NHS England has launched a public consultation this week on plans to regularly extract an expanded Hospital Episode Statistics dataset, including things like prescriptions and nursing observations. This will feed into care.data, which broadly has five pipes of information colour-coded to reflect the risk to a person’s confidentiality of the data flow. The two amber streams of information are pseudonymised and can only be given to accredited users. One set will be for the “NHS family” such as commissioners, providers and the Care Quality Commission. The other is for use by public health services, researchers and think tanks and currently comes with a hefty price tag. “We think £20,000-£30,000 is a barrier we would like to remove if possible. We want more people analysing this data because we see the benefits it leads to,” Lewis said. The plan is to reduce the cost to just £1.
Public Health England launches drive to widen NHS Health Checks: Public Health England has launched a drive to improve the coverage of the NHS Health Checks scheme in order to reach its goal of providing them to 15 million patients by 2018/2019, reported Pulse. The body has a goal of inviting 20% more eligible people locally each year, and will soon launch a 10-point plan to help local authorities to start offering NHS Health Checks. Health secretary Jeremy Hunt has urged patients to take up the offer of an NHS Health Check and ‘start thinking more seriously about their health’, in a publicity campaign aimed at trying to increase uptake of the government’s flagship programme. The programme is set to be rolled out across the whole of England over the next five years, as part of Hunt’s ambition to save 30,000 lives a year by 2020 under a new ‘living well for longer’ policy.
38 doctors investigated for inappropriate social media use: Between 2008 and present, the General Medical Council (GMC) has dealt with investigations into 38 doctors in relation to allegations of inappropriate use of social media, reported Commissioning GP. In 2013, three of these doctors were referred to a fitness to practice hearing and all three were suspended. In total between 2008 and present, 13 GPs have had their social media activity scrutinised and three of these have had warnings placed for five years on their registration and six have had advice issued to them relating to their use of social media. There has been growing confusion over the GMC’s publication of their new explanatory guidance on doctor’s use of social media alongside the new edition of good medical practice for all UK doctors. Particularly lively discussion has centred on the GMC’s use of the phrase “If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name”. The GMC has issued further clarity on this issue, advising doctors to “use their professional judgement” to ascertain whether it would be prudent to identify themselves. The GMC has also said that a doctor failing to identify themselves online in itself will not raise questions about their fitness to practice.
A&E crisis plans ‘not good enough’, MPs say: Plans put in place to relieve the pressure on A&E units in England are not good enough, MPs have warned, reported the BBC. The Health Select Committee said it had been given “confusing” and “contradictory” information about what was being done. It prompted the cross-party group to question how prepared the NHS would be for next winter. NHS England said it was considering various measures to take pressure off A&E units ahead of the cold season. The MPs said staffing issues and rising attendances were among the main causes of the problems. Their evidence found just 17% of hospitals had the recommended level of consultant cover, while difficulties with discharging patients and a lack of beds at times meant the flow of patients through the system was disrupted. The report comes after the NHS missed its four-hour waiting-time target in the first three months of this year. In the long-term, the MPs urged NHS England’s medical director Professor Sir Bruce Keogh, who is leading a review of urgent and emergency care, to look at the weaknesses across the rest of the health service.
Opinion
How telehealth can make savings and improve patient care
This week in The Guardian Dr Simon Fradd, a GP in Southwark, says that on international self-care day, it is time to support patients in their role as experts in their health.
“The NHS is facing a £30bn hole in its budget by 2020 and Clare Gerada, chair of the Council of the Royal College of GPs has said that we are currently short of 8,000 GPs, and by 2021 we shall need an additional 16,000.
“It’s obvious that the current way of delivering healthcare within the NHS is not sustainable.
“There is already wide recognition of this and the development of integrated care pathways is evidence of progress. However, the savings generated are limited and the shift of location of care simply puts an even greater burden on general practice and primary care. Real savings come through removing the need for NHS care.
“Even where best practice is initiated, it is not always followed. I have been a patient in the past three years and am aware just how disempowering it is. Even as a GP who has been practising for 40 years, I waited to be told what to do rather than acting on my own initiative. What every patient needs is their own healthcare professional who can give reassurance and advice as soon as it’s needed.
“The vital thing here is interaction. As well as the technology, there must be a skilled, trained individual monitoring the data and interacting with the patient. If a chronic obstructive pulmonary disorder sufferer’s breathing deteriorates, early advice to use rescue medication can avoid hospital admission. The same can apply to heart failure patients who gain weight as a result of fluid retention.
“We are not going to get another 16,000 GPs or an additional £30bn. It’s time to support patients in their role as experts in their own health. A prime plank of this should be telehealth.”
How to engage GPs in developing primary care
This week Shilpa Ross, researcher for the King’s Fund and Dr Louise Marshall, specialty registrar of public health for the Nuffield Trust talk to the Guardian Healthcare Network about their study of six CCG case study sites, focusing on governance processes and structures as well as emerging relationships.
Ross and Marshall suggest that there is a sense of togetherness amongst some GPs and an enthusiasm for CCGs to succeed: “More than two-fifths of general practice respondents to our survey felt they could influence the work of their CCG – far higher than the number who thought they could have influenced primary care trusts (PCT) in the past system. Interviews suggested that the GP voice is better represented in CCGs than it was in PCTs.
“Importantly, the majority of GPs believed that CCGs have a legitimate role in influencing their members in terms of referrals, prescribing, and other issues – although some felt wary about the form that this involvement could take. There was concern that the financial environment that the NHS is facing, with significant savings needed over the coming years, may lead to CCGs performing a rationing function that could damage GP-patient relationships.”
However, they add that engagement awareness, support and involvement among CCG members is not universal: “Nearly half of our survey respondents without a formal role in the CCG feel disengaged in its work – lack of time and capacity being the most frequently cited reasons. CCG members are also less likely than leaders to believe the CCG is owned by its members. Low GP engagement was a major barrier to the success of previous models of clinical commissioning. It is therefore critical that CCGs continue and build momentum on engaging GP members. Driving service changes that will win the support of the clinical community may be important here.”
How the NHS can build partnerships with other organisations
This week, Matthew Harker, from the Guardian Healthcare Network asks whether successful partnerships can offer benefits to both the public and private sectors.
“There is no silver bullet. Health services will continue to experience increasing demands, both demographically and societally driven. Against this backdrop, the challenges of maintaining and improving quality standards and improving things for patients, at the same time as reducing spend, have been brought into sharp relief by recent events in Staffordshire and elsewhere.
“But how does the NHS affect the cultural and practical changes to patient behaviours? How do they achieve the investment in technology and other resources? How, without surrendering control of the clinical decision-making agenda, do they seek the funding and additional, commercial and other skills that they require?
“To meet this challenge, commissioning support units (CSUs) are being encouraged to start building partnerships with other NHS, commercial and third-sector organisations, who can bring fresh thinking and wider expertise to the NHS.”
Harker concludes by explaining that: “Partnerships also mean that risks can be shared and that investment can be attracted from partners who are more able to fund new technology and other resources. And lessons can be learnt from the experience of other parts of the private and public sector about innovative ways to get service users and their families engaged, and providers of healthcare services doing things differently.”
NHS technology strategy needs to go that extra mile for frontline staff
This week Colin Reid, CEO of TotalMobile discusses in OnMedica why NHS England’s forthcoming technology strategy needs to employ a ‘bottom up’ approach, providing frontline staff with the correct tools to deliver compassionate care every day.
“We are on a journey. The Department of Health’s (DH) first mandate told the then NHS Commissioning Board where we needed to get to in order to deliver an improved national health service. The DH’s ‘Power of Information’ strategy plotted the routes of healthcare providers, commissioners and technology suppliers to drive better heath, care and support.
“NHS England are looking to build a technology strategy to support the ‘Power of Information’ and the 2018 paperless vision, and are seeking industry views on what this will look like. Their scoping document, ‘Shaping a Technology Strategy for a 21st Century National Health Service’, highlights some key areas in technology for the NHS to move forward. I certainly welcome a technology strategy and believe it will provide much needed support and guidance to technology suppliers as the boundaries of the new NHS market economy are still being established. The main theme fuelling the strategy is ‘knowledge for all’.
“Now is the time to provide frontline carers with the tools to do their jobs. In the mandate’s foreword, Health Secretary Jeremy Hunt cited “offering health professionals more power and space” and this should certainly be a key priority for any technology strategy in the making. Providing staff with shared knowledge that empowers them to make better decisions and saves their time on unnecessary repetitive non-clinical tasks.
“With a plethora of views and opinions on where the NHS needs to be, it is vital that the technology roadmap does not veer off course. Imagine nurses or clinicians are driving to their next house call or walking across a ward, with a clear direction on how best to help the patients they meet along the way. With the best tools to do the job to the best of their ability with a sense of pride and satisfaction; being able to seamlessly integrate with other areas of the trust in real time, whilst still being able to give the patient the full attention they deserve on a daily basis. This is when we know we have arrived.”
Highland Marketing blog
In this week’s blog, Alex Leyton looks at the issue of perspective in today’s NHS media coverage.
