News in brief
Punish EPR laggers – Kelsey: Healthcare leaders must consider implementing “radical” proposals to improve the use of electronic patient records (EPRs), such as stripping training accreditation from providers who fail to implement them, Tim Kelsey has said. Speaking at the Healthcare Efficiency Through Technology expo in London, NHS England’s director of patients and information said providers who do not make the most of EPRs must be held to account, reported eHealth Insider. “There must be no tolerance for hospitals that are not taking seriously their obligation to safely and digitally record what is happening to their patients, because that means we cannot measure outcomes,” he said. Kelsey added that he would like the National Information Board’s information strategy, which is set to be released this year, to be “radical” in dealing with providers that do not make enough effort to implement EPRs. He specifically cited the recently released report of the Sowerby Commission set up by Imperial College London to assess the benefits and risks of EPRs, which recommended removing the training accreditation from trusts that “don’t take seriously” their obligations. He also criticised the healthcare system for failing “to make the case for technology on a pound by pound basis”. He said the informatics strategy will look at the return on investment that technology can provide across the health system; arguing that it could make a significant impact on the gap between NHS funding, demand and costs that could reach £30 billion by 2020. “If we can get an £8bn saving – at the low end [of analysis conducted for NHS England] – that’s a very significant contribution to the sustainability of the health system,” he said.
Miliband announces £2.5bn NHS ‘time to care fund’: Labour party leader Ed Miliband has announced that they would introduce a “£2.5bn NHS Time to Care Fund”, increasing health service funding at a greater rate than at present, if he formed a government next year. Speaking at the Labour party conference in Manchester, Miliband said the first priority for the new fund would be to fund 20,000 more nurses, 8,000 more GPs, 5,000 more care workers and 3,000 more midwives. Health Service Journal (subscription required) reports that he said he would make the health service the centrepiece of Labour’s election campaign. The funding would be raised by a new “mansion tax”; a “sin tax”, levied against tobacco manufacturers, and a clampdown on tax avoidance, with hedge funds singled out as a targeted sector, he said. Miliband told delegates: “We will clamp down on tax avoidance including tax loop holes for the hedge funds. We will use the proceeds on a mansion tax on homes above £2m. We will raise extra resources from the tabacco companies who make soaring profits on ill health. Labour has not yet said how the funding would be phased. However, Miliband said “there will be £2.5bn in an NHS time to care fund to start transforming services for the future.” The party indicated the funds would be provided on an annual basis, saying it policy will “raise £2.5bn a year”.
Nursing tech fund 2 to be open to all: Further details about the second round of NHS England’s Nursing Technology Fund, including an expansion of eligible organisations, are set to be released, according to eHealth Insider. Caroline Alexander, NHS England’s regional chief nurse for London, told the Healthcare Efficiency Through Technology conference that the organisation is “at the final stages of decision-making” for the second round of the fund, with an announcement expected soon. NHS England received more than 220 applications from 140 trusts for the first round of the fund, with 85 projects from 75 trusts chosen to receive a share of the £30m on offer. Alexander said NHS England is aware of frustrations from care providers about the limitations of the first round, which was open only to trusts and foundation trusts. She said she “anticipates” that the second round will be open to any providers of NHS-funded nursing care, including social enterprises and local authorities. “In the future, when care is delivered in a range of different settings, there needs to be that backing there for everyone.” Alexander said the second round of the fund will also allow applications for a wider range of projects than the first round, which focussed on mobile working, digital pens and bedside monitoring. “The first round was very quick, but we had to get it up and running quickly to help make changes in the most systematic way possible.” She added that she hoped the second round will encourage collaboration between the nursing profession and healthcare IT professionals.
GPs central to Labour plans for integrated care, says Burnham: Under plans reported by GP Online, shadow health secretary, Andy Burnham said a Labour government will ask hospitals trusts and other NHS bodies to “evolve into NHS integrated care organisations, working from home to hospital, co-ordinating all care – physical, mental and social”. There were few surprises in the Labour shadow health secretary’s address to the party’s annual conference in Manchester this week, which built on longstanding plans for integrated health and social care, and covered policy that has emerged over the past few days on the conference fringe. Burnham received a standing ovation when he repeated his promise to repeal the ‘toxic’ Health and Social Care Act 2012. He again set out plans to make public NHS bodies preferred providers for services. Burnham told party delegates his new integrated health and care service would mean patients and carers no longer having to retell their stories over and over again. “You and your carers will have one person to call to get help,” he said. Integration, he said, would mean people could be supported in their homes rather than hospitalised, saving money and doing what is right for patients. The Tories had told a “bare-faced lie” before the last election when they said there would be no top-down reorganisation, Burnham said.
Programme to improve commissioning tech-enabled care: NHS England’s telehealth programme has been “re-focused” to create practical to commission technology-enabled care services, reports The Commissioning Review. The Technology Enabled Care Services (TECS) programme was borne from the NHS’ flagship telehealth and telemedicine programme 3millionlives. NHS England medical director Professor Sir Bruce Keogh said that the programme will empower patients and improve health outcomes. An online toolkit, aimed at helping commissioners and health and social care professionals maximise the benefits of TECS, will be launched later this autumn. In a letter sent to around 250 key stakeholders, Sir Bruce said: “The TECS programme has been re-focused to address the demand from health and social care professionals for support and practical tools to commission, procure, implement and evaluate technology enabled care services. “Our ambition is to create the right commissioning environment that supports and encourages the innovative use of technology to improve health outcomes, empower patients, and deliver more cost-effective services as part of a modern model of integrated care.”
Link consumer tech to health IT – Newton: More interoperability is needed between consumer health technology and NHS systems, Public Health England’s chief innovation officer has argued. John Newton told the Healthcare Efficiency Through Technology expo in London that apps, wearable technology and patient-held records all hold promise, but only if they can interact with the systems used in healthcare, reported eHealth Insider. “There is a complete lack of integration between technology for health and well-being and those that operate for healthcare IT systems. These need to be brought together,” he said, adding that better integration methods and better standards are needed for this to happen. “Standards need to be simple and easy to implement. They need to be designed by the people that implement them if possible. There is so much more we can do to make standards easy to use,” he said. PHE is an executive agency of government, sponsored by the Department of Health. It is charged with “protecting and improving the nation’s health and wellbeing, and reduce health inequalities.” At the moment, it is probably best known for public health marketing campaigns, such as ‘Stoptober’, which encourages smokers to give up smoking for a month. Newton said such campaigns are expensive to run, but very successful. However, he argued that in the longer term the NHS needs to have “three adult conversations” about health and technology. The first is with patients about how the health service can support [them] to take responsibility for their health and care. Technology can do that in ways we’ve only started to talk about. The second is about how to give health and social care professionals the data they need to reflect on what they are doing and how to improve. And the third is with industry, and “how to enable them to help us to implement these changes,” he said.
PHRs focus of IT strategy – Williams: Personal health records (PHRs) systems are set to be a significant part of the National Information Board’s upcoming informatics strategy, Health and Social Care Information (HSCIC) chief executive Andy Williams has said. eHealth Insider (EHI) has reported that the long-awaited strategy is set to be released later this year, outlining a ten-year plan for how to make the most of data and technology in healthcare. Williams told EHI the strategy will “say a lot” about access to personal health records for patients and what systems must be put in place for them. “I think over time, some of that [access to personal health records] will be done through national systems, some of it will be done locally, and our job is to make sure the national systems are developed, and that the local systems are enabled. The NIB strategy is about how do we bring that information together and make the most of it.” Williams said the strategy will provide a “high-level agenda” for the health and social care sector with the HSCIC set to implement the majority of the significant informatics projects. He said it should also clarify questions about the HSCIC’s role and its relationship with NHS England and other healthcare organisations. Williams acknowledged there have been some “misunderstandings” about the respective roles of the HSCIC and NHS England, but said the organisations have been working closely together to ensure there is no confusion. “This system has only been in operation for 18 months or so, and you still get some overlaps and confusion, but we are working those through. The governance arrangements that exist and are starting to work are now a key part of that, and we are certainly in the right direction.”
GPs restricting patients’ access to online records: GPs are restricting patients’ access to records to that specified in the GP contract amid fears over a “blunt tool” that could cause data protection issues, systems providers have said. EMIS has said that the numbers of practices providing patients with online access to their records has “shot up” after it allowed GPs to tailor the parts of the record that patients can see. The 2014/15 GMS contract requires GPs to provide patients with online access to the medication, allergies and adverse reactions in their summary care record as a minimum, by April 2015, reported Pulse. However NHS managers have said they expect GPs to “go beyond” these contract minimums. EMIS has made revisions to its system that allows practices to set access limits for the entire patient list, or customise it for individuals, including access to free text, letters and documents that would otherwise need to be assessed for third party or harmful information. Ben Foster, an operations director at EMIS, said that practices were “nervous” about the “blunt tool” of online access. He said: “All of this comes from conversations with practices who might say ‘I’m a bit nervous about this blunt tool: switching it on or off, if I could enable certain bits it’s really going to help us take up the service’.” He added: “Since going live, hundreds of practices have chosen to enable part of the record. I think, initially, around 100 practices had it enabled in the old [all or nothing] way, but since enabling [tailored access] we’ve seen it shoot up with the move towards April 2015.” Other system suppliers are currently developing their systems to allow tailored access in line with the GP Systems of Choice provider requirements.
Faster electronic reporting for GPs: Legal & General has announced it is the first insurer to adopt software which will cut the waiting times for GPs’ insurance reports. Intelligent GP Reporting (iGPR) allows GPs to automate the redacting of confidential patient information, before reviewing it and then sending it to insurers via secure electronic delivery. The iGPR system has been developed by Niche Health and Inchware and has been shown to reduce the time spent by GPs and administrators on insurance reports from 73 minutes to 10 minutes, reports Cover Magazine. Explicit permission must be gained from the patient before any records can be disclosed. Every GP surgery in the UK will be offered the chance to introduce iGPR, which should help surgeries which currently struggle to meet deadlines seat for delivering the information fast while still complying with Data Protection and NHS security requirements. Guy Bridgewater, managing director of Niche Health said: “iGPR will be adopted by other major insurers over the coming months and Niche Health is excited about the enormous benefits that iGPR will bring to patients, GPs and insurers alike. Legal & General are the first of many third party organisations that recognise the importance of making reporting as secure, simple and effective for GPs as possible, whilst responsibly serving their customers’ needs as quickly as possible.” A statement from the ABI said: “The ABI welcomes today’s launch of the Niche Health system for accessing medical information as it has the potential to benefit customers, GPs, and insurers.”
Patient safety incident reporting continues to improve: NHS England has welcomed the publication of six-monthly data on patient safety incidents reported to the National Reporting and Learning System (NRLS) between 1 October 2013 and 30 April 2014. The data shows the NHS is continuing to get better at recognising and reporting patient safety incidents. Acute hospitals, mental health services, community trusts, ambulance services and primary care organisations report incidents to the NRLS where any patient could have been harmed or has suffered any level of harm. The data published today sees an increase of 12.8% in the number of incidents reported compared to the same six month period in the previous year. This increase shows the NHS is continuing to be more open and transparent around the reporting of patient safety incidents. The reporting of incidents to a national central system helps protect patients from avoidable harm by increasing opportunities to learn from mistakes and where things go wrong. The NHS uses these reports to identify and take action to prevent emerging patterns of incidents on a national level via patient safety alerts. These alerts are a crucial part of the NHS’ work to rapidly alert the healthcare system to risks and to provide guidance on preventing potential incidents that may lead to avoidable harm or death.
Paper records could cause thousands of NHS deaths: Thousands of patients could be dying every year because of mistakes by nurses using paper charts to monitor them, new research suggests. A study published in BMJ Quality & Safety found that death rates at two major hospitals fell by more than 15% when nurses were instead given handheld computers to monitor patients’ vital signs. The drop in mortality represented more than 750 lives saved in a single year across the two sites, which could equate to tens of thousands of lives across the NHS, according to The Telegraph. In most hospitals, nurses record patients’ blood pressure, pulse, oxygen levels and other indicators on paper, which can lead to errors in calculations, and mistakes from poor handwriting. The handheld devices – now in use in around 40 hospitals in England – use software to calculate if the patient is deteriorating, and warns staff when they need to increase the frequency of monitoring, or alert a doctor or rapid response team. The introduction of the new system was followed by a fall of almost 400 deaths among patients in one year at Queen Alexandra Hospital, Portsmouth, and a drop of more than 370 in the same period at University Hospital, Coventry, according to the research. An accompanying editorial in the journal described the research as “an important milestone” in improving patient safety and said the lowering of mortality at these two hospitals “represents a truly dramatic improvement”. The system was developed by doctors and nurses at Portsmouth working together with health improvement company The Learning Clinic.
Elsevier enhances ClinicalKey, improving point-of-care search with new intuitive topic pages and any-device mobile format: Elsevier, a world-leading provider of scientific, technical and medical information products and services has launched an enhanced version of ClinicalKey that incorporates extensive feedback from clinician users, reported PR Newswire. New intuitive topic pages, a design easily viewable on any mobile device, and multi-layered search functions lead the list of improvements to Elsevier’s premier point-of-care clinical resource. By providing both a general topic view and specific answers, ClinicalKey helps clinicians rapidly access evidence-based, peer reviewed information to improve speed to accurate diagnosis and treatment, with the goal of improving patient outcomes and lowering the high cost of care. Its features have been designed utilising extensive research on the search behaviours and content preferences of doctors. “Physicians need a single, flexible clinical resource, one that provides trusted responses whether they’re making a quick drug dosage check, a short confirmation regarding a diagnostic study, or a deeper dive into current literature on a specific research topic,” said Dr Peter Edelstein, chief medical officer, Elsevier Clinical Solutions. “In all these cases, physicians require fast, complete, convenient and targeted answers. The enhanced ClinicalKey works on all those levels. At least one in 20 U.S. adult outpatients, or 12 million people, are misdiagnosed annually, according to an April 2014 study in BMJ Quality & Safety [1]. Only with rapid, accurate medical insights can physicians reduce misdiagnosis, delayed diagnoses, and inconsistent outcomes,” Edelstein said.
NHS whistleblowing ‘problems persist’: Whistleblowers still face real problems in speaking out in the health service – despite the push to create a more open culture, campaigners say. Promoting whistleblowing was a key recommendation of the public inquiry into the Stafford Hospital scandal. A number of steps have since been taken in England, but Patients First warned that a “culture of fear” still existed, reported the BBC. It has produced a dossier of 70 cases, highlighting problems like bullying and mismanagement of complaints. The document is being handed in as part of Patients First’s submission to an independent review of whistleblowing, which was set up by the Department of Health in England and is being led by Sir Robert Francis, who was in charge of the Stafford public inquiry. Nearly half the cases are continuing, but Patients First said all had suffered some loss either professionally, personally or financially. In 79% of cases, the whistleblower had experienced bullying and in a fifth of cases the individual had run out of money or was unable to access legal advice, the dossier – which also included some Scottish cases – said. It concluded there was a “real and continuing problem over the treatment of those who raise concerns”. The warning comes after a range of measures were put in place to try to encourage whistleblowing.
EHI Awards 2014: Highland Marketing is sponsoring the ‘Best use of social media to deliver a healthcare campaign’ category of this year’s EHI Awards. Media such as Twitter and Facebook are useful tools to seek out hard-to-reach groups and deliver information to support health campaigns. This category will identify the smartest operators and most successful campaigns. Finalists include – The King’s Fund digital advent calendar – using Vine to spread important health messages – The King’s Fund; Feel well, choose well – NHS Arden Commissioning Support; Facetime for ITU – The Walton Centre NHS Foundation Trust; and MyHealth – Patient.co.uk. The awards take place on Thursday 9th October at the Roundhouse, London.
Opinion
Using the right tool for the job – Mobile apps for healthcare
Andrew Jones, marketing director at Multitone, looks at the growing popularity of mobile apps and how they have revolutionised the way in which many of us live our lives. And he asks whether using apps in the healthcare sector is the right tool for the job.
“Mobile apps have revolutionised the way in which many of us live our lives. From the workplace to our private lives, having a dedicated app is an ideal way to access and share information with other interested parties.
“There are three main areas in which apps could be utilised in the healthcare sector – firstly the monitoring and reporting of health conditions and medication administration with regards to treatment. Secondly, an app can be used for vital communications between members of a healthcare team, including records and data collection. Thirdly, apps can be used to assess patient feedback on services to aid performance improvements and provide patient information. The degree by which accuracy can vary is important between each of these applications and therefore the level of regulation may need to alter to find the right balance between securing safety and opening the field up for app development.
“Applications that monitor healthcare conditions are arguably the most potentially risky applications to cater for, as people’s lives would be dependent on the integrity and reliability of the app. There are more than 13,000 medical apps available across the major mobile device platforms and yet only 103 of these can show they are recognised by the relevant regulatory board for professional use.
“In conclusion smart apps are here to stay and good use of them could save the healthcare industry money, resource and time. However, this form of device needs to be recognised for what it is and used only when it can be truly beneficial. Lack of regulation, poor advice or a lack of advice from the industry for medical-style apps could see a host of users seeking professional help inappropriately or when it is too late.”
The NHS faces the biggest funding challenge in its history
The financial situation facing the NHS is one of the biggest challenges in its history but pumping more money into the system alone cannot improve care quality, argues Richard Taunt, director of policy at the Health Foundation.
“What if there is no financial knight in shining armour coming to save the NHS? What if the black hole at the heart of NHS finances, projected to reach £30bn by 2021, stays empty? What would the NHS do, and what would be the effect? More than money: closing the NHS quality gap, published this month, explores these questions. In particular, in line with the Health Foundation’s focus on improving quality, we’ve zoomed in on how quality could be affected in such a scenario – and how you stop that happening.
“So what if there was no more money, and the NHS had to live within its means? Other countries have been there and had to make wide ranging changes in order to balance the books. Regional health budgets in Spain fell on average by 5% between 2010 and 2012. Salaries were slashed by 7%, the training budget was reduced by three quarters. A range of services were closed, from out of hours primary care to operating theatres. Patient charges were increased, and new ones introduced. If anything, Ireland’s response was even more drastic, with real terms spending per capita falling by 8.7% between 2008 and 2012. Starting salaries for nurses were cut by 20%, and 30% for consultants. Nursing numbers fell by 1,600 (4%).
“So far, so unappealing. The Health Foundation and the Foundation Trust Network held a workshop with 25 senior leaders from 25 NHS and foundation trusts to explore what they would do in order to ensure a hypothetical trust forecasting a deficit broke even in the short term. Responses were very similar to those seen internationally: reducing the staffing bill, missing access targets, stopping capital projects and cutting training budgets. With finances deteriorating rapidly and key areas of quality (such as accident and emergency waiting times) reducing, all the ingredients for a crisis in the NHS are starting to assemble. However, such a crisis is entirely avoidable. How much funding the NHS receives is a political choice. It is almost certain that without additional ongoing resources the NHS will be unable to maintain the current quality and breadth of services. There will always be a gap between the quality the NHS could achieve and what it does. That gap is already unacceptably wide, with far too much variation between and even within providers.
“However, without an adequate response to the financial challenge there is a real risk this ‘quality gap’ will grow ever wider. The question is not whether change is needed, but how it can be supported to happen.”
Involving hospital staff is key to implementing new technology
Asking clinicians for suggestions and feedback during new IT projects can lead to better patient outcomes, says Julia Ball, assistant director of nursing, University Hospitals of Leicester NHS Trust.
“During 2013-14, University hospitals of Leicester NHS trust (UHL) treated 1,194,000 patients (or 3,271 patients a day). With the numbers treated set to rise year-on-year, we need to better equip our staff to cope with the additional pressures that will bring. Like many trusts, our staff are feeling the pressure of the NHS constantly being in the media spotlight. The media focus is often on poor outcomes. It is almost forgotten that the vast majority of hard-working staff provide world-class patient care.
“Fifteen months ago, our chief executive, John Adler, took on the challenge of boosting morale. He recognised that in order to achieve our strategy to become “paper light”, and with government targets to consider, we needed to listen to our frontline staff. The overwhelming feedback has been frustration about the amount of time spent on paperwork and the subsequent impact on patient care. Staff want less paper and more technology to support them in their roles.
“So we have set out to use mobile technology to change the working lives of our frontline staff. This approach, along with our paper light vision, has been accelerated by applying and winning investment from NHS England’s nursing technology fund for mobile devices, such as iPads and iPhones for staff use, as well as mobile software, designed to record patients’ vital signs.
“Nurses no longer have to spend hours chasing updates by phone. As a result, staff are more visible to their patients, spending more time at their bedside. Our staff feel content as they are able to better use their skills for caring, and our patients are happier as they feel they are getting a better service.
“This is a very powerful way of working, which has produced strong advocacy for the new system. We have also been proactive in our formal internal communications activities and together the results have been staggering: the number of system users is continually increasing in frequency and I have found consultants and nurses knocking on my door asking when they are going to get the software!”
Facing the funding conundrum
Nigel Edwards, chief executive at the Nuffield Trust, evaluates the financial future of the NHS and Labour’s ‘time to care’ fund.
“The future funding of health and social care is arguably the big public policy conundrum of our age. Yet, until now, politicians have been reluctant to address the unprecedented financial squeeze facing both the NHS and social care.
“Alarm bells have been sounding about the financial health of the NHS for some time now. Back in 2012 we warned of a yawning £30bn funding gap within a decade; earlier this year we warned of a funding crisis before the General Election; and figures released just last week showed that even the hospitals we’d expect to be financially viable are going into the red.
“The announcement of additional nurses, midwives, doctors and care workers does respond to some obvious problems. But the specificity of the proposals and the top down way in which the changes are presented is a source of concern. The redesign of complex local delivery systems cannot be achieved by this type of initiative. Indeed the idea that the design of the system is done by the centre may undermine local initiative and make the task of change even harder.
“Sadly, without a plan for the NHS to break even in the next parliament, Labour’s ‘time to care’ fund may start to resemble another well-intentioned but problematic policy: the Better Care Fund. Both policies have the right end goal in sight – better care outside hospitals. Both purport to offer an answer to the question of where the money comes from. But both ultimately risk ending up falling into a black hole caused by an underfunded system.”
Highland Marketing blog
In this week’s blog Mark Venables reflects on this week’s HETT Expo and asks whether we can keep the public pound on NHS IT.
