News in brief
Lamb supports tech for integrated care: Technological innovation is “critical and central” to integrating care and addressing the financial pressures facing the NHS, care minister Norman Lamb has said. Lamb spoke about the government’s push for integrated health and social care at the Health + Care conference in London this week, reported eHealth Insider. He told attendees the “extraordinary fragmentation” between health and social care providers has to be addressed if a potential NHS funding gap of £30bn by 2021 is to be dealt with. “We need to think beyond bricks and mortar, this separation between health and social care – and collaboration at a local level of all the players seems to be vital for success.” Lamb said technology will play a “critical” role in helping to cut down on healthcare budgets, and cited the growing number of healthcare applications as an example of potential solutions. “There is a level of experimentation that has to happen if we are to meet the most extraordinary challenges that we face. We need to develop new ways of working and further efficiencies to ensure that we have sustainable healthcare in the future, and the role of technology is going to be critical and central to this.” Lamb said the 14 areas chosen as ‘integrated care pioneers’ by the Department of Health (DH) are doing “really fascinating and excellent work”, developing shared care records and using technology to provide a single point of contact for care users. The DH has also been working with the pioneers on the issue of data sharing. Lamb indicated it has been holding workshops with care providers and commissioners to address concerns about how to share information and remove “bureaucratic barriers” to progress. Better access to data will help clinicians to improve their decision making, he said.
Hunt calls for shared records and data: The NHS will not reach its full potential without the sharing of electronic patient records across health and social care, Jeremy Hunt has said. Speaking at the Health + Care conference in London, the health secretary set out four “basic things without which we will not reach the potential that is possible” in the NHS, according to eHealth Insider. “We need to be able to share electronic health records across the entire system so that patients feel that they are receiving absolutely integrated care,” he said. His second essential item was real time health and social care costs for every individual for whom care is commissioned. “Until we have that financial information, it is impossible to work out how integrated care can both give better outcomes and save money.” The third and fourth items on his list were leadership and the “full involvement” of the acute sector in making NHS commissioning work, and improving the reporting culture in the NHS. Hunt has been a consistent supporter of the use of IT in the NHS. In January last year, he called for the NHS to aim to become ‘paperless’ by 2018, and followed this up with two rounds of tech fund money to encourage trusts to buy electronic patient record and patient safety systems. The latest round of bidding for what is now called the ‘Integrated Digital Care Technology Fund’ opened in May and is open to both trusts and councils that want to put in bids for systems to support integrated care. Tech fund 2 bidding closes on 14 July. Responding to a question from the audience, the health secretary also promised that pharmacists would be given access to patient records.
Scotland’s NHS ‘teetering on the edge of collapse’: Scotland’s NHS is “teetering on the edge of collapse” and needs urgent reform to survive, the country’s most senior GP has warned in a scathing condemnation of the Scottish National Party’s (SNP) record in office. Dr Brian Keighley, chairman of the British Medical Association (BMA) in Scotland, said there has been “continuing crisis management of the longest car crash in my memory” over the past five years instead of ministers implementing long-term solutions, reported The Telegraph. Warning that “cracks” are emerging in everything from the provision of hospital food to cancer waiting times targets, he mocked the Scottish Government’s new promise of a truly seven-day NHS when all that is funded at the moment is “an inadequate five-day service”. He used his final address as Scottish chairman to the BMA’s Annual Representatives Meeting to warn that SNP ministers were “fiddling at the margins with short-term fixes” despite the fact “Rome is burning”. Dr Keighley said that, regardless of the independence referendum result, Scots are facing a crucial decision on how much tax they want to pay for a health service and how comprehensive they want it to be. Referring to his fight against “rampant managerialism” in the Scottish NHS, he concluded: “My main regret is that I have not been able to do more than act as a deckchair attendant on the good ship NHS Titanic.” His unprecedented intervention came as Alex Neil, the Scottish health minister, reacted to lengthening cancer treatment waiting times by announcing £2.5mn of extra funding for health boards.
Kelsey says ‘listen with data’: NHS commissioners cannot “listen” to what patients need without tools such as care.data to help them, Tim Kelsey, NHS England’s director of patients and information has argued. Speaking at the Health + Care conference in London this week, Kelsey said that in order to improve and sustain health services, there are four types of data needed, reported eHealth Insider. “The really important thing is how to do listening. Listening requires a data revolution. I don’t think we can listen without the data tools to enable us to do so,” he said. “It’s about the community being able to feed back on the services they need to use. That’s about four types of data.” The first is the controversial care.data scheme which will, in first instance, see patient data extracted from GP practices into the Health and Social Care Information Centre where it will be linked with data from hospitals. Kelsey said he is well aware that care.data has “run into a bit of trouble” because privacy campaigners and the public are concerned about how the data will be collected and used. The GP extractions were due to begin in March this year, but NHS England announced a six month delay to the start of the programme, claiming this would help it to make sure the right safeguards were in place. An earlier leaflet campaign ran into trouble from campaigners, who argued it lacked detail about what was proposed, failed to specify who would have access to data, and failed to include an opt-out form. “As it turns out there just aren’t the safeguards in place to ensure it’s only used for health benefits, so we delayed until autumn to make sure these are in place,” said Kelsey.
NHS England: CCG interest in controlling CSUs ‘evaporates’: The appetite of clinical commissioning groups (CCGs) to take control of their support service suppliers has dwindled, NHS England has claimed. Speaking at the Commissioning Show in London, Bob Ricketts, NHS England’s director for commissioning support strategy and market development, said there was “a lot of interest among commissioning support units in [becoming] staff mutuals and social enterprises”, reported Health Service Journal (subscription required). “That’s where I guess I would put most of my money if I was betting on it,” he said. CSUs have to become independent of NHS England by the end of 2016. The agency outlined four potential options for clinical support unit (CSU) autonomy at the beginning of 2014: a staff owned mutual; a social enterprise; a joint venture company limited by shares; and a CCG controlled option. Ricketts said: “Last year there was a lot of interest among CCGs for customer control. That seems to have evaporated a bit.” Guidance on the options for autonomy of CSUs is expected to be published in late July, along with details on the consultation process CSUs will have to go through to become independent. Ricketts also said that CSUs, which do not gain accreditation to NHS England’s lead provider framework for support services, will not be able to become independent. This framework aims to assure quality and accredit a range of support service providers, which either individually or through partnerships offer a full range of commissioning support services. CSUs would face a “crunch point” towards the end of this year when the lead provider framework procurement reached its invitation to tender stage, Ricketts added.
ASH consultation out ‘soon’: New regulations on how patient identifiable data can be provided to commissioners should be in place by the end of 2014, NHS England and the Health and Social Care Information Centre (HSCIC) have said. Representatives from both organisations discussed the contentious issue at the Health + Care conference in London this week. The Health and Social Care Act, passed in 2012, failed to pass some key data handling responsibilities from primary care trusts to the new commissioning organisations it established, according to eHealth Insider. Commissioners and companies working with them have said that the act makes it more difficult to obtain the information they need to deal with planning and population health issues. But Dame Fiona Caldicott’s second review of information governance confirmed that non-identifiable information should be used. Ming Tang, NHS England’s director for data and information management services, said it has been working closely with the Department of Health on changes to the regulations for data management. Tang said the work has included a focus on clarifying the legal status of ‘accredited safe havens’ – the organisations from which commissioners can access some patient identifiable data. She said a public consultation document on accredited safe havens will be released soon to provide a better understanding of which organisations will qualify, their purpose, and the restrictions they will face. Martin Dennys, the HSCIC’s director of data services for commissioners, said the safe havens will have “significant controls” that they need to meet, including explaining to patients what identifiable information is being shared about them and why.
Monitor encourages NHS to be innovative to deliver change: Monitor will aim to give healthcare providers and NHS foundation trusts greater freedom to take “appropriate risks” in order to deliver better care for patients through innovative services, reported National Health Executive. Within its annual plan for 2014-15, the regulator stated it will continue to help NHS foundation trusts develop their capabilities and strengthen their governance, in order to reduce the risk that providers fail in the future. In particular, it will focus on the capabilities that drive long-term performance, namely: strategic and business planning; organisational development; operational performance improvement and individual leadership. Dr David Bennett, chief executive of Monitor, said: “We’re planning for a lot of changes this year at Monitor; not just in our own work but in the way we support NHS foundation trusts to develop better care for patients. We recognise that in order to promote innovation we have to let healthcare providers take measured risks, and will be working to take a balanced approach when there are ideas for change. The need for change in the NHS is well known, but it shouldn’t be seen as a threat; it is an opportunity for radical and lasting improvement.” In addition to this work, Monitor will continue to assess NHS trusts applying for foundation trust status, but before this can be awarded they must meet “quality performance thresholds and can continue to do so on a sustainable basis”. To assess quality performance, Monitor will continue to work closely with the Care Quality Commission (CQC) and will set out how it will align its regulatory approach with CQC’s emerging inspection regime.
One-fifth of hospitals ‘may be covering up mistakes’: A fifth of hospital trusts in England may be covering up mistakes, a government review suggests. The analysis of reporting incidents shows 29 out of 141 trusts were not registering the expected number of safety incidents. The review said this may be a sign of a “poor” safety culture. Health Secretary Jeremy Hunt said it was important hospitals were “open and honest”, and that patients had a right to know about problems with reporting. The data has been released as part of the Department of Health and NHS England’s drive to improve safety in the NHS, according to the BBC. In March, Hunt set the target of saving 6,000 lives over the next three years by reducing the number of serious mistakes. He asked trusts to join the Sign up to Safety campaign and draw up plans to halve “avoidable harm” such as medication errors, blood clots and bedsores by 2016-17. He said this could stop a third of preventable deaths in the coming years – equivalent to 6,000 lives saved. As part of the Sign up for Safety campaign, Hunt launched a website that will let the public compare hospitals in England based on a number of safety indicators, reported eHealth Insider. The website, called ‘How Safe is my Hospital’, is part of NHS Choices and will include indicators such as ward level staffing levels, incident reporting levels, pressure ulcers, falls and how the hospital is complying with patient safety alerts. The website will allow patients to view the performance of individual hospitals on measures such as safe staffing levels and infection rates. It will also reveal which trusts have been given a poor rating for open and honest reporting.
Morecambe Bay NHS Foundation Trust placed in special measures: A failing health trust has been placed in special measures, meaning all Cumbria hospital trusts are now getting extra help to boost performance, reported the BBC. University Hospitals of Morecambe Bay NHS Foundation Trust was rated as inadequate in an inspection by the Care Quality Commission (CQC). It said the Royal Lancaster Infirmary and Furness General Hospital in Barrow needed to improve the quality of care. The trust said it was “part-way through a process of significant improvement”. Last year, a separate trust covering the north of the county, North Cumbria University Hospitals Trust, was one of 11 put into special measures after the Keogh review found higher-than-expected mortality rates. The CQC inspection took place in February and while inspectors said care in services such as maternity and A&E had improved since previous checks, they added other areas of concern had not been addressed. Medical care in one part of the Royal Lancaster was said to be “of particular concern”. The overall recruitment of nurses and doctors was identified as a “fundamental” worry with “too much reliance” on temporary staff. The chief inspector of hospitals, professor Sir Mike Richards, said: “There is a long history of concern with the quality of service provided by the trust, so it is disappointing to report that a number of the issues that have been identified in the past remain unresolved. I do not believe that the trust is likely to resolve its challenges without external support.” Full reports of the inspection have been published on the CQC website.
Open source EPR gives Taunton options: Taunton and Somerset NHS Foundation Trust says IMS MAXIMS’ open source plans are giving it options it has never had before as it prepares to implement the company’s electronic patient record system (EPR), reported eHealth Insider. However, trust IT director Malcolm Senior has said the EPR’s open source benefits are being put to one side as the trust focuses on getting the first phase of the system live by May 2015. Taunton chose IMS MAXIMS as its preferred bidder to provide its patient administration system as well as A&E, theatre and reporting modules in March. The announcement came as IMS MAXIMS confirmed plans to become open source and release the source code for its EPR system on GitHub, meaning Taunton could become the first acute NHS trust to implement an open source EPR. However, Senior said the trust chose IMS MAXIMS as a favourite before it announced its open source plans. It will have a “traditional” support contract with IMS MAXIMS, although it will not pay any software licence fee. “We’re looking to get support from them because it’s their system, and you just have to make sure you keep risks to a bare minimum when you’re migrating, because you’ve got a hospital to run.” Senior argued the software’s open source status will give the trust flexibility to look for other support providers once it is set up, rather than being locked-in to one supplier.
Over half the public still unaware of care.data: More than half of the public have still ‘never heard of’ NHS England’s flagship patient record sharing scheme, care.data, despite it being delayed to ‘build public understanding’ of its benefits, an IPSOS MORI poll has revealed. The results of the survey commissioned by the Joseph Rowntree Reform Foundation also found that more than half of the public did not think the scheme should be run on an ‘opt-out’ basis, reported Pulse. It comes as the British Medical Association’s annual representatives meeting voted in favour of a motion stating that care.data should be opt-in only – a policy previously passed by the Local Medical Committees Conference. The General Practitioner Committee have responded to the survey saying the figures demonstrate the ‘woefully inadequate’ understanding amongst the public which NHS England had failed to address. GP leaders added that an-opt out system could only ever be justified when patients can give ‘informed consent’ to opt out. The survey of 1,958 UK adults found that 40% of the public thought their GP should only be allowed to share their data. Around one in four – 27% – of the respondents said GPs should be able to share patient records if they had been informed and given a chance to opt out and 10% thought it should be shared even without informing them. Just 3% of the public said they understand the care.data scheme very well, with 9% saying they understood a little. But 51% of the public said they had never heard of the scheme and 13% had heard of it but didn’t know what it was.
Central London trust targets £21.38m IT transformation: Central London Community Healthcare (CLCH) NHS Trust is targeting a five year, £21.38m IT revamp, including the development of telehealth services and equipping frontline healthcare staff with mobile devices as part of a wider tender for corporate support services, reported Government Computing. IT forms one component of the tender, which calls for a strategic partner to work with the trust to perform transactional services in a number of areas including ICT, HR, finance and property maintenance. The total contract is valued between £81m and £289m, depending on possible extensions and changes to service volumes. According to the tender, the trust aims to simplify, streamline and automate its internal processes and provide an “enabled service” powered by new technology over a seven year period – with a possible option for a further three year extension. Services sought by the trust under the contract include the provision of software development, user application support and development, business systems training, application and data processing services. Temporary staffing, as well as workforce information services and payroll are also included in the tender requirements. The strategic partner being sought through the tender may also be tasked with overseeing the trust’s planned £21.38m IT strategy, according to the contract. This strategy aims to introduce improvements and innovations over a five year period that includes the planned introduction of telehealth services and providing frontline staff with mobile devices. Ian Millar, director of finance and corporate resources at CLCH said that the hospital body has a track record of maintaining small scale outsourced contracts. Millar added that the tender for its new transformational programme represented a “new and exciting future” for the trust.
Increasing challenges to healthcare come from over-85 age group: Health services need to adapt to suit the growing challenges of the over 85 age group, if the UK is to effectively meet the needs of an ageing populace, according to new statistics from the Health and Social Care Information Centre (HSCIC). Researching the health requirements of adults over 65 in England, the HSCIC results confirm that complications increase significantly once adults enter the over-85 age group, suggesting that reaching ‘old age’ now occurs later than society may have previously viewed, reported homecare.co.uk. With people aged 85 or over now accounting for 1 in 44 of the population, the results of ‘Focus on the Health and Care of Older People’ show that over the last 20 years the number of hospital day cases has decreased for all age groups except this one; that 77% of people from this age group accessed one of inpatient, outpatient or A&E services in 2012-13, compared to 65% aged between 65-85; and that two in three of these admissions were through emergency channels, compared to one in three for those aged 65-85. HSCIC lead clinician Martin Severs said: “Today’s report gives fresh insight, with original analysis, into the typical profile of an older person in England today. By looking at change over time our report provides a broad understanding of an ageing population and the implications this group may have for health and care services. As a geriatrician for almost 30 years I have seen huge changes in the health and care of older people and health and care activity for this group. We hope that a better understanding of the ageing population could help shape a better future for this group.”
Eight and half years ago Jane Eccles had an emergency c-section and gave birth to a son, George. Whilst in hospital she fell ill contracting Necrotising Fasciitis (NF), more commonly known as the flesh eating superbug. She was given 2 hours to live as once NF gets ahold there can be no stopping it. Jane was in Intensive Care and had numerous surgeries in a short space of time. Surviving against all odds, Jane was told that she would most probably never be able to walk again, let alone return to her role as a teacher. In the same defiant form that helped her survive, Jane spent the next few months in a wheelchair focusing on learning to walk.
Incredibly Jane and her husband Graeme are now about to cycle over 1000 miles in 14 days, with no backup support, raising money for the Lee Spark NF Foundation. The Foundation helps medical professionals become more aware of the NF disease, symptoms and treatments. It’s a huge challenge for Jane, especially as she could not even lift her leg over a crossbar 2 years ago.
To find out more about the charity cycle visit Jane’s website. To sponsor Jane visit her Virgin Money Giving page. Many thanks for your support!
Opinion
Integration pioneers dare to dream big
Despite its fiscal problems, Health Service Journal (subscription required) editor Alistair McLellan, argues that the Better Care Fund is being used as a “launch pad” to help health and social care organisations meet their integration ambitions.
McLellan says the fund has produced some very significant conclusions about the future shape of services, with many aiming for a single budget across health and social care: “However, pooling funds will mean nothing if it is not used to drive service change. In Sheffield the focus is on the development of intermediate care. Notably, the partners have already begun to think about how the aims of the joined up service might be expressed in contractual terms, while health and social care providers are being encouraged to get comfortable about working together. Equally significantly, may not need to hold a competitive tender to establish the new arrangements.
“Before Sheffield’s announcement the biggest joint budget was Hertfordshire’s £240m. The county’s plan speaks of ensuring service users are given “a lead or accountable professional” who would help them “navigate our health and social care system” and also promises services will “responsibly share data and information on patients” across organisational boundaries.
“The last few months have seen a regular drip feed of bad news about NHS finances and credible warnings about the sustainability of many social care services. The plans being put together in, for example, Sheffield and Hertfordshire will perhaps fall short of their lofty goals – but in the context within which they have been produced we should welcome their ambition.”
NHS performance: are we really getting it right?
This week Hugh Alderwick, the senior policy assistant to the CEO and integrated care programme manager, contributes to King’s Fund’s blog by questioning whether UK’s healthcare system ranking first among 11 other countries across a range of measures covering quality, access, and efficiency of care is really a good measurement of NHS performance.
“While it’s nice to be told that the NHS is performing well, there are limits to how much we can learn from comparative rankings.
“First, different rankings by different people can tell us different things. The UK moves up and down in various international scorecards depending on which indicators have been included and how different dimensions of performance have been weighted. Second, The Commonwealth Fund’s study is primarily designed to highlight poor performance in the US system. As we’re good at lots of things that the US isn’t – like access to care – we come out particularly well.
“What’s really striking is the variation that exists within health systems rather than between them. In the US, the focus of The Commonwealth Fund’s study, we know that the scale of unwarranted variations in outcomes and costs of care is dramatic – both across and within geographical areas. The story in England is no different.
“Lessons from high-performing systems internationally show us that sustained efforts to reduce this unwarranted variation can improve quality of care while also reducing the costs of providing it.
“Rankings can only tell us so much, and necessarily look through the rear view mirror. The NHS today is rapidly heading towards crisis and struggling to hold on to the performance gains made over recent years. The challenge is how to maintain our position against other health systems while focusing on the unwarranted variations that exist within our own.”
Do Jeremy Hunt’s NHS safety league tables focus on the right issue?
An emphasis on reporting rather than learning makes it unclear what focus or benefit new safety measures will bring, says Richard Vize, regular contributor to the Guardian Healthcare Network.
“The superficial appeal of Health Secretary Jeremy Hunt’s new safety league table obscures deeper questions about how to create a safety culture throughout the NHS. As part of the government’s Sign Up to Safety campaign, the NHS Choices website now carries a measure of “open and honest reporting” of patient safety incidents. Open and honest reporting is of course essential to developing a safety culture, but it is questionable whether this particular measure is focusing on the right issue.
“The indicator has five components, such as an organisation’s NHS staff survey rating on whether it has fair and effective incident reporting procedures, and potential underreporting of death and severe harm to the National Reporting and Learning System – the central database of patient safety incident reports, which has logged over four million cases since it was established in 2003.
“Being judged on reporting bad news is necessary, but odd. As always with a target, it is likely to create perverse behaviour. Will a ward that routinely reports fewer incidents than its neighbour be praised for the quality of its care or come under suspicion? Since it is the reporting, rather than the learning, that is primarily being measured, which will be the focus?
“NHS staff, not ministers, are the patient safety experts. How has the NHS got itself into a position of being lectured on the need for openness?
“The solutions to creating a safe, open culture will not be found in Whitehall. NHS organisations and their representative bodies should be way out in front of government on this. Hunt shouldn’t be leading; he should be running to catch up.”
Another view: of appraisal and software
The big issue this week for GPs is that the Royal College of General Practitioners (RCGP) and Clarity Informatics online GP appraisal toolkits are merging. Dr Neil Paul speaks out about how his GP colleagues have been upset by the news that two appraisal toolkits are merging and his worries that this may just be part of a trend to get away from proper software commissioning.
“While this might not seem like earth shattering news, it has upset quite a few. For one thing, the PR has been quite confusing to the end user. One email says what was free to RCGP members is now going to be charged for; and this has upset a lot of people. An email from Clarity seemed to suggest that RCGP members would get a 25% discount. Another article suggested RCGP toolkit users could continue to use it for free for three years. No one is really sure.
“For those that don’t know all the ins and outs of GP appraisal, it was brought in following the Shipman Inquiry (the public inquiry into Harold Shipman, the GP who was convicted of 15 murders, although the inquiry concluded he might have committed 250).” All GPs now have to have an annual appraisal which, despite the best efforts of the “educational” GPs to make it useful, has turned into a tick-box exercise.
“You have to show you have done such things as an audit, collected the right number of CPD points, done a patient feedback survey, and a multisource feedback questionnaire. Unsurprisingly, several toolkits exist to “help you” fill it all in. As indicated above, the RCGP has one. It’s hated by some – one local GP has probably spent more hours emailing the college to tell them how rubbish it is than he has spent doing his PDP. But, on the upside, if you are a member of the college you got free access.
“The main alternative has been the Clarity toolkit, which started free (presumably some bit of the NHS was paying for it) and then went paid (presumably when they stopped). Most GPs locally seem to think that it has improved a lot over time and is ok to use. The biggest issue is it lacks some fancy functions – like a mobile version – it costs money and lots of people, me included, object to being made to buy it.”
Highland Marketing blog
In this week’s blog Matthew D’Arcy reports from the Health + Care Show in London.
