News in brief
Digital care plans by 2015: Everyone with a long-term condition or disability must have a digital personalised care plan accessible online or via a mobile phone app by 2015, under a package of measures launched by NHS England, reported eHealth Insider. Transforming Participation in Health and Care provides online guidance to commissioners who promote the use of technology to put patients and their carers at the centre of treatment decision making. The NHS Mandate set an objective that everyone with a long-term condition will be offered a personalised care plan. The new guidance says this must be digitally accessible. It says that NHS England will develop and implement a best practice standard that defines what good, personalised, digital care plans look like, in order to support GPs and health professionals to create patient plans during 2014. It will also launch a new certification process for entrepreneurs to, “easily offer online tools and services that support personalisation, to help commissioners to identify high quality suppliers”. Anyone who can benefit should have a personal health budget and digital care plan by April 2015.
Miliband backs integrated health service: Labour leader Ed Miliband has said his party will seek to create an integrated healthcare system if it wins power in 2015, reported Health Service Journal (subscription required). In his speech at the Labour Party Conference in Brighton this week, Miliband recalled the 1945 Labour government’s creation of the NHS at a time of austerity, making the point that financial constraints should not limit ambition. He said: “I want the next Labour government to do the same, even in tough times, to raise our sights about what the health service can achieve, bringing together physical health, mental health and the care needs of the elderly: a true integrated National Health Service. That’s the business of the future.” It is understood the reference to care for the elderly refers to social care. During his speech at the conference, shadow health secretary, Andy Burnham told delegates that NHS values were under the ‘most audacious attack ever’ and the Coalition government was creating an ‘American healthcare system’. Setting out his radical plans for whole-person care and integrated services, Burnham said Labour would end the marketisation and privatisation of the health service and repeal the Health and Social Care Act 2012, which is fragmenting the service, reported GP. He said: “One valued team working around the person. It’s what clinicians want to do. But right now they can’t. In Cameron’s NHS, the competition lawyers call the shots. They call integration “anti-competitive”. Have you ever heard anything more ridiculous? The Health and Social Care Act 2012 has placed the NHS on a fast-track to fragmentation and privatisation. It has got to go – and it will.”
Pioneer database faces delay after watchdog intervenes: NHS England’s controversial plan to extract confidential information from patient records to build a national database faces a delay after an intervention by the information watchdog, reported Health Service Journal (HSJ, subscription required). HSJ revealed that the Information Commissioner’s Office (ICO) met with NHS England to discuss legal concerns amid mounting general practice opposition to the care.data project, particularly about the speed with which it was being implemented. The ICO said it was concerned GPs were being given insufficient time to carry out a legal duty to inform patients about the programme, which will link patient data across different care settings, and allow them to opt out if they wish. The Health and Social Care Information Centre – which will run the database – wrote an email to GP “early adopter” practices on 29 August warning they had “approximately eight weeks” before it began extracting data. However, NHS England has now agreed data will not be extracted until the ICO has approved its proposed timescales and it has also agreed to run a national awareness campaign. It is understood the information centre is reviewing data collection methods, potentially further exacerbating any delay.
Concern over premature deaths as millions die early: Conditions such as heart disease, breast cancer, hepatitis C, tuberculosis and asthma claim thousands of lives prematurely across the whole of England, but more often in the north, reported The Telegraph. Health secretary, Jeremy Hunt, described the findings as “shocking” and promised to introduce measures to reduce premature deaths. The data, compiled by the Health and Social Care Information Centre (HSCIC), shows that more than a million years of life are lost unnecessarily every year in cases where effective treatment is available. Kingsley Manning, the chairman of the HSCIC, said: “It is striking that more than one million potential years of life were lost for people registered with GPs last year in England – the equivalent to just over one week for every single registered person in the country.” The mortality figures show a striking north-south divide, with people in southern counties enjoying far lower rates of premature death than people living in areas such as West Yorkshire or Lancashire. Hunt said: “There is a shocking variation in early and unnecessary deaths across the country which I am determined to start putting right as part of my ambition to save 30,000 lives a year by 2020. Local authorities have been given the power and budget to tackle the needs of their local population.” The HSCIC points out that the figures do not take into account other factors that could also affect life expectancy, such as lifestyle and social-economic status.
No action over Stafford Hospital doctors: Four senior doctors who worked at Stafford Hospital at the height of the neglect and abuse scandal will not face disciplinary action, reported the BBC. Dr John Gibson, Dr Valerie Suarez, Dr David Durrans and Dr Dermot Mulherin, who all held senior management positions, were investigated by the General Medical Council (GMC). However the regulator has now said it is dropping the cases. Legal advice found there was “no realistic prospect” of success. The decision comes after widespread criticism when the public inquiry was published in February that those responsible for the scandal have not been held to account. At the time, Prime Minister David Cameron said the likes of the GMC and the Nursing and Midwifery Council had “some difficult questions to answer”. Since then three nurses have been struck off the register – with one disciplinary hearing ongoing. The GMC has given warnings and advice to other doctors who worked at Stafford Hospital. But as yet no-one has been struck off for their role in providing medical care – one doctor has been erased from the register for fraud. GMC chief executive Niall Dickson said: “Following the extensive investigations we have undertaken there is not the evidence to establish either misconduct or impairment against any of the doctors.”
One in five GPs on CCG boards has financial interest in a current provider: One in five GPs who sits on a Clinical Commissioning Group (CCG) board has a financial stake in a provider which currently provides services to their own CCG, a Pulse investigation has found. Figures obtained under the Freedom of Information Act from 76 CCGs reveal that dozens of GPs across the country are juggling commissioner and provider interests, with many being forced to leave board meetings when key decisions come up because of their conflict of interest. There is no suggestion that the GPs concerned have done anything wrong, and CCGs reported that procedures to safeguard against conflicts of interest are being fully followed. However the findings have raised fresh questions over how CCGs should tackle conflicts of interest – and whether GPs’ influence on CCG boards is being diluted as a result of the safeguards currently in place. The figures come as NHS England hinted at a move towards CCGs playing a greater role in commissioning primary care – a move opposed by the BMA due to the potential conflicts of interest. NHS England deputy medical director Dr Mike Bewick told a Royal College of General Practitioners event last month that it was a ‘waste’ for CCGs to have no role in commissioning primary care and suggested there could be ‘Chinese walls’ to prevent conflicts of interest.
‘More time’ on admin than patients: Doctors spend more than twice as much time on paperwork as they do on home visits, a survey suggests. The survey carried out by law firm Your Legal Friend, revealed that attending management meetings and doing administration takes up around 17 hours a week, compared to seven hours spent at patients’ bedsides, reported Health Service Journal (subscription required). About 400 doctors were polled for the survey, having previously expressed a willingness to be questioned about the NHS. More than one in four (28%) said they were “very concerned” about the health service and could not see a future for the NHS, while 44% believe the standard of patient care will drop in the next five years. Some 17% said cuts to the NHS was their number one professional concern, while the same proportion said they had too much paperwork. A quarter said they knew patients delayed seeing them because of appointment waiting times and 55% of these thought this had a negative impact on recovery. Doctors also criticised health secretary Jeremy Hunt, with 72% saying they questioned his ability in the role and 49% saying he failed to properly understand the needs of the NHS.
Caldicott Review response a step forward for electronic healthcare: FairWarning has commented on the outcome and UK government response to the Caldicott Review and the significance for electronic healthcare in the country reports ProHealth Service Zone. FairWarning has welcomed the UK government’s response to the Caldicott Review, describing its decision to accept all of the recommendations in the review as “a significant step towards transparent care and a landmark milestone for both patients and the NHS”. But the company says the announcement, which coincides with the publication of the Health and Social Care Information Centre’s guide to confidentiality in health and social care, is just the latest step in the long journey towards electronic healthcare and has urged healthcare stakeholders to work collaboratively to drive a culture of privacy throughout the NHS. Tim Dunn, general manager for FairWarning UK commented: “Tools to help NHS professionals provide transparency on who is accessing patient records, and enabling trusts to monitor access proactively, are readily available and being successfully deployed in parts of the UK. In its response to Calidicott2, the government has acknowledged the implementation of privacy breach monitoring in Scotland. We believe that the full implementation of these recommendations could bring the rest of the UK to the high standard levels achieved in NHS Scotland, and ensure information assurance for UK trusts.”
Tinder to train patients online: The Tinder Foundation has won a £1m contract to train 50,000 people to use online health services over the next six months, reported eHealth Insider. NHS England issued a tender in July worth up to £2m to train 100,000 to use online health services as part of its Health Online Programme. Tinder’s contract is to actively train 50,000 people, who will complete an online course being developed with NHS Choices. The programme will reach at least 100,000 people in total via events and campaigns. Tinder Foundation’s chief executive Helen Milner said there are three elements to the programme. The foundation already works with a network of 5,000 UK online centres such as libraries and community centres via contracts it has with other government agencies to improve people’s digital skills. As part of its contract with NHS England, it will provide these with e-learning tools and support for them to help people in their local community access digital health information. Milner said: “This is a core part of our bid because we already have that network established. They are in communities where there are higher numbers of people who don’t have basic digital skills.”
Hunt’s US fast-track management scheme will cost £10m: Health Service Journal (subscription required) reports that the government will spend £10m on its programme to draft in new leaders and give them training in America to help them run failing NHS hospitals. The health secretary announced earlier this month he wanted to introduce managers from outside the service on a new fast-track programme, as part of work to improve service quality. It will be open to senior NHS clinicians as well as managers from outside the health service. The scheme will begin in spring 2014 and involve approximately 50 people a year attending the Harvard Kennedy School, a leading business school in the USA. Around 40 of the participants will be clinicians, and 10 will be applicants from outside the health service. After completing the 10-month course they will be assigned a role and are expected to be “rapidly promoted” into senior management and chief executive roles. The Department of Health (DH) has said it will pay the salaries of NHS clinicians while they are on the course. A DH spokesman said details about the programme were still being developed, but it was expected that existing NHS chief executives would encourage staff to apply. The spokesman added: “We expect people from the private sector to come to us. These are likely to be people who share NHS values and may have wanted to work in the NHS but have been put off perhaps because of a lack of knowledge.”
Integrated care system gains recognition in King’s Fund report: ProHealth Service Zone reports that the use of electronic shared records enabling integrated care following a New Zealand earthquake has gained recognition in a King’s Fund report. “The best thing since the invention of the stethoscope” is the verdict of one doctor in New Zealand on Orion Health’s electronic shared care record view (eSCRV), a cross care clinical portal installed at pace and scale in the wake of Canterbury’s devastating earthquake in 2011. This view is quoted in the recently launched King’s Fund report on ‘The Quest for Integrated Care’ in New Zealand, which explains how the earthquake accelerated plans for an electronic record and how the problems involved in creating it were solved in record time. The report examines the progress Canterbury District Health Board (CDHB) of New Zealand has made in developing a fully integrated care system and how the consequences of the February 2011 Christchurch earthquake accelerated planned developments, which included the rapid development of the eSCRV. Commenting on the portal technology, CDHB chief executive David Meates said: “eSCRV provides one health portal, regardless of where you work in the health system. It has been designed to ease the patients’ journey, facilitate quality care and enhance communication, not only between the patient and the provider, but also between practitioners and services. The earthquake gave us the impetus to say that things we were planning to do needed to happen today.”
Half a million Londoners on waiting lists for NHS surgery: More than half a million patients are on hospital waiting lists in London. Figures released by NHS England for July, the most recent available month, showed that 508,555 people were waiting for operations or other treatment to begin — the highest total for at least five years, reported London Evening Standard. Of these, 39,145 people had waited beyond the target of 18 weeks — up 16% on the previous month. Almost 60,000 more patients were waiting for treatment at the capital’s 34 NHS trusts than a year ago. This included 76,396 at Barts Health and 2,523 children at Great Ormond Street Hospital — over 500 more than a year ago. Health campaigners said the figures highlighted the backlog of cases. Bernell Bussue, London director of the Royal College of Nursing, said: “Cuts to nursing posts in both hospital and community settings mean that trusts just haven’t been able to cope with rising demand.” NHS England said trusts were fined if they missed targets. It added: “Statistics show the number of people waiting for treatment is often higher in summer months. This is partly due to the summer break and patients choosing to delay elective operations to fit around holidays.”
Rise in complaints against NHS Scotland: Complaints against the NHS in Scotland have risen by 13%, new statistics show. In 2012/13 there were 9,161 complaints about hospital and community health services, compared to 8,117 the year before. 28% of the complaints were fully upheld and 35% partially upheld, reported National Health Executive. However, complaints about GPs and dentists had fallen; by 13% and 30% respectively. Only 61% of the complaints were dealt with within the national target of 20 working days. Scottish health secretary Alex Neil said: “Our health service does a fantastic job in the overwhelming number of cases. In an organisation of this size, care can sometimes fall below the standards we all demand. In those cases I want to encourage patients to give us feedback, whether good or bad, so that health boards can continually improve the care they provide. These statistics demonstrate this is happening.”
GP appointments auto-cancelled via text: GP practices are using new iPlato functionality to allow patients to automatically cancel GP appointments via their mobile phone, reported eHealth Insider. The new feature means appointments can be cancelled without intervention by practice reception staff. The Hammersmith Surgery has trialed the functionality. Practice manager Lesley Kenny said: “Whilst eliminating effort for practice staff to deal with incoming cancellation requests from patients, this new feature has significantly sped up the process of making short term appointments available for other patients.” Chief executive of iPlato, Tobias Alpsten, said automated appointment cancellations is part of a broader feature set that aims to update the practice’s GP system automatically based on incoming messages from patients. “The new iPlato feature recognises keywords so, when a patient sends a keyword such as ‘cancel’ as a reply to an appointment reminder, the appointment is automatically removed from the GP system and the practice reception are notified via email. This new feature improves patient services and reduces the administrational burden for practices to manage appointments,” he added.
Patients to access their own electronic records at NHS Lothian: Patients at NHS Lothian will be able to access their records electronically, reported National Health Executive. The move is expected to free up clinical and administrative time as well as improving patients’ understanding of their health. The information is provided by TRAK and the Scottish Care Information Store (SCI Store), through a patient portal provided by Harris Healthcare. NHS Lothian provides services for around 800,000 people across 10 hospital sites. Martin Egan, director for eHealth at NHS Lothian said: “We have had great success in utilising a clinical portal at NHS Lothian to share patient information amongst clinicians across other health boards. The patient portal is a significant stepping stone in our strategy to provide patients with access to their own patient information. It ensures that patients are better informed about their health meanwhile providing them with opportunity to monitor and take greater responsibility for their own healthcare. For too long, patients have relied on healthcare professionals to find out and monitor basic information about their health or condition. The portal helps to encourage a step-change in putting the patient at the centre of the NHS.”
Patients ‘self-funding treatment’: Health Service Journal (subscription required) reports that hospital patients are being allowed to pay for treatments that are no longer available for free, the shadow health secretary has claimed. Andy Burnham said health reforms introduced by David Cameron had led to rationing in the NHS, with some hospitals offering self-funding patients the treatment at standard NHS prices. Warrington and Halton Hospitals is one foundation trust offering treatments that are no longer funded, at these rates. Other hospitals offering similar deals included Southampton, Chelsea & Westminster and James Paget, according to data obtained under the Freedom of Information Act, Labour has claimed. Almost £100m worth of private work has been done by NHS hospitals since October 2012, when rules were changed to allow them to generate up to 49% of their income from private patients. Over the year, hospitals earned £434m from such treatments – up by £47m on the year 2010-2011. Forecasts predict an increase of another £45m to £479m by next year. The website of Southampton’s general hospital, for example, offers a cataract service which operates “between the traditional private sector and the NHS” to make private healthcare more affordable. The website says “Fewer non-urgent services can be paid for by the NHS but we know that patients still want to see our expert staff and be treated within the advanced care environment of a specialist teaching hospital.”
Digital Doctor Conference to demystify health IT: Demystifying software development and taking back control of the email inbox are just two topics on the agenda at the forthcoming Digital Doctor conference which Dr Justin Whatling, chair of BCS Health, part of BCS, The Chartered Institute for IT, will open. The conference titled ‘Mastering Personal IT – Revolutionising NHS IT’ takes place from 9 – 10 November, at the BCS Covent Garden offices. Dr Wai Keong Wong, one of the conference organisers said: “The premise of the conference is to help clinicians understand that technological change starts with them. If they want to be able to change and influence health IT in their hospitals or practices then they need to make changes, understand technology and what it can help them with. It is vital that clinicians engage with this if we are truly going to have a fully technology enabled healthcare system that is suitable for the 21st century.” The aim of the conference is to teach doctors how to use technology and tools to make everyday tasks (email, audits, task management, keeping up with literature, collaborative working and research) more efficient and fun. The conference programme features a range of high profile speakers including Martin Murphy, clinical director of IT in NHS Wales.
Opinion
Professionals need to be held to account on basis of transparent data
In the Guardian this week, Roger Taylor, explains that information, data and measurement play a central role in understanding quality but is not an alternative to it.
“From the publication of the new NHS plan in 2000, New Labour had an answer. More money would be put into public services. And an intelligent, data led bureaucracy with a democratic mandate would put the provider interest back in its box and champion the interests of patients. Don Berwick’s report into patient safety is the obituary for that whole project. It is appropriate to remember the good as well as the bad that came from it. There is no doubt that it was conceived with the interests of the patient in mind. And, it led to significant improvements in standards of care from which many patients have benefited.
“However, after reading the reports from Robert Francis into Mid-Staffordshire, from Bruce Keogh into high-mortality hospitals and from Don Berwick into patient safety there can also, no longer, be any doubt as to how corrupting it has been to the ethos of public services.
“Most devastatingly of all, people began to believe that the performance on a dashboard really was the same thing as delivering high-quality care. The numbers began to count for more than anything else, more than the judgment of skilled professionals or the complaints and distress of patients. In extremis, it led to the suppression or dismissal of any information that seemed to contradict the official numbers.”
Taylor concludes by suggesting that: “Professionals need to be held to account on the basis of open and transparent data. But they need to be held to account by people whose understanding of data goes deeper than the ability to read a dashboard.”
Embracing the digital library
In Commissioning GP this week, Wayne Sime, director of library services at the Royal Society of Medicine explains why the NHS changes mean that medical librarians should no longer fear digitisation and why the time has come for them to truly embrace the digital library.
“When I joined the Royal Society of Medicine (RSM) in 2006, a year before the Kindle was invented and four years before the iPad dominated the tablet market, the RSM’s library was a very different place. Footfall was low, books and journals could take an age to locate as library staff and members needed to use card catalogues to retrieve items. Librarians could often take days to deal with more complex requests and often when they were able to provide the information, books from the historical collection were found in varying states of deterioration.
“Fast forward just a couple of years and despite gradually replacing hardcopy books and journals with electronic versions, the wide reaching impact of commercial eBooks and tablets meant that our members, mostly made up of busy junior doctors and senior clinicians, were becoming frustrated that clinical reference material was not more readily available in a digital format to help them in their daily role.
“The implementation of electronic resources, including recent products such as Clinical Key, which has seen more than 3,000 journals including the Lancet titles and around 1,500books accessed directly online, has increased the footfall through the library dramatically. In fact in 2006, 16,000 people came through our doors, and this year we are expecting over 30,000 visitors. Not only is this a record number of visitors for the library but also satisfaction rates for the library service are at an all-time high.
“By the beginning of 2014, we expect all of our journals to be electronic. We anticipate footfall continuing to increase and have no doubt that the library will continue to evolve as the NHS faces more challenges and technology advances. For now, we are confident that the changes we are making are supporting the medical professionals of today in the best way possible.”
Patient feedback is essential to the NHS’s future
In Health Service Journal (subscription required) this week, Neil Churchill, director for improving patient experience, NHS England, explains why feedback from patients is helping local boards to see what the public really thinks about the services they provide, which can then be used to drive improvements in care.
“In the past two months, 600,000 people have given the NHS valuable feedback on their hospital care. The friends and family test makes patient experience an integral part of the care we deliver; and in doing so is bringing about a cultural change in the NHS. Such feedback cannot be reduced to a single metric to judge performance but it can be used to drive improvement.
“Providers, but also commissioners, need to get feedback wherever they can, not just from one source. Good as it is, real time feedback like the friends and family test works best when set alongside patient surveys, enabling trusts to test initiatives as they are implemented. The importance of feedback is not what we collect but what we do with it.
“First, we need to improve the experience of the most vulnerable, second, we need to improve patient experience at transition points between services and thirdly transformational change will only come when we stop treating all patients the same and introduce personalised care that supports self-management for many and risk based targeted interventions for others.
“Change is happening. Not because the friends and family test is in the NHS mandate, but because patients and the public demand it. The NHS needs to recognise and meet this demand to maintain its unique position in the hearts and minds of the public. Every positive experience of patient care builds consensus for our NHS, and helps to secure it for future generations.”
Political scoring
In OnMedica this week, GP and broadcaster, Phil Hammond, highlights how puerile adversarialism damages the NHS.
“Are you ready for a vitriolic election campaign, with the NHS centre stage? I thought not, but I’ve a nasty feeling that’s exactly what we’re going to get. You should never take anything a politician says about the NHS at face value. There is always vested interest and spin behind it. Even if politicians of opposite parties agreed on a way forward, they would disagree out of spite in a lame attempt to gain advantage. This puerile adversarialism puts most clinical staff off the thought of becoming leaders, when clinical leaders are desperately needed.
“We all agree the Health and Social Care Act was an unnecessary disaster for the NHS but we need to nurture the idealism and enthusiasm of CCGs, not wreck it with rhetoric. And you know precisely what the response from the Tories will be next week. ‘Mid Staffordshire happened on Labour’s watch, as did countless other scandals that we’re only just uncovering and which will take (let me hazard a guess) at least until after the next election to fix.’ Who on earth would want to be chief executive of NHS England in such a climate? Not Sir Bruce Keogh, the most credible clinical leader the NHS has, nor Dame Ruth Carnall, who helped revolutionise stroke care in London and has opted instead to advise Boris Johnson. Dame Julie Moore, who has done wonders at University Hospitals Birmingham would be an excellent choice but she’s not interested in what is becoming a pointless, powerless, political poisonous appointment. Good luck to whoever gets the job. They should start by super-gluing the mouths of Cameron, Miliband, Burnham and Hunt together until May 2015, and give us all a break.”
Highland Marketing blog
In this week’s blog Laura Steward asks why nurses need to prove their worth for technology?
