News in brief
NHS data-sharing project at risk, say MPs: NHS bosses risk undermining “public confidence” in the new data-sharing project, MPs are warning. Last week it was announced care.data, which includes collecting GP records, was being delayed amid criticism of the way it had been explained. Then this week it emerged that hospital data, which is already collected, had been given to the insurance industry, reported the BBC. Appearing before the Health Select Committee, NHS bosses were told they needed to get to grips with it. One of the biggest concerns about the creation of care.data is that the information could end up in the wrong hands. NHS chiefs have sought to reassure the public by pointing out that the hospital data has been collected for 25 years without a problem. However it has emerged the Health and Social Care Information Centre (HSCIC) – or NHS Information Centre as it used to be known – gave that hospital data, which was largely anonymous, to the insurance industry in 2012. A report was then produced advising insurance and investment firms how it could use the information to price their products. The HSCIC has now said this should probably not have happened as it should have applied “greater scrutiny” to the application. NHS England will use the six month delay to care.data to launch a re-engagement programme to get the public on board. Giving evidence about the programme to combine hospital, GP and other data to the Commons’ health select committee this week, Tim Kelsey, NHS England’s director of patients and information said: “We had a lot of confusion, suspicion and anxiety. We are going to be launching a very exciting programme, which specifically articulates the purpose of this programme. That is why we have this extension,” reported eHealth Insider.
UK shows biggest take-up of electronic health records in Europe: The UK is the biggest electronic health record (EHR) market in Europe, with $2.1bn expected to be spent on the technology by the end of 2015 following 4.1% annual growth, reported ComputerWeekly. The research from Accenture revealed that $22.3bn will be spent on EHR globally by the end of 2015, with 5.5% growth every year. The US market will be worth $9.3bn, with yearly growth of 7.1%. However the difficulty associated with measuring returns could slow adoption, according to Kaveh Safavi, global managing director of Accenture Health. “Although the market is growing, the ability of healthcare leaders to achieve sustained outcomes and proven returns on their investments poses a significant challenge to the adoption of electronic health records,” he said. “However, as market needs to continue to change, we’re beginning to see innovative solutions emerge that can better adapt and scale electronic health records to meet the needs of specific patient populations as well as the business needs of health systems.” In Europe, the market is expected to grow from $6.5bn in 2014 to $7.1bn by the end of 2015, with government-funded initiatives expected to generate most growth in the Nordic countries, the UK and Germany.
Joining up health and social care: The Scottish Parliament has voted to transform the way health and social care services are provided by passing “landmark” legislation. The Public Bodies (Joint Working, Scotland) Bill is the most substantial reform to the country’s National Health Services in a generation, and will also radically transform the way social care services are provided. The new legislation focuses on making services better for patients, especially those with long term conditions and disabilities, many of whom are older people, across Scotland by providing joined-up, seamless health and care social provision closer to home. Cabinet secretary for health and wellbeing, Alex Neil said: “This is a landmark health and social care reform for Scotland. I am delighted that the Scottish Parliament has reached this decision, which will see Scotland lead the way by legislating to integrate health and social care services. Every person in Scotland will come into contact with health or social care services at some point in their life – be that through ensuring that a loved one gets the social support they need to get an education, or go to work, or helping an older family member to stay in their own home for longer.”
Tech fund trusts still waiting: A significant number of NHS trusts are still awaiting Treasury approval for their technology fund projects despite some of the money having to be spent within a month, revealed eHealth Insider (EHI). NHS England has approved £218m in funding from the ‘Safer Hospitals, Safer Wards: Technology Fund’ for 234 projects, of which £90m must be spent before the end of this financial year. Treasury approval for part of the spend was confirmed in December, however projects worth more than £90m are still awaiting Treasury approval after having to resubmit their ‘value for money’ (VFM) cases before Christmas. A government spokesperson told EHI there is no delay in the approvals process. “The government is considering these bids closely to ensure that they represent good value for money and expects that a decision will be made shortly,” the spokesperson said. To be approved, trusts need to show a VFM of more than 1 for e-prescribing projects, higher than 1.5 for digital records projects and at least 2.4 for the rest. While the first tranche of money was made available to successful trusts this month, EHI understands that up to half of the £90m that must be spent by April has not been approved for release. The money will be returned to Treasury if not spent within this financial year.
InTechnology signs major deal to provide hosting services for the NHS: InTechnology, has signed a major seven-figure deal with the Health and Social Care Information Centre (HSCIC) on a project to deliver enhanced IT infrastructure for the health and social care sector, reported Building Better Healthcare. InTechnology won the contract through the government’s G-Cloud framework, which provides an open platform for technology firms to tender for Cloud infrastructure, platforms and software contracts, which ultimately leads to the increased adoption of Cloud computing across the public sector. InTechnology is also one of only a handful of managed service providers to offer an accredited N3 connection service as well as a number of geographically-dispersed state-of-the-art data centres across England and proven expertise in delivering Cloud services to the health sector. As a result of this partnership, the HSCIC will benefit from cost savings, 24/7 hands and eyes support, and impressive levels of data centre and network resilience.
Proposed wilful neglect law may see up to 240 health prosecutions a year: Up to 240 prosecutions a year alleging wilful neglect or ill-treatment of patients could take place under a new criminal offence to be introduced in England following the Mid Staffordshire hospital scandal, the government says. Individuals could face up to five years imprisonment and/or £5,000 in fines, says a consultation paper and impact assessment on proposed new legislation. The organisations that employ them could face far stiffer financial penalties, according to The Guardian. Such a law would act as a deterrent and match penalties that already exist for those who ill-treat people without mental capacity, says the Department of Health. “This offence will also send a strong message that poor care will not be tolerated and ensure that wherever ill-treatment or wilful neglect occurs, those responsible will be held to account.” The cost to the criminal justice system is estimated at £2.2m a year, although in a minority of cases defendants will be required to fund their own costs at about £400 a time. Other costs, though not quantified, will be incurred by police and organisations taking steps to reduce risk of prosecution. There may also be reputational damage, says the department.
Mid Staffs to be dissolved: The health secretary has announced that Mid Staffordshire Foundation Trust would be dissolved in line with the recommendation of the trust’s special administrators, reported Health Service Journal (subscription required). However, in a written statement, health secretary, Jeremy Hunt asked NHS England to identify whether consultant-led maternity services could continue at Stafford Hospital. The Trust Special Administrators (TSAs) recommended that the trust’s maternity unit should be downgraded to be midwife-led. Hunt said: “I am asking NHS England to identify whether consultant-led obstetrics could be sustained at Mid Staffs in a safe way in the future. In doing this, NHS England will work with local commissioners as part of their wider review of the local health economy.” A consultant-led maternity unit at Stafford Hospital would require paediatricians to look after the most seriously ill babies. This would mean that paediatric inpatient facilities are required – a service that the TSAs recommended should be decommissioned. Local campaigners have pledged to raise a legal challenge against the proposals. In December the TSAs recommended that the trust should be dissolved because it was “clinically unsustainable”. An emergency department with reduced opening hours will continue at Stafford Hospital.
£5bn commissioning support tender out: NHS England has released the tender for a commissioning support services framework worth £3-5bn, reports eHealth Insider. The new four-year framework, announced last October, will allow clinical commissioning groups (CCGs) and other health service bodies to purchase commissioning support services on a ‘call-off’ basis. It is divided into three lots. Lot one, ‘end-to-end commissioning support services’ includes IT support and business intelligence. Lot two is further divided into two sub lots; ‘medicines management and optimisation’ and ‘individual funding request case management’. The maximum number of potential providers to be shortlisted at pre-qualification questionnaire stage is 30 for Lot 1 and 20 each in the Lot 2 sub-lots. IT services available via the framework include: managed ICT infrastructure services; disaster recovery services; data hosting; systems integration and interoperability; service desk and desktop support; remote access services; and telephony and mobile device management. Business intelligence includes: decision support; dashboards; risk stratification; monitoring and alert system; and workflow management systems. Business analytics services include predictive modelling and benchmarking. The framework is open for use by NHS England and all the bodies it hosts as well as “any other health service body as defined at section 9 of the National Health Service Act 2006”, which includes; CCGs, NHS trusts; the Care Quality Commission; National Institute for Health Care Excellence; and the Health and Social Care Information Centre.
Private groups invited to help NHS buy services: The NHS has for the first time asked the private sector to help purchase billions of pounds worth of services for hospitals and GPs, reported the Financial Times (subscription required). NHS England has advertised for companies to compete for work worth at least £5bn advising the new doctor-led clinical commissioning groups, which spend more than two-thirds of the NHS budget buying care for patients. They will advise on patient care reforms, finances, drug purchasing, negotiating hospital contracts, handling NHS patient care data, supporting organisational change and outsourcing services to private sector providers. Bob Ricketts, director of commissioning support strategy at NHS England said the primary aim was to “create a competitive market” in the buying of healthcare services. He added that this would cut costs and shorten the procurement process by about six months, as NHS trusts and local authorities would only have to run “mini-competitions” for the work. The move indicates the extent of the changes sweeping the NHS as a result of the Health and Social Care Act in 2012. It also highlights the opportunities for private sector investment in the service despite political sensitivity. Roughly 30 bidders, including Serco, Optum, part of United Health, and Assura, are expected to compete for the work, which will see them appointed to a “framework” of preferred suppliers, which can be used by hospitals and GPs to buy services more quickly.
NHS staff increasingly ‘engaged’: Nine out of ten NHS staff feel their role makes a difference to patients, according to the 2013 NHS staff survey results. NHS England has published the results of the 2013 NHS staff survey − the largest canvassing of staff opinion in the world − which show that 90% of staff said their role makes a difference to patients. Almost two thirds of staff (65%) would recommend their organisation to friends and family as a place to go for treatment, reports The Commissioning Review. The results from the 203,000 staff who took part show improvements in 21 out of the 28 categories when compared to the previous year. Sue Covill, director of employment services for the NHS Employers organisation said the results were encouraging, considering that it has been a “challenging year for the NHS”, with a lot of “negativity”. She said: “Employers know that building staff engagement and pride in the organisation helps deliver high-quality, compassionate care. Staff feeling valued and being valued is absolutely vital to the effective delivery of patient care and we believe it is an important factor behind many of the positive results.” Other key statistics from the survey include: 84.3% of staff have received an appraisal, an increase of 1.2% on 2012, and an increase of almost 20% since 2007. The average score out of 5 for how engaged staff are with the organisation is 3.71, which has increased from 3.68 in 2012 and 87.4% of staff believe their place of work provides equal opportunities for career progression and promotion. However Nursing Times has reported that the NHS staff survey also revealed that 29% of all staff and a third (33%) of those working in acute hospital trusts said they had “witnessed potentially harmful errors, near misses or incidents” in the last month, although 90% reported them.
Senior citizens want online health: The majority of senior citizens in England want to use the internet to interact with the NHS, a new survey has found. According to the Accenture survey, 60% of senior citizens in England said that online access to their patient record is important, but only 8% were able to access it. The researchers interviewed more than 9,000 people in nine countries, including 1,000 people in England, out of which 194 were over the age of 65. Aimie Chapple, managing director for Accenture’s health business in the UK told eHealth Insider the survey shows that the NHS needs to invest in technologies that both the older and younger generation want. “Many senior citizens are using digital tools already such as internet banking, shopping and communication and would like to use [technology] to interact with their healthcare provider,” she said. “There are systems out there and the capability to look at our health record exists, but many healthcare providers have been slow to implement that and don’t necessarily believe that it’s what patients want.” Chapple said that the number of people using technology to access healthcare in England is “relatively low” compared to other countries.
National dementia strategy to be renewed and ‘refreshed’ from April: According to Pulse, the government’s national dementia strategy is to be renewed and ‘refreshed’ this year, health secretary Jeremy Hunt has announced. Taking questions in the House of Commons this week, Hunt said the government was committed to continuing to implement a national strategy beyond April when the current strategy expires. Responding to a question from Hazel Blears, Labour MP for Salford and Eccles, who campaigns on dementia and will step down from her seat this year in order to care for her mother who has the disease, Hunt said: “The national dementia strategy is here to stay.” GP critics have questioned the drive to screen at-risk patients for dementia as part of the national strategy, in particular because of doubts over government estimates of the current prevalence of dementia and under-diagnosis. However, the health secretary asserted the programme would lead to a “big improvement” on the 39% diagnosis rate estimated when the government came into office. The health secretary said: “When I say that the strategy is here to stay, I mean that it is here to be refreshed and updated. We are subscribing to some big new ambitions, including that by the time of the next election two thirds of people with dementia will be diagnosed and have a proper care plan and support for them and their families. That is a big improvement on the 39% of people who were diagnosed when we came to office. There is much work to do and we are absolutely committed to delivering.”
Dismay over moratorium on mental health commissioning: An NHS England moratorium on commissioning new specialist mental health services has exacerbated the sector’s bed shortage and led to a newly constructed hospital unit standing empty for six months, Health Service Journal (subscription required) has revealed. NHS England took responsibility for the £12.5bn specialist services budget in April 2013. It had previously developed national specifications for 143 service lines and committed to reviewing them during the year. This created uncertainty that led to a pause in the commissioning of new inpatient mental health services, which NHS England commissions. As a result there has been a disconnect between services commissioned by the national body, such as child and adolescent inpatient mental health service beds, and those commissioned locally by clinical commissioning groups, such as Child and Adolescent Mental Health Services community services. In one case a new £1.1m 15-bed low secure unit at Coventry and Warwickshire Partnership Trust was left empty for six months, forcing 15 patients to keep on receiving treatment out of their area of residence. A new learning disability service moved there in the autumn. Trust chief executive, Rachel Newson said: “I really think this was an accident of design, an unintended consequence, but I would hope this is something that gets rectified and that we find a common sense way forward to allow money to follow patients again so that we can do the very best for them and bring them closer to home.”
Monitor has been ‘value for money’: The health sector regulator Monitor has achieved value for money in regulating NHS foundation trusts, and has generally been effective in helping trusts in difficulty to improve, according to the National Audit Office (NAO). Monitor was created in 2004 as the independent regulator for NHS foundation trusts and its remit has now been expanded with significant, high profile new responsibilities, including that of ensuring continuity of services for patients, reports OnMedica. NAO’s report Monitor: Regulating NHS Foundation Trusts says that Monitor has rigorous processes and standards, which it has adapted and strengthened, for assessing NHS trusts applying for foundation trust status. As a result NHS trusts are finding it more challenging to meet the standards Monitor applies during the assessment process, so only two trusts were authorised during 2012-13. At the end of December 2013, 98 NHS trusts remaining had yet to achieve foundation status. The report adds that the fact that few NHS foundation trusts have got into difficulty soon after being authorised indicates that Monitor’s assessment decisions have been sound. Just three trusts have breached their regulatory conditions within 12 months of being authorised. Amyas Morse, head of the National Audit Office said: “Monitor has done a good job in regulating NHS foundation trusts. It has helped NHS foundation trusts in difficulty to improve and trusts have regularly taken radical action, such as changing their chair or chief executive, in response to Monitor’s interventions. However, bigger challenges lie ahead for Monitor, as it takes on its significant new responsibilities that stretch across the whole health sector.”
Opinion
Bottom up – The way to get to a fully digitised NHS
In Integrated Care Today this week, Mark Winstone, sales & marketing director for SynApps Solutions, argues that the only way to a ‘paperless’ NHS is by extending what we know works.
“According to a 2013 study, The NHS Information Evolution, produced by the Intellect trade body [now techUK], voice of the British IT industry, for too long NHS IT has been designed and implemented locally. And while these systems have worked perfectly well in a limited context, the important information in them has often been difficult to access, either internally within Trusts or by other Trusts and fellow health and social care institutions.
“A far better approach, says Intellect, is to build systems from scratch in a way designed from the get-go to allow information to flow and better follow the patient on their journey. It turns out a number of NHS customers are starting to move forward on just this basis. This is great news, as it could well be the only way to deliver the kind of Electronic Health Record the health secretary would like to see a lot more of.
“We all know that ‘the Holy Grail’ in healthcare is when patient services are seamlessly provided across any combination of service providers – all the way from acute and mental health trusts to community GP practices and pop-up clinics to caregivers out in the field. But the only way to ever stand a chance of making this powerful vision a reality is to use technology we know works in one part of the NHS and extend it to help in other areas, ending down those silos of information. That’s what makes VNA [Vendor Neutral Archive] a promising new option for an NHS-wide approach to electronic medical records.”
“The reality is, there aren’t enough VNA-capable suppliers out there. A VNA buttressed by an enterprise content management capability can be a powerful tool for getting us nearer to the kind of truly modern and efficient NHS we all want.”
Turning NHS data into patient safety
In this week’s EHI, consultant Joe McDonald talks to an EasyJet flight attendant who has some lessons for the NHS when it comes to helping staff learn from safety incidents.
Being impressed by the flight attendant’s adherence to procedure in the face of opposition from passengers, he asks how she enforces it so rigorously?
“She explains that her initial training included three weeks on passenger safety, including teaching on human factors by consultant psychologists.”
McDonald argues that “the NHS invests a considerable amount of effort in the investigation of serious untoward incidents. But it doesn’t get the message to frontline staff with sufficient emotion to make it stick like this.
“We need to turn the data into meaningful human stories. Data is for computers, stories are for people.
“So what could we do to make learning from healthcare disasters better? How about a commitment from every NHS trust to match easyJet’s commitment to training? That’s a three week initial patient safety training scheme, focused on human factors, with an annual week of refresher training.
“How about every trust committing to making one film of a serious incident a year? And how about creating a central repository for those quality training films that could help to avoid the same mistakes being repeated across the NHS?”
How reform of the tendering process will save the NHS millions
The cost of NHS competitive tendering is a scandalous waste of public money. So what can be done asks Sue Ward, head of business development and market at Central and North West London NHS Foundation Trust.
“Over the years there has been much talk about improving the bid process while retaining robust governance and intelligent commissioning. However, talk has not translated into change and costs continue to rise year on year. Now must surely be the time to take decisive and urgent action to streamline the process and save the NHS millions of pounds.
“We need a wholesale review of this process so that the NHS can lead the field in sensible, efficient procurement that ensures the best bidder is selected while saving money at the front line. We already have a model that offers some potential to achieve this in the “any qualified provider” process. Its core features are:
- Online submissions
- Standardised questions
- Service specific questions
- Local questions
“Through the use of technology, we could develop a centralised procurement hub where organisations respond to a set of core questions which can be accessed by commissioners to supplement the more local and specific information needed for individual bids – all of which would be managed online. Information could be updated as required and would reduce the huge amount of resources needed to manage the process for both providers and commissioners alike.
“I would love to see someone rise to the challenge of reviewing the procurement process as a political priority, so we can target our increasingly stretched resources to where they are most needed –at the front line, on high quality services for patients.”
Promoting innovation in primary care
This week in Integrated Care Today, Georgina Owen, freelance consultant with a particular focus on integration in adult social care and health, looks at promoting innovation in primary care.
“Nesta’s recent report on the extent of innovation amongst GP practices, “Which doctors take up promising ideas?” provides the newly licenced Academic Health Science Networks (AHSNs) with much useful food for thought.”
“The importance of having a culture of innovation and adoption of innovation within the NHS will be vital. This culture will help deliver the changes that are required across the whole health and social care system to create future financial sustainability of services and improve the health and wellbeing of the UK population.
“With the increasing focus on primary care in these models, AHSNs must make up for lost time and put in place practical plans for how to encourage a culture of innovation adoption within primary care as well. The Nesta report’s conclusions identify two key characteristics that impact the likelihood of GP practices to be early adopters of innovation. These will need to be addressed by AHSNs with the support of CCGs and NHS England to achieve effective adoption of innovation across primary care.
“The first characteristic is a capacity issue. Nesta’s research found that the size of the GP practice had a significant impact, with larger GP practices more likely to be early adopters of innovation. The second concerns the motivations of GPs to adopt innovations, with the Nesta research finding that the biggest influence on GPs by far is conversations with other doctors.
“The message is clear. If AHSNs are to achieve the required innovation in primary care, then very local GP networks are required. These GP networks need to be able to help address the capacity issues of smaller GP practices to innovate, as well as provide a forum to encourage and share knowledge around the adoption of innovation.”
Highland Marketing blog
In this week’s blog, Sarah Bruce looks at the real potential for eHealth Insider’s and NHS England’s Clinical Digital Maturity Index.
