News in brief
Focus on integration for ‘tech fund 2’: The second rounds of the NHS’ two technology funds are due to be “promoted and launched” over the next two months and will focus on integration reports eHealth Insider. The first round of funding has been approved and awarded for both the ‘Safer Hospitals Safer Wards Technology Fund’ and the Nursing Technology Fund, and second rounds will soon follow. NHS England director of strategic systems and technology, Beverley Bryant, said that she hoped to announce the criteria for ‘tech fund 2’ before Christmas. Guidance on the fund was then going to be released at the end of March, but appears to have been delayed again. Speaking at the HC2014 conference in Manchester, NHS England’s head of technology strategy, Paul Rice, said: “Both the tech fund and the nursing tech fund will be promoted and launched in the next couple of months.” The first round of the ‘Safer Hospitals, Safer Wards: Technology Fund’ was approved by Treasury in two tranches, of which the second was only given the go-ahead at the beginning of March. Of the £260m in funding available, around £220m was awarded to more than 200 projects, of which £90m had to be spent by this financial year or returned to Treasury. The first round of the Nursing Technology Fund saw 85 projects awarded a total of £30m for mobile working, vital signs monitoring and digital pens. Rice said that the first round has been “pretty restrictive” in terms of what kind of technology trusts could buy, but that the £70m second round would be more open. “Policy-wise we’re trying to orientate the conversation going forward around capability rather than the actual nature of the technology itself,” he said. According to Health Service Journal (subscription required), also reporting from the HC2014 conference, nearly half of the £90m ‘Safer Hospitals, Safer Wards Technology Fund’ originally earmarked to be spent this year will be rolled over into 2014-2015.
NHS unable to put figure on fraud: The Financial Times (subscription required) reports that Britain’s health department does not know exactly how much money is lost to fraud each year in the NHS, after an investigation suggested that up to £7bn was disappearing through mistakes or criminal schemes. Health officials said they “did not recognise” the £7bn figure, but were unable to come up with an alternative. NHS Protect, the organisation that leads work to tackle fraud in the NHS, “has a multimillion pound annual budget and has recovered millions of pounds lost to fraud, bribery and corruption for the NHS”, the health department said. Jim Gee, former director of NHS Counter Fraud Services, now with BDO, the professional services firm, said he had come up with the £7bn calculation based on an analysis of international fraud data. Gee said: “If the NHS is in line with the rest of the world, it would be losing around £7bn.” The government’s Annual Fraud Indicator based on estimates last year suggested only £229m was being lost. However, for the figure to be this low, Britain would have to do 30 times better at controlling fraud than the rest of the world, which was unlikely, Mr Gee suggested. Paul Briddock, of the Healthcare Financial Management Association, which represents NHS finance directors, queried the £7bn figure as “incredibly high”. Briddock added: “£7bn is around seven per cent of the whole NHS budget and seems huge based on my experience.”
NHS urged to halve serious mistakes and save 6,000 lives: Health secretary, Jeremy Hunt is urging the NHS in England to reduce the number of serious mistakes being made and save 6,000 lives over the next three years according to the BBC. Hunt said NHS trusts should draw up plans to halve “avoidable harm” such as medication errors, blood clots and bedsores by 2016-2017. He says this could stop a third of the preventable deaths in the coming years – equivalent to 6,000 lives saved. The trusts that take action will get reduced premiums for insurance cover. The push – called Sign up to Safety – will be voluntary and reliant on individual trusts identifying how many mistakes they make and coming up with plans to reduce them by half. It is being primarily aimed at hospitals, but other trusts including those providing mental health and community services are also being invited to take part. The drive is being accompanied by a number of other measures designed to improve safety in the health service. Peter Walsh, of the campaign group Action Against Medical Accidents, praised Mr Hunt for his “leadership” on this issue. He said the duty of candour was “potentially the biggest advance in patients’ rights and patient safety since the creation of the NHS”. Walsh said: “For decades the NHS has frowned upon cover-ups but has been prepared to tolerate them. A lack of honesty when things go wrong adds insult to injury and causes unnecessary pain and suffering for everyone.”
Millions spent on mobile tech: Successful Nursing Technology Fund trusts will spend millions on mobile devices such as tablet computers before the end of this month reports eHealth Insider. According to analysis done by EHI Intelligence, 31 of the 85 projects that have been awarded funding from the £30m first round of the Nursing Technology Fund involve deployments of mobile devices or systems. Because the money has to be spent before 1st April, most of these projects involve buying hardware such as laptops, tablets and smartphones. Devon Partnership NHS Trust has been awarded nearly £1m for two projects. Nick Hopkinson, the trust’s associate director of IM&T, said that because of the tight deadline, the trust will use the funding primarily to buy 200 Windows 8 hybrid tablets for its community and inpatient nurses and 136 iPads for its learning disability teams. The iPads come with specialist apps that are tailored to the needs of people with learning disabilities. Hopkinson said: “The fund is primarily for hardware purposes. It’s a challenging timescale but the orders have been placed and we are confident of delivery within the timescale. We knew we had to be looking at something which would be achieved within a rapid timescale. We made sure we could do that within the time given. It’s off the shelf equipment so it shouldn’t be too difficult.” NHS England has received more than 300 expressions of interest for the second round of the Nursing Technology Fund, worth £70m. It plans to launch the second round in June this year.
Healthcare staff reveal they have no confidence in Jeremy Hunt: Healthcare professionals have declared they have no confidence in the health secretary, Jeremy Hunt, over his handling of the NHS reports The Guardian. In a survey conducted by the Guardian Healthcare Professionals Network, an emphatic 77.6 per cent of members responded “no” when asked: “Do you have confidence in Jeremy Hunt?” Of the 1,069 network members who took the survey, just six per cent said they had confidence in Hunt as a health secretary, while 17 per cent said they were unsure. A vote of no confidence is to be expected after Hunt’s role in controversial reforms, and after he alienated key staff groups including GPs, nurses and managers and cancelled the NHS workforce’s recommended one per cent pay rise. The chief executive and general secretary of the Royal College of Nursing, Dr Peter Carter, said: “Following the government’s completely unfair decision on NHS pay, morale among nursing staff in the health service is at an all-time low. There’s certainly a widespread feeling that their commitment and hard work is not being recognised and so this lack of confidence is not surprising.” A British Medical Association spokesman said: “We have concerns about the direction of travel of the NHS. The introduction of competition is worrying and we have concerns over funding problems. But it is not the personality that matters; the important thing is getting policies changed.”
High quality standards are vital for accurate patient records: Good standards are important in maintaining the integrity and accuracy of patient records, the Professional Records Standards Body (PRSB) said at this year’s HC2014 conference. The Information Daily reports that Professor Iain Carpenter, associate director at the Health Informatics Unit, Royal College of Physicians said that standards were of “huge importance” to patient records. Carpenter believes that records standards fill an important place in the electronic patient records (EPR) “interoperability space”. The PRSB, launched only last year, are in the process of implementing their new standards for patient records. Carpenter said it is important to “articulate” what is needed for both care professionals and patients to ensure that EPRs reflect what is needed. The latest set of standards, published in July, are an “information model” for the way a clinical record works, Carpenter explains. He adds that the PRSB are in the process of implementing the standards, and that their next challenge is in tailoring the records to each speciality or department. In light of the recent delay in the rollout of care.data, Carpenter explains that similar initiatives risk releasing a “mélange of medical terms and codes that have no meaning in their own right”. Carpenter believes that by having standards in place at the start, you can ensure that the information extracted is the “right data”. In terms of implementing information systems into the health service, Carpenter believes they are following an old, outdated method. There are many “agile” SMEs who have developed the kind of technology that is required, he adds. But they have a “challenge” getting into the marketplace due to the traditional approach to IT the health service currently employs, and this is “a problem for the health service”.
Trusts bid for £376m in bailouts: NHS trusts are hoping for bailouts totalling £376m this financial year, figures published by the NHS Trust Development Authority (TDA) reveal. Health Service Journal (subscription required) reports that twenty non-foundation trusts have either already submitted requests to the Department of Health’s (DH) independent trust finance facility, or planned to do so this month. So far 14 applications have been approved, totalling £247m. Another six were due to be considered this month. The TDA’s report gives a regional breakdown of the requests made for revenue funding across the trust sector, with the largest overall sum requested by London trusts. Seven trusts in the capital requested a total of £125m for 2013-2014, with £58m agreed across four organisations so far. In the north of England, two trusts requested a total of £70m with one £28m payment currently approved. Fifty-four of England’s 141 hospital trusts are now predicting deficits at the end of the year and the sector anticipates a net deficit of £373m. Twenty-four of the 54 deficit trusts are in the Midlands and East, nine in London, 13 in the north and eight in the south. Midlands and East trusts are responsible for £311m of the total £630m deficit predicted by the 54 trusts. In his report to a TDA board meeting last Thursday, chief executive David Flory said the financial position of the sector “remains a significant challenge” and its sustainability was at “very significant risk”.
Minister: Mental health trusts should ‘fight’ over contracts: A health minister has indicated mental health providers should “fight” contracts with commissioners in cases where they would be “losing out” due to the greater price reduction for the sector specified in controversial national guidance reports Health Service Journal (subscription required). Norman Lamb, speaking at the annual Mental Health Network conference in London, repeated his strong criticism of NHS England for its decision to set the 2014-2015 price deflator at 1.8 per cent for mental health and community trusts, compared to 1.5 per cent for acutes – implying a 20 per cent greater price reduction. Lamb said the decision was “flawed, not based on evidence and cannot be defended” and that NHS England’s justification – that acute trusts faced greater costs due to the Francis inquiry report – was “nonsense”. Mental health providers have sought to negotiate with their commissioners for the guidance not to be followed, but sources in the sector have said some have not accepted this. Speaking about the impact of the pricing decision, Mr Lamb told delegates to “be resolute” in negotiations with commissioners and said: “If you are confronted by [clinical commissioning groups] not applying the principles of parity of esteem…do not accept a proposed settlement which results in mental health losing out. NHS England has argued the greater price reduction for mental health is justified because of the cost of employing extra staff, to improve care quality following the Francis inquiry report last year. It has said clinical commissioning groups have freedom to set prices and budgets as they wish locally.
Nicholson awards NHS England ‘five out of ten’ for first-year performance: The chief executive of NHS England has admitted that its direct commissioning duties – which include holding the GP contract – has been a ‘weakness’, awarding it ‘five out of ten’ for its first-year performance according to Pulse Today. Sir David Nicholson also said that the competition environment was the ‘worst of all worlds’ is his keynote address at the Commissioning Live conference in London – his last appearance before stepping down on 29th March. He explained that competition had been intended as a tool for commissioners to improve services for patients but that ‘between the regulation and legislation, we’ve lost it’. Sir David said that clinical commissioning groups (CCGs) had deserved “eight out of ten” for their start, but warned that his own organisation had failed to focus on “direct commissioning”, which includes primary care services. He said: “NHS England’s weakness has been our own direct commissioning. We spent quite a lot of time thinking about setting up CCGs and organising that, I don’t think we quite put the same amount of discipline in organising our own direct commissioning. Part of the downside of how commissioning is organised at the moment is the split between primary care and other services commissioned at the local level. [So I’d give NHS England] about five out of ten I think, they’ve made a decent start but the potential is all there.” Sir David stressed that competition should only be used for improving care, and not because of fears of the external regulator or legal advice which invariably says “to be safe you have to compete. We’ve been struggling manfully – womanfully – with Monitor to get a simple set of rules that everyone can understand.”
Last of South acute groups out to tender:
A variety of care providers in the south west of England have jointly tendered for an integrated community-wide e-prescribing system reports eHealth Insider. The ten-year contract is worth between £2.5m and £4m. South Devon Healthcare NHS Foundation Trust is the lead organisation in the South Devon consortium, which is one of six southern acute collaborations formed to invest in a variety of new IT systems; having received nothing from the National Programme for IT. The groups have attracted £80m in central funding for their projects and will contribute another £100m locally. All six groups have now gone out to tender via the Official Journal of the European Union. The South Devon partnership is unique because it includes only one acute provider. Torbay and Southern Devon Health and Care NHS Trust, Torbay Clinical Commissioning Group, Devon Partnership NHS Trust, South Western Ambulance Service NHS Foundation Trust and Devon Doctors Limited will also benefit from the contract. Together, they are looking to procure an integrated community wide e-prescribing solution, including implementation, maintenance and ongoing support. “The solution must directly contribute to improvements in patient care, for example by providing comprehensive decision support, based on information such as pathology results from other systems, to support the creation and management of prescriptions and recording of medicine administration (including full decision support),” the tender document says. It explains that organisations are looking for functionality that will support cross community working on prescribing and medication administration, including patient-held records systems. The system should provide e-prescribing functionality for both acute and community hospitals, “with full flow of information to and from GP Practices so that medicine reconciliation and changes to prescriptions can be shared”, the tender says.
Health Service Journal reveals the top provider chief executives: Dame Julie Moore and Sir Robert Naylor are among the 50 chief executives doing an exceptional job of steering provider trusts, according to a panel of expert judges assembled by Health Service Journal (HSJ, subscription required). HSJ’s Top Chief Executives 2014 recognises for the first time the outstanding leaders of English NHS provider organisations. Other names on the list include Stuart Bell of Oxford Health Foundation Trust; Mike Cooke of Nottinghamshire Healthcare Trust; and Peter Homa of Nottingham University Hospitals Trust. A judging panel selected the 50 names on the list, and highlighted the 10 most exceptional leaders. Editor Alastair McLellan said: “Leading a provider trust is a mission which surely at times appears thankless – political sensitivities abound, as does the pressing target to deliver outstanding care at reduced cost. What judges focused on in their deliberations was not mortality rates or financial bottom lines; instead their litmus test was one particular question in the staff survey: the percentage of staff who would be happy for a friend or family member to be treated at the organisation at which they work.”
Two more London trusts stick with Cerner: Two London Cerner trusts have confirmed they plan to stick with their Millennium electronic patient record (EPR) systems beyond the end of their national contracts in 2015 reports eHealth Insider. Royal Free London NHS Foundation Trust and St George’s Healthcare NHS Trust have selected Cerner as preferred supplier for their EPR. Both are members of a consortium of six London trusts (formerly nine) that went out to tender for a patient administration system (PAS)/EPR, a clinical portal and hosting services in February 2012. All received Cerner Millennium delivered by BT under the National Programme for IT and must transition to a new supplier before the contract expires in October 2015. The London framework lists Cerner, Epic and InterSystems as potential EPR suppliers. A spokesperson for St George’s said: “Cerner has been selected by the trust as the preferred supplier of acute clinical information system, and Servelec (providers of RiO) as the preferred supplier of community clinical information systems”. St.George’s has also been working with the Health and Social Care Information Centre (HSCIC) on exit planning from the current contract arrangements and has indicative dates for transfer to new service arrangements, the spokesperson added. The London framework, worth between £250m – £400m, has three lots. The successful suppliers for the portal lot are CGI (formerly Logica), Harris and Orion. For hosting, the contracts have gone to Capita Health Decisions, Cerner and HP.
Opinion
Charities can ease the burden on healthcare
In the Guardian this week, Lisa Weaks, third sector manager for the King’s Fund, discusses how organisations close to their communities can often respond to needs in a more targeted way, find solutions and co-ordinate services.
Sir Stephen Bubb, chief executive of the Association of Chief Executives of Voluntary Organisations wrote to David Cameron earlier this year to raise concerns that: “Large private sector providers are cornering new markets in public services at the expense of charities and other smaller community-focused organisations. [He] argued that contracts are too often focused on cost savings rather than “engagement, collaboration and social value”.
“Big is not necessarily beautiful when it comes to addressing ingrained, complex and costly health challenges. Organisations that are close to their communities can respond to their needs in a more targeted way. Their understanding of their client group enables them to identify pockets of unmet need and find innovative solutions, while engaging and galvanising local communities and helping to co-ordinate services across a range of organisations.
“Those commissioning public services face many challenges, not least significant financial pressures and the need for efficiency savings. The temptation to think that contracts with big, private-sector providers will deliver better and more cost efficient services will always be there, but at what cost? It is important to not lose sight of the vital contribution made by small community-based organisations and really hear what they have to say.”
The Friends and Family Test – proof of success through action
This week Tim Kelsey, national director for patients and information, NHS England, looks at the Friends and Family test and says that proof of success will be through taking action.
“The Friends and Family Test (FFT) was one of the many responsibilities NHS England inherited from the Department of Health when it came into being on 1 April 2013. Since day one, we have not looked back, rolling out data from A&E, inpatient and maternity services from every trust in the country.
“In his report Robert Francis told us that it is when the small things are ignored, that these little indignities lead to tragedy. We have listened to that and taken action. More than 1.8 million individual pieces of patient feedback have been collated in our first year and, more importantly, frontline staff have been able to react to the comments and views from patients to make immediate, clear, dynamic and demonstrable improvements to services.
“To prove that nothing is too big or small in terms of staff reacting to FFT feedback, you only need to look at the efforts of staff at Chesterfield Royal Hospital where patients said they were getting peckish between the 6pm dinner and the 7am breakfast. It promptly led to snacks being offered at supper time around the wards.
“It just goes to show that the Friends and Family Test can lead to real change and improve the patient experience of the services we provide – from things as diverse as better access to doctors and nurses, to having a jar of Marmite on the breakfast tray.”
Long live the new healthcare influencers
In Health Service Journal (subscription required) this week, Karen Lynas deputy managing director at the NHS Leadership Academy, describes some of the attributes required of leaders to deliver a successful future for the NHS.
Interestingly, Lynas highlights the increasing role of social media in influencing groups within healthcare: “Social media has played an enormous part in giving a voice to people who previously had no platform. It has helped us magnify the weak signals of influence that come from groups that used to be seldom heard, and who are not always from the top.
“Think of the enormous influence on behaviour someone like Kate Granger has had; through social media able to launch a huge campaign, be recognised by the secretary of state, and positively touch the lives of thousands. WeNurses has demonstrated the power of creating a virtual community and the influence that it can have.”
Lynas provides some tips for people who want to influence the industry: “The tendency is to think the things that engage you are the same as those that engage others. Leighton Andrews (Welsh Assembly member for the Rhonda) recently tweeted some top tips about influencing politicians on Twitter – and the list makes some good generic points.
“He starts with the point that remembering what is of enormous significance to you isn’t necessarily of importance to anyone else, so do not assume it is. Influencing successfully is, above all, about understanding those that you want to influence. Successful influencers have different tools to use with different people.”
What can we learn from how other countries fund health and social care?
This week in the King’s Fund, Sarah Gregory, researcher of health policy, discusses how England is not alone in facing the implications of an ageing population with changing patterns of illness.
“By comparison with other Organisation for Economic Co-operation and Development (OECD) countries, two features of the English system stand out. First, we have an unusually defined split between our health and social care systems. By comparison, many countries have developed a funding system for social care that complements their funding for health.
“Second, we are at the lower end of the range for public spending on social care, although it is difficult to establish direct comparisons as we do not report on social care funding to the OECD.
“The UK spent 1.2 per cent of GDP on long-term care in 2012/13, while the highest figure reported to the OECD was 3.7 per cent (in the Netherlands). Where there has been extensive reform it has often been implemented very gradually. Settlements can also be revisited: benefits to social care packages were cut in Japan and the Netherlands as they struggled financially.
“As a rule, countries develop systems that fit with their culture, history and politics. This can be seen most clearly when looking at attitudes to informal care. In Japan informal care is completely taken out of the equation when assessing eligibility for care: assessment is ‘carer blind’. Germany has taken the opposite approach, going so far as to put a premium of 0.25 per cent on the social care insurance paid by individuals with no children, in anticipation of the extra cost that the state is likely to bear in later life. As a comparison, England has a relatively high proportion of the population providing informal care compared to most countries – only Italy and Spain have higher. Political scientists call this ‘path dependency’.
“So while the options may seem to be wide open, international experience shows that reforms are more likely to hold when they work with the grain of the systems and culture already in place. This poses a challenge for the Commission, which is looking for solutions in England, where the public is attached to universal health care, free at the point of use, with less understanding that social care is severely rationed and means-tested.”
Highland Marketing blog
In this week’s blog our CEO, Mark Venables, reflects on the golden opportunity for Simon Stevens to lead the NHS as Sir David Nicholson departs.
