News in brief
Sick could be monitored by video as NHS looks to US: Critically ill NHS patients could be monitored by video link under plans to learn from models of care used in the United States, reports The Telegraph. Hospital watchdogs have announced plans to examine the way care is delivered in other countries, including the US, France, Germany, and Canada, and recommend changes which the health service could introduce. Monitor, the regulator for NHS foundation hospitals, said its experts will examine systems used by other countries, including the use of “remote intensive care units” which are common in the United States. Officials said they would examine a range of services abroad, including stroke, maternity, and Accident & Emergency departments, in order to recommend ways to improve British healthcare and make systems more efficient. Senior managers at the watchdog said the NHS needed to “change and improve in order to survive”. More than 300 hospitals in the US use video links, with high definition cameras and two-way audio. The systems connect patients in intensive care with critical care doctors and other specialists, allowing round-the-clock monitoring of vital signs across long distances. Last month two London hospitals announced plans to pilot a scheme next year using the same technology. Research suggests the systems can reduce mortality rates by 27%, when used properly. However, health campaigners have raised concerns that the schemes should not be used to make staffing cuts, as the right help needs to be immediately on hand when patients’ conditions deteriorate.
NHS Spine infrastructure transition successful, says HSCIC: The infrastructure behind the critical NHS Spine platform has been replaced by the Health and Social Care Information Centre (HSCIC), reports Computer Weekly. The nationwide infrastructure – upgraded between 22nd and 25th August – connects clinicians, patients and national applications, as well as stores patient information. The Spine core services and messaging were moved to the new infrastructure in phases, enabling the majority of connected services to continue working over the weekend and minimising disruption to the NHS and patients, according to an online statement. The second iteration of the Spine platform will undergo a 45-day period of intensive monitoring to ensure it is performing as expected. Prior to the transition, Andrew Meyer, programme head for Spine 2 at the HSCIC, said a main priority was minimising any impact on the service because it is fundamental to the NHS and how it operates. “We are very aware we have to make the transition as painless as possible for the NHS and we have worked really hard to do that,” he said. The Spine platform is a communications hub that connects key IT services, developed as part of the troubled NHS National Programme for IT (NPfIT). The services include electronic prescriptions and GP2GP, which enables patients’ electronic health records to be transferred directly and securely between GP practices. On a typical day, 275,000 people connect to Spine. Using open source software, the HSCIC and BJSS have collaborated to build the core services of Spine 2 – such as electronic prescriptions and care records – in a “series of iterative developments”.
Dementia research ‘revolution’ using EPR: Five mental health trusts have launched a partnership to “revolutionise” dementia research in the UK, using non-identifiable patient data, reports eHealth Insider. Using funding from the National Institute for Health Research, researchers from the trusts will use software developed by the NHS that takes information from patients’ records without revealing sensitive information. South London and Maudsley NHS Foundation Trust, Oxford Health NHS Foundation Trust, West London Mental Health NHS Trust, Cambridgeshire and Peterborough NHS Foundation Trust, and Camden and Islington NHS Foundation Trust will use the Dementia Clinical Record Interactive Search, or D-CRIS, to pool together large data sets. Dr Matthew Patrick, chief executive at South London and Maudsley, said this is an exciting collaboration which will make the most of patient data held by the NHS. “D-CRIS software means we can now link information about patients’ conditions directly with their treatment and care, helping to improve their health,” he said. “For example, for those with schizophrenia, we will be able to identify whether there are some drugs which are associated with less time spent in hospital and have better outcomes for some people. I am looking forward to seeing the results of this collaboration.” The D-CRIS system was developed at the NIHR Dementia Biomedical Research Unit at South London and Maudsley and the Institute of Psychiatry at King’s College London and has gained ethical approval from an independent committee as a safe, secure and confidential information source for research.
NHS complaints rise to 480 every day: The number of complaints made about NHS care in England increased to an average of 480 every day, official data shows. The Health and Social Care Information Centre (HSCIC) figures on written complaints showed an 8% rise in 2013-14, compared with the previous year, according to the BBC. The complaints cover all aspects of the NHS from hospitals and GPs to dental practices and ambulances. However, a patients’ watchdog said the official figures were just the tip of the iceberg. In the year 2013-14 a total of 174,900 complaints were made about the NHS. It compared to 162,019 the previous year and 131,022 in the 2007-08 financial year. The most complaints – 34,400 – were focused on inpatient hospital care. The largest percentage increase in complaints was for ambulance crews – up 28.5% to 5,700. Kingsley Manning, the chairman of the HSCIC, said: “Our latest figures show that the NHS is receiving a large number of written complaints each day. Today’s report also shows a rise over the last year in the number of written complaints made against NHS hospitals and community services. I’m sure staff who manage NHS complaints will want to pay close attention to these statistics.” The patients’ watchdog Healthwatch England said most people do not report poor care. A survey by the body suggests there were 500,000 unreported cases of unsatisfactory patient care across the NHS in the past two years.
3 per cent of patients have EPR access: Fewer than 3% of patients have access to their GP medical records online, according to figures from the Health and Social Care Information Centre’s (HSCIC) indicator portal. Patient access to medical records has been promoted by successive governments. eHealth Insider reports, that the present administration promised that patients would have access to their full medical records online by April 2015. However, the target has been scaled back, first to access to GP records, and then to access to a subset of the GP record; the information in the Summary Care Record. In April this year, it was scaled back even further, with GP practices being told they either need to provide people with access or “have published plans to do so” by April 2015. With just over six months to go, the indicator portal suggests progress would have to be extremely rapid to hit the access target. The figures from the HSCIC also show that 37.5m people, or two thirds of the population, have a Summary Care Record.
Ambulance service hunts down patient data loss: East Midlands Ambulance Service NHS Trust has admitted it is hunting for a data cartridge that has gone missing, containing thousands of patient records, reports Government Computing. The cartridge, which the trust believes went missing from its Beechdale divisional headquarters in Nottingham, contains just around 42,000 electronic copies of scanned, handwritten patient report forms from September 2012 to November 2012. To its credit, the service has admitted in a statement that the data cartridge may be missing and said it has informed the Information Commissioner’s office. Sue Noyes, East Midlands Ambulance Service chief executive, said: “We take our responsibility for the security and confidentiality of the information we record and store very seriously, and express sincere apologies for a patient data loss incident which we have reported to the Information Commissioner this week. The cartridge is small and there is a possibility that it is still on our premises; we are conducting a thorough search of the building.We are certain the data can only be read via specific hardware which we have in our premises, and which is no longer in production i.e. it is obsolete. Therefore it is unlikely that the information stored on the missing cartridge can be viewed by anyone outside of the organisation. The incident has been reported to the Information Commissioner, to NHS organisations who monitor and regulate our service and to Nottinghamshire Police.”
Up to one quarter of GP referrals ‘avoidable’: Pulse reports that up to 25% of GP referrals could be avoided through a combination of better signposting, education, pathway redesign and use of technologies, according to the authors of an audit of referrals carried out by a clinical commissioning group (CCG). The audit – led by two GPs at NHS Southern Derbyshire CCG – found 15% of GP referrals were inappropriate and could have been dealt with in primary care and another 8% were made before the condition had been fully explored, while a further 1% of referrals were classed as ‘bonkers’ by the authors. However, they concluded that these avoidable referrals were as a result of “busy practices”. Dr Komal Raj and Dr Callum McLean carried out the audit, in which all 20 practices in the locality sent in GP referral letters for the whole of November 2013 – a total of 1,995 letters weighing 42kg. As well as the 15% of inappropriate referrals, and 8% of early referrals, the audit also found 7% were re-referrals, whereby patients had to be referred again after being wrongly discharged back to the GP. The audit also revealed very marked variation in referrals among practices – with a 400% variation in the total number of referrals and a 2,000% variation in inappropriate referrals – which Dr Raj said showed a lot of the problems were down to some practices struggling with demand. Dr Raj said: “I think it’s just busy practices, they are just so busy they have not looked at different ways to see patients or run their practices, and the end result is you get more referrals and admissions.”
London mental health web service planned: London Councils and Public Health England are planning to establish an open access digital mental health service to help Londoners with untreated mental disorders, reports eHealth Insider. The London Procurement Partnership has issued a prior information notice on behalf of the two organisations for an OJEU tender for an “online pan-London digital mental health service”. The notice says the service will offer a “strategic response to a gap in service provision” for the estimated 1.1m Londoners with undiagnosed and untreated common mental disorders. The vision is to improve mental wellbeing and increase mental health resilience of adults in London, by offering an open access digital service to London’s 6.5m adults. It will be delivered across mobile and desktop applications with access through self-referral. The service will allow users to self-assess and manage their mental wellbeing with evidence-based resources, peer-to-peer support and contact with mental health professionals. The notice says that while there are a number of “excellent” existing online services that provide mental health support, such as computer-based technology programmes, specialist chat forums and interactive apps, “they are far from a strategic response and there are many gaps in service provision”. Delivering the service at scale will offer a number of advantages including cost savings, service benefits and opportunities for innovation, the notice says. The service will be constantly monitored by trained mental health professionals to minimise the risk of harm and maximise positive impact, with clinical governance of the service including due diligence on all evidence-based resources and supervision of monitoring staff. The notice says a successful service will help to reduce London’s greater levels of need, while also reducing pressure on other health and care services.
Isis spin-out’s software aims to fix healthcare postcode lottery: Award-winning software which guides doctors and patients through the scientific and clinical information they need to make the best and safest decisions has been developed by Deontics, a spin-out from Isis Innovation, Oxford’s research commercialisation company. As Building Better Healthcare reports, the Deontics software gathers, processes and presents scientific and clinical information, allowing a personalised treatment guide to be generated for each patient. A Deontics system has already been used to manage the treatment of thousands of breast cancer patients at the Royal Free Hospital in London, where it was shown to increase compliance with clinical guidelines. Deontics has secured £700,000 of investment from a group of high net worth investors including former head of technology investments at Apax Partners, John McMonigall, who has also joined Deontics as chairman. The Deontics technology was invented and refined over 10 years by Professor John Fox and his team at the engineering department at the University of Oxford. He said: “Patient safety and improving patient outcomes are at the heart of why we developed this software. All patients should have access to healthcare guided by the very latest scientific and clinical evidence. We would like to give all doctors the tools and information to make best-practice decisions for each and every patient, ensuring that even patients in the most-remote areas receive gold-standard treatment. Our software will also give patients information that doctors have, in a lay format.”
GP practice website problems would be solved by going private, claims Scottish think tank: A Scottish think tank has recommended that GP contracts be opened up to private companies to improve patient choice after finding only two thirds of the country’s practices have their own website, reported Pulse. Reform Scotland – an independent public policy organisation that claims to have no links to any political party – said that opening more surgeries in Scotland would widen patient choice, thereby putting ‘greater pressure on all GP practices to improve’. Reform Scotland’s director, Geoff Mawdsley, said that giving individuals greater choice over their GP practice would mean that people “were able to easily walk away” from GP practices if they felt their services did not suit them. He added: “We don’t envisage that such a policy would lead to a mass exodus of patients from GP practices, but the potential that they would give them much greater influence over the way services developed.” Reform Scotland’s report, Examining Access: Survey of GP practices in Scotland, highlighted discrepancies in ease of access between GP practices across Scotland and drew particular attention to ‘frustrating’ issues with online access. Reform Scotland made several recommendations as the result of the survey, including the provision of more and clearer information to patients about GP services, improving online access and information, and giving patient ‘greater choice’ over their GP practice.
Apple tells developers they may not sell personal health data to advertisers: Apple has tightened its privacy rules relating to health apps ahead of next month’s product launch, which is expected to see the unveiling of an updated iPhone and could include new wearable technology, reports The Guardian. The technology firm has told developers that their apps, which would use Apple’s “HealthKit” platform on the forthcoming products, must not sell any personal data they gather to advertisers. The move could stave off concerns users might have around privacy as Apple seeks to move into the health data business. Apple announced in June this year that a new standard app called “Health” will collect data on blood pressure, heart rate, and stats on diet and exercise. Its new rules clarify that developers who build apps that tap into HealthKit, of which Nike is rumoured to be one, can collect the data it holds. But, they stated, the developers “must not sell an end-user’s health information collected through the HealthKit APIs to advertising platforms, data brokers or information resellers”. Although, the rules add that they could share their data with “third parties for medical research purposes” as long as they get users’ consent.
Opinion
NHS trusts woefully unprepared for wearables
This week in Building Better Healthcare, Ennio Carboni, executive vice president of customer solutions at Ipswitch discusses how NHS trusts need to implement ‘wear your own device’ policies in an effort to enhance patient care.
“Wearable technology has rapidly shifted from the world of science fiction to reality, with great health and welfare benefits promised. NHS trusts, however, seem to be behind the trend for Wear Your Own Device (WYOD), both in terms of employees adopting the technology, and healthcare devices that could benefit patient care.
“A recent Freedom of Information Act (FOIA) request by Ipswitch has revealed that when asked specifically about managing wearable technology entering the workplace – from Google Glass to smart watches – 83% of NHS trusts admitted to having no strategy in place. The FOIA request was designed to identify whether public sector organisations, including 122 NHS trusts, were putting in place effective plans to meet the challenge of managing a growing number of devices on their networks.
“Wearable technology can do much to improve nursing efficiency and boost patient satisfaction. By tracking how a care team performs on a shift and patient outcome, an NHS trust can better plan its resources, for example. Wearable vital sign monitors are already being deployed to collect patient data on a frequent basis, keeping nurses up to date so that they can better manager their workload.
“So, while wearable technology can do much to help patient outcome, better deploy resources and improve communication, many NHS trusts are still getting their heads around the challenges of BYOD (Bring Your Own Device). They are burying their heads in the sand when it comes to wearable technology and have no plans in place to cope with an influx of devices that could dramatically improve efficiency, but instead will leave their networks struggling and open to security risks with no roadmap in place.”
Can giving addicts access to medical records aid recovery?
Lloyd Humphreys from Patients Know Best, a social enterprise working towards putting patients in control of their medical records, discusses the importance and possible benefits of giving individual, and specifically addicts, access to their medical records online.
“As a clinical psychologist who’s spent many years helping people recover from drug and alcohol problems, I know that the substance misuse sector can be a minefield – for both service users and practitioners.
“If you give an individual access to their medical records online, their record stays with them – no matter where they are or who treats them. If the service user is put in control, they can share their record and their treatment plans with whoever needs to see them – police, probation, social services or the NHS. This not only coordinates the care around the individual but also has the added benefit of overcoming information-sharing problems between agencies.
“We know that when patients take control, communication can flow more rapidly and, potentially, lives can be saved. Putting the person in control means that problems and relapse signs can be spotted before they become critical. If the service user is empowered to know what symptoms or behaviours to look for when their health might be deteriorating, their medical teams can step in before a relapse occurs.
“Lastly, people with substance misuse problems often feel they’re not in control of their lives – having interventions done to them without consultation breeds further distrust. However, if you show the service user that you trust them to control their medical records, this builds confidence all round. And with confidence comes self-belief – perhaps one of the strongest aids to recovery.”
The Facebook Challenge
John Cormack, recently received a call from a journalist, telling him that an Essex practice had banned patients from using social media – and asked if he would like to comment. This is an area in which angels fear to tread – so, needless to say, he jumped at the chance.
“What did the practice do to merit so much attention?” Lizzie Dearden in The Independent tells the story: “A poster at the St Lawrence Medical Practice in Braintree, which has since been changed, was put up after staff read personal comments online.” The practice commented: “Any comments we see on social media sites may be seen as a breach of our zero tolerance policy.” She explains that “The ‘zero tolerance policy’ referred to appears to be NHS guidance on dealing with rude, abusive or aggressive behaviour towards staff.” The manager, speaking after the story broke, is quoted as follows: “I admit it wasn’t worded well originally, so we have amended it and added another line at the bottom” The poster now says: “This ensures we can respond to people’s concerns with patient confidentiality in mind.”
“The advice given by the Braintree practice to those with genuine complaints (which I think most practice managers would echo) is to follow ‘the normal channels’ – ringing or writing to the practice manager setting out the concerns.
“Practices have to deal with this relatively new phenomenon in their own way – and until now that has been, by and large, to ignore it. There are alternative ways, however, and clinicians look on with interest at what others do in these circumstances. When criticisms go beyond fair comment and are untrue/malicious/defamatory it is possible to sue.
“Some say that the ‘Facebook’ pendulum seems to be slowly swinging the other way … and that some of these sites are losing credibility. We hear criticisms like: “I used to read the comments but they do seem to attract the lowest common denominator now” … or “The language is awful and the spelling is worse!” They say, for example: “The problem is that people can publish criticisms on impulse – before they have had time to consider the consequences.” These comments may just reflect the fact that, as an old fogey, I talk a lot to old fogeys – but, as things stand, there seems to be a case for waiting patiently until the storm blows over.”
Without motivated people, no new model can change the NHS
The healthcare sector is made up of people, not machines. Steve Peak and Simon Dodds look at what is really needed to get those people to bring about organisational change.
“The challenges facing the health and social care sector are well documented. Understandably the urgency to respond is growing ever stronger as the fiscal constraints continue to bite and the current design flaws of our systems become ever more obvious. All the talk is of the need for transformational change, with radical shifts in models of care being the answer. This is often said without following on with either the clarity or detail on what this really means in practice. Yes, the sector requires transformational change but it is, sadly, not well placed to achieve these ends and is currently in the uncomfortable position of potentially being overwhelmed by the sheer enormity of the challenges that lay ahead.
“Why is the sector not well placed to respond? First, we believe too little attention is given to the application of system design or improvement science principles to understand where the opportunities exist to deliver the required three wins: quality gains, productivity increases and improved motivation. Second, the skills and knowledge base simply do not exist with sufficient critical mass in our clinical and operational teams to apply these principles. Third, not enough time is being set aside to allow team members to both truly understand the principles and techniques of service improvement or to put those skills into practice. Finally, organisations are not, generally, developing cultures of permission to allow clinical operational teams the opportunity to get on and make the changes that would lead to service improvements.
“The ability to deliver the large scale quality and productivity gains can be achieved by sharing and nurturing individual teams to take responsibility. If enough teams do so, the necessary critical mass is more likely to happen than with a top-down approach. But they need the training and tools to ensure a systematic approach is taken to understand how the service currently works, what outcomes it delivers for patients and what impact the new designs will have on the system outputs and outcomes.
“We must give them the skills in improvement science in healthcare if we are to see the necessary radical, transformational change required. Leaders of improvement have to demonstrate their commitment by taking the plunge first.”
Highland Marketing blog
In this week’s blog, Matthew D’Arcy suggests changing the tone for posters in NHS waiting rooms could add much needed positivity.
