Call for new body to oversee patient records

Fifteen leading organisations have called for the setting up of a body to oversee the development of patient records in health and social care. The Joint Working Group (JWG) believes that a Professional Record Standards Development Body (PRSDB) is essential as the patient record ‘is likely to become the single most important unit of information in the NHS.’

Membership of the JWG ranges from the Royal College of Physicians to the DH Informatics Directorate, and the report has earned backing from nine additional organisations such as Cancer Research UK and the Wellcome Trust. The report recommends that the PRSDP should include bodies such as Intellect.

EHI reports that the JWG was concerned that while the NHS is ‘awash with information’ there are major frustrations because it is stored in so many different ways. JWG chair and DH national clinical director for informatics, Charles Gutteridge, says information can only flow more freely if standard formats are in place. HSJ (subscription required) claims that this is likely to occur through the mandating of new standards by the NHS Commissioning Board.

The need for new information standards and governance requirements have been identified as a key risk to the health service in a new document on the design of the NHS Commissioning Board.

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Select committee cuts warning wins wide support

The Tory-led Commons Health Select Committee has warned that the health bill is threatening efforts to achieve £20 billion in efficiency savings. The committee, led by former Conservative health secretary Stephen Dorrell, claims in its new report that ‘salami slicing’ cuts are being made to services rather than the introduction of structural changes needed if the NHS is to do more with less.

Powerful and respected organisations lined up to support to the committee:

    • Director of the Nuffield Trust, Jennifer Dixon, said: ‘The report is spot on … the bill has been a distraction. It has also been divisive.’
    • Foundation Trust Network: ‘The health service needs fundamental reforms to make effective long term savings.’
    • King’s Fund chief economist, John Appleby, said: ‘The report should serve as a wake-up call for ministers and the NHS about the magnitude of the task ahead.’
    • Dr Hamish Meldrum, chairman of BMA Council, said: ‘We would agree with many of the committee’s observations, particularly about the disruptive impact of the reforms.’
    • RCN CEO Dr Peter Carter said: ‘The dual impact of the reform process and the full extent of the efficiency savings is seriously destabilising the NHS.’

In addition 19 out of 20 royal colleges, representing almost the full might of the British medical establishment, have come out against the health bill.

Double trouble for Cerner Millennium

Two trusts have blamed performance problems on ‘issues’ with Cerner Millennium. North Bristol NHS Trust has had to return to paper processes to deal with some outpatient appointments. Wirral University Teaching Hospital NHS Foundation Trust says the system is responsible for its seemingly poor performance on long waits.

EHI says that the figures for the Wirral trust appeared to show that in November it had 700 patients waiting more than a year for treatment – putting it among the worst performers in the country. However, director of information, Luke Readman, claimed the figures were ‘inflated’ because of an issue with the way staff were using the electronic patient record system.

North Bristol says that it is working to fix implementation problems, which include patients being given non-existent appointments or not being informed about scheduled operations. This should be completed by early February. In the meantime 40% of outpatient activity is being handled on paper or with other applications.

On the plus side Homerton University Hospital NHS Foundation Trust has ended its run with the National Programme for IT in the NHS and signed a contract directly with Cerner for its Millennium electronic patient record.

European data protection laws toughened

The entire legal framework for companies whose products or services deal with personal data is about to change. EU justice commissioner Viviane Reding has set out new plans which include a citizen’s ‘right to be forgotten’ and an obligation for organisations to report data breaches as soon as possible.

While much of the coverage is concerned with the consumer business the implications for the healthcare sector are profound. Principles of the new legislation will include:

    • Explicit rather than assumed consent to data collection.
    • Deletion of data when there are no grounds for its retention.
    • Easier access to one’s own information.
    • Stronger data protection authorities.

The announcement of new legislation comes shortly after an EC-sponsored Eurobarometer survey on attitudes to data protection across member countries. This revealed that most Europeans regard health information as profoundly personal and sensitive and wanted it well protected. It also suggested high levels of trust that healthcare organisations were committed to privacy.

GPs left out of NHS 111 development

GP commissioners feel left out of the development of 111 services. According to GP online the findings come from an NHS Alliance survey of members of its clinical commissioning federation.

The service is a hotline for patients with urgent, non-life threatening health problems set up as an alternative to calling 999. Despite clinical commissioning groups (CCGs) being key to its implementation in 2013, they feel disengaged and are concerned that it will not improve patient care.

Sixty eight per cent of the 51 CCG leads who responded to the survey disagreed with the suggestion that NHS 111 would ensure that patients got the right service more quickly. Just 23% were confident that 111 would be a success in their area.

Results also revealed that despite CCGs being told they could choose whether to pilot or procure NHS 111, or set up a service using existing providers, very few had such a choice. Nearly 80% of commissioners whose CCG had procured the service said they had done so because the decision was made by their SHA or PCT cluster.

News in brief

    • IT fraud investigation: Police are investigating allegations of fraud at the Royal Surrey County Hospital. HSJ (subscription required) says concerns surround £200,000 of unbudgeted spend on one IT project and £400,000 relating to other informatics projects.
    • Genome report: The Human Genomics Strategy Group has released a new report, Building on our Inheritance, which sets out recommendations for realising the potential of genomic technologies within healthcare, and for the UK economy.
    • Diabetic weight loss research: Randomised controlled trials reported in BMJ have proved promising for the treatment of obese patients with type 2 diabetes. Agonists of glucagon-like peptide-1 receptor (GLP-1R) were found to result in weight loss in overweight or obese patients with or without type 2 diabetes mellitus.
    • New company to run NHS estate: Ownership and management of much of the NHS estate is to be handed over to a government-owned company. HSJ says its objectives will include cutting costs, and the disposal of surplus land and property.
    • DH staff confidence plummets: Pulse reports that the latest DH staff survey reveals that only a third believe the department is well managed while less than two thirds now feel it is doing a good job for health in England.


Look after the pennies and the pounds will look after themselves – a new paper from the King’s Fund shows how using patient-level data to identify small amounts of waste can yield huge costs savings. Lara Sonola looks at how service-line management can make efficiencies add up.
‘Two examples stand out in my mind … in the first case, the team found that some patients were undergoing duplicate tests. One unfortunate patient had one test more than 40 times, during a hospital stay in which the result could not possibly have changed from the first occasion.

‘In the second, staff found an anomaly when they compared the quantity of tests ordered by clinicians within a department. One clinician appeared to be ordering a £50 test far more frequently than the rest. Was this due to differing clinical opinions? No, the doctor in question mistakenly believed that the test cost £0.50 rather than £50.’


Does tele-health really deliver for patients? GP online (registration required) talked to two south London GPs about their experience with projects designed to raise efficiency and cut costs.
Dr Raza Toosy, whose project saved £55,000, said: ‘All too often there is a gap between the vision and the application of holistic services, and time and again we have found that when considering the effectiveness of patient care, the system fails when patients do not engage or are unwilling to change, despite help from service providers.’

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Mark Venables looks at what the Health Select Committee report means for the NHS and the drive for efficiency savings.

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