News in brief
£1bn question answered “shortly”: Freeman: Details of how the government will invest more than £1bn on digitising the NHS over the next five years will be announced shortly, minister for life sciences George Freeman has said. Treasury documents relating to last November’s Spending Review indicated that the government would invest £1bn in NHS IT over the course of this Parliament. Freeman indicated the final figure will be “quite a lot bigger”, but could not give more detail as it is not yet in the public domain. “Digitisation of the NHS and our healthcare sector is absolutely central to our commitment and our investment in a 21st Century healthcare system,” Freeman told DigitalHealth.net. “That’s why we have prioritised it in the Spending Review and will shortly be announcing the total spend on that programme over this Parliament.” Some of this money has already been earmarked for investment in installing free wi-fi across the NHS estate. It is also expected to fund the six key workstreams identified by the National Information Board as part of its vision for a digital NHS, outlined in “Personalised Health and Care 2020”, the IT framework issued in 2014. These include: providing patients with online access to health information and transactions as well as apps; the creation of interoperable electronic patient records to allow better data sharing; and supporting health and care professionals to make the best use of technology. Freeman said the government has already funded a number of projects to trial new innovations, such as the 50 vanguard sites looking at new models of care and the newly announced “test bed” sites piloting ideas such as telecare and remote monitoring of patients.
NHS England unveils ‘test beds’ partnership plan: NHS England has unveiled a series of trial “test bed” programmes that will see select local health bodies and companies working together around the development and adoption of internet of things (IoT), bio sensors, apps and telehealth innovation, reported Government Computing. As part of a joint initiative with the Department of Health and the Department for Culture, Media and Sport, select clinical commissioning groups (CCGs) and trusts will trial different combinations of technologies to try and tackle “a locally-identified clinical challenge.” During the first wave of the programme, five health and care and two IoT test bed programmes will be implemented by organisations in the West of England, Surrey, Sheffield and Birmingham as part of work alongside companies like IBM, Philips and Verily. Various small and medium-sized enterprises will also be involved. Clinical challenges that will be focused on during the initial phase will include the improved prediction of care needs for local populations, as well as supporting the elderly and patients with long-term conditions to remain independent in their homes. Each initiative is then expected to undergo an evaluation process with the aim of potentially supporting wide-scale adoption of the successful programmes. NHS England chief executive Simon Stevens said the programme reflected the growing importance of combining innovative technologies like biosensors, mobile communications and artificial intelligence computing. “Our new NHS test beds programme aims to cut through the hype and test the practical benefits for patients when we bring together some of these most promising technologies in receptive environments inside the world’s largest public, integrated health service.”
Public sector “scrambling” to meet digital infrastructure demand, admits NHS IT chief: Andy Robertson, NHS National Services Scotland (NSS) director of information technology, has raised concerns over the capacity to simultaneously deliver large-scale programmes such as fibre broadband and a single digital network for the public sector at pace. The Scottish Wide Area Network programme (SWAN) is intended to deliver a single public services network for use by the NHS, councils and other public sector organisations north of the border, allowing information to be shared more easily and securely. It comes at the same time as Scotland also presses ahead with plans to roll out high-speed fibre broadband to 750,000 premises by the end of March 2018. Robertson, who was speaking at the Holyrood conference on SWAN, said: “There is the Broadband [Delivery] UK initiative to deliver fibre to the cabinet up and down the country for retail consumption. And that’s somewhat competing for capacity with the SWAN programme, trying to do the same thing for the public sector. We have escalated that on a number of different occasions and have made it clear that is understood by the civil service, by the politicians, by the different companies that form the industry in Scotland. But I think that is something we’re certainly struggling with, [which] is capacity rather than the ability to deliver. I don’t think anybody is questioning the ability to pull this off but the ability to deliver it in a hurry with the amount of demand there is across the piece has been the real issue. You’ll see that, there is the whole of the Scottish public sector scrambling and I don’t see the demand diminishing either.”
Hunt’s digital guru assembles multinational review team: The US digital health expert commissioned by Jeremy Hunt to advise on how the NHS can become a world leading digital health system has assembled a heavyweight group to assist his review. Health Service Journal (subscription required) understands Robert Wachter’s advisory team, which will help him prepare a digital review scheduled to be published in the summer, contains experts from the US, senior NHS figures and well regarded international digital IT specialists. The group is understood to include David Brailer, who was the first US national coordinator for health IT in 2004-06, and is now chief executive of private equity firm Health Evolution Partners. Other notable members understood to be on group are: Aziz Sheikh, professor of primary care research and development, Edinburgh University; Sir David Dalton, chief executive of Salford Royal Foundation Trust; and Ann Slee, e-prescribing lead at NHS England. The health secretary revealed he had commissioned Professor Wachter to carry out the review at the HSJ annual lecture in October. He said Professor Wachter “will conduct a review for the NHS on the critical lessons we need to get right as we move to a digital future. He will guide and inspire us as Professor Don Berwick did on safety and we look forward to receiving his report next summer.” Full terms of reference for the review are still to be published.
Put senior doctors on the door of A&E to reduce needless elderly admissions, say experts: Hospitals should put senior doctors at their front doors to assess whether elderly people really need to be admitted via A&E units, a major report has said. An independent commission says frail pensioners are too often being forced into “continually overcrowded hospitals” which can cause their health to worsen, reported the Telegraph. The report says senior clinicians should carry out a full assessment of elderly people who arrive at hospitals as emergencies, to determine whether hospital is the best place for them. Too many pensioners are being needlessly admitted via A&E, for lack of basic care, then left stuck in hospital for weeks, often getting frailer by the day, experts said. The stark report comes amid growing pressures on hospitals. Over five years, the number of hospital trips for those over the age of 75 has risen by 65%, while latest bed blocking levels are among the highest on record. Dr Mark Newbold, chairman of the Commission on Improving Urgent Care for Older People, said health and social care systems needed to be radically overhauled to work around the patient. “It is unacceptable to expect older people and carers to navigate a very complex system,” he said.
100,000 patients set to receive personal health budgets by 2020: NHS chiefs are aiming to increase the number of people receiving personal health budgets by 2,000% over the next five years under the government’s drive to roll out the scheme to more patients with complex needs and multiple long-term conditions, reported Pulse. Under plans announced by the NHS England lead on implementing the budgets, as many as 100,000 patients will be given a lump sum to buy services as they see fit. However, experts criticised the pace of the rollout when questions remained about the evidence behind the budgets and their impact on the rest of the health service. Dr Sam Bennet, head of personal health budgets and integrated personal commissioning at NHS England said: “Our task looking forward is to start to map out what that looks like for each Clinical Commissioning Group (CCG) and to start having those conversations about how we support that rollout over the next few years.” However, Professor Peter Beresford, an expert in personalisation in social care from Brunel University, questioned the pace of the rollout when independent evidence to support the scheme was lacking. He said: “The scale of the change that is being demanded that we should move from 4,700 – with less than 3,700 receiving direct payments – to 100,000 in less than five years, does not fit well with our politics of austerity.”
GS1 demonstrator sites announced: Six NHS hospital trusts have been named as demonstrator sites for the use of GS1 barcoding standards and will share £12m in funding from the Department of Health (DH). The government hopes this will accelerate the implementation of electronic procurement systems that will help deliver up to £800m in efficiency savings, reported DigitalHealth.net. Health secretary Jeremy Hunt said earlier this month that the trial: “will see every product given a barcode, from medical items such as pacemakers to day-to-day items such as stationery, which will mean supply chains for hospitals are made simpler, reducing the estimated £150m the NHS wastes each year on products which have been either oversupplied or perished.” The six sites: Derby Teaching Hospitals NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; North Tees and Hartlepool NHS Foundation Trust; Plymouth Hospitals NHS Trust; Royal Cornwall Hospitals NHS Trust; and Salisbury NHS Foundation Trust will demonstrate their use for; inventory management; improving patient safety through surgical instrument tracking; medical equipment management; product safety recall; and purchase to pay.
Delivery of over 70% of NHS priority programmes at risk: Over 70% of NHS England’s portfolio of priorities and programmes are rated as either “amber” or “red” for delivery confidence, the organisation’s board has revealed. National director for transformation and corporate operations Karen Wheeler and interim national director for commissioning operations Richard Barker said that while good progress is being made across several primary care programmes, the poor delivery confidence “reflects challenges in both implementation of the infrastructure fund programme and finalising the General Medical Services (GMS) contract.” NHS England said its delivery confidence was affected by the process to procure the first wave of the national diabetes programme, reported National Health Executive. The programme is due for nationwide roll-out this year, with up to five million at-risk people expected to participate in a prevention effort. Learning disabilities also continue to be under threat, with no change to its amber/red status since the last reporting period. NHS England blamed this on the “complexity and scale” of the transformation required to the service. Several red risks are also currently being managed through the “corporate risk register”, according to the national body. At the top of these is urgent care, for which “robust winter planning arrangements” are already in place, including initiatives with the private and voluntary sectors.
New code for open source EHR released: IMS MAXIMS has released the latest version of its open source electronic patient record (EPR), including all of the enhancements made for Taunton and Somerset NHS Foundation Trust, reported DigitalHealth.net. Taunton was the first trust to go live with openMAXIMS in September last year and has been working closely with the company on developing new functionality, which is now available on the open source website GitHub. New features of openMAXIMS 10.5 include; clinical triage of referrals; elective list management; clinical coding; appointment outcomes; and pre-operative assessment for theatres. IMS MAXIMS first released the code for its EPR as open source to the NHS in June 2014. Eighteen months on, there is 50% more source code available. Paul Cooper, research director at IMS MAXIMS believes the open source approach is maturing in the NHS and said: “NHS trusts looking to adopt openMAXIMS will benefit greatly from the developments made for Taunton, whose clinicians were involved throughout the design of the system, ensuring it suited the trust’s clinical needs and processes across A&E, theatres, outpatients and the hospital’s 30 wards.”
London mental health trust doctors use Skype for patient consultations: South West London and St George’s Mental Health NHS Trust is using Skype to give patients an alternative to face-to-face appointments, reported ComputerWeekly. The trust is in the process of rolling out Skype consultations across its sites, meaning that, instead of having to come into hospital for an outpatient appointment, patients can video chat with their clinicians from the comfort of their own home. The aim of the project is to make it easier for patients to attend appointments, especially those unable or reluctant to leave their house for physical or mental health reasons, or those who can’t get away from work. The head of communications and engagement at South West London and St George’s Mental Health NHS Trust, Ranjeet Kaile, said that, because clinic appointments are held during the day and patients often have to take a lot of time off work, “did not attend” (DNA) rates were creeping up as people missed or cancelled their appointments. “Skype has helped reduce travel costs for patients and meant that clinicians are able to add more appointments – and it has reduced DNAs, as patients can video chat when it’s convenient for them,” he said. He added that the aim was not to take away the opportunity to see a clinician face-to-face, but rather to give patients another option if they want it. “It’s really about making sure we can be as flexible as we can to suit our patients’ needs and that we always offer them the alternative. It helps save time for both clinicians and patients.”
Orion Health enters French market with two landmark contracts: Orion Health is contributing to the transformation of the French healthcare sector as it embarks on two major projects in France, reported eHealthNews.eu. Orion Health CEO Ian McCrae said the contracts represent a significant milestone for the company, as it is the first time it will deliver its solutions in France. “These are landmark contracts for Orion Health. We are entering the French market with our strategic solutions and are in a great position to leverage our experience and platform for other projects as France transforms its health system,” said McCrae. Jonathan Selby, Orion Health executive vice president for EMEA said the company is playing an integral role in France’s shift from a hospital-centric model of care to a patient-centric model. In order to find the right model of care, the French Ministry of Health is funding a nationwide programme called TSN (Territoires de Soins Numériques – Digital Care Regions). The TSN has pilot projects in five regions and Orion Health is participating in two projects – the TerriSanté project in Paris and the eTICSS project in the Burgundy region. In both contracts, the Orion Health solutions chosen have been built on an open data platform that scales to aggregate and manage different types of health-related data.
Islington awards £7.4m IDCR contract: Islington council and clinical commissioning group have awarded a five year, £7.4m contract to BT to create an integrated digital care record for the borough’s patients, reported DigitalHealth.net. The new system will pull together a shared record for more than 200,000 patients and will also be made available to the patients themselves. Islington is one of NHS England’s 25 Integrated Care pioneer sites, chosen to try out new approaches to joining up health and social care. BT will build and manage a hosted interoperability service working with a number of partners including InterSystems and Nanthealth. This will pull together patient data from information systems used across the area’s various different care settings, including Emis, System C, Adastra, Carecast and Liquid Logic. The new integrated digital care records will be accessed by clinicians and care workers and show all of a patient’s encounters with the NHS and social care. Ian Dalton, president of global government and health at BT said staff will be able to access the records on any device that has secure access to their organisation’s network, including a tablet, laptop, personal computer or smartphone. “They can do this in a number of ways, including via their own clinical systems, through an icon, via single sign on or via an app. The exact method used will depend on the clinical system they are using,” he explained.
NHS Wales: Waiting times worse than in England: NHS patients in Wales wait longer for treatment and diagnosis than patients in England for most of the main categories, BBC Wales has revealed. Hip operations showed the biggest difference of four months, with an average wait in England of 75 days compared to 197 in Wales in 2014/15. Diagnosis of heart disease takes on average 10 days longer in Wales. Deputy health minister Vaughan Gething called for a focus on the results of treatment, not just waiting times. Waiting times for hip surgery have deteriorated significantly in Wales over the past four years. Since 2011/12, the average wait has risen by a fifth for the nearly 6,000 people who had hip operations in 2014/15. Waiting times in Wales for the treatment of cataracts, hernias and some heart operations are around two months longer than in England. The figures are drawn from the headline figures measured in the Hospital Episode Statistics from the English NHS and the Patient Episode Database for Wales. The difference in waiting times since 2011/12 and 2014/15 has narrowed significantly for heart operations but has grown for hip and cataract operations, and the diagnosis of hernias. Gething said he did not accept there had been failings in the Welsh NHS, but added: “I know we have more to do. We want to have a system that properly runs on waiting for treatment that is acceptable, but importantly the focus has to be on outcomes.”
OptimiseRx™ is first to provide medicines optimisation support to five NHS CCGs: Hearst Health International has announced that OptimiseRx has become the first solution to be procured by a federation of five London Clinical Commissioning Groups (CCGs) under a new procurement framework from NHS Shared Business Services (NHS SBS), reported eHealthNews.eu. The contract was announced by Simon Radcliffe, head of UK commercial management, Hearst Health International. NHS Central London, Ealing, Hammersmith and Fulham, Hounslow and West London CCGs will now be able to use OptimiseRx to enable better prescribing decision support through patient-specific care guidance. “We wanted a solution that would enable our CCG to provide GPs with clinical information before a prescribing decision is made”, said Dr Tony Willis, Diabetes and IT Clinical Lead for Hammersmith and Fulham CCG. Thomas Slater, strategic procurement lead at NHS SBS commented: “This is a great example of a real NHS collaboration that will help the wider NHS make significant savings on an important technology needed across the country. The five CCGs with whom we have worked with are already reaping the benefits of supplier choice. Our newly launched framework allows the wider NHS to achieve best price, terms and wider market choice in the same way, without the need to conduct their own time consuming and expensive competitions.”
BMA chairman: GPs’ can’t be ‘middleman’ for all patient care: The chairman of the BMA’s Scottish GP committee has said that the current model for patient care is no longer viable and their role needs to be refocused as part of a new contract for family doctors, reported The Scotsman. Dr Alan McDevitt told a conference in Edinburgh yesterday that general practice could no longer be “the middle man” for all patient care, as Scotland’s chronic GP shortage will not be resolved within the next decade. Doctors will need to think of how they can share the burden with other healthcare workers including pharmacists, nurses and voluntary organisations, said Dr McDevitt. It comes after the Royal College of General Practitioners (RCGP) Scotland accused ministers of viewing family doctors as “dispensable”, as new analysis revealed GPs only received a 1.9% funding increase compared with 3.8% for health boards. A new GP contract is due in 2017 and Dr McDevitt is currently working with the Scottish government on what this will entail. He had claimed the contract was about doctors’ pay, but later said it was about redefining the role of the family doctor, as there is currently no explicit detail on the remit of the job in Scotland. Dr McDevitt said: “In the contract we will be trying to refocus the time of GPs and their energies. I don’t want to be the middle man. People shouldn’t have to come through me if they want to see a dentist.” He said current workloads are “unbearable and unacceptable”, which is making general practice unattractive.
Opinion
Can the NHS bear to be special?
Joe McDonald is worried that “NHS special” technology services are coming at too high a development and financial cost to be sustainable. Time to use other people’s infrastructure and ideas…
“I am tired of being “NHS special” and paying the special price that goes with it. For example, I have noticed that – after a slightly shaky start – Siri on my iPhone is increasingly capable.
“It rarely puts a foot wrong when I ask it to look something up on the internet for me. In fact, I can use it to dictate letters and emails if I am in a quiet environment and it types more accurately and spells better than some typists I have had. So why not use it to dictate NHS letters? Why not use Apple’s expensively developed speech recognition technology to dictate direct into my electronic patient record? Because I am “NHS special” and I must be sure that the data is not, however briefly, going to Cupertino and infringing information governance rules.
“Instead, I must buy an “NHS special” speech recognition package at a cost that is infinitely more expensive than Siri (free with the device and no annual licence fee). Going back to the 1980s, I was an early adopter of telephone banking and later internet banking. I am sure that the banks must, for a time, have considered whether they would need “banking special” telephone networks that would involve them in laying their own network of copper across the world that would be accessible to only the bank. In the end, however, they decided to go with the public telephony and the internet. The banks realised that they could ride the wave of rapidly developing consumer communications and add the necessary security and authentication apparatus as required. They did not need to develop a separate system.
“The NHS’ online rivals, like Babylon, are managing to leverage consumer communications systems, apps and the cloud to deliver services. These rivals deliver security that paying patients are happy with. And they are doing it at a price that the NHS may struggle to compete with.
“The Netflix approach – building your business on somebody else’s expensively developed infrastructure – is being widely adopted by the private health market and may be something the NHS needs to adopt to survive.”
Why would we want to encourage patients to book appointments online?
Following a government task force, headed by Baroness Lane-Fox, Dr Pete Devison asks why we are encouraging patients to book appointments online.
“A government task force, headed by Baroness Lane-Fox, wants GPs to be contractually obliged to increase the percentage of our patients who book appointments online by 10% each year. Despite the fact that GPs have been obliged to provide online access since April, only 2.7% of appointments are actually booked via the internet. It’s the classic DoH algorithm: pay GPs to do something → discover no-one really wanted the thing in the first place → penalise GPs for people not wanting the thing → rinse and repeat. This from the same numpties whose response to the nationwide apathy about Sunday opening is to threaten to hardwire it into the contract.
“Let’s leave aside for a moment the fact that without the guiding hand of an informed human, patients might book inappropriately for things like travel jabs, suture removal or 30 minute DVLA medicals (to quote genuine examples from the last month). I’m no Luddite, but I’m not entirely convinced that we need to make booking appointments more convenient.
“And the idea of a direct link between practice income and how tech-savvy my elderly patients are is very worrying. I don’t want to spend March 2019 sweating over whether we’ll lose a chunk of QOF income because Vera can’t get past Level 97 of Candy Crush. And just think of the potential for complaints! ’You showed my grandad how to use an iPad and now he’s silver surfing the dark web!’ You can be sure that when Skynet becomes self-aware and we’re all enslaved by Terminators the Daily Mail will trace it all back to the day a greedy lazy GP gave Nanna a router.
“But ultimately this feels a bit like another exercise in pre-iceberg deck-chair rearrangement. The reason it’s hard to get an appointment is we have too few GPs trying to do too much with too little money. No amount of fancy apps is going to solve that.”
Patient involvement: GP practices should not be scared of using Facebook
Social media can play an important role in promoting patient-centred care writes Dr Ruth Chambers on GP Online.
Chambers, the chair of Stoke on Trent Clinical Commissioning Group, says: “‘Facebook? It’s just used by teenagers to share pictures of their family and say what they had for tea.’ This is what, I suspect, most of my fellow clinicians would tell you if you asked about the social media channel.
“But I firmly believe, if used properly, it can transform the relationship between GP practices and the patients they serve.
“Latest stats show 85% of homes have access to the internet, more than seven in 10 adult internet users have a social media profile and the fastest growing smartphone market is the 65-plus age group. In 2013, 28.9 million people accessed Facebook regularly. This is set to increase to 33 million by 2018.”
She goes on to detail examples of how 30 practices in Stoke-on-Trent are now each reaching as many as 700 patients per week through Facebook.
“We have no option but to embrace technology to improve outcomes for patients.
“Facebook and other forms of social media are cost effective tools we can use to meet this agenda. Indeed, the potential is huge. But professionals fear it. We shouldn’t let fixed ideas about what it is stop us exploring and exploiting that potential.”
Tracking down kidney failure: Western Sussex develops AKI alerts
Western Sussex Hospitals NHS Foundation Trust has been developing acute kidney injury alerts for Patientrack, and is now planning a big expansion of its use of IT. Lyn Whitfield went to visit.
“Hannah Prince, the outreach lead for Worthing Hospital, looks alarmed as an overview of patients with sepsis is pulled up on a computer screen. “Wow,” she says, “that’s a lot of patients. Normally, there would only be four or five. It’s really busy out there today.”
“The overview is being generated from Patientrack, which Western Sussex Hospitals NHS Foundation Trust has been using since 2012. At its simplest, Patientrack enables doctors, nurses and other clinical staff to electronically record observations at the bedside, that are then used to calculate National Early Warning Scores, or NEWS.
“Richard Venn, a consultant in anaesthesia and intensive care, and the lead clinician for the development and implementation of the system at the trust, says it was initially used to identify and locate deteriorating patients. But more recently, a lot of work has gone into using the system to pick up patients with specific problems, such as sepsis and acute kidney injury.
“But more recently, a lot of work has gone into using the system to pick up patients with specific problems, such as sepsis and acute kidney injury. “Before we had this system, I could come in on a weekend and I would not know where patients were,” Venn recalls. “I would not know which patients were deteriorating, perhaps until an arrest call went out. So that was the driver to deploy this.”
“Worthing started with a pilot of Patientrack in its admissions unit, but is now using the system across its ‘emergency floor’. Patientrack has also been rolled out to all the wards at the trust’s two main hospitals, but not yet to its A&E, maternity or paediatric services, for which different scoring is needed.
“Venn says it is hard to disassociate its effects of the IT system from other initiatives, including the outreach team, the emergency floor, and safety campaigns. But in combination he says they have led to a change in culture. “Now, if you ring a ward to say they have a deteriorating patient, they usually say: ‘Yes, we know, we are dealing with it’,” he says.”
