News in brief
BMA rejects ‘undesirable’ Labour proposals to integrate health and social care: The British Medical Association (BMA) has rejected the Labour Party’s suggestion for full integration of health and social care budgets, saying it is neither ‘necessary nor desirable’ according to Pulse. In a formal submission to the party’s policy review into care integration, the BMA said integration may lead to the NHS budget being tapped to prop up underfunded social care, and argued that clinicians should stay in charge of budgets as they have expert knowledge of local health needs. Proposals for full integration of health and care services were floated by Labour upon launching an independent commission to inform its policy on integration in April, with health and wellbeing boards taking over the health budgets from Clinical Commissioning Groups (CCGs) to create a truly integrated system. The Labour review is led by Glossop GP Sir John Oldham, who has been asked to come up with a range of ideas for how to integrate health and social care to make NHS more effective and affordable. However, the BMA warned that instead Labour should consider designing new tariffs or transferring parts of the local authority budgets to CCGs to improve integration.
Health secretary “breached his statutory powers”: Jeremy Hunt has had his plans to downgrade Lewisham Hospital quashed by the High Court this week, reported Commissioning GP. The health secretary wanted A&E and maternity services at Lewisham Hospital to be downgraded, but the judge has ruled that this was acted outside his powers and was in breach of the National Health Services Act 2006. A campaign group, Save Lewisham Hospital, attracted mass support from the public, health professionals and politicians, and the reversal was partly down to their efforts in what is a blow to the government. Lewisham’s Labour MP, Joan Ruddock, told The Independent: “This is the most significant community-based battle that has ever succeeded in my political life. To take on the government in the High Court and to win, is exceptional. We had a demo which tuned out 25,000 people for a local cause.” Dr Louise Irvine, a local GP and chair of the Save Lewisham Hospital Campaign, added: “The support from thousands of people in Lewisham is a very real demonstration of the Big Society.”
Mid Staffordshire NHS Trust ‘should be dissolved’: The trust that ran the scandal-hit Stafford Hospital should be dissolved, administrators have recommended. The Mid Staffordshire NHS Trust went into administration on 16 April after a report concluded it was not “clinically or financially sustainable”, reported the BBC. Critical care, maternity and paediatric services should also be cut, the proposals unveiled by Trust Special Administrators said. The trust’s two hospitals would come under two other trusts. Stafford Hospital will be part of the University Hospital of North Staffordshire in Stoke-on-Trent while Cannock Hospital will become part of the Royal Wolverhampton Trust. The proposals include – Stafford Hospital losing its maternity unit but keeping its accident and emergency department, downgrading Stafford’s critical care unit and losing some emergency surgery and introducing a “Frail Elderly Assessment service”, which would mean different sources providing information on older people’s needs when they are referred to hospital. The proposals will now go to a public consultation, which will end on 1 October.
NHS Direct confirms 111 withdrawal: NHS Direct has confirmed it is seeking to pull out of all 11 of its contracts to provide NHS 111 as they have proved “financially unsustainable”, reported Health Service Journal (subscription required). Health Service Journal reported in June that NHS Direct was losing more than £1.5m a month on its NHS 111 contracts and was likely to exit the market by the end of the year. Earlier this month the organisation – which has the status of an NHS trust – confirmed it was pulling out of contracts in Cornwall and North Essex. In its annual report for 2012-13 chief executive Nick Chapman confirmed NHS Direct was seeking to withdraw from the remaining nine contracts. These include the West Midlands, North West, South East London and Somerset and account for about one third of England by population. The annual report said although the board had agreed to bid for contracts at a cost of between £7 and £8 per call it was “now clear that the trust is not able to provide the 111 service within this lower cost range”. NHS Direct operated at a cost of closer to £20 per call.
Councils get £11.8m for data collection: Councils will get an extra £11.8m of funding to support the move to a new social care data collection system, due to be phased in over coming years, reported eHealth Insider. An expanded set of social care data is due to be collected and published annually by the Health and Social Care Information Centre (HSCIC). The Department of Health (DH) says the statistics will help to improve social care standards, rather than simply counting activities and processes. In order to support the new data collection requirements, the DH will give local authorities an extra £11.8m of funding for implementation. In 2010, the HSCIC led a review to consider the types of data that councils would need in order to understand their performance and outcomes. The review recommended changes to data collections, which will be phased in over the next couple of years. These include; a new safeguarding collection; a new data item on staff qualifications; and a new short and long-term support collection and finance collection. Each local authority will receive money to cover costs of moving to the new data collection system, which forms part of wider work to transform the care and support system to be more integrated.
Patient privacy top priority as Norway rolls out national Summary Care Record: The Norwegian Health Directorate has selected FairWarning® Patient Privacy Monitoring solution as an integral part of the national roll out of the Norwegian Summary Care Record (SCR), reported HealthTech Wire. The deployment of the solution will enable compliance to new legislation introduced in June 2013, which mandates the protection of patient privacy. The objective of the SCR is to improve the quality of healthcare delivery and standards of patient care and safety. This will also create greater patient engagement, through the provision of easy access to secure digital services. Rune Røren, director of development for the National Summary Care Record, Norwegian Health Directorate commented: “Norway has a world leading reputation for healthcare. This is why we have partnered with FairWarning® to assure the reputation of the Summary Care Record in protecting the privacy of patient’s health information. It sends a clear signal to patients, who have the choice to opt out of the SCR, that we take their privacy very seriously and that they can trust that their medical data is safe and secure.”
NHS reform a treasure trove of opportunity for small VARs (Value Added Reseller): Smaller IT suppliers with specialised skills are well placed to reap the benefits of the changing NHS IT landscape, according to Ovum, which warned medium-size firms could miss out on big deals. CRN UK reported that on 1 April, a wave of change swept the health service, with Primary Care Trusts abolished in favour of new Clinical Commissioning Groups, which are supported by Commissioning Support Units. At the time, suppliers of all sizes were hopeful they could cash in, but Ovum’s lead analyst for healthcare and life sciences Charlotte Davies said the changes could see smaller firms muscle their way in on big deals. “A number of trusts will have well-developed ICT teams and will have IT teams working with clinicians,” she said. “They’re in a position to say to a supplier that they want to work with them on a bespoke service. There are more opportunities for local providers here, especially in areas where people have bad memories of the National Programme for IT. That legacy is still there and many associate that with big vendors and a big-project approach. Instinctively, there is a preference to work with local suppliers.”
Friends-and-family patient test failed by 36 wards: Patients on 36 of 4,500 hospital wards in England would not recommend them to relatives, a new survey suggests. The latest results of the new “friends and family” test saw one English A&E department out of 144 get a “negative score” – Chase Farm Hospital in London, reported the BBC. Critics say the survey is too blunt an instrument for feedback as response rates at some hospitals are low. NHS England said the findings contained “home truths” but it was “early data” and should be treated carefully. The survey, which started in April, looked at patients who stayed in hospital overnight or attended A&E. The questionnaire, backed by the prime minister, asked the question: “How likely are you to recommend our ward/A&E department to your friends and family if they needed similar care or treatment?” About 400,000 people overall responded to the friends and family test data survey.
Care Connect going live: A multi-channel patient feedback service developed by NHS England is going live in 18 trusts in London and the North within a week, reported eHealth Insider. Care Connect allows patients to go online, ring a telephone number, text or use social media to log concerns that need resolving, ask a question or provide feedback on their experiences. These will be published online and where necessary, passed on to providers to respond. Jane Barnacle, London’s regional director for patients and information, said 16 trusts in London and two in the North are piloting the service. They include a range of acute, community and mental health providers. Website access will initially be via NHS Choices or myhealthlondon, but will ultimately become part of the integrated customer service platform being developed by NHS England. A central team of existing call handlers from NHS Choices and NHS Direct will monitor the various channels patients can use to interact with the service. In some cases they will answer questions themselves, or they will pass the issue on to the trust involved. Trusts are expected to respond using their existing patient liaison teams.
NHS England ‘should spend more on general practice’: NHS England needs to increase spending on primary care in order to achieve the desired shift in patient care out of hospitals, says the policy director of the Nuffield Trust. In an exclusive interview with Pulse, Dr Judith Smith said that at the moment GPs feel constrained by workload, funding pressures and ‘being stuck’ in the current general practice service model. Speaking after the think-tank’s joint report with the King’s Fund on the future of general practice, which suggested a new alternative GP contract is developed to incentivise larger-scale working, Smith said that this would require general practice taking a larger chunk of the overall NHS budget – than the current 9% – in the longer term, alongside investment in workforce and premises. She said: “Primary care spending has been flat and even reducing as an overall percentage of NHS funding in the recent past, and I think as we look forward and there is a requirement for primary care to take on more if we look at changes to how our hospitals might run. We have to think seriously about how primary care is funded and supported.”
IMS MAXIMS open to open source: IMS MAXIMS is considering opening up its patient adminsitration sytsem (PAS) so that it is open source reported eHealth Insider. Guidance released this month by NHS England, ‘Safer Hospitals, Safer Wards: achieving an integrated digital care records’, says it wants to create a “vibrant market” of national solutions and products that are available under open source licensing arrangements. Beverley Bryant, NHS England’s director of strategic systems and technology, told eHealth Insider: “We are currently in discussions with a number of organisations about making their proprietary software open source and persuading them that the future is open source because we want to give clinicians the flexibility.” One of the commercial providers in discussions is IMS MAXIMS. CEO Shane Tickell has written an Industry View on why the company is considering the idea. “Rather than feeling threatened by the potential for open source, we have been evaluating, for some time the implications to our business and to our existing and future customers of moving to make part of our product portfolio open source,” he said.
Capita and Circle join up to bid for healthy returns: Capita, the FTSE 100 outsourcer, is to bid for lucrative NHS contracts in partnership with Circle Holdings, the AIM-listed business that took over a state-funded hospital in a £1bn deal last year according to the Financial Times (subscription required). The two companies will compete for a range of NHS contracts covering everything from hospitals to adult and social care as well as back office functions such as managing payrolls and handling legal claims. Capita is understood to have proposed the tie-up. Steve Melton, chief executive of Circle, said: “Our joint partnership combines Circle’s unique clinical expertise with Capita’s world-class business transformation capabilities.” Andy Parker, deputy chief executive and joint chief operating officer of Capita, added that the alliance “will allow us to deliver a genuine end-to-end solution to the NHS, one that will maintain and improve quality standards, at the same time as driving down costs”. The move underscores the surge in private sector opportunities in the NHS. According to Bain, the consultancy, companies are engaged in an “arms race” as they compete to get first-mover advantage and prove their credentials in a market that is increasingly being opened up to the private sector. A record £5bn NHS contracts are out to tender, including seven that are worth more than £100m in value. The largest is a £1.2bn or £160m-a-year deal providing health services, including end of life care for older people, in Cambridgeshire and Peterborough.
Royal Berks spends £16m on consultants: Royal Berkshire NHS Foundation Trust has spent £16.6m on external consultants working on its Cerner Millennium implementation reports eHealth Insider. A Freedom of Information Act request made by BBC Berkshire asked how much the trust has spent on external consultants to help manage the electronic patient record project. The response was a staggering £16.6m spent employing 213 external consultants since the inception of the programme. More than 40 contractors continue to work on fixing the troubled implementation, compared to 10 trust staff who are employed to oversee the system. Royal Berkshire has been facing significant operational and financial pressures since deploying Millennium in June last year. Documents obtained by EHI under Freedom Of Information showed it had spent £30m on the system up to October 2012. A report to the Council of Governors earlier this year revealed that it expected to spend another £6.2m implementing the system in 2013, compared to a budgeted £2.5m. In February, the trust confirmed it was “in dispute” with Cerner over the costs of the system, which chief executive Ed Donald described as unsustainable. He said at the time that the increased costs were due to significant data correction being required each month and an increased number of patient administration staff being needed to run the system.
NHS is providing patients with inconsistent and unclear information: The NHS is “awash” with conflicting patient information from a range of different sources, warns Dr McCartney, a Glasgow GP. Some NHS hospital trusts commission information leaflets from a range of external companies, whilst others choose to write their own. Dr McCartney, a GP and regular writer for the British Medical Journal (BMJ), warned that the lack of cohesion between different trusts can lead to the spread of ineffective, inconsistent and confusing information across the nation. One study of a set of leaflets on the removal of kidney stones found that common complications were mentioned in some, but not all of the leaflets. In fact, when complications were mentioned, they were frequently poorly explained. One researcher at the University of Oxford called the system of NHS leafleting “amateurish”, arguing that, often, “evidence and uncertainties [are] not expressed clearly”. An NHS England spokesperson has, however, assured The Information Daily that a “major project” is underway to address the problem.
Caradigm supports Caldicott2 with UK launch of its clinical IT solution: Caradigm has launched its clinical application provisioning solution in the UK reports eHealth News EU. Caradigm Provisioning, the latest module which completes its Identity and Access Management (IAM) suite, has been designed to help healthcare organisations efficiently manage clinician access to applications and data while supporting their compliance with data privacy regulations. The timely introduction of this solution supports the recent publication of the Information Governance Review (Caldicott2), which explains that the sharing of information, when sharing is appropriate, is as important as maintaining confidentiality. The release of the new provisioning solution represents a milestone in the delivery of advanced role lifecycle management, governance and analytics capabilities for health systems. “With large and dynamic workforces, health systems and hospitals face a uniquely complex set of challenges related to identity management and data access. All organisations providing health or social care services must have robust information governance processes in place if they are not to fail the people that they exist to serve,” said Richard Craven, VP and managing director, UK and Nordic region for Caradigm. “By focusing exclusively on the healthcare industry, Caradigm is able to deliver sophisticated features out of the box that help healthcare organisations align their processes with national government targets and regulations, and provisioning of patient information and clinical data with speed, while managing risk and protecting staff and the organisation’s reputation.”
Jeremy Hunt calls for major GP contract rethink: The GP contract could be heading for its biggest overhaul since 2004 after health secretary Jeremy Hunt called for a ‘fundamental rethink’ on the deal. In an exclusive interview with GP magazine, Hunt said he did not regret imposing the 2013/14 contract settlement because the NHS had to make savings. But he added: “I wouldn’t want those changes to the GP contract to be the last word, because I think we need a more fundamental rethink about whether the GP contract is achieving things it set out to achieve in 2004.” The health secretary said that he wanted to transform GPs’ roles, to enable them to deliver more ‘personalised care’. QOF targets could be stripped back to reverse the target and box-ticking culture that “gets in the way of the personal relationship between doctor and patient”, he suggested. GP reported earlier this year that access would feature in GP contract talks. Hunt said ensuring patients could access urgent and emergency care out of hours may also “involve changes to the GP contract”. Changes to the deal could also involve moves to make named GPs responsible for frail elderly patients when they leave hospital. General Practitioners Committee (GPC) negotiator Dr Beth McCarron-Nash called for caution and said the profession needed stability. “The answer to everything is not that we need a new contract,” she said.
Devon community does digital: Northern Devon community health staff are using mobile devices to electronically record more than 9,000 patient contacts a week, reported eHealth Insider. Northern Devon Healthcare Trust rolled out a mobile working programme to 800 community health professionals early last year. The ComPAS project was created using integration and mobile working toolkits from NDL, in conjunction with the trust’s inhouse-built patient information system. It allows nurses and therapists working in the field to access and update information on the trust’s systems via Samsung Galaxy tablets. More than half a million appointments have been created to date, with 9,000 contacts entered by more than 130 teams each week. Outcomes of appointments are now entered electronically in 90% of cases, providing the trust with a significantly richer dataset on performance and allowing it to achieve new Department of Health Community Information Data Set targets. A further £500,000 of savings have been identified around planning and resourcing.
Opinion
Can the new NHS bodies solve the current problems?
In the Guardian this week, Richard Vize, discusses why few people would look at the new NHS structure and conclude that the health service needs more organisations.
“Who is in charge? Hidden among the predictable dissection of urgent and emergency care woes in the health select committee report, published on Wednesday, are serious concerns about whether the myriad of new NHS bodies are capable of sorting the problems out.
“Ignoring the primacy of clinical commissioning groups, [NHS England] imposed urgent care boards across the country, under the auspices of its local area teams, charged with rapidly producing plans to sort out A&E. But it then seemed to lose its nerve. The health select committee says it is “unclear whether [the boards] are voluntary or compulsory, temporary or permanent, established structures or informal meeting groups”. They seem to have power, but questionable formal authority, weak accountability and no money.
“This is more than a matter of organisational tidiness. The committee points out that the local A&E plans will need to be funded with cash which clinical commissioning groups (CCGs) have already allocated – so the boards are spending someone else’s money, hardly a robust set-up for ensuring it is used to best effect.
“In measured parliamentary tones, the committee has told NHS England to sort this mess out. At a time when even the best CCGs still have a long way to go to establish themselves, and many health and wellbeing boards are having an uncertain start, they do not need to be destabilised by the imposition of another commissioning organisation. NHS England should be helping them succeed, not undermining them at the first sign of difficulty.”
‘We should listen to our frontline staff – they know the patients’
Dr Na’eem Ahmed, junior doctor at the Faculty of Medical Leadership & Management and a member of the advisory board for the Keogh review, tells the Guardian how the review looked closely at the culture that persists at hospitals with high death rates, by utlising an often-overlooked asset, the frontline staff.
“Studying the observations and recommendations from frontline staff is a well-known method of improving the services offered by hospitality businesses. Similarly, frontline healthcare staff have the most direct interaction with patients and public; they understand challenges faced by both patient and provider and are therefore a rich source of intelligence.
Ahmed goes on to say that a supportive rather than investigative approach to the review was well-received by peers: “Juniors quickly honed into potential pressure points; areas of discussion included hours of direct supervision, out of hours staffing, ease of reporting adverse incidents and channels to suggest improvements, educational opportunities and areas of patient care such as escalating sick patients. With training now requiring frequent clinical rotations around several hospital sites, frontline staff involved in the review were able to make comparisons with standards of care expected at other trusts.
“Following these reviews it is clear that the belief that frontline staff should be seen and not heard continues to persist in some parts of the NHS. It must be overcome. We have a talented and enthusiastic workforce that needs to be nurtured and not stifled.”
Keogh review: A missed chance for integrated care
This week in Health Service Journal (subscription required) Billy Boland, a consultant psychiatrist and lead doctor in safeguarding adults at Hertfordshire Partnership University NHS Foundation Trust, says that by overlooking social care concerns and focusing exclusively on health the Keogh review missed out on the opportunities of integrated care.
“Sir Bruce Keogh’s investigation into 14 NHS trusts with “persistently high mortality rates” was published earlier this month. Undertaken at the request of the health secretary and the prime minister, the review gathered a “vast array of hard data and soft intelligence held by many different parts of the system”.
“Sir Bruce argued that the capability of senior leadership in the trusts to access and use data was a common issue. In setting out the vision for the future, he said the hospitals should have the ambition to become organisations that are “confidently and competently using data and other intelligence for the forensic pursuit of quality improvement”.
“While the report is undoubtedly thorough, it is a missed opportunity for thinking about integrated care. Sir Bruce’s selection of quality indicators exclusively concerned health, looking at parameters such as infections and serious incidents resulting in death. Not surprising, one might think, given the investigation was prompted by higher than expected deaths rates.
“Without question, the Keogh review’s analysis is astute, and the remedy canny and compassionate. It will do much good and help those trusts reviewed make significant progress. But leaving social care out in the cold is a missed opportunity. Robert Francis has already highlighted the need for information sharing and for organisations to work together. Including social care in our plans for the future can only enhance our vision of high quality services.”
The open source debate begins – your chance to join the conversation
NHS England’s announcement that open source will be a key feature of its new approach to IT has sparked widespread controversy. This week suppliers have begun to respond. In Commissioning GP, Wayne Parslow, VP EMEA Harris Healthcare explains why for the past three years he has spoken out about the need for the NHS to embrace open source technology.
“A move to open source would potentially mean vast reductions in licence fees for the NHS, the ability for the NHS to develop systems to their bespoke needs, no more supplier lock-in – which results in NHS organisations struggling to get the IT products they use to work with another supplier’s – and of course, no need for “one size fits” all contracts such as we saw with the National Programme for IT.
“Having been involved in numerous open source projects including the development of the electronic patient record system Vista in the US, my strongest advice would be for the NHS to walk before breaking into a canter.
“As for existing suppliers, if trusts were to begin to demand the provision of open source solutions, we would not necessarily see a wave of suppliers releasing their code but we probably would see a whole raft of suppliers being forced to build open interfaces that other solutions can be ‘plugged in to’ or be pushed out the market.
Shane Tickell, chief executive of IMS MAXIMS also spoke out this week saying it’s time to be open about open source and explains why his company is giving careful consideration to opening up one of its key products.
“The benefits to the NHS have been widely covered by the media, with more integrated, tailored, flexible and potentially cheaper systems cited as the end goal. But the supplier industry has remained largely quiet and, in many cases, negative towards the potential change. Many companies, it seems, feel threatened and concerned about what it might mean for their future.
“As chief executive of a healthcare IT company, I believe that open source may have the potential to provide all of the above in a market that has remained largely unchanged since the inception of the National Programme for IT in the NHS.
“Whilst we are far from committing to this model – and still have a long way to go in making any decision – we believe that open source solutions could enable the NHS to leverage intellect from a wider range of sources, share success and, ultimately, help to implement more tailored, efficient systems and at a far greater pace.
“Our consideration in moving to open source involves ensuring that the code remains clinically safe and suitable for mission critical healthcare institutions. While we’re not there yet, we are certainly being open about being open source.”
Highland Marketing blog
In this week’s blog Joanne Murray highlights the benefits of using IT to diagnose dementia.
Highland Marketing news
Cayder appoints Highland Marketing to raise profile in UK healthcare: Highland Marketing has been appointed by Cayder, a provider of real-time patient flow software, to deliver a marketing strategy aiming to communicate their position as leaders in Patient Flow Management (PFM) solutions within the UK healthcare marketplace. In an effort to expand its strong customer base, which includes the Chesterfield Royal Hospital NHS Foundation Trust and Hull and East Yorkshire Hospitals NHS Trust, Cayder recognised that working with experienced healthcare marketing and PR professionals would provide competitive advantage. The strategy to be implemented will take an integrated approach covering PR, thought leadership articles, case studies, news releases, social media and digital communications, brand development, event support, and on-going advice and consultancy. Stuart Rankin, managing director at Cayder said: “We wanted to work closely with an agency who demonstrated knowledge, understanding and passion of the healthcare marketplace and Highland Marketing ticked those boxes. We believe we have a true collaborative partnership with the team working as part of our organisation. I have no doubt they will continue to provide value as we grow and develop.”
