Government risk register warns that reform will raise costs
Internal government documents warn that the newly passed Health and Social Care Act could drive up costs and lead to poorer management of emergencies. The information comes from a leaked draft version of the ‘risk register’. The courts have ordered the government to publish the risk register, but it has failed to do so.
Set out as a colour coded chart, the document shows different levels of risk and likelihood on a scale of one to five. Those with a 4/5 score include:
- Point 3: Using the private sector could ‘add costs to the overall system.’
- Point 4: Implementation without adequate planning.
- Point 5: A disjointed system with the NHS moving faster than other areas.
- Point 7: Loss of financial control due to restructuring.
- Point 15: More failures such as bankruptcies and service cuts.
- Point 34: Low staff morale.
A 3/5 score was given for:
- Point 12: Emergencies being less well managed/mitigated.
- Point 13: The costs of the future system not being controlled.
IT is a specific danger area according to EHI. The register says the ‘future design of informatics’ is something that ‘comes too late to feed into the overall system definition/architecture’. Although the government has twice said it will dismantle the National Programme, it has yet to publish its IT strategy.
A Department of Health spokesperson said: ‘We have always been open about risk and have published all relevant information in the impact assessments alongside the bill. As the latest performance figures show we are dealing with those risks.’
Technology vital to a sustainable NHS
A major report by the King’s Fund highlights the role of technology in the financial and environmental sustainability of health and social care. The document was issued ahead of Wednesday’s NHS Day of Action on Sustainability. Both focus on the need to cut waste to reduce costs and to meet legal demands for an 80% cut in carbon emissions by 2050.
Sustainable Health and Social Care, the King’s Fund report, points out that the NHS is responsible for a quarter of public sector emissions. One of its top five recommendations (see audio slideshow) is to explore the opportunities presented by tele-care and tele-health. Another addresses the need to focus more on preventative care in order to avoid unnecessary interventions and hospital admissions.
Teleconferencing is encouraged and examples of savings include North Yorkshire Council’s £1m cut in spending through tele-care. Both are seen as ways of reducing ‘care miles’ travelled by staff and patients. The King’s Fund points to the findings of the 2006 Wanless Review which found that tele-care could play a critical role in providing better home-based care for older people.
Dr David Pencheon, director of the NHS Sustainability Unit, said the sustainability day – which involved over 100 trusts – is to emphasise that the benefits of healthcare are not outweighed by the environmental harm caused by their delivery. GPs were encouraged to take part by carrying out energy and waste audits.
Top tips provided by trusts include everything from cutting bills by investing in bio-enzymatic digesters to dispose of waste food to dealing with the menace of pigeons by getting a Harris Hawk! Pharmaceuticals have been identified as an area of key concern – responsible for 22% of the NHS carbon footprint – with huge quantities going to waste through poor storage or inappropriate prescribing.
Failing care commission gagged staff
The Care Quality Commission gagged its own staff to stop them talking about failures while shutting down an NHS whistleblower’s hotline. The Telegraph reports that the health and social care regulator has again been severely criticised by the House of Commons Public Accounts Committee.
The CQC has recently been condemned over a number of issues including failure to take action at care homes where staff were abusing residents. An unnamed board member said she tried to speak publicly about her concerns over the CQC but had been ‘ostracised and vilified’. Departing staff had also been made to sign gagging agreements, which committee chairman Margaret Hodge said was ‘unacceptable.’
Even though the head of the CQC, Cynthia Bower, has announced her resignation there are doubts about whether it is fit for purpose. The PAC says (subscription required) it is not up to its main task of registering 10,000 GP practices during the next year and should not take on responsibility for regulating IVF services. The DH has already extended the deadline for registering GP practices from April 2012 to April 2013 after the pressure of registering other healthcare providers led to a sharp decline in the number of inspections carried out.
The MPs concluded the CQC had failed its vital role of protecting people from poor quality and unsafe care. Looking ahead, they said that while things were improving, the CQC still had a ‘long way to go’ to become an effective regulator.
A CQC spokesman said: ‘We are disappointed that the report does not recognise the significant improvements of recent months.’
Slow progress on e-prescribing, but 111 presses on
Just 110 GP practices have gone live with the Electronic Prescription Service Release 2, nearly two years after first deployment. Meanwhile TPP is looking for NHS organisations to pilot its new call centre module for the troubled NHS 111 urgent care calls system.
The DH says EPS R2 take-up is expected to accelerate with two more of the main GP systems suppliers due to get full roll-out approval within weeks. EPS R2 should allow all practices in England to produce prescriptions electronically. These are digitally signed and sent to the pharmacy.
The SystmOne 111 module is a management system for organisations deploying the free urgent care number. It can send electronic referrals directly to other services, including messages to call out ambulances.
Pilots for 111 have had mixed results with claims that it increases, rather than reduces, hospital referrals and pressure on GPs. There has though, been great enthusiasm for the GP comparison site myhealthlondon, with more than a third of the capital’s practices now signed up.
In an industry where there are frequent reports of projects running late and over budget, HSJ (subscription required) reports that Kent and Medway NHS and Social Care Partnership Trust saved £500,000 by completing its roll-out of the RiO IT system three months ahead of schedule. Around 3,000 staff were trained in support of the roll-out in six months.
At the same time there has been huge interest in the £600m University Hospitals of Leicester NHS Trust’s 15-year plan for a comprehensive new IT system. Reports say that a shortlist of six potential suppliers has been drawn up after over 70 expressions of interest.
News in brief
- Monitor must dig deeper: David Bennett CEO of the Monitor NHS regulator has admitted that Morecambe Bay (subscription required) probably had ‘deep-seated problems’ when his organisation granted it foundation trust status. He says revelations about the trust’s maternity services and management show that his team must dig deeper to identify troubled organisations.
- Over £500m of non-acute services tendered: HSJ (subscription required) reports that services worth £555m over three years are being put out to tender by PCTs in Bristol and Gloucestershire. The tenders, for community, learning disability and secondary mental health services are attracting attention from the private and third sectors.
- Bring your iPad to work scheme trialled at Liverpool hospitals: Liverpool Women’s NHS Foundation Trust is letting some staff use their own tablet devices for work, and may help pay for them in future, reports The Guardian.
- Dementia research pledge: Prime Minister David Cameron has pledged that the dementia research budget will be doubled to £66m by 2015, saying it is an area in which Britain can lead the world.
- Doctors could vote to withdraw care: Pulse says the BMA has announced plans to ballot doctors on plans to withdraw all but urgent and emergency care for 24 hours in protest at proposed pension changes.
Blog
GP online blogger Neil Durham was born in Surrey’s Frimley Park Hospital – he never expected to end up there again, sitting at his dad’s bedside in the coronary care unit. With the NHS so often lambasted for its failings, he writes about the superb quality of service and the compassion and professionalism with which it has been delivered.
‘As [Dad] told me how he came to be there, I couldn’t help but think what a brilliant example he is of how exemplary NHS care can be; from the GP who realised immediately how ill he was and called an ambulance to take him to hospital, to the nurses who allowed my family to flout the two visitors only per bed rule (my sister and her husband-to-be had travelled 100s of miles to be there).
I remembered a conversation I’d had with former health secretary John Reid years earlier about his frustration with a media which concentrated on the one in a million problems with the NHS at the expense of the everyday stories of professionalism and expertise which, fingers crossed, will see my dad leaving Frimley Park today with a spring in his step and a newly fitted pacemaker: a story unremarkable in the big scheme of things but of huge importance to my family and me.’
Highland Marketing blog
Mark Venables takes a look at what the leaked risk register actually tells us.
