News in brief
Hunt: Safety and technology are key to surviving squeeze: The NHS can withstand the financial squeeze it faces during the next parliamentary term by adopting new technologies and making care safer, the health secretary has claimed. Jeremy Hunt told Health Service Journal, (subscription required) that the NHS would also need to maintain its current rate of efficiency savings in 2015 and beyond, but said the emphasis would have to shift to safety and technology. “There’s a very big step change over safety,” he said. “It’s very clear that unsafe care is the most expensive thing we could possibly do in the NHS. I don’t think we’ve focused nearly enough on understanding the savings that can be made through safer care.” He pointed to avoidable mistakes, “never events” and clinical negligence claims as sources of unnecessary expense. The Salford Royal Foundation Trust had saved money by improving safety, while the safest US health systems were also the most cost efficient, Hunt said. While the focus on safety over the past year has led to many trusts spending more through hiring extra nurses, Hunt said “the long term impact of safer care is to significantly reduce costs”. He would not be drawn on whether the NHS was financially sustainable without a real-terms funding increase. Instead, he emphasised that the NHS had to “live within its means”. In the next five years, he said, innovation must be focused on integrating care and adopting new technologies. Hunt also claimed the NHS was “ahead of schedule” on his aim for it to become paperless by 2018.
If NHS were an airline, planes would always be crashing, warns Mid Staffs inquiry chief: The NHS is so unsafe that if it were an airline “planes would fall out of the sky all the time,” the chairman of the inquiry into the Mid-Staffs scandal has warned. In an interview with The Telegraph, Robert Francis QC said the public had been given a falsely positive impression about the quality of care being provided in many of the country’s hospitals. The barrister said the NHS needed to make radical changes to meet the needs of the public – instead of simply blaming patients for “crowding out” A&E because they did not know where else to turn. Francis said that for too long, those in charge of the health service had become “complacent” about the care meted out to patients, believing it was reasonable for some patients to be badly failed, as long as the majority were not harmed. Francis, one of Britain’s leading QC’s, now president of the Patients Association charity, said it was a “refreshing change” that the current health secretary, Jeremy Hunt, had shown himself prepared to speak up for patients. However, he said the public was still not given a true picture of standards of healthcare across the health service. “Because we’ve not had access to genuine information about how well things are done, the public have had a perception that things are rather better than they probably are,” he said. “If we ran our airline industry on the same basis, planes would be falling out of the sky all the time. We’ve just got to change the attitude that because it’s provided by the state it’s all right for a number of people to be treated badly; well it’s not. Airlines would go out of business very quickly if they worked that way,” he added.
Dalton unveils plans for hospital reform: The hospital chief heading a major government review has spoken for the first time about the reforms he thinks will be needed to accelerate the spread of new organisational forms across the provider landscape. Salford Royal Foundation Trust chief executive, Sir David Dalton, has been tasked by health secretary Jeremy Hunt with finding ways to encourage the best NHS providers to take charge of the most challenged. Early ideas included the establishment of European-style national hospital chains. But speaking exclusively to Health Service Journal (subscription required), Sir David said he hoped the review would offer NHS providers a series of new options. Alternatives could range from loose federations, which share back office functions, joint ventures to share surgical services, to management franchises and national chains. Sir David revealed his early thinking on what would be needed to entice outstanding trusts to take an interest in those in chronic difficulty, saying the review would consider various options including – how to create a system – dubbed “credentialing” – for accrediting a list of excellent providers that would be the go-to candidates to take on ownership or management of failing trusts and “redeploying” the money currently spent on management consultants, turnaround directors and bailouts for failing trusts to create financial incentives for high-performing providers to get involved in their management. Sir David said he hoped the review would reinforce “the need to create a system of consequence where successful organisations are rewarded and encouraged to spread their learning, their improvement and success into other areas.”
UCL Partners to publish IT strategy: Academic health science centre UCL Partners is close to finalising a new informatics strategy aimed at developing a “single culture” of information sharing between its partner organisations. The centre, a partnership of over 40 healthcare providers and universities across north London, Hertfordshire, Bedfordshire and Essex, including University College London Hospitals NHS Foundation Trust and Barts Health NHS Trust, is one of six official centres which focus on researching new treatments and improving patient care. Dr Catherine Kelly, UCL Partners’ director of informatics, told eHealth Insider that the centre decided to develop the strategy as part of a greater focus on informatics and information sharing. Kelly said: “There’s a lot of recognition that informatics needs to be improved, as it’s really an enabler to delivering better healthcare and better research, so I think it’s really a priority area for everybody.” Kelly added that one of the aims of the strategy is to improve information sharing between the individual care providers and universities, working with a “single culture” rather than separate organisations. Patients with complex diseases like cancer often dealt with more than one health organisation but information about their condition is not shared as well as it should be. “There’s very little sharing of information across the boundaries, and to have information that follows the flow of the patient rather than hitting organisation boundaries is quite challenging. Improving data sharing will help to reduce clinicians’ frustration at a lack of access to information which can help them, while also allowing patients to have a greater role in managing their own care pathways,” Kelly said.
Scottish health minister under fire over waiting times: Scotland’s embattled health minister has faced renewed calls to resign after official figures showed NHS waiting times at their longest in years and a series of keynote treatment targets being missed, reported The Telegraph. Labour said the statistics showed the NHS was “breaking under pressure” and its deteriorating performance under the watch of Alex Neil means he should stand down. A target that 90% of patients should wait no longer than 18 weeks for treatment after being referred by their GPs was not met for the first time since its introduction in December 2011. The figures showed waiting times targets for accident and emergency departments continue to be missed, while the number of patients ‘blocking’ hospital beds when they are well enough to be discharged has increased fourfold. Meanwhile, short-staffed health boards were forced to spend an additional £17m bringing in extra nurses and midwives on a temporary basis. A third target, to cut hospital deaths, was also missed. In a further blow to Mr Neil, an annual survey of Scottish patients found increasing dissatisfaction with the NHS and particularly the care provided by their GPs. Labour used the figures to renew its attack on the health minister, arguing that the failure to meet the 18-week waiting time target for the first time must “raise alarm bells” that health boards do not have the capacity they require.
GPs call for patient opt-in to care.data: GPs have called for patients to be able to opt in to their data being extracted from GP practices as part of care.data, reported eHealth Insider. At the British Medical Association’s Local Medical Committee (LMC) conference last week, two thirds of GPs voted in favour of an opt in system for the controversial programme, which will see patient information extracted from GPs in monthly datasets and linked with other datasets within the ‘safe haven’ of the Health and Social Care Information Centre. Dr Christine Harris from Bedfordshire LMC, who proposed the motion, said that the data should not leave the GP practice without the “explicit consent of patients opting in”. She said that without clear information on how the data will be used, the public would lose confidence in the NHS. “Confusion around how data will be collected and stored, and how it may be used, has alarmed the public as much as the profession,” she said and added that GPs were left with an impossible situation as they have a duty to ensure that patients’ personal data is handled transparently, but also that patients expect GPs to keep their confidential information private. “GPs are placed in a catch 22 situation. Without an explicit waiver saying that GPs are not data controllers when mandated by the centre to release the data, they will break one act while complying with another,” she said.
Trusts win up to £8.2m in ‘tech fund 1’: Fourteen trusts received more than £3m in funding from the first round of NHS England’s technology fund, which distributed just under £182m in total. NHS England has published a list of the 131 NHS trusts that were successful in their bids for the ‘Safer Hospitals, Safer Wards Technology Fund’, which shows that a small number of trusts won significant amounts for electronic patient record (EPR) projects, reported eHealth Insider. Four trusts received more than £7m. Nottingham University Hospitals NHS Trust was successful in two bids, one for electronic clinical noting, and the other for digitised health records, bringing its total funding up to £8.2m; the most received by any one trust. Leeds Teaching Hospitals NHS Trust received a total of £7.7m for its integrated digital health record programme and an e-prescribing project, and Guy’s and St Thomas’ NHS Trust won £7.1m in total for two projects: £4m for e-noting and £3.1 for e-prescribing. North Tees and Hartlepool NHS Foundation Trust, which recently announced it has chosen to implement InterSystems’ EPR, making it the company’s first major English EPR site, has received more than £7.1m to deploy the system. In total, nearly a quarter of the funding has gone to trusts, which are implementing EPR systems: there are 22 EPR projects funded by a total of £38.6m. Other striking trusts to receive EPR funding include Cambridge University Hospitals NHS Foundation Trust, which won £3.5m for its eHospital project, which is using Epic, and Papworth Hospital NHS Foundation Trust, which won £4.3m to join eHospital. The tech fund was launched to support health secretary Jeremy Hunt’s call for a ‘paperless’ NHS by 2018. When the first £260m of funding was announced in May last year, it was billed as being for e-prescribing and other patient safety initiatives.
NHS awards N3 aggregator status to InTechnology: The Health and Social Care Information Centre (HSCIC) has been awarded aggregator status for the N3 network to InTechnology Managed Services. N3 was set up in 2004 and serves as the internal national broadband network for the NHS. It provides hospitals, medical centres and GPs in England and Scotland with access to BT’s broadband and voice services, as well as a range of software solutions such as digital x-rays. It is used by over 1.3 million NHS employees and has Public Services Network certification. Aggregators are responsible for assessing and approving applications from third parties wanting to connect to the N3 network, such as software suppliers, commercial and third sector providers. InTechnology follows Capita, which also won aggregator status in March. ComputerworldUK understands that other suppliers will join them as aggregators in future, though HSCIC is yet to confirm this. N3’s future has been in question for months as its contract with BT was due to expire in March. HSCIC explained that it has recently negotiated to extend the contract, which it says will now move into a “three year transition period”. According to the HSCIC website, “existing funding and service arrangements will continue whilst a replacement service is designed and procured.”
NHS SBS targets supply chain transformation with e-invoicing: NHS Shared Business Services (NHS SBS), a business support services provider to the NHS, has entered a new partnership to help transform the health sector’s supply chain by encouraging the use of electronic invoicing (e-invoicing). By using the Tradeshift platform, NHS SBS is hoping to make the invoicing side of its operations – it processes around seven million invoices each year for 175,000 different suppliers – more efficient. Simon Murphy, NHS SBS director of finance and accounting, told National Health Executive: “We have around 300 NHS organisations as our customers, so the size and scale of the opportunity to improve invoicing is huge. The way Tradeshift works, we think is absolutely the key to e-invoicing. With Tradeshift from both a technology standpoint, and the fact it is free to the supplier, we think we have a real opportunity to convert millions and millions of paper invoices into much more robust, faster and efficient e-invoices.” Using the Tradeshift platform, NHS SBS is encouraging suppliers to its NHS clients to submit and track their invoices electronically through Tradeshift, making payments more efficient, reducing the burden on NHS resources and helping suppliers receive payments more quickly. NHS SBS has invested significantly in the new platform, and Murphy is confident that the technology is perfect for the NHS, especially as it is PEPPOL (Pan European Public Procurement On Line) standard compliant – a key mandate in the Department of Health’s new eProcurement strategy.
West Cornwall to pilot record sharing: Eight practices in West Cornwall will pilot a data sharing scheme using Microtest’s Guru to allow local A&E clinicians and the local out-of-hours GP service with access to patients’ GP records, reported eHealth Insider. Penzance GP Dr Matthew Boulter, who is leading the project on behalf of NHS Kernow Clinical Commissioning Group (CCG), said the pilot comes from GPs’ frustrations at their patients being unnecessarily admitted to hospital due to a lack of information sharing. “A GP puts in place what we thought were pretty detailed plans to avoid admittance, only to find out they’ve been admitted because the admitting physician didn’t know about the plans, and had no way to find out.” Dr Boulter said allowing doctors and out-of-hours services to view a patient’s GP record can have an enormous benefit, reducing unnecessary admissions and costs to the healthcare system. “Information is power – the more information you’ve got, the better decisions you can make.” He said the CCG is aware of concerns about information governance and patient consent, and spent nine months developing an agreement for all the practices to agree to. Each practice is able to dictate how much information it shares, while access is restricted to those on the local GP performers’ list with no temporary locums allowed to use it. As part of the safeguards, the Guru system, which can also be used on mobile devices, has a consent screen that pops up when a user tries to access a patient’s records, asking them to confirm whether or not the patient has given their consent for the service. Dr Boulter said the system includes an override option for access in emergency situations, but doctors who use this are required to fill in a free-text box justifying their access of the records.
Whitehall big hitter joins DH to lead on pharma and IT: Will Cavendish, who currently oversees policy implementation across government for the Prime Minister, is to join the Department of Health (DH) in a new director general post with responsibility for pharma, IT and life sciences. Cavendish with become director general of innovation, growth and technology, Health Service Journal (subscription required) has learned. He previously worked in the DH between 2005 and 2009 as director of strategy then of health and wellbeing. He is currently executive director of the Cabinet Office’s implementation group, where he has been responsible for overseeing implementation of policy priorities for the prime minister and improving implementation across government, as well as for its open public services and reducing regulation programmes. At the DH his responsibilities will include pharma, health informatics and IT, life sciences, innovation and medical technology. He will have responsibility in the department for the National Institute for Health and Care Excellence, Medicines and Healthcare products Regulatory Agency, and Healthcare UK. Later in the year he will also take on responsibility for the Health and Social Care Information Centre. Cavendish is expected to join the department in coming weeks.
UK and France join forces to drive telehealth deployment: Telehealth supporters have announced a link-up between English and French technology experts in an effort to drive the growth of eHealth in Europe, reported Building Better Healthcare. The MALCOLM project – Mapping Assisted Living Capability Over La Manche – brings together the South East Health Technologies Alliance (SEHTA), a health technologies cluster with expertise in care and assisted Living; and Pôle TES from Basse-Normandie in France, a cluster with expertise in the field of secure electronic transactions. The project will research and map the needs and capabilities of the eHealth sector in Normandy and the South East of England in order to help organisations and companies involved in delivering care services to develop and implement innovative ICT-based home support systems. The subsequent needs analysis will focus on two target groups: people aged 60 to 75 years (65-75 in England); and those aged over 75 years. These target groups were chosen because the care issues are the same on both sides of the Channel: namely an ageing population with a longer life expectancy, and the isolation of some of the coastal populations. The research conducted by the MALCOLM project will be of particular relevance to SMEs and other organisations involved in the assisted living supply chain; health and care providers such as hospitals, old people’s homes, specialised clinics, etc; and third sector and charities working with older people. The assisted living capability in both regions will be summarised in a report that will provide a sound analytical basis to support regional implementation plans, identify good practices, allow a direct comparison between the two regions, stimulate the cross-border development of new products and services, and stimulate the development of new clusters.
Patients and clinicians must be engaged in data sharing models: Involving patients in data sharing initiatives means more than just telling them what is happening, London’s Digital Health 2014 has heard. Andrew Fenton, associate director of commissioning support at the NHS Central Southern Commissioning Support Unit told delegates that communication programmes alone were not enough when trying to create digital records in health and social care and keeping patients in the loop. “It’s not just the communications process and about making people aware of how data will be used but crucially it’s about engaging them in what that model looks like,” he said. Equally important was the engagement of clinicians combined with clinical and professional leadership. “There has to be system wide and solid leadership right up to the executive levels across health and social care,” said Fenton. The emergence of the chief clinical information officer (CCIO) was seen as vital, a role that was now not only important in the acute sector but Fenton told delegates which was now becoming expected in clinical commissioning groups to aid in work around integration of services. Dr Jenny Dean, medical director for EMEA at Harris Healthcare Solutions told the conference that there was a growing important role played by clinical leads in the acquisition and rollout of technologies, with the number of CCIOs more than doubling in the last year. She added that there are a wide range of benefits of clinical involvement including clinicians were the end users and could ensure the correct solution was relevant for their clinical needs, clinically safe and that it would improve patient outcomes. But she added that clinical input did need to be balanced with the needs of the entire system in order to achieve success.
No quick fix for IT problems at Royal Berkshire Hospital: The problematic electronic patient records (EPR) system at Royal Berkshire Hospital will not be fixed in the near future, reported Get Reading. Acting chief executive Alistair Flowerdew told a public meeting at the Well Church in Whitley this week, the situation with the EPR had improved, but there was still a way to go before it would be sorted. Last May the Reading Post reported that after the trust spent £28.5m on purchasing, developing and implementing the system, its value was just £10.5m – a write-off of £18m. The Cerner Millennium EPR System was adopted by the hospital in June 2012, as part of a seven-year contract agreed in March 2009. The system is meant to improve efficiency by retrieving patient records in a matter of seconds, however staff have been left frustrated by its complexity. At the meeting, Reading West MP Alok Sharma admitted complaints to him about the system had tapered off in recent months but he still pressed Flowerdew about how long it would be until it is fixed. Flowerdew said: “We have inherited a huge problem.” He admitted the system would not be fixed “in the near future” but reassured the trust is working hard to resolve the issues. South Reading Patient Voice chairwoman Carol Munt said she had heard the same promises before. She said: “This is 2014 – I think we should have got this sorted.”
Opinion
Clinical commissioning groups are key to transforming the NHS
This week on The Guardian, Dr Steve Kell, co-chair of the NHS Clinical Commissioners’ Leadership Group and chair of NHS Bassetlaw CCG, argues how CCGs building relationships locally and leading the integrated and innovative work can help to transform the NHS. “For the past year clinical commissioning groups (CCGs) have been working hard to make a difference in a system that isn’t set up to support them. But in spite of increasingly unstable finances and an NHS that is still embedding and adapting to new ways of working, CCGs are making responsible, clinically-led decisions in partnership with GPs, patients and providers which are making a difference to the care being delivered to their communities. I’m not pretending that creating a high-quality and sustainable NHS is going to be easy, but the ambition and appetite from CCGs to make services the best they can be for patients is real. “All too often people don’t see clinical commissioning as an equal player in the system, but if we are going to transform services locally for the benefit of patients, CCGs must be at the centre of decision making. “We need to make sure that whichever party or parties are leading the country after the election understand the value and impact that clinical commissioners are having and why it’s critical that we don’t go backwards or face another massive reorganisation of the NHS. “The whole system – providers, local authorities, regulators, think-tanks, as well as NHS England and the Department of Health – needs to recognise the system leadership role that CCGs play at the local level, and appreciate their clinical expertise and patient understanding.”
Connecting our way to integrated care
On Building Better Healthcare, Dr Joel Ratnasothy, medical director at Caradigm UK, offers a clinician’s view of how the NHS can realise the benefits of connecting data at all levels. “As a doctor the benefits of integrated care and the focus on quality outcomes are obvious. The World Health Organisation defines it as a ‘means to improve services in relation to access, quality, user satisfaction and efficiency.’ The question is: how do we achieve this? “So where do we start? Integrated care will require primary, secondary and social care providers to connect their data like never before. This will not be achieved in one go. There is no ‘big bang’ solution. Instead, we need a strategy that can be implemented in a step-by-step approach. There are four distinct areas of care that must be connected before these larger groups can be meaningfully integrated. Although each group is slightly different the problem of information sharing remains the same – 1. Connect the departments 2. Connect the trusts 3. Connect primary to secondary care 4. Connect health and social care “The vision of an NHS delivering integrated care is the right one and information technology will be crucial in delivering it. But to achieve it we need to learn the lessons of the past – large ‘big bang’ IT implementations across multiple departments, let alone institutions, will not work. “We need to start small, connecting the most-important systems first – project by project, business case by business case and build on a solid foundation. That is why I believe the best approach is to start ‘connecting’ departments, trusts, institutions and services, until we have achieved true integrated care.”
Ade Memoire: gets source-y
Following the announcement that ‘Tech Fund 2’ is to focus on open source software, Adrian Byrne, director of IM&T at University Hospital Southampton NHS Foundation Trust discusses the pros and cons for the NHS, in eHealth Insider. Byrne challenges the ‘openness’ of the software and argues there remains a level of ‘lock-in’ for healthcare providers: “Open source has also become synonymous with “open” as in transparent and standards based, and “agile” as in adaptable. It is often promoted as a panacea to avoid the dreaded vendor lock-in. “None of these comparisons are correct or fair: you can get into similar problems with both modes of operation; and just because you avoid vendor lock-in, you should not assume that application lock-in isn’t just as bad. “In a large electronic patient record application, it is unlikely that you are going to want many people from different organisations modifying code. There are various models for creating a trust or custodian of the software, but in the end someone, some ‘organisation’, has to own this.” In an article with many challenges to open source, Byrne confirms he is not ‘anti’ the software: “By now, some of you might have conclude that I’m against the whole thing. You’d be wrong. Open source has its place. What I’d like to know is why, when the rest of the world is marching on using open source products…we are not creating relationships in which our vendors move into these technologies within a vibrant marketplace. “Why aren’t we doing that, instead of getting into some of the higher risk and largely uncertain areas where we seem to be bound?”
Highland Marketing blog
In this week’s blog, Sarah Bruce looks at the return of the electronic patient record system to NHS IT.
