News in brief
Addenbrooke’s Hospital paperless system goes live: A £200m electronic patient record system that will eventually make two hospitals paperless has gone live, reports the BBC. The system at Addenbrooke’s and Rosie hospitals in Cambridge means nurses can access patient records on handheld devices instead of waiting for notes. Addenbrooke’s said it is the biggest patient care investment it has made. Chief information officer Dr Afzal Chaudhry said patients should get medication quicker and leave sooner with the system in place. The hospital is the first in the UK to use Epic’s eHospital system, which is used in hospitals in the US. The software currently contains more than 2.1 million patient records from the last five years and it can be used on 7,000 computers and devices at the hospitals. Nurses can quickly access and update patient records using 500 iPod Touch devices and using its barcode scanner and run tests such as measuring blood pressure. The software can also be accessed on staff smartphones. Dr Chaudhry said: “It is the biggest single investment the trust has ever made in the quality of patient care, and will make a real difference for everyone who comes into the trust.” It is expected to take a year until the system works entirely without paper.
NHS basic model to change, pledges Jeremy Hunt: The NHS “basic model” is to change to focus on providing help at home, Jeremy Hunt has pledged, as he announces an “army” of 18,000 community workers to ease pressures on hospitals, reports The Telegraph. The health secretary said £5bn will be invested in 151 plans across the country to help keep elderly people healthy at home, and avoid needless admissions to hospitals and care homes. The new national fund will be spent on schemes that operate seven-day care in a bid to end the scandal of vulnerable people being stuck in hospital simply because social services are not available to help them. Hunt said the changes would mean a transformation in the way care is delivered, to respond better to the needs of the country’s ageing population. Writing for The Telegraph, setting out his ambitions for health and social care, he said the new model was part of a three-part plan to respond to the challenges facing the population. “The first pillar of our plan is to change the basic NHS model from one centred on hospital care to one that helps people stay healthy and happy at home,” he writes. “Prevention is better than cure – not just for the patient, but for the NHS which picks up the tab when things go wrong.”
NHS investigation exposes failings for every generation: The NHS has made “devastating and shocking” blunders involving members of every generation from the cradle to the grave, an official report has found. A dossier by the Parliamentary and Health Service Ombudsman tells how a woman in her 80s died after being left unattended by doctors for six hours, after suffering a fall to the floor, while a baby just one day old was left with permanent brain damage because of glaring errors by hospital staff. Dame Julie Mellor said her report into 126 investigations into NHS complaints left her concerned about a lack of “care and compassion” in some cases, while in others, basic mistakes led to catastrophic harm. She expressed particular concern about the number of patients placed in danger because they were “unsafely discharged” from hospital. The health service ombudsman checks complaints by families who allege they have suffered failings at the hands of the NHS which were not fairly investigated by the services at fault. Earlier this year Dame Julie pledged to publish regular summaries of her findings amid concerns the NHS was failing to learn from mistakes. Her second report, looking at complaints made between April and June, is the most damning. Dame Julie told The Telegraph: “These investigations illustrate the devastating impact that failings in the NHS can have on the lives of individuals and their families – they cover from the very young to the very old, and they cover all types of health care, hospitals, GPs, and dentistry.”
Osborne’s NHS spending claim disputed: NHS England chief executive Simon Stevens appeared to back this analysis of senior health economists this week, when he told MPs the rate of real terms funding growth requested in the forward view was “about twice” what the NHS had seen in the current parliament. The document, released by the NHS national leadership last week, indicated extra resources worth more than 1.5% a year in real terms were needed over the next parliament to bridge a projected £30bn funding gap by 2021, according to Health Service Journal (HSJ, subscription required). It warned without extra funding the health service would be £8bn short at the end of that period, even if it achieves efficiency savings at the maximum level, which would be unprecedented. Over the long run the NHS has managed average annual efficiency gains of 0.8%, the document states, and during the recent years of austerity it has delivered 1.5-2%. The forward view sets out an ambition to deliver net efficiency savings of 2% a year over the next half decade – perhaps even rising to 3% in the later years. Stevens told the Commons health committee that the 1.5% a year funding growth was a “big ask” and was “about twice the rate of real terms increases that has happened in this parliament”. However, he added that it was still “substantially less than” the rates of funding growth that the NHS had received over the medium term or long term past.
NHS Scotland finding it ‘difficult to cope’: The NHS in Scotland is finding it “increasingly difficult to cope” with the “significant pressures” being placed on it, according to a watchdog. Audit Scotland said NHS budgets were tightening at the same time as demand for health services was increasing. And it said the NHS had not met waiting time targets, and may not be able to do so in the future. Health Secretary Alex Neil said the Scottish government’s long-term vision for the NHS would be “refreshed”. This was to ensure it “reflects the increasing demands from patients and the new way services will be delivered under health and social care integration”, he told the BBC. Dr Peter Bennie, chairman of the British Medical Association (BMA) in Scotland, said: “An honest, public debate about what needs to change to make the NHS sustainable in the long-term is urgently required and politicians must have the confidence and determination to make the difficult and perhaps unpopular decisions that may follow.” Theresa Fyffe, director of the Royal College on Nursing in Scotland, added: “When patient care suffers because health boards are trying to make ends meet, it’s obvious something is going wrong. People are being moved from ward to inappropriate ward because of a lack of space or shortage of care available at home or are waiting longer for treatment and turning to A&E just to gain access to the healthcare they need.”
Salisbury tenders for EPR: Salisbury NHS Foundation Trust has gone out to tender for an integrated electronic patient record (EPR) system, reported eHealth Insider (EHI). The trust currently uses the iPM patient administration system developed by iSoft, which was bought by CSC in 2011. Salisbury is one of so-called iSoft 7 trusts that signed a deal with the company to stick with their existing systems, instead of becoming part of the National Programme for IT. The seven trusts in London and the South would have been slated to take Cerner Millennium as part of the programme. They signed the iSoft deal in 2006, and extended it in 2011 to 2016, taking over the contracts from NHS Connecting for Health in the process. A tender notice, published in the Official Journal of the European Union, says that Salisbury is looking to procure a “fully managed service to provide an integrated EPR.”
Many NHS trusts will miss the extended Windows XP deadline: The NHS computer system is in a critical condition after new evidence reveals that 35 percent of NHS trusts are still running Windows XP seven months after it reached the end of its life, says The Inquirer. The government spent £5.5m for a year of additional support for Windows XP after the cut-off date to allow its departments time to make the change. But a large number of them have done nothing and the window to begin rollout in time for the end of support is fast approaching, after which time a further, larger payoff will be needed to extend the support still further. In spite of this, 74% plan to leave it until March 2015 to make the switch, while 14% were not able to set a date for transition, according to new information from Citrix. Jason Tooley, UK country manager at Citrix, said: “Like the rest of the public sector, the NHS is under tremendous pressure to do more with less. The IT department is no exception. These findings highlight a wider opportunity for NHS trusts across the UK to harness technology today to transform IT processes for the better.”
NHS Wales changes integration platform: The NHS Wales Informatics Service (NWIS) has chosen Fiorano Software to replace its existing integration platform with a flexible messaging service between its systems, claims eHealth Insider (EHI). The integration framework, which will replace the service’s existing JCAPS platform, will help it to connect national systems such as the Welsh Clinical Portal, test requesting and results reporting. It will also provide multi-agency integration with a range of NHS Wales organisations. The new platform is based on a distributed architecture, with centralised management and control, and is compatible with the NHS Interoperability Toolkit that was developed to encourage the use of standards in systems that need to connect to deliver a specific service. An NWIS spokesperson told EHI the Fiorano system will help the service to make it easier for healthcare professionals to access “vital information” about their patients. “We are doing this by bringing together information from a wide number of sources, some of which are new and some of which already exist. To ensure that this works effectively, services and systems need to interact with each other in a timely and robust manner.”
Leeds children’s heart surgery halted by ‘incomplete’ data: The decision to suspend children’s heart surgery in Leeds was based on “invalidated and incomplete data”, but was made “in the interests of patient safety”, a report has found. The BBC reports that operations at the hospital’s unit were halted in 2013 when NHS England raised concerns about data on mortality rates. However, surgery resumed 13 days later after an investigation revealed the data was flawed. The report said: “Inaccurate data are worse than useless and can be positively damaging. At Leeds incomplete information was instrumental in causing the suspension of surgery and great consternation both at the hospital and in the community it serves.” The report, written by management consultants Verita, said the timing of the events had led to the belief there was a connection between the two. However, it said: “We examined closely the sequence of events that led to the suspension [and] concluded that the suspension was made in the interests of patient safety rather than for any other reason.”
Totalcare data centres shut in February: NHS trusts running the legacy McKesson Totalcare patient administration system (PAS) have been warned they must move off the hosted service before the system’s data centres close in February next year, reported eHealth Insider (EHI). The caution comes as Medway NHS Foundation Trust, one of the trusts still using the Totalcare PAS, has raised the risk level for its implementation of its new Oasis PAS, which is set for early February. The Department of Health signed a deal with McKesson to support 26 trusts running either the Totalcare or Star patient administration systems in 2010, as it became clear that delays to the National Programme for IT were mounting. The support contact extension was due to expire in March this year, but the company agreed to provide “limited support” for trusts moving to its Medway PAS. System C has now confirmed the two data centres that host its legacy systems will be closing at the end of February. A spokesperson said there are two remaining Totalcare sites moving to System C’s own Medway PAS before the end of the year, with three sites moving to third party systems “in the new year”. “It is worth noting that alternative ways forward were offered earlier this year, but were deemed unnecessary by the trusts concerned,” the spokesperson said.
Ministers keen to extend joint commissioning: Ministers want to extend NHS joint commissioning with councils to public health and children’s services, after being convinced by the better care fund planning process that the model will reap service improvements and financial benefits, Health Service Journal (HSJ, subscription required) has been told. It comes as the government announces today that health and wellbeing boards across England believe they will save more than £500m in 2015-16 because of the fund. Half of this is planned to come from a 3% on year reduction in the number of emergency admissions. The plans are for 2015-16, the first full year of the fund, so are as yet untested. However the government is understood to be satisfied the approach has now proved itself as a concept, and should be adopted more widely. HSJ has learned that Department of Health ministers believe the model should be applied to children’s services, which are currently commissioned by the NHS and councils with involvement from the Department of Education. Public health, which has primarily been the responsibility of local authorities since April 2013, should also increasingly be jointly commissioned with clinical commissioning groups, the DH believes.
County Durham and Darlington NHS trust saves through digitising medical records: County Durham and Darlington NHS Foundation Trust has digitised its medical records to enhance operational efficiency and patient care, as well as save money. The trust told Computerworld UK, the move will save it £4.5m over a 10 year period, and it enables multi-site access to notes for clinicians via desktops and mobile devices. TNT Business Solutions was brought in by the trust to do the digitisation job, using scanning kit from Kodak Alaris. Sarah Perkins, the trust’s associate director of operations and performance, said: “Whilst our records staff have delivered a very good service in terms of notes availability, there was always a constant level of stress to get paperwork to the right place at the right time and then filed away correctly.”
Google is developing cancer and heart attack detector: Google is aiming to diagnose cancers, impending heart attacks or strokes and other diseases, at a much earlier stage than is currently possible, reported the BBC. The company is working on technology that combines disease-detecting nanoparticles, which would enter a patient’s bloodstream via a swallowed pill, with a wrist-worn sensor. The idea is to identify slight changes in the person’s biochemistry that could act as an early warning system. The work is still at an early stage. Early diagnosis is the key to treating disease. Many cancers, such as pancreatic, are detected only after they have become untreatable and fatal. There are marked differences between cancerous and healthy tissues. Google’s ambition is to constantly monitor the blood for the unique traces of cancer, allowing diagnosis long before any physical symptoms appear. The project is being conducted by the search company’s research unit, Google X, which is dedicated to investigating potentially revolutionary innovations. It marks the firm’s latest shift into the medical sector following its work on glucose-measuring contact lenses for patients with diabetes and the acquisition of a start-up that developed a spoon to counteract the tremors caused by Parkinson’s disease.
St George’s develops BI analytics portal: St George’s Healthcare NHS Trust is developing a bespoke portal to share interactive reports and dashboards produced by its Tableau visual analytics solution across the organisation. eHealth Insider (EHI) said, that the trust is also expanding the number of licences it has to allow staff to produce their own analysis. Tom Dewar, the trust’s head of information, told EHI he started work to select a single business intelligence system for the trust shortly after starting his role 18 months ago. “We had a range of systems in place, but we didn’t have a key system or put our support behind anything.” Dewar said the trust chose Tableau because it could produce interactive reports and dashboards in an automated, interactive and timely manner, allowing the information team to widen the scope of its data analysis. “Our aim is to answer general questions, not just the specific ones. If someone in a specialty wants to see how outpatient appointments are trending over time, then we should be able to answer that for them, but also for the other specialties.” He said the software is “particularly quick” and can easily produce summaries with a small enough data set.
NHS board in email ‘error’ apology: A health board is to offer unreserved apologies to 86 patients after “human error” resulted in a confidentiality breach on Monday, reports Yahoo. NHS Greater Glasgow and Clyde (NHSGGC) said it was “extremely concerned” about the incident which centres around an email communication from a member of staff. Officials said they will investigate the breach and are taking steps to contact those affected by it. The Information Commissioner’s Office has also been notified. It said in a statement: “We are aware of the incident at NHS Greater Glasgow & Clyde and we will be looking into the details.” The health board has not revealed details of where the breach occurred. BBC Scotland reported that the people affected were transgender patients at Glasgow’s Sandyford Clinic. The member of staff sending the message made the “unfortunate error” of attaching all the email addresses of the patients in the one email. In a statement, the health board said: “Patient confidentiality is of the highest priority and we are extremely concerned that this breach has occurred as a result of human error. We have already made the Information Commissioner aware of this issue and have been guided by him.”
App of the Day – NHS Emergency Handbook: Doctors and nurses will be able to access treatment information much quicker, potentially saving lives in an emergency, reports The Business of Mobile Content. App developer, Appitized, has launched an app for NHS doctors and nurses, enabling them to retrieve the information they need, on the go. Commissioned by the Royal Liverpool and Broadgreen University Hospital Trust, where senior emergency medicine consultants came up with the idea – the NHS Emergency Handbook delivers patient details in no time at all, potentially saving lives in emergency situations. All the desired information is sent directly to the doctor’s device, eliminating the long wait for a response from the hospital database. Dr Ray Raj, from the Royal Liverpool and Broadgreen University Hospital Trust, said: “I had a vision for us after a trip overseas where I observed technology becoming an integral tool for healthcare and really wanted to take that on board here.”
Opinion
Sometimes the slow road is the best route for new technology
Any roadmap for introducing new technology to the NHS has to focus on delivering on what is realistic, achievable and beneficial – even if that means going a bit slower than is ideal, writes Shane Tickell, CEO of IMS MAXIMS, in Health Service Journal (HSJ, subscription required).
“The debate within the industry is normally around how we meet this objective while managing complex chronic diseases, an ageing population and dwindling budgets. Although there is some way to go to get NHS-wide buy-in, technology is being more frequently cited as a vehicle to support these challenges.
“Already we are seeing pockets of great achievement across health and social care settings, many are progressing their paperless journey and are sharing information across organisational boundaries.
“To prevent IT implementations within the NHS from becoming impractical and delayed, it is key that the right technology is adopted at the right time in accordance with a roadmap that is established between both supplier and end user. Too often we hear healthcare being compared with other industries, such as finance. One of the major successes is online banking, which was introduced in early 1990s. This service was not popular straightaway – consumers needed to adopt the technology to use it and overcome security concerns.
“Engagement is key to adopting new technology within healthcare as well – strong, focused clinical leadership across an organisation with staff that are prepared to embrace and integrate IT into their day to day routines is crucial. Engaging at all levels allows suppliers to understand exactly what healthcare professionals need to deliver better, safer patient care and to not deliver unnecessary extras that sound like a good idea, but that will actually create extra levels of complexity, effort, and cost.
“While we as an industry strive for world class standards, we are continuously learning along the way. Any roadmap should be a sensible development of technology to meet the needs of healthcare providers, but only when they are ready for it.”
NHS Five Year Forward View: Bold promise of £22bn savings will fall short
Simon Stevens’s plans are ambitious but unlikely to get the £8bn annual funds the NHS needs without further cuts to services, says Colin Cram on the Guardian Healthcare Network.
“The Five Year Forward View blueprint by NHS England chief executive Simon Stevens, which claims that the NHS could deliver £22bn of annual savings in five years’ time, is the latest of a long line of reports to assert that there is scope for the NHS to make major savings. The previous one was issued in October 2013 by Monitor, one of the NHS’s regulatory bodies, which claimed the NHS could save between £10bn and £18bn by 2021 through greater efficiency and joint working between hospitals.
“Such figures illustrate how much of a blind alley the reorganisation of the NHS was, three years ago. Its justification was that savings of £20bn a year needed to be delivered. Health secretary Jeremy Hunt’s recent assertion that the reorganisation had delivered just £1bn of savings is an admission that the reforms had failed.
Stevens seems to have accepted Monitor’s figure for £30bn of extra funding annually. However, the idea that £22bn of savings will be achieved by 2021 (a 3% year-on-year saving) is not credible if it relies on local initiatives to do so. The various models that have been described will deliver some benefits. However the history of the NHS shows that while there are some great local initiatives these are rarely taken up widely.
“Where does this leave the NHS’s finances? The £8bn a year that Stevens says the NHS will need by 2021 assumes efficiencies of £22bn a year. There is no chance that any political party will give the NHS anything like an extra £8bn a year, so we should expect some radical surgery to the services being provided.”
The NHS five year forward view: the man matters more than the plan
Whilst most of the commentary of the Five Year Forward View has been on policies and approaches to care delivery, Chris Ham, chief executive of The King’s Fund blogs on the leadership behind the report.
“Far more important was the passion and confidence with which Simon Stevens launched the plan and challenged politicians to provide the funding needed to deliver it. His performance stood in stark contrast to the bickering over the despatch box on the same day, when Labour and the Conservatives sought to claim the plan as their own.
“Commentators on the right and the left found much to admire in Stevens’ advocacy of the case for change and his skill in rising above narrow partisan debates on the NHS. So much so that the story centred on Stevens’ own role as the de facto leader of the NHS, and the critical part he has to play in navigating the treacherous waters that lie ahead.
“The elevation of Stevens should be a cause of celebration not regret among politicians. The role of health secretary has always been challenging, never more so than in the current climate when funding and service pressures are growing by the day.
“There may be little that is original in the plan but it outlines persuasively the case for change and the new models of care needed in the future. It also avoids offering a national blueprint, instead giving leaders of NHS organisations freedom and flexibility to adapt these models to the circumstances in which they find themselves.
“The appointment of a leader who knows the NHS from the inside and who is rapidly gaining the confidence of those providing care creates a once in a lifetime opportunity to change fundamentally how the NHS is run. Taking the NHS out of politics entirely may never be possible but placing politicians in the role of allocating resources and setting the direction for the NHS while leaving it to others to turn plans into practice suddenly seems an achievable goal. The prize for health ministers is to enhance their own position by doing less while properly remaining accountable for the overall performance of the NHS.”
Joined-up care: Sam’s story
The jargon of ‘integrated care’ is much-used in health policy and management circles. But why does ‘integrated care’ matter? And what will it mean for patients? This short animation from The Kings Fund aims to bring integrated care to life for anyone involved in improving patient care. If those working towards integrated care can share this vision with others in their local health and care system, then there is a real chance they can make integrated care happen.
Highland Marketing blog
This week, industry advisor Simon Rollason observes the act of window dressing and likens its concealments with a high profile social care scandal.
