News in brief
NHS England to begin extracting data from GP records: NHS England will begin taking data from GP records in a ‘small number of practices’ in the upcoming months, in order to pilot their new data extraction system before a wider rollout later in the year, reported Pulse. NHS England said they agreed to run the pilots of the GPES system after a meeting with the Information Commissioner’s Office (ICO) earlier this month. They could not confirm how the practices will be selected, if the data will be de-identified or identifiable or which read codes will be extracted. When asked by Pulse, they also could not confirm if patients are able to opt out of these extractions. An NHS England spokesperson said: “A meeting was held between NHS England and the ICO, which we requested some time ago. This was a routine meeting and forms part of regular engagement between our organisations where we update the ICO on our plans and seek their advice. A number of items were discussed with the ICO in what was a positive meeting and we are now working through the detail, including agreement to begin the data extraction process with a small number of practices, as planned, before wider rollout later this year.”
Virtual wards urged as answer to strain on NHS: The NHS is being urged to relieve the pressure on hard-pressed hospitals by treating thousands of patients in “virtual wards” – at home, with regular visits from health staff replacing long stays on wards, reported The Guardian. The service could create 5,800 “virtual beds” in people’s homes to help hospitals cope with bed shortages and overcrowded A&E units deal with patients arriving as emergencies, a new report revealed. A few hospitals have begun treating certain types of patients this way in an effort to provide a patient-friendly response to growing demand at a time when NHS budgets are tight. In some places up to 35 patients a week, whom doctors agree do not need to be kept in hospital, are being cared for this way. Patients who agree to have their treatment in a virtual ward can avoid anything more than a few hours of treatment at hospital before being discharged to such care. Advocates of virtual wards claim that patient satisfaction with such arrangements is very high and recovery is hastened by being at home. A spokeswoman for NHS England said virtual wards were an excellent idea, which typified the sort of innovation the NHS needed to embrace in order to meet the growing challenges it is facing.
Jeremy Hunt reveals push for more IT use in NHS: The NHS is looking to Silicon Valley as ministers look for a fresh push to turn Britain into a global technology leader, reported the Financial Times (subscription required). As part of the drive to raise standards, Britain will become the first country to allow online access to information about NHS doctors’ surgical survival rates across 10 specialities so prospective patients can compare performance, said health secretary, Jeremy Hunt. Publishing data at the level not only of hospitals but of individual consultants or consultant teams would inspire doctors to match their peers. “It’s going to save thousands of lives and it’s going to drive up our clinical standards to the very best in the world, where they aren’t already,” said the health secretary. Hunt is expected to spell out the opportunities for US technology companies when he addresses an audience of policy makers and IT providers at the Health Datapalooza conference in Washington this week.
NHS England allowed to share GP data outside recommended ‘safe havens’: Ministers have gone against the findings of their own information governance review and allowed patient-identifiable data from GP records to be used in the NHS outside of the ‘safe havens’ recommended by the Caldicott report for six months, revealed Pulse. Health secretary, Jeremy Hunt has approved plans for NHS England to waive common confidentiality laws for six months under a legal exemption called section 251, allowing patient identifiable data to be passed to commissioners and support units. This is despite the safe havens for potentially identifiable patient data recommended by the government’s own Caldicott2 report published earlier this year not being in operation. Dame Fiona Caldicott said that most commissioning activities could be carried out without patient identifiable data and that any data carrying a high risk of being identified and being used for ‘any purpose other than direct care’ should be transferred using an accredited safe haven. Dame Fiona defined a safe haven as a ‘specialist, well-governed, independently scrutinised and accredited environment’.
GPSoC tender worth £1.2 billion: The Department of Health has tendered for a new GP Systems of Choice (GPSoC) framework worth up to £1.2 billion over two years, reported eHealth Insider. GPSoC is a framework contract that funds GP IT systems for more than 80% of practices in England. The framework expired in March, but an extension has been agreed until a new contract is in place, which is expected to be by end of this year. The tender is split into three lots. The first, ‘GP clinical IT systems and subsidiary modules’, will be centrally funded and is worth between £300m – £770m. The second lot is for ‘additional GP IT services’ and includes things like; patient arrival systems; physical device APIs; finance systems; hardware system maintenance and hardware. These services will be funded locally at a cost of £20m-£220m. The final lot is for ‘cross care setting interoperable services’ and covers services that interoperate between systems used in care settings inside and outside of the GP practice. This lot will also be funded locally and is valued at £5m- £220m. Requests to participate must be received by 4th July.
London and Southern NHS trusts adopt electronic patient records: Community and Mental Health NHS trusts in London and the South of England have started using an electronic patient record (EPR) system with the ability to share patient information across organisations, reported Government Guardian Computing. The EPR system, known as ‘RiO’, is now available to 110,000 healthcare professionals across London and the South, having been rolled out to 62 sites. A new feature of the system, called ‘RiO2RiO’, allows trusts to see patients’ medical histories even if they are held by other organisations, meaning, for example, that if a patient has recently moved, they do not need to wait for their medical records to be transferred and can be seen first time they go to an appointment. Lee Griffin, child health manager at North East London Foundation trust, said: “RiO2RiO has been extremely positive from both a clinical and patient point of view. For example, at a glance we are able to see what immunisations, health checks or blood spots have been given to a child and if necessary add these to our local record at a click of a button.” The system, which is provided by BT and CSE Healthcare, is already used by 25 other NHS bodies across the UK.
Anonymised patient data to link GPs to hospitals: GP practices will receive guidance to improve their use of anonymised patient information, reported National Health Executive. The GP Technical Specification, published by NHS England, explains the process of how data will be collected, anonymised and used to improve patient care. Developed in partnership with the British Medical Association and the Royal College of GPs, it will link information from GPs with hospitals and community health care services. The guidance will be made available to NHS organisations in anonymised form and will help to evaluate and improve the quality and safety of care, by supporting clinical commissioners to plan services. Implementation will start with a small number of practices and be rolled out. Tim Kelsey, national director for patients and information for NHS England said: “We are committed to putting patients first in every decision the NHS makes. Giving patients more information about their treatment and care can make a huge difference to improving health and keeping people well for longer. I am extremely excited about the potential of care.data, of which the GP Technical Specification is the first part, to increase transparency within the health service and encourage greater participation by citizens.”
‘Big bang’ go-live for Sunderland: City Hospitals Sunderland NHS Foundation Trust deployed Meditech version 6.0 in a “big bang go-live”, reported eHealth Insider. The trust, which has been using the Magic version of the Meditech electronic patient record system since 1992, is now live with v6.0 across all trust sites. Sunderland’s director of IT and information governance, Andrew Hart, told eHealth Insider that it made sense to deploy the whole system in one go. “Because we already had the Magic version and we had a lot of functionality, it would have been impossible to implement this in phases. It was a big bang go-live across the trust,” he said. The trust has deployed all the EPR functionalities in the new version of Meditech, including an A&E system, e-prescribing, pharmacy, electronic medical records, physician care management, patient care management, a reporting management module and a health information management module.
GPs threatened with breach of contract over ‘diverting’ calls to NHS 111: A row has broken out between London Medical Council (LMC) leaders and NHS England after officials threatened all London GP practices with contract breach notices if they continue to divert phone calls to NHS 111 during the day, reported Pulse. The letter, sent to all London GPs last week, quoted clauses from the GP contract and warned that NHS England would issue contract breach notices to practices if patient calls continued to be diverted to NHS 111 during core hours. But Londonwide LMCs said they had not seen any evidence to back up the claim that practices were diverting patients to NHS 111 and have written to NHS England’s London area team asking them to withdraw the threats. The letter from NHS England said that GP practices were contractually obliged to have ‘suitable arrangements’ for patients to access care in-hours, but that there were ‘increasing numbers’ of GP practices diverting patients to NHS 111. An NHS England spokesperson said: “The NHS 111 contract is clear that it should not be used by GPs during normal working hours when arrangements for patients should be in place.”
Labour warn over increase in ambulance ‘diverts’: The pressures on A&E departments show “no sign of abating” Labour has warned, after figures revealed a “major increase” in the number of ambulances turned away from busy emergency departments, reported HSJ (subscription required). Shadow health secretary Andy Burnham said the number of hospitals that have been forced to turn away patients in need of emergency care rose by 24% in the last year. Figures obtained by Labour show that, in 2011-12, 287 hospitals in England reached capacity and were no longer able to accept any new patients brought in by ambulance – apart from cases deemed to be life threatening. But in 2012-13, the number of A&E “diverts” rose to 357, Labour said. Burnham said: “A&Es across the country are in crisis and the pressure shows no sign of abating. This is a crisis of their own making. Instead of casting round for others to blame, David Cameron and Jeremy Hunt need to accept responsibility and develop an urgent plan to relieve the pressure.”
Scotland’s A&E waiting times worst since monitoring began: According to new figures people in Scottish accident and emergency (A&E) departments are waiting longer than ever, reported the BBC. In January of this year, one in 10 patients waited longer than four hours to be treated – the worst record since monitoring began in 2007. Only four out of 14 health boards met the government’s target of treating 98% of patients within four hours. The Scottish government has announced it is investing £50m in an action plan to improve waiting times. The figures also showed that during March, across Scotland, 92 people spent more than 12 hours waiting in A&E to be treated – although this figure was down from 323 people for December 2012. The government says it is setting up a task force to oversee the £50m plan to improve the emergency care within hospitals. Scottish health secretary Alex Neil said: “There is no doubt that pressure on our A&E departments is a pressing issue. The action plan would look at how staff work so that people can leave hospital as soon as they are ready.”
CCG tenders integrated older people’s service worth up to £1bn: Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) have outlined plans to put up to £1bn worth of contracts out to tender to potential bidders, reported HSJ (subscription required). The CCG told HSJ it wanted to secure “a lead provider” for its older people’s services and provide an integrated acute and community pathway. A meeting held by the CCG this week to outline opportunities to potential bidders, attracted interest from local and neighbouring NHS providers and private and third sector organisations. An advert placed by the CCG on procurement site NHS Supply2Health said the value of the contract, which was likely to be a five-year deal, could range from £750m to over £1bn. The notice said the contract could cover a range of services including “acute, community, long-term care, respite care and community health, dental services; therapies and community support services”.
Half of medical students should become GPs, minister vows: Health Education England, backed by a £5bn budget, will ensure NHS staff have the ‘right values, training, and skills to deliver the very highest quality of care for patients’, health minister Dr Dan Poulter announced this week. The government’s commitments for the new arms-length body include a 50% target for medical students going into general practice, reported GP Online. More GPs will be given ‘mandatory training’ in mental health and children’s health, the minister said, although it remains unclear how this will operate. By autumn 2013, there will be a five-year workforce plan to ensure the right levels of staffing and training across the health service. Dr Poulter said: “As people are living longer with more complex medical and care needs, we must ensure that our NHS workforce has the right skills and values to provide more care in the community for older patients as well as to give each and every child the very best start in life. Plans for the future training and recruitment of our NHS will lead to better working lives for staff and better care for patients.”
Chief inspector of hospitals revealed: Former cancer tsar Sir Mike Richards has been appointed as the first chief inspector of hospitals, reported HSJ (subscription required). The chief inspector and his team will sit within the Care Quality Commission and will lead the use of new powers to place trusts in a failure regime in response to care failures. Sir Mike is currently director of improving mortality at NHS England. He was previously national cancer director for 12 years. The post was created by the government in response to the findings of the Francis report into care failings at the Mid Staffordshire Foundation trust. It will be a highly prominent role.
Foundation trusts ‘boost UK wealth’: Foundation trusts in the NHS benefit the UK economy by around £30bn a year, a new report has found, reported HSJ (subscription required). This value is achieved through the employment of staff, procurement of services and partnership work with other public and private sector organisations, according to the study by Barclays and the Foundation Trust Network. It is also said to be derived from investment in research and direct support of local suppliers, transport operators, energy providers and construction companies. The report – titled Providing Value: The economic and social value of foundation trusts and written with MHP Health Mandate – is the first of its type to detail the regional economic benefits gained from foundation trusts. Paul Birley, head of healthcare at Barclays, said foundation trusts sit at “the heart of their communities”. He said the report demonstrates the ways in which foundation trusts are “a vital component of local lives” both in terms of the workforces they employ and their community initiatives.
Opinion
An NHS for the digital generation
This week on eHealth Insider Colin Jervis, an experienced consultant in healthcare transformation with IT, uses extracts from his book ‘Stop saving the NHS and start re-inventing it’ to argue that this will mean accepting some disruptive technology in order to create a new kind of health service with a very different relationship to its patients.
“The NHS often defends itself against claims that it is inefficient by referring to international benchmarks against which it claims to represent value for money. However, the risk of benchmarking is that it gives a false sense of security and may simply compare one obsolescent system with one other.
“Over the past decade, the NHS has absorbed massive increases in funding without increasing productivity. It now needs to find efficiency savings of between 4% and 6% a year to bridge the gap between constrained funding and the rising demand caused by rising medical costs and demographic changes.
“However, constrained funds and fatter, older, sicker and better informed consumers are not the only challenges the NHS faces. Technology, medical advances and changed expectations will challenge it even further.
Jervis continues saying that information technology can save the NHS.
“It is clear that the NHS needs substantial changes to its working practices. But in the current context these can do little more than speed up a system at capacity.
“Further, the NHS is essential a nine am to five pm service in a 24 hour world. This leaves expensive assets like operating theatres and imaging equipment under-utilised [and] is a mismatch with the expectations of the Digital Generation, who are used to service at their fingertips day and night.
”Tomorrow’s healthcare is not today’s NHS. Tomorrow’s healthcare is integrated, continuous, standardised, personalised and based on evidence and prevention, rather than cure. The key is to escape from mindsets and to dare to create something new.
“Part of me thinks the time is right for wholesale change, and part of me thinks powerful interests will make it impossible. To them, I say: please stop saving the NHS and start reinventing it.”
With Francis’ main concerns ignored, expect more scandals
This week in NursingTimes.net Roger Kline, director of Patients First, a visiting research fellow at Middlesex University, explains that we should expect more scandal with the main concerns of the Francis report still being ignored.
““We must ensure,” said health secretary Jeremy Hunt in January, “that the compassion that led nurses and healthcare assistants into the profession does not get ground out of them.””
“Four weeks later, the report on the Mid Staffordshire inquiry by Robert Francis QC showed what happens when excessive workloads, diluted skill mix, bullying and the sacrifice of patient care for financial targets grind compassion away. Four weeks after that, the 2012 NHS staff survey showed that one in four NHS staff were bullied at work last year and even more fear the consequences of raising concerns. It’s no wonder that the number of reported incidents fell by 100,000 last year just as the NHS was facing the perfect storm of rising demand and funding cuts.
“Another four weeks later, the health secretary published the government’s response to the Francis report and then, on April Fool’s Day, ushered in the chaos of the Health and Social Care Act.
“Yet almost none of the key causes of the Mid Staffordshire scandal identified by Mr Francis have been tackled. There is no regulation of healthcare assistants, even though most trust chief executives support this; it beggars belief that the person treating your cat is better regulated than the person caring for your mum or dad.
He concludes “Almost no one emerged well from Mid Staffs other than the courageous patients’ and relatives’ group led by Cure the NHS founder Julie Bailey.
“The Nursing Times Speak Out Safely campaign encourages staff to raise the alarm and seeks to protect them when they do so. It is a scandal that many staff still rightly fear the consequences of whistleblowing. Every week, along with colleagues in Patients First, I hear examples of NHS staff from all walks of life who have raised concerns and then paid a heavy price. If Mr Hunt is serious about stopping compassion being “ground out” of NHS staff, then protecting those who blow the whistle before it happens should be a top priority.”
Paperless NHS? Not without Caldicott 2
This week in Public Service, Tim Dunn, general manager at FairWarning UK explains why a digital NHS can only be successful if clinicians and patients have confidence that sensitive data is secure.
“The latest information governance review from Dame Fiona Caldicott and her team marks a decisive step forward for patient privacy. It lays the foundation for building a secure and trusted digital healthcare system and the achievement of a paperless NHS by 2018.
“The widespread use and continued growth of electronic healthcare systems, coupled with the free flow of information are essential for the sustainable delivery of better outcomes for patients. This can only be successful if clinicians and patients have confidence that sensitive data is secure. The implementation of the Caldicott recommendations will lead to better care through privacy and respect for the patient.
Dunn goes on to say that the recommendation to notify patients when their records have been breached is particularly welcome and is a key element of patient privacy rights and would truly represent a turning point for UK healthcare… “Furthermore, the recommendation to enable patients to review access to their records would also make the UK the first nation in the world to mandate this requirement and mark a step towards transparent healthcare.
“Another decisive move forward for patient privacy was the identification of audit controls and access reporting as top priorities. Auditing and monitoring access to patient records is absolutely vital for gaining the trust of patients and hence enhancing the reputation of healthcare providers in a market that is becoming more competitive.”
The challenges facing integration pioneers
This week Nicola Walsh from HSJ explores the key issues that will be faced in order to successfully integrate care services.
“Announcing the government’s invitation to local organisations to apply to become pioneers of integration, health minister Norman Lamb emphasised how crucial this initiative is. But will the pioneers be given the freedoms and flexibilities to overcome the current challenges they face? And how can we ensure this initiative promotes the transformation in care and support services we need to meet the demographic challenges and changing patterns in disease?
“At the King’s Fund’s recent integrated care summit, one of the key policy challenges identified was the current contractual and commissioning arrangements for primary care and the importance of redesigning the existing model.
“Other challenges facing local NHS and social care organisations wishing to implement integrated care at scale and pace are a variety of technical issues, such as payment mechanisms, contracting, governance arrangements and regulation.
“However, although overcoming these challenges is important, from our work with a range of different localities across the country, we argue that integration of care in itself is not a technical or a policy challenge, it is much more of a leadership challenge. If pioneers are to successfully implement integrated care at scale and pace, we will need to see changes in behaviour and, in some instances, a significant shift in organisational culture.
Walsh concludes by suggesting that local leaders will have a key role developing the vision of integrated care. “Perhaps even more important, however, they must also model more collaborative behaviours to those delivering and managing services. In addition, they will also need to focus on what best meets the needs of their local populations rather than their individual organisations.”
Highland Marketing blog
In this week’s blog, Sarah Bruce looks at how one NHS trust CEO is creating a new type of leadership using social media.
