News in brief
MPs say new NHS safety organisation ‘must be independent’: A new organisation designed to make the NHS in England safer must have its independence guaranteed in law, a committee of MPs has said, reported the BBC. The Healthcare Safety Investigation Branch (HSIB) is due to begin work this autumn with a budget of £3.6m and will carry out about 30 reviews a year. The government says it has made legal provisions for HSIB’s independence. The cross-party Public Administration and Constitutional Affairs Committee (PACAC) has been examining the work of the new body, which will sit within NHS Improvement. The aim is to model the “no blame” approach taken to investigating air accidents. The hope is this will enable NHS staff, patients and their families to raise awareness about serious risks to safe care, and allow hospitals and other providers to learn from mistakes. But patients’ organisations have warned that this “safe space” should not be prioritised above guaranteeing openness and honesty with patients. And the PACAC report warned the organisation will fail without new legislation. Committee chairman Bernard Jenkin MP said: “We have consistently called for primary legislation to make HSIB fully independent, and to create a credible ‘safe space’ which will enable the NHS to properly learn from past mistakes.” The MPs said the HSIB should be “an exemplar of high quality clinical investigations”, with local NHS providers still carrying out the bulk of inquiries. A Department of Health spokeswoman said: “The new independent HSIB will carry out investigations and share its findings to improve patient safety. We agree that the independence of the branch will be essential to its success, which is why we made explicit legal provisions for its independence when we set it up.”
Majority of junior doctors will vote down contract offer, online poll suggests: A majority of junior doctors could vote down the contract offer agreed between British Medical Association (BMA) and the government, an online poll has suggested, reported Pulse. The poll of almost 900 respondents on a closed Facebook group for junior doctors revealed that 56.5% intend to vote ‘no’ when the vote opens later this month. Just 19% said they had decided to vote ‘yes’, while 24% said they were undecided. It comes as NHS Employers published the terms and conditions of the new contract last week, after last-ditch negotiations resulted in a proposed contract to end the protracted dispute on 18 May. The poll, launched by GP Dr Hamed Khan on 29 May, asked: ‘Now that we have (some) more details of T&Cs, what do you intend to do?’ Out of 891 respondents, 504 said they would vote no, while just 166 said they would vote yes. Dr Khan, a GP in the emergency department of St George’s, London, and a clinical lecturer, said: “This is interesting. In my opinion nobody doubts the intentions or dedication of the BMA and the Junior Doctor Committee, who have clearly spared no effort in getting the best deal they can for doctors. From what I gather, most of the concerns that junior doctors have seem to be centred around the effectiveness of the ‘guardian’ in ensuring that doctors hours and rota patterns are safe and reasonable, the fact that there is no pay increase between ST3 and ST8, despite the increase in responsibility and defence fees, and the whole ‘fidelity’ concept which seems to restrict on junior doctors in terms of where they can locum and the rates they can command.”
Figures for outpatient waits soar since Holyrood guarantee: The number of new outpatients waiting more than 12 weeks for treatment has increased fivefold since the Scottish government gave a “guarantee” that nobody would have to wait that long, reported The Scotsman. Some 32,961 waited longer than 12 weeks in March 2016, about five times more than the 5,945 waiting in September 2012 immediately before the 12-week treatment time “guarantee” was introduced and the 7,010 seen in March 2013. The number of inpatient or day case admissions waiting longer than 12 weeks has also increased by a factor of four, from 1,460 in March 2013 to 5,715 in March 2016. Performance against the target has dropped from around 97% in March 2013 to 92% in March 2016. The Patient Rights (Scotland) Act 2011 established a legal 12-week treatment time guarantee for eligible patients who are due to receive planned inpatient or day case treatment from 1 October 2012. Health secretary Shona Robison said: “More clearly needs to be done to maintain and improve performance to meet the rightly-demanding targets we have set. Patients should expect nothing less. That’s why we have provided recent investment to ease pressure and set out long-terms plans to ensure our NHS is fit for the future. This includes our commitment to investing £200m to create five new elective and diagnostic centres across the country, as well as expand services at the Golden Jubilee Hospital. In addition, a £2.7m investment to reduce outpatient waits is reflected in the improvement in outpatient performance.”
Patients are being let down by lack of electronic health records, finds review: Patients have only limited access to electronic health records and their expectations are not being met by the NHS, according to the findings of a review into the roll-out of patient records across the United Kingdom, reported The BMJ (subscription required). The review of current UK activity in personal electronic health and care records (PHRs) was carried out by the Royal College of Physicians (RCP) Health Informatics Unit for NHS England. It found a lack of available information on the use of PHRs but concluded that the numbers of both individual and organisational users are low. “The functional maturity, implementation and uses of PHRs are also relatively limited,” it said. The review found that where PHRs are being used the focus has been on enhancing information sharing and communication between patients and their care providers and not on changing the methods of delivering care or saving money. “The failure to fully utilise PHRs for health service improvement projects may mean that potential improvements in cost efficiency and effectiveness are not being realised,” it warned. Jeremy Wyatt, the RCP Health Informatics Unit lead for new technologies, conducted the review and said that although many people now wanted to get more involved in managing their health, they found it hard to do so. “Personal health records are a tool that can facilitate this, but at present they are only available to restricted groups of patients,” he said.
Manchester proposes single trust for hospital services: Central Manchester’s three hospital trusts will be united in a single NHS trust, under new proposals being considered by the city council, reported National Health Executive. Papers submitted to the council’s health and wellbeing board ahead of a meeting on 8 June confirm that it has completed two stages of a review of the proposal to create a partnership between Pennine Acute NHS Trust, Central Manchester University Hospital NHS Foundation Trust and University Hospital of South Manchester NHS Foundation Trust. The proposed benefits of the partnership include reducing healthcare inequalities and service gaps within the city, standardising care pathways, recruiting more specialist staff and improving use of estate and data. In a letter to Sir Richard Leese, chair of the health and wellbeing board, Sir Jonathan Michael, who led the review, warned that there is currently “an unacceptable level of variation” among Manchester’s health services. “Patients who live within 10 miles of each other, and who have the same severity of the same condition, are less likely to survive, or more likely to stay in hospital for an unduly long time, depending on where they live and the part of the system that they first attend,” he said. He added that the introduction of a single hospital service within the city will not only address the existing variation in services but will also help to tackle some of the other challenges that Manchester is facing.
Cuts making integrated health and social care difficult: The reality of integrated care is falling short of its ideals in the UK, because of increasing financial constraints on councils and NHS bodies, new government-funded research has warned, according to a report on Health IT Central. The study, as reported in the UK’s Community Care magazine, has found that engaging frontline staff in initiatives to integrate care was proving challenging in a climate where they were ‘firefighting’ to keep existing services running. The study followed the progress of 14 pilots, set up to test new ways of integrating care, over the period from January 2014 to July 2015, as part of the Department of Health initiative. It discovered that, where they started with ‘ambitious visions to transform care… reduce costs and improve people’s experiences of care’, the ideals of those taking part in the pilots changed over time, becoming more limited and coming to focus on “short-term, financially driven goals”, mainly around containing hospital admission and discharge costs. Interviewees identified a number of barriers to integration. “Growing need and declining budgets provided an even stronger imperative for more effective integration. However, at the same time, this context made it more difficult to make progress,” stated the report. The context increased the incentives for organisations to “defend existing roles and resources, for fear of something worse”.
Mackey only in NHS Improvement job for two years: Jim Mackey has confirmed that he is only in his job as chief executive of NHS Improvement on a two year secondment, reported Health Service Journal (subscription required). Mr Mackey said he could “absolutely not” see any problems with the fact that he was only in the job temporarily, arguing that it was a “better position for everybody”. He took up the job as chief executive designate of NHS Improvement in late 2015, before the organisation’s predecessor bodies, Monitor and the NHS Trust Development Authority, had formally begun operating under the new name. Asked about the fact that he was in his new role on a temporary basis, Mr Mackey said: “It’s similar to the position Pauline Phillip has got on emergency care, and Cally Palmer has got in cancer. We’re actually building it in our biz model, we’re going to have chief executive leads on various things in the regions. I don’t see how it’s a downside. I’m going to throw myself at this with absolutely everything I’ve got. I’ve never made any secret of the fact that I’m a provider at heart, but I’ve stepped up and I’m going to have a right go.”
cSUS: big differences in usability of clinical software: The Clinical Software Usability Survey has found big differences in the reported usability of the software used by NHS staff, reported DigitalHealth.net. Digital Health Intelligence launched the survey as a pilot project in November 2015, and closed it in March after more than 1,300 clinicians had provided detailed usability ratings for the clinical systems they use most often. NHS users gave their software an overall average rating equivalent to ‘OK’, slightly lower than many other industries. But contained within this aggregate score was an extremely wide spread of rating scores for types of software and individual software systems. The comparative analysis revealed that, on average, GPs and other staff working in primary care gave the highest usability scores to their systems. The second highest average usability rating scores were given by staff working in mental health services, followed by staff working in hospital services. Common themes that have emerged from the initial analysis include widespread frustration at the slow speed of networks and computers, and having to use clunky software that requires users to painstakingly navigate between multiple screens and applications. Dr Marcus Baw, who has been one of the project leads, said: “I’m proud to be part of the team behind the first ever national study of NHS software usability, which will hopefully be the first step towards much more open discussion of system usability across the NHS.”
Patientrack recognised as one of ‘the best’ eHealth solutions in Europe: UK healthcare technology company Patientrack has been recognised as providing one of the best eHealth solutions anywhere in Europe, in an EU competition focussed on healthcare innovations from small to medium sized enterprises (SMEs), reported eHealthNews.eu. The Patientrack early warning system is used in NHS hospitals to prevent avoidable harm and alert doctors and nurses to patients at risk of deterioration, so that they can intervene early. The SME behind the Patientrack system has been named as the only UK company in the champions category finals of the 2016 EU eHealth Competition, a programme supported by the European Commission as a means to increase visibility of what it describes as “the best” of healthcare technologies from SMEs across the continent. Donald Kennedy, managing director at Patientrack, said: “It is great to see recognition for what can be achieved for safer care when hospitals work in partnership with UK SMEs. I hope that the successes achieved with our colleagues in the NHS can now be spread even further to benefit patients across Europe.”
White hack exposes risk posed by connected devices: An ethical hack by an IT security provider of a private health clinic’s IT system has highlighted the vulnerability of internet connected medical devices, reported DigitalHealth.net. The hackers, from Kaspersky Lab, were able to take control of medical devices and to hack the electronic patient record. They said that this vulnerability could open the door to cyber criminals not only to lock down sensitive data and demand a ransom to unlock it, but also to alter it. Kaspersky Lab Global Research and Analysis Team worked with the unnamed clinic to test the IT security. The research team used the Shodan search engine to identify hundreds of internet-connected devices – including MRI scanners and cardiology equipment. The team went on to gain access to the clinic’s network by exploiting a vulnerability in the wi-fi connection. In a statement, the team explained: “Exploring the local clinic’s network, the Kaspersky Lab expert found some medical equipment that was previously found on Shodan. This time, however, to get access to the equipment, a password wasn’t required at all because the local network was a trusted network for medical equipment applications and users. This is how a cyber criminal can gain access to a medical device. David Emm, principal security researcher at Kaspersky Lab, said the hack had highlighted vulnerabilities that could have devastating consequences if exploited by cyber criminals.
GP-led vanguard scheme cuts hospital stays, finds report: Hospital stays have been slashed by a vanguard scheme in south-east England involving GP checks on care home residents, according to a report outlining early progress from new models of care, reported GPOnline. The NHS Confederation study said Sutton Homes of Care had taken three days off the average length of time spent in hospital by care home residents in the region. Resident visits to accident and emergency departments were down 10%, according to the study entitled New Care Models and Prevention: an Integral Partnership. The vanguard’s new approach includes a pilot project of GPs or care co-ordinators carrying out health and wellbeing reviews of residents’ needs every six months. One Sutton-based GP was quoted in the report as saying: “The health and wellbeing review pilot has given us the gift of time to do our job properly.” Other results from Sutton Homes of Care, which serves a population of 200,000, include less wastage of medication, financial savings and improved job satisfaction, according to the report. “At this stage of the programme, what the vanguards are doing on prevention is very much emerging practice rather than evaluated practice,” said the NHS Confederation study. But given the ambition to deliver the GP Forward View vision at scale and pace, we hope that the case studies will prove to be a valuable resource for other organisations and partnerships developing new care models across the country.”
Forward View must be ‘implemented urgently’ as one in eight GP posts unfilled: The scale of the GP crisis has been revealed in a survey showing that 11.7% of all GP posts in the country are vacant, reported National Health Executive. The vacancy rate has increased by more than five times since 2011, when it was 2.1%, and by 2.6% since last year’s rate of 9.1%. Dr Maureen Baker, chair of the Royal College of General Practitioners, responding to the survey, said: “General practice is currently facing intense resource and workforce pressures, caused by years of underinvestment in and undervalue of our service. This survey brings home just how important it is that we do everything in our power to recruit more GPs, urgently implement schemes to retain existing ones, and make it easier for trained family doctors to return to practice in the UK following a career break or period working abroad.” She called for the recommendations in the General Practice Forward View, which seeks to tackle the shortage of GPs with increased funding and recruitment, to be “implemented urgently”. GP consultations increased by 15% in 2010-15, and the growing demand has had consequences across general practice. One in 10 GP practices have described their finances as unsustainable, and UK GPs have the highest rates of stress in the world.
Coordinate My Care integrates care plans into EMIS Web: Urgent care plans for thousands of London’s most vulnerable patients are now just a click away for almost 1,000 of their GPs, reported DigitalHealth.net. Plan sharing scheme Coordinate My Care will now be available to 962 of London’s GPs from within their EMIS Web systems. This will allow GPs, along with other emergency services, to easily access, create, update and share the urgent care plans of nearly 30,000 palliative and highly vulnerable patients. Care plans are a combination of a patient’s wishes, such as a preferred place to die or do-not-resuscitate orders, and their medical history. They are predominantly used by very unwell patients at high risk of becoming incapacitated or requiring urgent care. Professor Julia Riley, clinical lead for Coordinate My Care, said: “These are all people that don’t want to have to repeat their stories, especially in an emergency. They want the professionals to know what to do already.” While acute services have had access to Coordinate My Care since late last year, integrating the system into EMIS Web was seen as an important step in getting GPs on-board.
Welsh hospital pioneers hi-tech trial to improve patient tests: The Neath Port Talbot Hospital’s (NPTH) four medical wards and Rheumatology Blood Monitoring Clinic have started using electronic test requesting (ETR) for blood or tissue tests instead of paper forms, reported Health IT Central. At the push of a button, the process allows clinical staff to gather information such as when a sample reaches the laboratory, who asked for the test and if a patient’s earlier test result is still acceptable. It not only improves turnaround times for tests but also means lab staff won’t face transcription mistakes or concerns with legibility that they can experience with paper records. The new system is cost-effective and enables better management of demand, developing the quality and validity of test requesting. Lead advanced nurse practitioner Ceri Thomas said: “A positive thing is that it alerts you if certain blood tests have been requested recently, avoiding duplication and preventing patients from having blood tests when they don’t necessarily need them.” ETR is an integral part of the Welsh Clinical Portal. This system allows health professionals to look at patient information in one single secure online location.
Bradford trust forges ahead with data management transition: Bradford Teaching Hospitals NHS Foundation Trust has followed up its migration of radiology images from its incumbent AGFA PACS into an “independent clinical archive (ICA)” by migrating more than 50,000 cardiology studies into the same BridgeHead Software archive, reported Government Computing. The move marks the second stage of the teaching hospital’s data management project with the latest exercise intended to ensure that its cardiology data is protected as part of a comprehensive environment that is safeguarded from risk of loss, corruption or disaster. Geraldine Metcalfe, head of cardiology at Bradford Teaching Hospitals NHS Foundation Trust said: “We were delighted that cardiology was selected for the next stage of the data management project as our legacy GE archive was ageing and needed replacing.” Dr Jonathan Barber, divisional clinical director of clinical support services, said: “This investment will allow us to plan and realise the second stage of our PACS replacement, which is to provide an updated and integrated, long-term imaging archive, manipulation and display solution. For the first time, this will allow us to archive, manipulate and share images from other clinical modalities outside radiology, in such specialities as cardiology, ophthalmology and medical illustration. I consider this ability as key to the integration of medical imaging in the development and deployment of our new electronic patient record.”
Opinion
Securing the Internet of Medical Things
The Internet of Things is an exciting prospect for healthcare; but when everything from transfusion pumps to home testing kits are linked to your network, how do you secure it, asks information security journalist Davey Winder.
“It’s relatively easy to secure things from the perimeter. It is far less easy to secure ‘things’ that extend beyond fixed network architectures. Start throwing myriad connected devices into the healthcare equation and pretty quickly you end up with a new borderless network perimeter paradigm that cannot be adequately defended without a paradigm shift.
“This borderless network, often spread across multiple locations comprises everything from wearable devices such as personal glucose monitors and fitness trackers, through to IV pumps. All of these devices will be networked in order to deliver on the patient care promise, and that’s where the software involvement comes in – along with the risk.
“This software is where vulnerabilities are most likely to exist – and will be exploited if discovered. What matters is that these devices probably haven’t been designed with security in mind from the bottom up. It’s not that cybercriminals will be after the results of that glucose monitoring; but they will see IoMT devices as a weak link, providing an easy ride into the healthcare information systems where profitable data resides.
“Researchers have already demonstrated how easy it can be to gain access to, and ultimately control certain connected insulin pumps, for example. Billy Rios is the researcher responsible for discovering the insulin pump hack, and he also remotely installed a game of Donkey Kong on a machine that controls the delivery of radiation to a patient. Device manufacturers are taking notice, and thanks to high-profile media reporting of the kind of problems illustrated by Rios and others they are removing the vulnerabilities in newer models.
“Until medical devices have security baked into software from the design process up, and some kind of accepted standardisation for secure data exchange between them and health information systems exists, the Internet of Medical Things is in danger of becoming the Android marketplace of healthcare hardware.”
The future of the NHS is in the hands of its workforce
We cannot hope to deliver high-quality care to patients if we do not look after the people who are responsible for looking after our patients, writes Danny Mortimer on the Guardian’s healthcare network.
Mortimer, chief executive of NHS Employers, says: “Employers are already taking steps across the health service to cope with rising demand but we need to learn from the examples that are working well and help employers to think about how they can introduce new roles where it meets the needs of their local population. At the NHS Confederation conference Bradford District Care will talk about how they managed to create a successful new role to meet the needs of their patients.
“Learning and applying the lessons from examples such as Bradford will be really important for employers to address their challenges locally. They cannot however do this alone, and we must ensure that national interventions support the changes that are needed. This includes regulation of new roles such as the physician associate (I would propose by the Health and Care Professions Council) as well as recognising that greater progress is needed to support, for example, prescribing by non-medical clinical staff. It also includes support for investment in education and training through the Sustainability and Transformation Plans process.
“All this investment and innovation risks being only partially realised if we do not provide a more consistent experience for our people. We cannot hope to deliver high-quality care to patients if we do not look after the people who are responsible for looking after our patients. The annual staff survey results were again profoundly sobering in parts with a rise in the number of staff reporting that they feel bullied or harassed, for example.”
Former health minister Norman Lamb on parity of esteem: Interview
Having two separate government departments for health and social care does not make sense, Norman Lamb says in an interview with Primary Care Today.
Lamb, the former Liberal Democrat health minister from the coalition government, says: “I was responsible for policy on care at the Department of Health, but the Department for Communities and Local Government was responsible for the funding.
“That doesn’t make sense at all, there needs to be one government department that’s responsible for health and care. All the money needs to flow through that direction.
“So let’s bring them together so that everyone can see that everyone benefits from these changes.”
In the interview, he also reflects on successes and regrets for mental health from his time in government. Successes include ending the practice of face-down restraints in patient units, and the establishment of a scheme to get the top graduates into mental health social work.
“I am very proud of the fact that we also halved the number of people who end up in police cells as a result of a mental health crisis and that we tripled the number of people up to 900,000 who get access to psychological therapies.”
“My biggest frustration while I was there was the fact that we set a very ambitious objective of getting people with learning disabilities out of institutions where in many cases they shouldn’t be.
“I was very frustrated by the failure of the system to deliver change that they committed to doing back in 2012.
“If I failed in some way to force that change then obviously I very much regret that. But I remain equally committed to driving that change albeit from the outside.”
