News in brief
NICE new role to support spread of technology in NHS: The National Institute for Health and Clinical Excellence (NICE) has seen its remit widened to help encourage and accelerate the uptake of innovative technologies throughout the National Health Service reports Pharma Times. NHS England has commissioned the Institute to take over the work of the NHS Technology Adoption Centre (NTAC), which was set up to assist organisations in overcoming obstacles to adopting new technologies. A central role of the NTAC’s work was to link with industry and the NHS and support products assessed by NICE’s Medical Technologies guidance programme. Now the team has joined the Institute to become the Health Technologies Adoption Programme, as recommended by the government’s 2011 Innovation Health and Wealth report. NICE’s new programme will look to develop ‘adoption guides’ describing how NHS organisations can introduce specific technologies into routine clinical use in a sustainable manner.
Two Cerner live sites go to tender: Two Southern Cerner live sites have gone out to tender to replace their patient administration and electronic patient record systems provided under NPfIT reports eHealth Insider. North Bristol NHS Trust has released a tender for a ten-year contract for an EPR which must include a patient administartion system (PAS), A&E, theatres and clinical documentation functionality with a single solution from a single supplier. “The trust is looking for a strategic partner whose chosen solution must be adaptable or extendable to meet the future needs of the trust in building towards an electronic patient record,” the document says. “The trust therefore reserves the option to utilise additional existing and future functionality provided by the chosen supplier.” Royal United Hospital Bath NHS Trust has also issued a tender for a PAS, which says the procurement will be open to other southern NHS trusts. Both trusts were ‘greenfield’ sites in the South that received Cerner Millennium from BT as part of NPfIT. The third was Oxford University Hospitals NHS Trust.
New anonymisation standard: A new Anonymisation Standard comes into force today for health and social care bodies according to eHealth Insider. The Anonymisation Standard has been devised by the Health and Social Care Information Centre (HSCIC) and approved by the Information Standards Board. It applies to all organisations that publish information about publicly-commissioned health and social care activity and outcomes. It sets out a process that organisations are required to follow to ensure that the health and social care information they publish is anonymised. The HSCIC said the standard would help organisations meet some of the challenges set out in the recently published Caldicott report on information governance. HSCIC solution design standards and assurance director Clare Sanderson said the government’s open data agenda was putting more data into the public domain, allowing the public to find out more than ever about the performance of public bodies. “That’s a great benefit to everyone, but we must ensure that we don’t publish information that could identify individuals,” she added. The new standard has been developed and tested in partnership with a range of stakeholders and will be included within the statutory Code of Practice of the Management of Confidential Information, due to be published this year.
NHS 111 advice line ‘still fragile’: NHS bosses admit that the new NHS non-emergency 111 telephone service in England is in a fragile state in a number of areas ahead of the bank holiday weekend, according to the BBC. Reports have been emerging for weeks of calls going unanswered and poor advice being given, leading to hospitals being inundated with patients. The problems plaguing the advice line will now be discussed at a board meeting of NHS England today. Officials are expected to agree to an urgent review of the system. A board paper produced by NHS England says some of the problems have been “unacceptable” and, despite improvements, the system still remains in a “fragile” state in places. There are 46 individual 111 services across England. They were supposed to have been in place by 1 April to replace NHS Direct, but seven have yet to go live. And of those that have, several have subsequently been suspended because of problems, while a number are relying on extra staff and support brought in from other parts of the health service.
NHS Hack Day presses for free wi-fi: The first results of an ongoing nationwide survey on wi-fi in hospitals have suggested that two thirds of clinicians believe that having access to wi-fi would improve patient care, reported eHealth Insider. The NHS Hack Day community created the survey to find out how many clinicians have access to wi-fi, how many patients have access, and how this impacts patient care. The survey is being run jointly by NHS Hackday, OpenGPSoC and HANDI. It was set up after discussions on the Hack Day’s Google group showed that most hospitals did not have free wi-fi access for clinicians and several complained that this was stifling app innovation. Commenting on the Google group, Dr Marcus Baw, a locum GP who set up the survey, said that non-consultant doctors, who provide the majority of staffing in hospitals, are not given access to wi-fi. “Oh yes there are networks, there’s hardly a corridor in my hospital without a Cisco router nailed to the roof, but they seem to be for managerial types and possibly consultants. Not the likes of me,” he said. The survey, which is the first step in a campaign towards free wi-fi for clinicians, will run until further notice.
NHS Leadership Academy launches development programme: The NHS Leadership Academy has officially launched the largest ever NHS development programme to bring across-board change to leadership according to National Health Executive. The programmes combine successful strategies from international healthcare, private sector organisations and academic experts. They are designed to support staff to provide high-quality care and the programmes are open to all backgrounds and experience levels. Over the next three years, thousands of NHS staff are expected to take part in the leadership development programmes, at a cost of over £30m. Four levels of programme are available, all named after inspiring leaders in health and social care. Karen Lynas, deputy managing director of the NHS Leadership Academy said: “These programmes recognise that the NHS is about providing not only some of the best healthcare in the world, but doing so in an environment where staff feel able to focus on care, compassion and respect.”
Insight Dashboard goes public: An Insight Dashboard being developed by NHS England to display patient experience data will be made available to the public, reports eHealth Insider. A report being presented at NHS England’s board meeting today by national director for patients and information Tim Kelsey, says the dashboard is due to be officially launched this November. It will have a daily feed of data on patient satisfaction, recommendations, complaints and general impressions of the NHS, as well as weekly survey data on which NHS services have been used. The development of the dashboard as an iPad application came to light in February this year, but papers at the time indicated it was for use by only NHS England staff. “The Insight Dashboard will be a publicly available tool to enhance both transparency and participation; it will be a rich source of information to help people understand what their fellow patients and citizens are saying about health services,” today’s report says. The dashboard will be launched alongside the new integrated customer service platform, which is due to replace NHS Choices in the autumn.
NHS errors ‘deliberately hidden’: The NHS has “failed” to hold anyone to account for a large scale financial mismanagement at a local trust, a damning report has concluded according to The Telegraph. In June 2011, Croydon Primary Care Trust reported a £5.5m surplus when the true balance was actually a £22.7m deficit. Poor accounting practices “masked and prevented” the deficit from being identified sooner, a scrutiny committee into the finances at the south London trust found. They said that accounting errors were “deliberately hidden” and called for the health service to identify and take action against those responsible. There should be an investigation into officers whose “action or inaction” may have been the cause of the overspend and the subsequent “cover up”, their report states. A previous investigation into the “fiasco”, conducted by NHS London, did not provide proper public accountability and did not hold anyone responsible, the Joint Health Overview and Scrutiny Committee said.
GPC negotiator threatens to report health minister to the GMC: A GPC negotiator has written to health minister Dr Dan Poulter, threatening to report him to the GMC over his recent remarks regarding GP out-of-hours care, reports Pulse. Dr Peter Holden, a GPC negotiator and a GP in Matlock, Derbyshire, has given Dr Poulter until today to withdraw comments he made to BBC Radio 4’s Today programme in which he claimed that GP out-of-hours care had been ‘scrapped’ and said people turn up at A&E at times when they don’t have access to their GP. Dr Holden told Pulse that he has asked Dr Poulter to explain why he should not refer the health minister to the GMC for ‘reducing [doctors’] standing with the public, and reducing the public confidence in the profession’. Dr Poulter told the BBC: ‘There isn’t the community-based care that there used to be, thanks to the previous government scrapping the GP out-of-hours system and that has put a lot of pressure on the system.
Many trusts weak on medical leadership, research finds: There is a six fold variation in the amount of time medical directors spend on their board duties, new research into leadership has found, reported HSJ (subscription required). The project, partly led by the King’s Fund and shared with HSJ, aims to provide an up to date picture of medical leadership in the NHS. Authors, including King’s Fund chief executive Chris Ham, surveyed 72 NHS trusts and foundation trusts providing acute, specialist and mental health and community care in England. They found almost three quarters of trusts had just one medic on their board. The number of programmed activity sessions medical directors dedicated to their board work, as part of their consultant job plan, ranged from four to 24 a week. The average was 8.5 sessions which would typically equate to 34 hours. The maximum number of doctors on any trust’s board was four. Most doctors’ board roles were additional medical directors. The report, Are we there yet? Models of medical leadership and their effectiveness, was published by the National Institute for Health Research study.
Kingston becomes first hospital trust to achieve foundation status since April 2012: A London hospital trust has been granted foundation status, becoming the first acute provider to be authorised by Monitor in a year, reported HSJ (subscription required). It is the first since the Royal Free London was granted foundation status in April last year. Kingston’s approval is also the first for any trust since the Health Act came into force, changing Monitor’s role, at the beginning of April. Kingston Hospital, a £200m-turnover organisation, was one of two earmarked for closure under the 2007 ‘Healthcare for London’ service plan for the capital. Its chief executive Kate Grimes said: “This achievement marks the end of a very long road for Kingston Hospital and I am delighted that after many years of hard work and commitment we have achieved foundation trust status and I would particularly like to thank all of our staff who have tirelessly supported the process.”
NHS counts £900 million cost of treating EU visitors: This week The Telegraph reported that Britain has paid out more than £900 million to EU countries to cover the costs of British patients who fell ill abroad – and received just £49 million back for NHS treatment of overseas visitors, according to new figures. Under EU rules, countries should be able to claim back the costs of health care provided for foreign visitors. The figures suggest that while Britain has been quick to pay out costs for holidaymakers who fall ill abroad, it has not secured payment for most EU visitors who fall ill here. The government data shows that for every £18 paid out to EU countries, the UK receives £1 back for caring for their patients. The “balance of payments deficit” means that NHS budgets lose £16 million a week to fund treatment of those who come here from abroad. The figures do not include treatment for those who migrate to this country from elsewhere in Europe.
Is the NHS really over-managed?: The BBC reported this week that it has become fashionable to bash NHS managers. Ministers have been quick to criticise the “pen-pushing culture” in the NHS with both current Health Secretary Jeremy Hunt and his predecessor Andrew Lansley, promising to reduce bureaucracy in the NHS. The number of managers in the health service has already been cut by nearly 7,000 in the last three years and now stands at 35,650 in England. Research to be published later this summer by the Chartered Management Institute (CMI) shines an interesting light on the issue. The work has found the NHS has a poor record in investing in its managers. Compared to other sectors, it spends nearly 30% less on training its leaders, the research suggests. The CMI goes on to argue that this is misguided as good management leads to an engaged workforce that is more productive and provides better care. Ian Reynolds, the chairman of Kingston Hospital, who has been crunching the figures for the CMI, is clear. “It may be unfashionable to say so, but overall the NHS is under-managed.”
Opinion
The NHS failure regime: what have we learnt so far?
Candace Imison, acting director of policy for The King’s Fund, discusses why using the ‘failure regime’ may actually be beneficial for dealing with financially unsustainable providers.
“Back in 2006, legislation was passed giving the Secretary of State power to appoint a trust special administrator to take over the day-to-day running of any NHS trust that was deemed to be failing financially. Remarkably, it took six years before the regime was first applied. In July 2012, South London Healthcare NHS Trust was put into administration. Not long after, in October 2012, Monitor took the initial steps towards enacting its own failure regime for the first time, by applying the ‘distress’ regime to Mid Staffordshire Foundation NHS Trust, before putting the Trust into administration on 16 April 2013.”
Imison goes on to explain the lessons learnt from the early experiments. Firstly, “if we thought the failure regime would bring a rapid resolution to problems then we should think again. The administration process itself is indeed rapid – certainly compared to a traditional attempt to reconfigure NHS services”.
Secondly, “there is a disappointing lack of forensic diagnosis of the causes of financial failure.”
Lastly, “the regime focuses on developing recommendations but does little to support their implementation, or safeguard for risks that occur in the transition period.”
She concludes by saying: “The point of a good failure regime is to avoid failure, and protect the continuity of high-quality services for the local population. Early signs are that too much attention is being focused on the formal process and not enough on why we got here in the first place.”
How technology can tackle long-term health challenges
This week on the Guardian Healthcare Network, Matthew Swindells, senior vice-president of population health and global strategy for Cerner, explains why we should be learning from the US and put people in charge of their health.
“The fact that Britain faces long-term health challenges from demographic and lifestyle change is hardly a new idea. Nor is it a challenge unique to Britain; developed countries around the world are grappling with a rise in chronic conditions associated with adverse trends in diet, exercise and obesity. There is a widespread recognition that health systems should intervene earlier to prevent the development of chronic conditions.
“What is less understood is the role of technology in turning the theory into reality. Evidence from other countries can correct this, and tells us that information must be at the heart of efforts to drive more intelligent, affordable care. The economic reality that underpins the need for change is obvious. Left unchecked, public health trends will place an unsustainable strain on health budgets. Research published by the Lancet in August 2011 showed that the UK is on track to have an extra 11 million obese adults by 2030.
“Making preventive health a reality won’t be an easy job. It requires significant investment, clinical leadership and patient support. In an NHS facing short-term targets, it is all too easy to defer long-term challenges. Technology can help to drive this process; providing the information required to identify risks and put people in charge of their own lifestyle to avert problems.”
Turnaround is everybody’s problem
This week, Bill Shields, chief financial officer at Imperial College Healthcare Trust, tells HSJ (subscription required) that there should be an organisational-wide approach to turning around a failing healthcare provider, and it should not rest solely on the shoulders of the finance director.
“Organisational turnaround is often seen as the sole preserve of the finance function. Equally, it is often perceived to reduce quality and increase clinical risk. The reality is somewhat different: poor quality costs money through, for example, litigation, duplication, waste and reputational damage. Financial turnaround, if properly targeted, can therefore lead to increased quality at lower cost while creating surpluses for investment in new services.
“Turnaround must focus on three areas: people; process; and culture. It has four phases: control; turnaround; transformation; and, ultimately, stabilisation. No process, however well designed, will operate effectively with poorly trained operatives. Equally, the best people will not succeed with antiquated, inefficient processes and systems. It is, therefore, crucial to recruit the best possible staff while, at the same time, ensuring systems are optimised and based on best practice.”
Medical leadership is vital for quality patient care
In this week’s HSJ (subscription required) Chris Ham, chief executive of the King’s Fund, writes that doctors should be encouraged to enter into leadership roles. Ham explains that it is essential for raising the standard of patient care.
“New research from the King’s Fund and Birmingham University has found between 10 and 20 percent of consultants are involved in formal leadership roles in most trusts, with clinical directors committing around 20 percent of their time. This means that no more than five per cent of consultants who are not clinical directors’ time is allocated to leadership roles.
This matters because the Francis report highlighted that one of the factors behind patients dying unnecessarily or being harmed at Stafford Hospital was the disengagement of doctors. The report paints a picture of a hospital where many doctors and nurses chose not to act when patients were neglected and did not appear to take or accept responsibility for the quality of care those patients received.
“Several studies show a clear and positive relationship between medical engagement and organisational performance, reinforcing Lord Darzi’s argument that involving doctors in leadership roles is not an optional extra but central to raising standards of patient care. Why then does so much still need to be done almost 30 years after Roy Griffiths argued for medical leadership to become a much higher priority in his seminal report on NHS management?
“The challenges facing the NHS in responding to the Francis report, together with the need to find unprecedented efficiency savings, can only be met through the active and enthusiastic engagement of doctors. This must be done in collaboration with other clinicians and the support of managers. Never has there been a greater need to move medical leadership into the mainstream.”
Highland Marketing blog
In this week’s blog, Alex Leyton looks at the top five futuristic technologies that could change healthcare.
