News in brief
Sharing patient data must be embraced despite “understandable caution”: Jeremy Hunt says record sharing must be embraced when in a patient’s “interest” as NHS England reveals scrutiny plans for care.data launch, reported Government Computing. The open availability of data will be a “great ally” in improving patient safety in the NHS despite concerns over confidentiality, with transparency serving as the main engine to drive such change, secretary of state for health Jeremy Hunt has said. Hunt told delegates at the Improving Patient Safety Towards Harm Free Care Conference in London that healthcare organisations faced a long and difficult journey to enact a culture change within hospital trusts to encourage more sharing of data and patient records. However, he maintained that while health providers needed to be cautious in sharing patient records, open data was the preferred direction towards positive reform of healthcare when deemed to be in the “interest” of patients. “I think people have a right to have their medical records accessible by a clinician seeing them. I think we have changed the rules so clinicians and trusts don’t just have a huge duty to protect confidentiality, but they also have to share records where it is in the patients’ interests to do so,” he said. “I think there is understandable caution and we do need to be cautious because we don’t want to destroy public confidence in the huge potential of single electronic health records that can be used everywhere in the system, which everyone agrees is where we have to go.” The comments were made as Tim Kelsey, national director for patients and information at NHS England, told a parliamentary health committee hearing that the organisation’s care.data programme would be scrutinised by an independent panel during a pilot phase planned for later this year. Kelsey told the committee that Dame Fiona Caldicott would lead the panel reviewing the organisation’s controversial data collection plan, which aims to share patient medical records from GPs and healthcare providers with researchers and other specific groups.
Public fear for the future of free healthcare: Voters fear the principle of free healthcare is in danger and that the NHS is threatened by the private sector, an exclusive Health Service Journal/FTI Consulting (HSJ, subscription required) poll has found. The survey also reveals that the NHS retains extremely high levels of support among the general population. A huge majority (90%) would approve of a cash injection into the service as the economy improves. The research polled a representative sample of 2,000 voters from across England in June. When asked to score out of 100 how much they agreed with the assertion “free care is under threat”, one in four said 100%. The average score was 70%, despite no major political party actually offering a policy to end the principle of healthcare free at the point of use. This survey also revealed widespread concern about the role of the private sector. An average score of 65% was recorded in response to the statement: “The NHS is under threat from private healthcare companies”. Despite this perceived threat from private firms, half of respondents agreed it did not matter whether the NHS was privately or publicly managed as long as the service remained free to users. The poll also offers insights into what voters want from their NHS services. Accident and emergency (A&E) was named as the most consistent area of concern for the general public. Seventy-four per cent of voters would be “very concerned” at a national announcement relating to A&E closures – much higher than levels of concern over new charges for services, restrictions of access to drugs or reductions in eligibility.
Scale of data release to police revealed: More than 2,700 releases of non-clinical information about NHS patients were made to law enforcement organisations in the year to March 2014, the Health and Social Care Information Centre (HSCIC) has revealed. The information is in the HSCIC’s latest quarterly register of approved data releases, covering the period from January 2014 to March 2014. The details about releases to law enforcement over the longer 12-month period were included after privacy campaign group medConfidential drew attention to their absence from the HSCIC’s data audits. From April 2013 to March 2014, there were 2,758 releases of non-clinical information made from the National Back Office (NBO), including 491 to police forces, 321 to the National Crime Agency and 1,944 to the Home Office. The HSCIC said the NBO will release “strictly circumscribed” non-clinical information about the geographical area where someone is registered with a GP, along with their name and date of birth, “only…when appropriate legal criteria are met”. Phil Booth, the co-founder of medConfidential, told eHealth Insider that he welcomes the release of the information, and said it shows the scale of data being shared with law enforcement. “We knew police were going and asking and getting data from the NHS… but we weren’t aware of the scale of it. It’s quite shocking. You’re talking of thousands of requests a year – it’s routine.” Booth said he is particularly interested by the “huge spike” in Home Office requests, and would like to see further information about which groups are making the requests. He said the HSCIC needs to be transparent about how it releases information for law enforcement so the public knows it is being handled appropriately.
NHS managers ‘expect’ GPs to go beyond contractual requirements on IT drive: NHS England has said it expects GPs to go beyond the minimum requirements set out in the contract for patient online access, after admitting that the minimum requirements will lead to ‘no meaningful improvement’ for patients. An NHS England board paper on risk assurance has said that unless GPs go beyond the requirements of their contract then the benefit for patients will be limited. A spokesperson subsequently told Pulse that they ‘expect practices to implement access to records in the most beneficial way for their patients’ which, they add, ‘may mean going beyond the minimum’. However, GP leaders have said that practices could only go beyond the ‘minimum requirements’ if they were willing to ‘shut up shop’ for six months in order to check the accuracy of existing records. The NHS England risk update states that the ‘technical solutions to support GPs are on track’ to implement the changes in the 2014/15 General Medical Services contract, which brought in a requirement that patients should be able to access their records online by April 2015, and that practices should be able to offer appointments and order repeat prescriptions online by April 2014. However, it added: ‘The concern is that practices may only implement the minimum requirement, thus there would not be meaningful quality improvement for patients.’ Beverley Bryant, director of strategic systems and technology, NHS England, told Pulse: “The evidence shows that patients that benefit most from access to records are those with long term conditions. Those practices that currently offer the service, give access to much more information than the contractual minimum. A minimum requirement has been set to enable practices to turn the service on without the fear of being overwhelmed. We expect practices to implement access to records in the most beneficial way for their patients. This may mean going beyond the minimum.”
SCR reaches 40m patients: The NHS Summary Care Record (SCR) has hit the 40m patient mark, just over a year after low usage rates led to calls for it to be scrapped, eHealth Insider reports. NHS England says it is now focussing on rolling out the SCR in A&E, NHS 111, and GP out-of-hours services. The SCR was one of the key projects of the National Programme for IT in the NHS. It was intended to create the ‘national’ element of an integrated care records service that was otherwise to be delivered by the roll-out of detailed care record systems at trusts. However, the SCR was held up for years by rows about consent and confidentiality that mirror the present arguments about the care.data programme. Privacy campaigners and medical groups argued that patients were not sufficiently informed about the creation of the first, national database of patient records, and that they should opt-in rather than out. The SCR was eventually given the go-head by the present government on an opt-out basis. The record provides a core set of required clinical data, including allergies, medications and adverse reactions, pulled from GP systems, which can be viewed by health professionals involved in a patient’s care. In July 2013, it was expanded to include patients’ end-of-life care information, immunisations, and significant past problems and procedures.
Dementia charter highlights role of technology: Dementia sufferers and their carers are to be given information about how assistive technologies could help people live independently at home for longer, reported Building Better Healthcare. The news comes after a YouGov poll commissioned by the Alzheimer’s Society revealed that 85% of people want to stay living at home for as long as possible after being diagnosed with dementia. But the study also revealed that a third of the general public do not know where to find information about how to adapt their property to make it suitable. Last week the society launched a landmark guide aimed at helping to improve access to life-changing technology, which could enable people with dementia to live independently for longer. The Dementia-Friendly Technology Charter has been produced as part of the dementia-friendly communities strand of the Prime Minister’s Challenge on Dementia. The charter, developed by a diverse working group led by Tunstall Healthcare, gives people with dementia and their carers, information on how to access technology. It also provides guidance to health, housing and social care professionals on how to make technology work for people based on their individual needs. Assistive technology includes products and modifications to the home that can make life easier and safer for people with dementia. Jeremy Hughes, chief executive at the Alzheimer’s Society, said: “Technology can be invaluable in enabling people with dementia to live independently for longer, empowering people with the condition to stay at home while reducing stress and worry for carers concerned about the safety and comfort of loved ones with dementia.”
Insurance company refuses NHS request to delete patient data: The Health and Social Care Information Centre (HSCIC) has admitted it has no power to force private companies holding potentially sensitive patient data obtained from its predecessor body to comply with its requests to delete the information, Health Service Journal reports (subscription required). The centre announced last month it had written to three re-insurance companies asking them to delete patient data they had obtained legally from the NHS Information Centre. New regulations are to be introduced under the Care Act this autumn restricting the flow of potentially identifiable data solely to purposes of benefit to the health and social care systems. But HSCIC non-executive director Sir Nick Partridge told the Commons Health Committee that one of the companies, SCOR, had refused to agree to delete or stop using the patient data. The centre’s chair, Kingsley Manning, added: “I am advised that we do not have powers to ask them to delete the data under the current sharing data agreement.”
Out-of-hospital plan ‘a recipe for disaster’, MPs warn: Cutting back on hospital services in England – before community services are geared up to provide care – is a “recipe for disaster”, MPs say. The Health Select Committee said the NHS faced “one of its greatest challenges” dealing with patients with long-term conditions, such as diabetes, reported the BBC. They account for 70% of health spending but only 30% of patients. The NHS has tried to ensure more care is done in the community, but the MPs questioned the wisdom of this strategy. The cross-party group said these patients would still need specialist hospital care. The MPs acknowledged doing more in the community was perhaps desirable for the patient, but added it would not necessarily save the NHS money – as has been widely assumed. They said it was already clear there were gaps that needed to be plugged in the community, pointing to figures that showed there was a shortfall in GPs in training. But they said the NHS could not simply cut back on hospital care to pay for this. Instead, the MPs said there needed to be greater understanding of what drove patients with long-term conditions to hospital on such a scale. Figures show these patients are responsible for two-thirds of outpatient and A&E visits and occupy 77% of beds. The committee’s report said evidence presented to them suggested that by 2016 the NHS would need to be finding an extra £4bn a year to cope with the rising burden of treating people with these incurable conditions unless a more efficient way of working were found.
NHS England struggling to balance £97bn budget: NHS England this week confirmed it had still not managed to set plans to balance its £97bn budget for 2014-15, in what experts saw as a sign that the NHS overall could face financial crisis sooner than expected. A report to the national commissioning body’s board meeting this week by its chief financial officer, Paul Baumann, showed that three months into the financial year he was still unable to present it with a balanced financial plan for approval. Plans submitted by clinical commissioning groups and NHS England’s own direct commissioners in late June showed an aggregate overspend of £137m against the commissioning system’s £97.3bn spending limit for the year. NHS finance experts told Health Service Journal (HSJ, subscription required) it was a sign that the commissioning system – which has to date fared better than the provider sector amid prolonged austerity – was now under huge financial strain. They warned the NHS overall could tip into the red in 2014-15, ahead of a widely anticipated crisis of health finances in 2015-16. Richard Murray, the King’s Fund policy director and former chief analyst at NHS England, said while the projected overspend was small compared with commissioners’ overall resources, “the fact that they can’t get it down to zero is really significant”. He told HSJ: “It shows the commissioning system is really grinding its gears at the moment.”
‘VistA for NHS’ ready for trusts: An Anglicised version of the VistA electronic patient record system is now ready to be deployed at NHS trusts, according to one of the companies behind its development. General Dynamics Information Technology has worked with fellow US company Medsphere to develop a UK-specific version of the US Veterans Health Administration (VA) system. The companies prepared a “first cut” of the system in December 2013 with Tony Shannon, the chief clinical information officer of Leeds Teaching Hospitals NHS Trust. Mark Meudt, General Dynamics IT’s vice president of communications, told eHealth Insider that this version has now “advanced considerably”. He said it is now ready to be deployed by trusts with configuration only needed to meet specific local requirements. Meudt said ‘Vista for NHS’ is substantially different from the VA version. The differences include a more intuitive and modern interface, the introduction of different modules not typically provided in the VA – such as maternity and child health – and the addition of implementation, maintenance and support services. Meudt said: “The system includes a focus on e-prescribing, clinical decision support, medication orders, clinical notes and medication administration – where most NHS trusts are looking to increase their digital maturity. By providing a complete end-to-end closed loop medication administration module, we are providing clinicians a single source where all information for the patient can be viewed and processed. We also have been working with First Databank to make sure that UK drug knowledge is incorporated into the NHS VistA for better medication decision support.”
NHS England launches the NHS Number survey for all trusts: This week NHS England launched a survey on the uptake and use of the NHS Number as the primary patient identifier aimed at trusts across all services. NHS England has reported that the survey – the first of its kind – will enable NHS England to create a comprehensive picture by trusts across England of use of the NHS Number in direct care. The NHS Standard Contract for 2014-15 states that “the provider must use the NHS Number as the primary identifier in all clinical correspondence” and is a key criterion for applications to the Integrated Digital Care Fund. NHS England has asked chief information officers (CIOs) in acute, ambulance, community and mental health trusts to complete the survey by 31 July 2014 and plans to have a complete report on progress by September 2014. The findings of the survey will be the catalyst for targeted support aimed at local level to facilitate the widespread adoption of the NHS Number. The survey is vital to understanding where that support is most needed. The central programme team, regional leads and clinical commissioning groups (CCGs) will work closely with trusts to support CIOs to meet their contractual obligation and to track progress across their organisations over the coming months. “We want to help all trusts in England, and the populations they serve, to reap the benefits of integrated and safer care as quickly as possible and the use of NHS Number as the primary patient identifier is fundamental in enabling this”, said Beverley Bryant, director of strategic systems and technology. “Support in driving the use of NHS Number will be a cross-organisation initiative led through our central programme team but working hand in glove with regional leads, the CCGs and, of course, the trusts themselves.”
Denley and Bolton back to lead System C: Symphony Technology Group has completed its acquisition of the majority of McKesson’s European healthcare software business and appointed the former senior management team of System C to lead the new UK business. In a remarkable comeback story, Dr Ian Denley and Markus Bolton have been appointed by Symphony to lead the new business, which will be called System C. In an exclusive interview with eHealth Insider, the pair said they plan to “disrupt” the current health and social care IT market. The pair successfully led the System C business, founded by Bolton in 1983, up to a £87m sale to McKesson in 2011. The company enjoyed rapid growth as deployment and services specialist under the National Programme for IT, while still developing the Medway electronic patient record (EPR) software. The two left McKesson in 2012 and subsequently set up the health IT accelerator firm Shearwater Health, which has invested in firms including Graphnet Health. The new System C’s core products will be the Medway EPR, and related clinical applications, plus social care software specialist Liquidlogic and all the UK-based McKesson businesses acquired by Symphony. Dr Denley will be responsible for corporate affairs, research and development, and the overall running of the company. Bolton will be responsible for sales, strategy and deployment services. Both have taken a stake in the new company. They will bring with them key former System C directors, including chief technology officer, and original lead developer of the Medway EPR product, Simon Cavell.
NHS England appoints GP as chair of patient data oversight committee: A special independent group of experts set up to advise NHS England about patient data privacy issues is to have a doctor as its chair, according to Commissioning GP. NHS England confirmed this week that a GP, Dr Joanne Bailey, will be the new lead for the so-called General Practice Extraction Service Independent Advisory Group. The group was created in 2012 before the current crisis over the care.data harvesting scheme. However, it is now expected to assume a critical role in helping address privacy and security issues around the plan, which is set to be re-launched in a few months time. No data has yet been taken from GP systems except to enable payments to GP practices to take place, NHS England added. Commenting on her appointment, Dr Bailey said: “I intend to ensure that the independent advisory group continues to put at the heart of its decision making the dual aims of protecting patient confidentiality and using data to improve health services and treatments in the future.” Dr Bailey, who has been an existing member of the group since its inception as the nominated representative of doctors’ ‘union’ the British Medical Association, takes over as chair from a colleague who is stepping down after two years in the role. Bailey is an NHS GP, holds a Masters degree in healthcare ethics and has worked with national GP IT programmes since 2004.
Eight and half years ago Jane Eccles had an emergency c-section and gave birth to a son, George. Whilst in hospital she fell ill contracting Necrotising Fasciitis (NF), more commonly known as the flesh-eating superbug. She was given two hours to live as once NF gets a hold there can be no stopping it. Jane was in Intensive Care and had numerous surgeries in a short space of time. Surviving against all odds, Jane was told that she would most probably never be able to walk again, let alone return to her role as a teacher. In the same defiant form that helped her survive, Jane spent the next few months in a wheelchair focusing on learning to walk.
Incredibly Jane and her husband Graeme are now about to cycle over 1000 miles in 14 days, with no backup support, raising money for the Lee Spark NF Foundation. The Foundation helps medical professionals become more aware of the NF disease, symptoms and treatments. It’s a huge challenge for Jane, especially as she could not even lift her leg over a crossbar two years ago.
To find out more about the charity cycle visit Jane’s website. To sponsor Jane visit her Virgin Money Giving page. Many thanks for your support!
Opinion
Patient safety: How local NHS leaders can best use data
Data is essential for improvement but it requires careful handling and analysis, says Penny Pereira, assistant director of strategy at the Health Foundation.
“The NHS Choices website last week published a range of additional safety related indicators as part of the government’s response to the Francis inquiry: a positive step towards greater transparency. However, looking at the neat rows of symbols made me reflect on how rarefied this sort of data can seem when summarised for a national website. Even data reported to the boards of organisations can sometimes seem remote from the reality where care is delivered.
“Data is an essential active ingredient for improvement. But like many active ingredients it can be somewhat volatile: to get the outputs you want you should also include in the mix thoughtful presentation; opportunity for local action and support for broader analysis.
“It will be interesting to see how the debates about the data on the NHS Choices website play out. Will regulators, politicians and the media use this as the opportunity for improvement-orientated conversation and action, while recognising the limitations of what it currently tells us? Whatever type of attention this headline data gets, I hope the examples highlighted here suggest how local leaders can make best use of the wider range of data available locally.”
New organisational models for the NHS won’t be built in a day
Candace Imison, the deputy director of policy, comments on the Dalton review and the future of the new organisational models for the NHS in this week’s blog on The King’s Fund.
She starts off with a golf reference saying: “The team leading the work on the Dalton review for the Department of Health uses the analogy of a set of golf clubs – the NHS is currently trying to play with only a few clubs in its bag, primarily standalone or foundation trusts and trust mergers, but the new organisational models would give the NHS a full set of clubs.
“The default option to address provider failure – trust merger – is certainly far from effective. Of the 112 mergers between 1997 and 2006, 102 brought no improvement in productivity or financial position. With 40% of trusts stuck in the pipeline to achieving foundation trust status, different approaches are needed.
She believes the options under consideration are as following: “what the Dalton team call ‘federations’ but others might call networks, for example UCL Partners who work with an academic health science network; service level chains such as the one led by Moorfields for ophthalmology; joint ventures; management or operational franchise, geographically dispersed multi-service chains; and vertically integrated care organisations. It’s a long list. Lots of potential clubs in the bag.
“Our review of the evidence suggested that any of the arrangements under consideration could bring benefits but it is not the organisational form that will determine the outcome, it is the quality of leadership alongside a culture of excellence in performance and accountability for results. If successful leaders take on the running of other organisations they and their boards will need to establish new ways of working that achieve the right balance of ‘exploitation’ and ‘exploration’. Their political masters will also need to remember two important things. First, successful organisations, like Rome, are not built in a day. Second, the performance of secondary care is increasingly interdependent with the performance of primary care – where is the successful leadership model for that?”
How the Nursing Technology Fund can help improve patient care
Richard Phillips head of m.Health practice at BT Global Services, talks about the Nursing Technology Fund and how it can help improve patient care. The NHS has made £70 million available this financial year to help nurses, health visitors, and midwives to integrate smarter technology into their working lives.
“There is a huge demand for better technology in healthcare. Round one of the Nursing Technology Fund closed after 220 applications from 140 different health trusts. Of these, some 75 were awarded almost £30 million to support 86 care enhancing projects. The majority of initiatives centred on mobile technology, a quarter focused on vital signs monitoring solutions, and eight projects involved digital pens.
“So, could submitting an application for round two lead to you spending less time at your desk, more time with your patients, delivering safer, more effective and efficient care? NHS England has made £70 million available in this financial year to support nurses, health visitors and midwives to use digital technology to improve patient care. With so many applications put forward in round one, and around 300 Expressions of Interest (EOIs) received for 14/15 funding, it’s clear the healthcare sector understands the palpable benefits to both staff and patients that can be gained from integrating smarter technology into their working lives.
“To qualify, you have to get the technology right. We’ve seen trusts looking to put in place everything from mobile working projects and location tracking to digi-pen implementation. Our guidance is that as long as your application meets the principle of delivering strong benefits to staff and to patients, improves productivity and increases time spent with patients, then it fits with the Fund’s priorities and eligibility criteria.”
Technology sees rise of the ‘expert patient’
Rose Jacobs writes in Financial Times (subscription required) about the increased usage of technology by patients and how the new services emerging are affecting the medical technological development from various specialists’ perspectives.
“Most of us have grown accustomed to turning to our computers for guidance. Look up a book on Amazon, a film on Netflix, a contact on LinkedIn, and the websites will suggest: “If you liked that, you will love this.
“George Carpenter, chief executive of a small neuroscience analytics company called CNS Response, wants to offer a similar service – only his is for psychiatrists trying to decide what if anything to prescribe their depressed patients. “It’s like Amazon . . . we’re like that, for your brain,” he told a conference last year.
“The idea of crowdsourcing prescription decisions may seem a step too far, but it is the sort of initiative that might produce a real change in the way healthcare is administered. This area has traditionally seen incremental improvements at best, even as huge advances are made in the science of medicine.
She also says, “People with rare diseases might find one another online, join forces to pool data and advocate for research into new treatments and even ease the process of pharmaceutical groups finding candidates for clinical trials by volunteering themselves.
“That could improve health outcomes and reduce costs. Studies have shown that patients involved in decision making are more likely to visit a pharmacy than a GP, and less likely to opt for surgery, choosing instead less invasive but equally effective measures.
“In a forthcoming report on “the expert patient”, Mr Cawston cites a 2012 study suggesting that “mobilising patients’ knowledge and contribution to care through a programme of initiatives costing between £100 and £450 per person could deliver savings of £4.4bn in the NHS. Consumer-driven systems best serve motivated, engaged consumers. As for the rest, whereas in retail or entertainment, it does not matter if they are left behind, in healthcare it does.”
Highland Marketing blog
In this week’s blog, Danielle Gibson advises on how to make the most of your social media presence using keywords and tags.
