News in brief
NHS care regulator to be made independent of ministers, says Hunt: Health secretary, Jeremy Hunt has launched an attack on Labour predecessor Andy Burnham over a succession of ‘cover-ups’ in NHS hospitals reports The Guardian. The health secretary is to make the key NHS regulator of care quality, legally independent of ministerial control, he announced this week as he accused his Labour predecessors of applying pressure to cover up failures in the health service. Casting the Conservatives as the “patients’ party”, Hunt told the Conservative Party Conference in Manchester that he would relinquish the health secretary’s powers to dictate the hospitals that the Care Quality Commission (CQC) should inspect, how it should carry them out, and how to write up its findings. Currently inspections require ministerial approval. In a hard-hitting attack on Andy Burnham, the last Labour health secretary and current party spokesman, Hunt pointed to a series of what he described as “cover-ups” he had overseen in the NHS. In evidence to the Francis inquiry it was claimed that Lady Young disbanded the CQC’s national investigations team because it was being used to “bayonet the wounded on the battlefield”. In a swipe at Labour, Hunt said his proposals “will stop politicians ever attempting to cover up poor care again”. Key to his attack was the appalling care uncovered at Mid Staffordshire and the damning verdict delivered on the regulatory failures by Robert Francis QC. Hunt said Labour refused 81 requests for a public inquiry.
£50m GP fund for expanded access: GPs can apply to a new £50m Challenge Fund to offer e-consultations, online appointment booking and telecare to patients, reported eHealth Insider. New proposals set out by Prime Minister, David Cameron aim to make it easier for people to access their family doctor from 8am to 8pm, seven days a week. Practices can apply to the fund to set up a pioneer programme. There will be nine pioneer sites established nationwide, which are expected to cover up to half a million patients. The pioneers will test a variety of services to suit modern lifestyles, including; greater use of Skype, email and phone consultations; electronic prescriptions; online booking of appointments; and easier online registration and choice of practice. They will also work on giving patients better access to telecare to help people stay at home for longer, as well as to healthy living apps. Dr Charles Alessi, chair of the National Association of Primary Care, said the announcement has the potential to be the most exciting development in primary care in the last decade. Alessi said: “It is an opportunity for doctors to be the good family doctors they want to be while working with everyone in the system to deliver better care for everyone, especially those most in need.”
Hunt pledges to restore ‘personal link’ between GPs and patients: The ‘personal link’ between GPs and their patients will be restored from next April through introducing a named GP responsible for care for all vulnerable older people, pledged the health secretary in his speech to the Conservative Party Conference. Pulse reported that Jeremy Hunt announced that the changes would mean that patients had someone to ‘champion’ their care and would correct the ‘mistake’ made in the 2004 GP contract. In his speech at the Conservative Party Conference, the health secretary said that transforming care out of hospital was the ‘one big change we need’ and called for a move towards preventative care, rather than curing illness. Hunt added that the GP contract introduced by Labour in 2004 saw a move away from named GPs, and in doing so ‘destroyed the personal link between patients and their GPs. Hunt said: “Trust between a doctor and patient is what professionalism in the NHS stands for, and we should have never have allowed that GP contract to undermine that. So from next April we’ll be reversing that mistake for introducing a named GP responsible for care for all vulnerable, older people.”
NHS England says no to VistA: NHS England has announced it will create a framework for NHS trusts to buy open source system support, hosting and change management. Beverley Bryant, NHS England’s director of strategic systems and technology, told eHealth Insider (EHI) that two UK companies and one NHS trust have shown a serious interest in open-sourcing their health IT systems, one of which is PAS and EPR provider IMS MAXIMS. The news comes as NHS England said that it had decided not to pay £7m to anglicise the US Veterans Health Association’s open source electronic medical record, VistA. Bryant said 64 trusts who applied for the fund ticked the box to say they were interested in the VistA project and when investigated, 13 of them were “really serious about picking it up and running with it”. However, NHS England brought in experts to investigate the option of anglicising VistA, who determined that it would cost £7m and take eight months to make it ready for the UK market. IMS MAXIMS chief executive Shane Tickell told EHI his company would be very interested in joining the new framework. It is in the advanced stages of assessing the legal issues and business change needed to open source some of its products. “I’m really continuously enthused by the energy and the speed and foresight that Beverley and her team have demonstrated,” Tickell said.
IT system problems fixed in Glasgow health board area: According to the BBC, Scotland’s largest health board has said its IT system is working again after a two-day crash saw hundreds of appointments and procedures cancelled. NHS Greater Glasgow and Clyde (GGC) said it still does not know what caused the problem which affected 11 hospitals. The health board said no patient information had been lost and data gathered during the crash would be manually added to update the system. The computer system crash meant that 599 outpatient appointments were postponed along with 62 planned inpatient procedures and day cases and 48 chemotherapy patient treatments. NHS GGC chief executive Robert Calderwood reiterated his “unreserved apology” to patients and said those affected would be given new appointments. Calderwood said: “Although 709 patient episodes have had to be postponed our staff were able to see some 10,000 patients using manual back-up systems. Arrangements are now being made to ensure that all the other patients affected will be offered a re-appointment as quickly as is possible.” Mr Calderwood said the “unprecedented” systems crash related to the health board’s computer network and the way staff connected to clinical and administrative systems. Although the problem has been resolved, NHS GGC still does not know what caused it.
Care.data extractions on hold: Extractions of GP data for care.data have been halted while issues around patient awareness of the scheme are resolved reports eHealth Insider. The care.data programme will take a monthly dataset from practices covering patient demographics, events, referrals and prescriptions. This will be linked with Hospital Episode Statistics and other data-sets to create new Care Episode Statistics. GPs received a letter in late August explaining care.data and telling them that they have eight weeks to inform their patients about the scheme before extractions begin. Patients can opt out of the extracts via a read code in their record. However GPs said most patients will not be in their surgery within that eight week time period. They are therefore concerned about their ability to fulfil their obligations under the Data Protection Act to ensure patients are properly informed about their confidential information leaving the practice in identifiable form. GPs said the current publicity campaign, which involves posters and leaflets in practices, is not adequate, with many arguing that NHS England should write to all patients about the scheme as they were required to do for the Summary Care Record Service.
Delayed hospital discharge to blame for A&E pressure: According to research poor accident and emergency performance this year has not been caused by GP out of hours provision, increased attendances or a lack of doctors. In a report by Health Service Journal (subscription required) the research by the former Department of Health national clinical director for urgent and emergency care suggests there has been little change in these factors in recent years. Matthew Cooke, clinical director of Heart of England Foundation Trust, says that instead his research indicates the widespread breaches of the four-hour waiting time target were down to increased delays in discharging patients. This is likely to have affected flow of patients through hospital and resulted in delayed admissions, the analysis suggests. Professor Cooke’s analysis also found no change in the time of day patients presented to A&E during last winter and spring, compared with past years, suggesting any alterations to out of hours primary care had not had a significant effect. A&E attendances increased by just over one per cent in 2012-13, while the number of medics working in emergency departments increased slightly over the same period. The news comes as figures show recent A&E performance to be worse than at the same period in 2012-13. NHS England data showed a national performance of about 94.4% for type 1 A&Es during the second quarter of this year − below the national 95% target – compared with 95.4% in the same period last year.
GP care in England ‘faces funds catastrophe amid cuts’: The BBC reports that doctor’s leaders are warning the GP system in England is facing a “catastrophe” because of cuts in funding. Analysis by the Royal College of GPs suggests that over the past three years, investment in general practice has fallen by £400m in real terms. That is equivalent to a 7% cut in spending per patient, it says. The government said it was providing new funding to help under-pressure GPs, but Labour said the figures showed ministers’ promises had not been kept. The warning comes in the week ministers said they wanted to extend GP surgeries’ opening hours. The Prime Minister said he wanted more patients to be able to get help in the evenings and at weekends, as he set out details of a £50m pilot programme in nine areas of England to widen access. However, the college said the analysis – based on official data from the Health and Social Care Information Centre – showed the government was taking money away from GPs despite claiming it wanted to move care away from hospitals.
NHS England may outsource further functions to CSUs: NHS England is to carry out a fundamental review of its use of commissioning support units (CSU), which could see more of the national commissioning body’s back office functions being outsourced reports Health Service Journal (subscription required). NHS England interim director for commissioning development, Ros Roughton, said that the review would identify its functions that could potentially be provided by CSUs or procured competitively. Roughton said budget pressures were one reason for the national body, which currently employs around 6,000 people, to reconsider which services it hosted in house. CSUs are already providing some services for NHS England, and for many clinical commissioning groups (CCGs), on a regional or national scale. These include procurement support and support for NHS England’s specialised services commissioning. Roughton said that since NHS England was encouraging CCGs to use CSUs rather than employ their own staff, “we should ask the same of ourselves”. She suggested NHS England needs to reduce costs by outsourcing may be greater than that of CCGs. The review is expected to be finished by the end of November. It is not yet clear which functions are likely to be outsourced to CSUs. However, Roughton said family health services − which covers the commissioning of GPs and other primary care − was not likely to fall under the scope of the review, as it was currently subject to a “massive transition programme”.
Nearly half of acute hospital trusts predict deficit: The NHS hospital trust sector is predicting a deficit at the end of this financial year, according to Health Service Journal (subscription required). Slashed income and a reduction in bailouts have led to a spike in the number of individual trusts predicting deficits at the end of the year. Data from the NHS Trust Development Authority (TDA) shows nearly half of the hospital trusts it regulates are predicting a deficit at the end of 2013-14. Twenty-five of the 62 acute non-foundation trusts started the financial year with a deficit plan, the data shows, but five more have since had to adjust their forecasts from a breakeven or surplus position to deficit. The 30 trusts predict a total shortfall between spending and income of £232m, dragging the sector as a whole into a deficit of £87m. If the predictions are accurate it would mark the first time the acute non-foundation trust sector has ended a financial year in deficit, although in previous years the underlying shortfalls were masked by “transitional funding” from strategic health authorities, primary care trusts or the Department of Health. The TDA’s report said: “There [has] been a £282m reduction in non-recurring income planned to be paid to NHS trusts in 2013-14 compared to the previous year, and [there is] variation in approach across England with trusts in the Midlands and East seeing a reduction of just over £122m while NHS trusts in London see a reduction of just over £25m.”
3ML Pathfinder pulls telehealth tender: A key 3millionlives pathfinder site has abandoned its tender for a telehealth contract worth up to £30m over five years, after failing to find a supplier willing to share risk reports eHealth Insider. Worcestershire County Council and three local clinical commissioning groups (CCG) make up one of the seven pathfinders identified by the 3millionlives programme to identify the first 100,000 of three million people who can benefit from the use of telehealth and telecare. The pathfinder consortia went out to tender for a managed service for assistive technology in January this year and was due to award the contract earlier this summer. However, the procurement has been plagued by delays and Rosemary Williams, director of practice engagement and service development at NHS South Worcestershire CCG, said that none of the responses they received from suppliers met their requirements. Williams said: “The CCGs in Worcestershire and Worcestershire County Council can confirm that we have received no offers which met the combined risk sharing requirements of the original tender. We are committed to investigating potential telehealth offers and we will be considering telehealth amongst our priorities for development over the coming months.”
GPs open doors to non-registered patients at weekends as ‘viable alternative’ to A&E: Pulse Today reports that GPs in central London will run walk-in clinics for non-registered patients on both days over the weekend, under a Clinical Commissioning Group (CCG) scheme to provide a ‘viable alternative’ to A&E. NHS Central London CCG is hoping to tackle A&E pressures by funding three Westminster GP practices to offer a Saturday and Sunday walk-in clinic. The move sees the CCG joining the growing number of commissioners hoping to reduce A&E pressures by funding seven-day GP services. However this service, commissioned for Westminster only, will not require patients to be registered at the practice to access a GP or a nurse on the weekend. The CCG said patients will be able to access the service without an appointment and using it will not affect their registration with their own GP. It also said the practices taking part will also accept redirections from A&E departments and urgent care centres where this is clinically appropriate. NHS Central London CCG chair Dr Ruth O’Hare said: “Statistics show that most patients attend A&E when their GP practice is closed, even if they don’t have a life-threatening illness. The tough message we want to send to these patients is that they are increasing the pressure on hospital services, which are there to help those who are more seriously sick or injured.”
Providers hit with raised efficiency requirement: Providers will lose hundreds of millions of pounds in income under Monitor and NHS England plans to raise the efficiency assumptions that govern how much they are paid under tariff reported Health Service Journal (subscription required). In a joint announcement this week the two bodies said they planned to increase the proportion of tariff payments withheld from providers as an incentive for them to lower costs. This proportion to be retained by commissioners will be raised from 1.5% at present to 1.9% in 2014-15. Foundation Trust Network chief executive Chris Hopson said: “Giving more money to commissioners at the expense of providers increases risk significantly where it most counts – at the sharp end of NHS service delivery. Trusts will want to know how reducing their income will help them manage the quadruple whammy they are facing – implementing the Francis inquiry’s recommendations on quality such as improving staff to patient ratios, putting seven-day working in place, coping with increasing demand and investing in much needed change.” Monitor and NHS England also said they planned to encourage local price setting and hoped to finalise their proposals in December to come into effect in April 2014.
Ambulance trusts step into breach to provide NHS 111: Health Service Journal (subscription required) reported that NHS ambulance services are to take on the temporary provision of NHS 111 in most of the areas where NHS Direct is pulling out of delivery. The news follows months of talks to find organisations to step into the breach left after NHS Direct announced back in July it was pulling out of its 111 contracts because they were “financially unsustainable”. NHS Direct’s board meeting heard commissioners had appointed a “range of step-in providers” to deliver the non-emergency telephone service until a full procurement process identified replacement providers to take over in 2015. It is understood that ambulance services lobbied hard to be given the NHS 111 service when it was in development. However, the then health secretary Andrew Lansley announced in 2010 that it would be procured by local commissioners. The report to NHS Direct’s board said discussions were taking place with the NHS Trust Development Authority, the Department of Health and NHS England about its future as a stand alone organisation.
InSource looks to drive revolutionary change in healthcare: InSource, provider of data management solutions, this week hosted a unique thought leadership event bringing healthcare and technology professionals together at the British Racing Drivers Club, at Silverstone. The event, Automation, Innovation and Collaboration – Driving Revolutionary Change in Health, was also used to launch InSource’s new i-Health data enterprise product suite. The event focused on the ‘data revolution’, with presentations and discussions centred on how to get reliable information relating to quality of care throughout the whole patient journey. Topics for improving the healthcare service’s technology provision included availability of data, technology platforms, and turning data into actionable information, from guest speakers Phil Koczan, CCIO at UCLPartners, Neil Pearson, industry market development manager for health at Microsoft, and Kirsty Andrew, head of commercial operations at Williams Advanced Engineering. The day also featured group ‘break out’ sessions which saw CEO’s, CIO’s, professors, directors of IT and finance discussing how healthcare providers can start using data better for long-term service improvements. The day ended as InSource revealed their new i-Health data enterprise product suite, which pulls multiple, disparate, inconsistent data sources to a single, unified, consistent supply of accurate, trustworthy data.
Opinion
‘Most of the change needed to boost care doesn’t cost a penny’
This week, Jenny Winslade (subscription required), chief nurse at NHS Northern, Eastern and Western Devon CCG, argues that despite the Keogh and Francis reports addressing major issues in healthcare, nurses have an opportunity to influence the cultural changes needed for better care.
Winslade said: “The difficulty is that “caring for people” has not always been easy to measure. This is changing and patient experience is rapidly gaining importance. It is acknowledged you can have all the data and metrics in the land but they are no substitute for sitting down and listening to patients.
Winslade adds that patients’ experiences are all different and subjective, meaning nurses have to apply softer skills: “People have to be treated kindly, with respect – which means being listened to. When they are, they will feel more valued. And, when people feel valued, they feel able to say more about themselves or their care.
“We can start by asking the right questions and keeping it simple – no one wants to answer pages of complicated questions. If you ask people if they feel cared for, it will encourage a conversation. This may prompt further conversations about their home life and if they feel they have the right support there.”
How to relieve pressure on the NHS
In the Guardian this week, Angela Coulter discusses how the new model, the house of care, places the patient at the heart of the delivery system and encourages personalised care planning.
“As the NHS faces the challenge of improving care for the 15 million people with long-term conditions, one hope for improving health outcomes while balancing the books is to shift from a reactive healthcare system that treats people when they become ill, to a proactive one that co-ordinates care and supports people to stay well. The Wanless report said as much in 2002, but progress towards this goal has been painfully slow.
“The house of care is both a metaphor for a proactive co-ordinated system of care and an implementation checklist. Devised to help primary care staff and commissioners reorganise local services, it explicitly places the patient at the heart of the delivery system. Personalised care planning is at the centre of the house, the fulcrum of a co-ordinated delivery system. People with long-term conditions are encouraged to play an active part in determining their own care and support needs.
“The model builds on the experience of 3,000 primary care practitioners in 26 communities who have begun to implement it via the Year of Care programme and similar initiatives. Instead of focusing on a standard set of disease management processes, the aim is to ensure that patients’ values and concerns shape the professionals’ response. It requires clinicians to rethink the way they work, recognising that the knowledge and experience the patient brings to the care planning process is as important as the clinical information in the medical record.”
How technology can help people with long-term conditions in rural areas
In this week’s Guardian, Angela Single, BT’s clinical lead for telehealth, explains why telehealth and telecare can improve the way we deliver healthcare, no matter where the patient lives.
“Millions of people in the UK live with ill health, injury or disability. Being diagnosed with a long-term health condition can have a huge impact on their lives as well as on the care services, with £7 out of every £10 spent in the NHS directed to helping those with long-term conditions.
“Through technology, we can put the power where it needs to be – in the hands of the patients who are the consumers and users of health and care services. Since the NHS was established, technology has significantly changed our day-to-day lives. Yet, in health and care service delivery, technology has not been used to deliver the radical, disruptive change that benefits users. For example, patients still have to travel to hospital; we don’t travel to banks and travel agents anymore, so why do we still have a health service that demands patients visit a hospital or GP?
“There are incredible technologies in use every day to help improve and save lives. There are also simple technologies being used in creative ways. Future generations of patients will expect technology to support their health and wellbeing as much as they already expect it to support them at home, at work and in education.
“Telehealth and telecare can improve the way we deliver healthcare and the lives of those with long-term conditions, no matter where they live. We just need to look beyond the technology to a new world of care.”
Keep politics involved in the NHS
In this week’s Health Service Journal, Sean Duggan (subscription required), chief executive at the Centre for Mental Health explains that although taking politics out of the NHS may seem desirable, it could be the wrong direction entirely.
“Political interference is often blamed for the short-termism of healthcare planning, for placing those who shout loudest ahead of those with the greatest needs, and for standing in the way of progress when that necessitates changes to existing services.
“We believe that political leadership can make a positive impact − in building up public understanding of mental health, in supporting people who have mental health needs to be involved in decision making, and in fostering partnerships between services to improve the lives of people with mental health conditions.
“Nationally, too, political leadership is vital for the health of the NHS. Some of the most effective health ministers from Bevan onwards have brought about lasting change for the better in health and healthcare by leading the way in challenging established practices and inequities. Members of parliament play a crucial role in scrutinising government and the NHS − more often for good than for ill.
“Taking politics out of the NHS may seem desirable, but could in fact be the wrong direction entirely. Making politics work for the NHS, in contrast, might be crucial for its future success.”
Highland Marketing news and blog
Highland Marketing continues to grow it’s experienced team with the appointment of Matthew D’Arcy.
In this week’s blog Chris Marsom urges us not to write off the press release.
