News in brief
Carter report paints grim picture of NHS: A government-commissioned report has painted a damning picture of a health service where bullying and harassment of staff is rife and there is little attempt to harness the NHS’s huge collective buying power. Enormous variations in everything from sickness absence to the costs of hip prostheses were uncovered by the inquiry, led by Lord Carter of Coles. His findings underline the distance the NHS still has to travel as it attempts to deliver on a target of £22bn of annual savings by 2021, reported the Financial Times (registration required). The Labour peer estimated that, if hospitals raise their standards to those of the best by standardising procedures, being more transparent and working more closely with neighbouring trusts, the NHS could cut costs by £5bn in the hospitals sector alone. However, Nigel Edwards, chief executive of the Nuffield Trust, pointed out that the health department had hoped to achieve about double that figure as hospitals’ contribution to the overall savings target. “The fundamental concern about the headline figures is not that there is £5bn of “waste” by NHS hospitals but that we need to find so much more. We need a credible picture of where the rest of this is supposed to come from,” he said. The goal of achieving more than £20bn in savings emerged in a five-year plan for the NHS published in 2014 by its chief executive in England, Simon Stevens. He made clear that only if this level of savings was achieved would the sum promised by the government — an additional £8.4bn a year by the end of the parliament — be sufficient to keep the service going at current levels. The report also found nearly one in 10 beds was taken by someone medically fit to be released. It said it was a “major problem” causing operations to be cancelled and resulting in the NHS paying private hospitals to see patients, reported the BBC.
Next week’s junior doctor strike on: Next week’s strike by junior doctors in England will go ahead as talks with the government have failed to reach a solution – but union leaders say medics will provide emergency cover. The 10 February action was originally a full walk-out meaning medics would not have staffed emergency care, reported the BBC. It would have been an historic move and caused major disruption to hospitals. However the British Medical Association has now stepped back from that, saying it wanted to minimise the impact. But the strike will last longer than planned – 24 hours rather than the 08:00 to 17:00 which was first announced. The decision to scale back on the scope of the strike will bring a huge sigh of relief to hospitals. A full walk-out has never happened before in the history of the NHS and would have led to a mass cancellation of routine treatments, such as knee and hip replacements, as consultants and other staff were redeployed to cover behind the junior doctors.
Ireland consults public on identifier: Ireland’s Health Service Executive has launched a public consultation on the privacy implications of creating a unique health identifier, similar to the NHS Number. A privacy impact assessment has been issued that outlines the purpose of the Individual Health Identifier (IHI) and discusses some of the potential privacy risks, reported DigitalHealth.net. Members of the public are being asked for their views on whether the benefits and risks have been correctly identified, and whether proposed safeguards are adequate. Richard Corbridge, the chief information officer at the HSE, said: “We are looking for feedback from the public, through this consultation process, as it will be [their] information that will be processed as part of the IHI.” Ireland launched a “Knowledge and Information Strategy” in June last year that focused on getting new IT infrastructure, interoperable systems, data use and patient services in place for its health services. A top priority for the new organisation was the creation of the IHI. “The IHI is primarily built to protect patient safety and to allow privacy to be protected and understood,” Corbridge said. “The reason it exists is to ensure once digital health records are being shared they are done so appropriately, safely and effectively.”
EMIS Health claims first mover advantage in open standards for interoperability move: EMIS Health has claimed to be the first UK clinical systems provider to implement new open standards for interoperability in the NHS, reported Government Computing. The move, which EMIS said will enable clinicians using its systems to securely share data with any other third party system across health and social care, was announced at an EMIS Health conference and follows the company’s recent signing of techUK’s Interoperability Charter. From mid-February, the company said it will begin rolling out an update to its EMIS Web clinical system – which is used by almost 4,500 GP practices in England and Wales – that allows it to interoperate with any third party supplier that conforms to a published set of open application programme interfaces (APIs). Eventually, EMIS Health said, clinicians, whatever IT system they use, will be able to securely share data with colleagues using any of the company’s primary, community, secondary and pharmacy clinical systems. Initially, third party systems will be able to securely obtain real-time primary care patient information, subject to tight information governance controls. EMIS Group’s chief medical officer Dr Shaun O’Hanlon said: “For the last 13 years we have run a highly successful partner programme using our own API to enable integration with third party systems. We are now taking that commitment to a new level, using best practice standards developed by the wider healthcare IT industry as the basis on which we will open up access to our systems for any supplier within the NHS and social care, including NHS trusts.”
NHS London Procurement Partnership to tender for EPR framework: The NHS London Procurement Partnership (LPP) will go out to tender in February 2016 for a clinical digital information systems (CDIS) framework to support NHS organisations in becoming paperless at the point of care, reported Computer Weekly. The LLP wants the CDIS to be live by August 2016, and made available to mental health and acute NHS trusts, GPs, social care services, charitable organisations, private healthcare providers and clinical commissioning groups (CCGs). The latter have been tasked by NHS England with driving the paperless agenda. By spring this year, CCGs will need to publish roadmaps on how everyone in their health and care economy are working to ensure interoperability and access to patients’ records across the service by 2020, when all NHS organisations will have to be paperless at the point of care. To help with the agenda, at the request of the London NHS Chief Information Officers’ Council and a consortium of 38 NHS trusts, LLP has been working to launch the tender for the framework. The framework, which will consist of four lots, aims to give organisations access to “a highly flexible suite of software applications which bring together key clinical and administrative data in one place”. “It will combine the benefits of an electronic patient record (EPR) system with the integration and interoperable digital tools which will give care professionals and carers access to all the data, information and knowledge they need, where and when they need it,” said the LLP.
NHS 24 admits IT ‘systemic failure’: A frank report to the Scottish government’s Public Audit Committee has admitted that “systemic failure” is responsible for the ongoing failure to introduce new IT to the NHS 24 service, reported DigitalHealth.net. The report said the governance measures put in place by the organisation and the Scottish government simply failed to “mitigate the substantial risks” carried by the programme. In addition, it added, NHS 24 “underestimated the risk of developing an ambitious, next generation system and bringing it to market”, drew up an “inadequate” business case, and then failed to manage its suppliers. “Commercial management was weak, too much reliance was put on suppliers’ promises, and the organisation had insufficient understanding of call centre implementation to successfully launch.” The report also admitted that “various audits and reviews have proved ineffective in recovering the programme”, costs for which are continuing to rise. NHS 24 was supposed to go live with the new IT system in November last year, but was forced to withdraw it and revert to paper operation after it crashed on go-live. According to UKAuthoirty.com, the report concluded: “NHS 24 apologises unreservedly for its failure to effectively implement the Future Programme but wishes to reassure the committee that lessons have been learned and the system is expected to finally launch in the summer of 2016. The current system continues to enable NHS 24 to provide a safe, effective and person centred service but is incapable of further development to support the future evolution of our services and therefore needs to be replaced.”
Health devolution not appropriate in every area – MPs: Despite its great potential, health devolution “may not be needed” in all areas and some city-regions would be wrong to pursue it at the expense of other health and care initiatives, MPs have said. In a report this week, the Commons Communities and Local Government Committee found that health devolution has come at a particularly difficult time for the health and care system and its staff, with “significant structural change” recently and an “unprecedented level” of financial challenge, reported National Health Executive. Because of these uncertainties, the committee said it was concerned about the long-term consequences of formal health devolution and recommended that areas with similar and already fruitful health initiatives – such as joint working and pooled budgets – ignore it entirely. The government should also gather evidence over an appropriate timescale, it said, on the impact of these health reforms. Areas that do wish to pursue health devolution “must have clearly defined objectives for what they expect it to deliver”. In these areas, the committee said it is still unclear how accountability will work in practice. They found care minister Alistair Burt MP’s explanation “confusing”. The report said: “Considerable concern has been expressed about whether health services in areas with devolution deals would remain subject to national standards. Clause 19, inserted into the Devolution Bill in the House of Lords, confirms the continuation of NHS accountabilities and the regulatory responsibilities of the CQC, Monitor and others under devolved arrangements.”
“Suicide prevention app” trial: An NHS mental health trust is working with US researchers to develop an app that may stop people from killing themselves, reported the BBC. Liverpool-based Merseycare and Stanford University have been in talks on how the technology could work. The aim is to have the prototype ready by June with the first patients being monitored in January. There were 6,122 suicides in the UK in 2014 – a 2% decrease on the year before. The app would allow clinicians to provide round-the-clock observations on people who they fear may be considering suicide. It would work by monitoring all digital communications by a patient – emails, social media, even phone calls – and spot potential dangers. Three quarters of suicides are in men. If for instance someone was tracked as being at a well-known suicide hotspot, or missed an appointment, or even told a friend they were feeling suicidal, the app would alert clinicians who would then be able to contact the person and provide appropriate support. All patients would have to voluntarily submit to being monitored. Dr David Fearnley, medical director at Merseycare, said: “The potential is incredible. We think we can anticipate people who may be likely to harm themselves with greater accuracy than we currently do, and therefore be able to do something about it and save their lives.”
1m blood donors book online: Nearly 1.5 million blood donation appointments have been booked online since NHS Blood and Transplant introduced a digital booking system two years ago, reported DigitalHealth.net. The organisation has saved £1.2m by allowing patients to book their own appointments electronically. One million people across England and North Wales are registered to use the digital service via www.blood.co.uk, making it one of the largest digital booking systems of any blood service in the world. People can register as a donor online, arrange, amend or cancel their own appointments and update their personal details and share feedback via Facebook. Donors can also download a mobile app to allow self-service appointment booking. There have been more than 150,000 downloads already and more than 45,000 donors used the app in the last month. Ian Trenholm, chief executive of NHS Blood and Transplant, said the savings of £1.2m are due to a reduction in transactions through the contact centre and a reduction in print costs as donors can view their welcome pack online and manage their own records. “Donors are still able to use the contact centre to book appointments, but we hope that the success of the online appointment booking system will encourage more donors to register online and begin using this as a reliable and quick route to booking appointments to give blood,” he said.
Digital health firms welcome health app guidelines: Now Healthcare, EMC, Arkivum and CommonTime have voiced their encouragement of the European Commission’s working group regulating digital health apps. Jim Cook, CEO of Arkivum, said: “Having guidelines relating to the validity and reliability of health app data is a great initiative.” The working group initiative is a follow-up to a consultation announced in April 2014 that asked digital health companies and others for help in identifying ways to encourage and regulate mobile health. Safety and transparency of information were identified in the consultation as the main issues for mHealth uptake, reported DigitalHealthAge. James Norman, UK public sector CIO, EMC, said: “There needs to be distinction between the different types of devices used in the healthcare industry and the purpose of the devices. What’s important to note, is that the device itself – whether a mobile or wearable – isn’t the key element, it’s the data insights that can be gleaned to inform decisions and connected with other clinical data, that matter.” The large number of lifestyle and wellbeing apps available, combined with no clear evidence on their quality and reliability, has been raising concerns about the ability of consumers to assess their usefulness, which could limit the effective uptake of mHealth apps to the benefit of public health, according to the European Commission. Steve Carvell, head of healthcare at CommonTime, said: “Without a regulated approach to mHealth app development, we’ll never see the true benefits that mobile apps can bring to healthcare. Integration between apps and EHRs (electronic health records) is achievable now, the issue is that without effective regulation, healthcare providers will never have the confidence to embrace mHealth universally.”
Oracle Boosts UK Cloud Platform Capabilities: Oracle is adding platform-as-a-service (PaaS) capabilities to its data centre in Slough, the first of a series of local investments the company said it plans to make in public cloud services aimed at UK government organisations, reported Forbes. The new PaaS capabilities will allow Oracle customers that are required, or just want, to keep their data in the UK to rapidly develop, test and deploy applications in the Oracle public cloud at low cost, without compromising security. In addition, UK customers will have the option of running Oracle platform and infrastructure services behind their own firewalls, in their private clouds, said Thomas Kurian, Oracle’s president of product development, during his keynote address at a series of Oracle cloud events in London this week. He noted that cloud services will play “a huge part” in helping customers quickly exploit new digital innovations necessary to remain competitive. Oracle already delivers cloud software and infrastructure services to more than 500 global customers out of its Slough data centre. Iain Patterson, CEO of common technology services for Government Digital Service, said Oracle’s new PaaS offerings will help UK government departments abide by the government’s “cloud first” policy, which requires them to buy IT products and services under the cloud model unless they can prove an alternative is more cost effective.
Maternity EHR gets ‘big bang’ launch: Southport and Ormskirk Hospitals NHS Trust has gone live with Medway Maternity in a “big bang” approach across two maternity units. Its acute hospital maternity units went live with the system last month, while the trust has also deployed the Medway Maternity off-line community module, reported DigitalHealth.net. This allows community midwives to collect and update data in pre-populated forms and sync the information later, contributing to an integrated maternity record. More than 300 staff are using the software, working in a range of clinics and assessment units, delivery suites, wards and remotely in the community. System C said in a statement that within the first three days of go-live, its Medway Maternity system had been used for more than 500 antenatal assessments, 75 postnatal assessments and nearly 20 deliveries, many of which were in the community. The trust’s head of IT, Matt Connor, said the deployment had been very smooth and clinical feedback so far has been very positive. IT project midwives, Rebecca Owens and Joanne Unsworth, said the ability for community midwives to upload assessments without having to return to a base had reduced travelling time, giving them more time to spend with patients. Midwives are also able to record telephone assessments directly onto the system in real time and to track the number of calls a woman makes in a defined period of time; so they can tailor their advice appropriately. Markus Bolton, joint chief executive of System C, said the company has worked hard at integrating its acute and community solutions and making them easy to use.
Opinion
NHS and social care must not play the blame game on delayed discharges
Only by focusing on the needs of patients and carers can we end long, damaging waits in hospital. The blame culture is the ‘lazy default’, writes former care services minister Paul Burstow, on the Guardian’s social care network this week.
Burstow, who also chairs the Tavistock & Portman NHS Foundation Trust and is professor of health and social care at City University, says: “At the bottom of the delayed discharge challenge is a simple question: where do you invest your energy? You can chose to invest in finding someone to blame – social care, relatives, the hospital – or you can invest time in really understanding the data to map the flow of people through the social care and health system.
“The blame culture is the lazy default. According to one ICM Unlimited survey, commissioned for the Astellas Innovation Debate, 60% of healthcare professionals believe the cost of delayed discharges should be recouped from existing social care budgets, a mind-bogglingly stupid response.
“Hospitals do not exist in isolation. They are part of a complex system of services, human expectations and interactions. Those places that have reached a shared understanding and centred themselves on the needs of the patient and their family carers are making the changes needed to tackle delayed transfers of care.
“Delays are a symptom of mounting pressures and unnecessary waits at all points in the urgent and emergency care pathway, not just at the point of discharge.
“The consequences of transfers of care can be life-changing for the person on the receiving end. In as little as 12 hours an older person admitted to hospital as an emergency can lose the ability and confidence to stand unaided. Time is muscle! Poorly managed transfers of care harm people. They can mark the end of staying in your own home.”
Earlier cancer diagnoses requires an urgent NHS shift to digital pathology
As a former NHS radiographer, I have seen the clinical benefits of digitisation first-hand says Chris Scarisbrick, national sales manager at Sectra UK & Ireland.
“Radical recommendations were set out by England’s Independent Cancer Taskforce in July 2015. The goal: to allow an additional 30,000 patients every year to survive cancer for 10 years or more by 2020. 11,000 of these patients could survive cancer and live longer as a result of earlier diagnoses, sparking a new national ambition.
“When it comes to pathology, a key cancer diagnostic function, many of the processes and practices in the NHS remain largely unchanged since the birth of modern pathology in the 19th century. The discipline has also been facing diminishing capacity and now faces a serious challenge in attracting younger people, many of whom don’t relish the idea of decades stood at a microscope.
“Significant and immediate action must be taken to modernise pathology and provide pathology departments with technology that a rapidly growing number of pathologists are calling for, so that they can more effectively share expertise and findings with clinical colleagues, and carry out their reporting much more quickly. Digitisation of the discipline is essential to achieving this, a move which is already having a significant impact on improved diagnoses and timely cancer care in other parts of the world.
“As a former NHS radiographer, I have seen the clinical benefits of digitisation first-hand. Radiology embarked on the digital journey 15 years ago to eliminate x-rays being lost in the backs of cars and from the draws of office desks, which at the time led to approximately 10-15% of all imaging being mislaid, with a detrimental impact on timely care. The results of radiology digitisation have been transformative beyond this, allowing imaging to be rapidly shared and analysed.
“It should now be a priority for NHS hospitals to move away from analogue approaches to pathology, so that growing demand can be matched, access to specialist expertise increased and the speed and accuracy of reporting improved so that, ultimately, timely intervention can save more lives.”
Three challenges for clinical leaders in 2016
Vijaya Nath, director, leadership development at The King’s Fund, writes about the turbulent start to 2016 for clinical leaders, with industrial disputes and increasing pressure to deliver high-quality care alongside the ‘eye-watering productivity improvements required under the NHS five year forward view’.
“Through our work supporting clinical leaders, at all stages in their careers, we hear first-hand about the issues they’re facing, and some of those we’ve worked with have shared their perspectives on our blog. Three main challenges emerge for clinical leaders in 2016.
“The first is ensuring a renewed focus on quality improvement. The exemplars of quality improvement include NHS Highland, Salford Royal NHS Foundation Trust and Wrightington, Wigan and Leigh NHS Foundation Trust. These organisations have strategies that are focused on continuous quality improvement and identifying, developing and nurturing leadership talent. For example all have invested in data systems (identified by clinicians) that link their outcomes to systems for delivering care. Early successes in the vanguard sites in the United Kingdom have come from clinicians’ desire to have better data on which to base their clinical decisions.
“The second challenge is for clinical leaders to remain focused on their values, passion and purpose. For example we are often reminded by doctors in primary care, secondary care and mental health settings that their first and foremost priority is to act in the best interest of patients – to ‘first do no harm’ and that in tough times it is their core values that help them to maintain focus and to lead effectively. These values enable clinicians to lead and manage services that are truly patient-centred, and they go some way towards increasing levels of trust in our culture of care.
“Third and finally, clinical leaders need to appraise traditional power relationships with patients, using their specialist knowledge in ways that take account of the needs, wants and beliefs of patients. As patients we are much better informed and demanding consumers, and are moving towards becoming ‘partners’ in designing our health care. It’s an area we’re actively exploring at the Fund and supporting through our work with patient leaders.
“Over the next year and beyond, we’ll work with clinical leaders to support them to face these challenges.”
Highland Marketing blog
Health technology has a crucial part to play in delivering the cost-saving ambitions of the Carter Report.
