On the 65th anniversary of the NHS here are 65 fascinating facts about our glorious health service.
News in brief
To celebrate the NHS’s 65th birthday the Department of Health has made a series of announcements to continue to enhance the delivery of care. The first announcement came from the prime minister and health secretary setting out plans to make the NHS a more personal service for vulnerable and elderly patients. Public health leaders also helped celebrate the 65th birthday of the NHS by announcing that a life-saving NHS screening programme is now available to all 65-year-old men in England.
NHS England introduces IDCR: NHS England has released guidance for trusts to achieve fully integrated digital care records (IDCR) across all care settings by 2018, reported eHealth Insider. ‘Safer Hospitals Safer Wards: Achieving an integrated digital care record’ “sets out the benefits case for adopting safe digital record keeping as a precursor to achieving integrated digital care records across the health and care system”. It also gives full details on how trusts can get their hands on some of the new, £260m Safer Hospitals, Safer Wards Technology Fund and sets a deadline of 31st July for expressions of interest. Health secretary, Jeremy Hunt said in January this year that he wants to see a paperless NHS by 2018. NHS England’s guidance goes a step further by saying its vision is for a fully integrated digital care record across all care settings by 2018. It describes an IDCR as the ability of local health and care services to “use digital technology to ensure that vital patient related information and clinical decision and support tools can be viewed by an authorised user in a joined up manner in any single instance”.
NHS England mulls open source patient record systems: NHS England is considering offering cash to trusts to develop “open source” software which it says offers flexibility and speeds up their development of electronic patient record systems. In a HSJ (subscription required) interview, Beverley Bryant, NHS England director of strategic systems and technology, also said she was overseeing an audit charting every trust’s progress towards paperless records, the first version of which will be published in November. Funding for open source projects could be made available from the £260m technology fund, the prospectus of which was launched this week. Open source software – usually created collaboratively between different trusts and technology companies – involves a programme in which the source code is available to the general public to use and modify free of charge. The use of open source products would mean trusts do not become locked into one IT provider’s ‘proprietary’ programme, a scenario that has had disastrous effects in some trusts in recent years. Bryant added open source software could be quicker to implement as it did not involve 18-month procurements like existing single provider systems.
Suppliers to help define meaningful use: NHS England wants a “strategic relationship” with suppliers to develop and measure the ‘meaningful use’ of integrated digital care records (IDCRs), reported eHealth Insider. New guidance issued by NHS England on the adoption of electronic working in secondary care introduces the concept of a clinical digital maturity index to help trusts benchmark their capability to deliver the meaningful use of IDCRs. “Going forward, we expect to measure and monitor organisations and systems to make sure that they can demonstrate a progressively increasing level of meaningful use of an IDCR and wider digital technologies in the delivery of care,” it says. Beverley Bryant, NHS England’s director of strategic systems and technology, said that NHS England does not have time to implement the US accreditation process, Certification Commission for Health Information Technology (CCHIT), for suppliers. Instead, it wants to build a strategic relationship with them. “If we have better relationships with the IT suppliers, we can articulate what we want better; and they can translate what we want into better delivery,” she explained.
Growth of payment by results ‘unsustainable’, says Monitor director: The past decade’s rapid expansion in the number of nationally set “payment by results” prices for NHS services is unsustainable – and “may already have gone too far”, Monitor’s pricing director has told HSJ (subscription required). Jason Mann, interim director of pricing at the health sector regulator, said he could foresee a future in which the number of “tariff” prices for hospital services was reduced “quite a lot, by virtue of the fact that it’s almost too complex at the moment”. The past 10 years have seen vast increases in both the scope and complexity of the payment by results system. Over that period, the value of healthcare activities for which there are fixed NHS unit prices has gone from nothing in 2003 to nearly £30bn in 2012, according to King’s Fund research. Asked by HSJ if the NHS had reached the limits of what could be achieved by applying activity based tariffs to healthcare, Mann said: “I would say that the trajectory of travel − of starting with 60 prices in 2003 or 2004, going to over a thousand, [and] I think it’s over 2,500 now − is not sustainable.” Mann’s comments are included in an in-depth HSJ briefing on the reform of payment by results, published this week.
OFT investigates public sector IT deals: The Office of Fair Trading (OFT) is investigating whether public sector IT deals limit interoperability and competition in the sector, reported eHealth Insider. In its launch document, the regulator says it is seeking information on the IT market, such as whether suppliers seek to limit their interoperability with other systems and if the IT procurement market is inhibiting competition. It will also look at whether there are barriers that make it difficult for small and medium enterprises to enter the public sector market. “Stakeholders have told us they believe margins may be high and that competitions may be restricted by other practices and features of the market,” says the document. “These include the cost and difficulties of switching because of factors such as the terms of the licence agreements/contracts, lack of interoperability with other systems and the risk of disruption to critical services.” The Office of Fair Trading’s chief executive, Clive Maxwell, said it wanted to hear from both suppliers and public sector users on how the market works, problems experienced and what could be done to make it better.
Hunt says NHS 111 will be reviewed as patients and providers find problems: Health secretary Jeremy Hunt has admitted that the public do not have confidence in the new non-emergency health hotline NHS 111, reported Public Service. The service is now to be reviewed by NHS England’s medical director Sir Bruce Keogh, as it separately emerged that providers are encountering major problems, with NHS Direct pulling out of two areas it has contracts for. Hunt told the Health Service Journal that the “concept” of NHS 111 was now to be re-examined by Keogh as part of a review of urgent and emergency care. The health secretary appeared to recognise long reiterated warnings from medical groups over the pressure the service was placing on the emergency services when it failed to deliver the information patients needed. A Department of Health spokesperson was quoted as saying: “The majority of the country has a good NHS 111 service but we know that there are still problems in a few areas. It is only right that NHS England and the NHS Trust Development Authority both work closely with NHS Direct to help it offer a high quality NHS 111 service.”
NHS ‘not an international service’ – Jeremy Hunt: Plans to introduce a £200 charge for non-EU nationals who come to the UK for more than six months and access non-emergency NHS treatment have been defended by the health secretary. Jeremy Hunt told BBC News that the UK was the only major country not to charge foreigners for healthcare and would not prevent anyone from receiving treatment. The health secretary said it was only right for immigrants to have to contribute towards the NHS, which costs taxpayers around £5,000 per family, reported The Telegraph. Under the plans, foreigners from outside the European Union applying for visas lasting more than six months will have to pay the new “healthcare levy” under plans to stop exploitation of the health service. They are currently entitled to free treatment. Shorter-term visitors will also face charges for their treatment. There are additional plans to make it easier for the NHS to recover the cost of treating EU nationals and to help doctors identify those eligible for treatment.
NHS funding gap costs hospitals £500m, survey finds: England’s NHS hospitals lost more £500m of income last year because of a rule governing the way they get paid for emergency patients, a survey reveals. The Foundation Trust Network (FTN) polled its members and found many were unhappy with the “30% margin rule”, reported the BBC. It limits how much money hospitals get for emergency admissions, in order to discourage over-reliance on A&E. The Department of Health says its priority is to ensure the NHS is fairly reimbursed for services provided. The 30% marginal rate rule was introduced in 2010 following concerns over the growth in emergency admissions. Once hospitals reach a set number of emergency admissions they only get 30% of the full cost of treating the patient thereafter. The idea is that the remaining 70% of the money can be invested into other services, such as primary care, which should reduce inappropriate A&E referrals. A survey carried out by the FTN reveals 96% of its members think the marginal rate is not achieving this aim. According to the FTN, emergency admissions have gone up by 35%.
Six councils to test integrated health and care: Six Labour-dominated councils are to develop schemes to fully integrate health and social care services as part of the party’s plans to devise a ‘new settlement’ for the NHS, shadow health secretary Andy Burnham has said. Plymouth, Derbyshire, North East Lincolnshire, Lancashire, Islington and Gateshead authorities will develop ‘whole person care’ regimes by working with local NHS Clinical Commissioning Groups through Health and Wellbeing Boards, reported Public Finance. In a speech to the Local Government Association conference this week, Burnham said the health and care system was currently unable to treat the whole person, as it focused on different elements. This separation of social and medical care was ‘seriously wrong’ and didn’t make any sense, he told delegates. The split also meant the NHS had a vested financial interest in the failure of preventative social care, as it received funds when older people required more intensive medical treatment in hospitals. Therefore, there was a need to create ‘one service’ that worked to the same set of rules, and the ‘full integration’ of health and social care to break down ‘the wall’ between the systems, Burnham added.
NHS England to review RCGP proposals to take back out-of-hours care for vulnerable patients: NHS England will consider Royal College of General Practitioners’ (RCGP) proposals for GPs to take back responsibility for the out-of-hours care of the 5% most vulnerable patients as part of its consultation on reforms to urgent care, reported Pulse. The proposals for GPs to assume responsibility for 24/7 care for the elderly, those with complex medical problems and those needing palliative care or with mental health problems were not included in a recently announced public consultation on proposals for improving out-of-hours care services in England. But the primary care lead at the body told Pulse that they were ‘interesting’ and that they would use them to inform their ideas on how to take forward Jeremy Hunt’s suggestion that ‘the buck’ should stop with GPs out of hours. Dr David Geddes, NHS England’s head of primary care commissioning, said its consultation document is only a ‘first stab’ at solving the issue, meaning the RCGP proposals would also be considered.
NHS ‘must get tough on consultants’: Failings in care in England can be directly linked to the NHS’s inability to properly manage hospital consultants, MPs say. The warning was made by the Public Accounts Committee after it studied the impact of a new contract in 2003, reported the BBC. The MPs said problems with working hours and bonuses worked against the interests of patients – and urged the NHS to get tougher on doctors. But the criticisms have been rejected by the British Medical Association. The cross-party group found that since the contract was introduced a decade ago, pay had risen by between 24% and 28% for the 40,000 consultants working in the NHS. It also noted the deal had allowed doctors to refuse to work during evenings and weekends, prompting trusts to fork out up to £200 an hour in overtime payments or rely on locums, which was not good for continuity of care. The report was also critical of the way consultants were being managed – nearly half of trusts were not assessing if consultants were meeting their objectives. It concluded the failure to implement a proper culture of performance management was a “crucial factor” in poor standards of care, such as that seen at Stafford Hospital.
Doctors to monitor NHS patients via video link: Critically ill NHS patients are to be monitored via video link by doctors in a central control room for the first time in Britain as part of a new scheme aimed to improve out-of-hours care, according to The Telegraph. The project uses high definition cameras to allow consultants to check on patients’ conditions from a centralised control room, from where they will then be able to alert and advise bedside teams if action is required. The “eICU” scheme is being trialled by Guy’s and St Thomas’ NHS Foundation Trust. Dr Richard Beale, clinical director of perioperative, critical care and pain services at Guy’s and St Thomas’, said: “It’s like an airport having a control tower, supporting what is going on throughout the system, so that the overall quality goes up and senior people are available when needed.” The cameras are so powerful that they can detect whether the pupil in a patient’s eye dilates to bright light. Patients will also be “wired up” to a series of monitors programmed to raise the alarm if their condition suddenly changes. It is hoped the scheme will improve the standard of care at nights and weekends, when wards are typically staffed by junior doctors. However, it has raised safety fears and critics have described it as a “doctor-led” rather than “patient-led” response to the problem of poorer quality out-of-hours care.
Norman Lamb: Failing NHS and care home bosses must be prosecuted: Care minister, Norman Lamb wants to introduce a “fit and proper person” test to ensure all NHS and care home directors are trustworthy and not ripping off patients, residents and their families, reported The Telegraph. Under a consultation launched this week, the Care Quality Commission (CQC) watchdog will be given new powers to prosecute NHS directors who have failed to keep patients safe. The CQC will also be able to order the removal of any director of a care home who fails basic background checks. The care minister told The Daily Telegraph that the current regulatory system was “completely flawed”. “Despite all the things we have heard about in the health and care sector over the last few of years, there hasn’t been a single prosecution by the Care Quality Commission under the powers that they have,” he said. Under Lamb’s proposals, the CQC would no longer need to issue a warning notice before launching a prosecution where there are clear failures to meet basic standards of care.
Most patients satisfied with GP opening hours, shows survey: Fewer than one in five patients are dissatisfied with their GP opening hours, a Labour Party survey has shown. The analysis of the 2012/13 GP patient survey of 971,000 people found that 83% of patients were happy with their practices’ opening hours, reported Pulse. The report found that people living in the London commuter areas, such as Slough, Ealing, Harrow and Thurrock were the least satisfied, with 26% of Slough residents expressing dissatisfaction. Of those who were dissatisfied, 72% said they would like their surgeries open on Saturdays, 70% would like evening opening and around a third each said they would like practices open before 8am and on Sundays. Labour claims that the number of people dissatisfied with opening hours has risen by 6% in the past year. This comes as NHS England has announced that this year’s GP contract negotiations will focus on ensuring patients have ‘good access’ to GPs as a way of reducing the pressure on urgent care services. Liz Kendall MP, Labour’s shadow health minister, said: “Millions of people want to be able to book an appointment with a GP outside of normal working hours. It’s hard to take time off during work, and many people also have to commute or pick their children up after school.”
Probe launched after NHS documents found in loft: Health chiefs launched an investigation after medical records containing personal details of 70 NHS patients were found in the attic of a Preston home, reported Lanchashire Evening Post. Jeff and Mary Robertson, who live in Ashton, Preston, were shocked when a family member made them aware of the find while clearing out the loft of a house where a Royal Preston Hospital employee used to live. The couple took the paperwork to hospital chiefs at Lancashire Teaching Hospitals NHS Trust in April but claim the hospital have not kept them fully informed since as to the investigation. They have now spoken out about the discovery as they are concerned that the affected patients and their families are not aware that the documents left hospital premises and are demanding to know how this was allowed to happen. Speaking to the Lancashire Evening Post, Sean Hughes, medical director of the trust said: “In April this year, Mr Robertson returned a file of hospital documents to us. We immediately conducted an internal investigation and found that the documents had been used legitimately as part of an authorised study project. The Information Commissioner’s Office is satisfied with our investigation and the actions we are taking.”
Opinion
New acronym; new hope?
In eHealth Insider this week, Lyn Whitfield has an initial look at whether guidance published by NHS England on the creation of integrated digital care records (IDCR) for the NHS, will do the job that eHealth Insider readers want it to do.
“One of the first and clearest messages to come out of The Big EPR Debate was that NHS England should define its terms before setting out the future of electronic patient records. So the first, good piece of news to come out of the ‘Safer Hospitals, Safer Wards: Achieving an integrated digital care record’ guidance that was issued today is that the commissioning board has done just that.
“The less good news is that in doing so it has introduced a new acronym to NHS IT – IDCR. Despite the first half of the guidance’s title (with its unfortunate focus on hospitals), this is meant to convey the idea of a record that can be used across health and social care and accessed by patients.
“The guidance emphasises that it wants solid underpinnings for IDCRs, ranging from solid infrastructure to a “user interface that is intuitive and accessible in an increasing range of operational environments”. It wants to make sure that records are well kept, and linked by the NHS Number, the use of which will become a contractual requirement from next April.
“However, in contrast to the years of the National Programme for IT in the NHS, it wants trusts to buy their own IT – with some support from the £260m Technology Fund for projects already in the pipeline.”
An end to health tourism?
In HSJ (subscription required) this week, Michael White asks whether Jeremy Hunt’s latest plan to ensure foreign visitors pay to the use the NHS is simply diverting the attention away from the recent problems with A&E and attempting to please voters.
“This is not a matter of whether or not a policy actually works beyond looking good in the Daily Beast for a day or two. I think the “bedroom tax” on spare rooms is unfair and unworkable (arrears have soared). Last week’s decision to take away winter fuel allowance on oldies that have retired to hotter countries may not be unfair, but it’s trivial and unworkable. The fact is that these policies and the £25k benefit cap are popular, especially with younger voters who are socially and economically liberal − but not politically so.
“So what is Mr Hunt up to in raising the old problem of foreigners “bashing the Nash”, as some Aussie chums call the process of tax free use of the NHS? Is he diverting attention from the problems with accident and emergency − last month’s bloodsport on Fleet Street? Or is he creating what’s called “a dividing line” (a favourite dodge of Gordon Brown’s, which Osborne copies), intended to embarrass Ed Miliband with voters?
“After his friendly NHS 65th birthday interview with HSJ (“fairest healthcare system in the world”), let’s take [Hunt] at face value. Whether or not health tourism costs us £20m or £200m (it was £33m in 2011-12 with £21m of that recovered, according to one official figure), it’s money worth saving provided admin costs are not self-defeating. The awkward fact is estimates vary, as they do when judging the impact of last week’s Osborne statement on health spending.”
Concluding White suggests “The goal is laudable, but it is a hit on NHS budgets, amounting to £16m per hospital on some counts. Things could be worse, but even if Osborne is right about economic recovery, life is going to be tough and stay tough.”
Time for truth and reconciliation in the NHS
In this weeks’ HSJ (subscription required) Kim Holt and David Johnstone, leaders of Patients First, discuss how the on-going fallout from a succession of whistleblowing scandals and cover ups is stalling vital cultural change in the NHS.
“As leaders of Patients First, we think it’s time for an NHS Truth and Reconciliation Commission. The title is not melodramatic: the NHS is in need of both.
“The commission’s purpose will be to promote a process of truth about the revealed failings of patient care and an acceptance of the mistakes made, leading towards healing, reconciliation and renewed relationships between those who provided care, those who received it and those who monitor the quality of care.
“Healthcare’s purpose is to treat people and make them feel better than before. Pockets of dysfunction and unsafe care within the NHS have taken years to become public. We now understand how near impossible it can be for both staff and families to get action about concerns. Public inquiries and independent investigations drag on for months and years. We are caught in a blame game that feeds anger and breeds a sense of injustice − but does not bring resolution or healing to any party.”
They conclude “The commission could be a temporary body where serious concerns could be investigated until the system and public policy changes are implemented that will ensure reliable openness and transparency going forward.
“Truth and reconciliation does not mean that there cannot be accountability. The lessons from the commission will inform how and where accountability would be expected, and who would hold responsibility for that.”
Leading from the front – tackling the dementia challenge head on
In an opinion piece in Care Talk Business, Frazer Underwood, associate director of nursing and consultant nurse for older people at the trust explains how new software has given the trust the ability to collect important patient information that has the potential to redesign services and help meet quality initiatives, set by the Department of Health.
He explains how following a partnership with IMS MAXIMS, the trust became one of the first in the country to exceed all its CQUIN targets for dementia care in March 2013. As a result, the trust retained a financial incentive worth £392,750. Integral to this success was the deployment of the collaborative development of dementia-specific software.
Underwood continues: “This software means we are able to ensure that all patients over 75 years old are identified, assessed and referred as appropriate. It enables us to increase the early identification of people with dementia and prompt appropriate referral and follow up after they leave hospital.
“Since deploying the software, we have been through a peer review process for our dementia services, and other trusts have been very impressed. These trusts are working with paper systems and have not been able to hit their CQUIN targets, so being able to deliver them has really helped us lead the way in dementia care provision.”
Highland Marketing blog
In this week’s blog Laura Steward asks whether the Technology Fund gives trusts enough time to make a real difference in healthcare IT.
