News in brief
Health secretary unveils four-part action plan: Measures to drive efficiency, improve transparency and diffuse best practice across the service have been unveiled by the health secretary, in a bid to move from “words to action” following the general election, reported according to a post on the NHS Confederation website. Over the next few months, healthcare services will take part in nationally-led initiatives to deliver efficiencies in procurement, develop hospital chains, change how and when performance data is published, and establish transparency metrics for clinical commissioning groups (CCGs), the health minister announced. Speaking to health and care leaders at the NHS Confederation annual conference and exhibition in Liverpool, Hunt outlined a series of actions to combat a “triple whammy” of pressures. “The time for discussion has passed,” he said. Also at the conference Simon Stevens, in his key note speech, set out his plans for how the NHS can deliver the Five Year Forward View. He said the forward view had power because it was based not on his personal plan but on the collective view of organisations across the sector. According to the Guardian, among the measures announced in his speech were: success regimes; urgent and emergency care redesign; harnessing NHS ‘purchasing power’; new models for learning disability care and a focus on public health. “Health is what we are after,” he said. “Healthcare is what we do when we have not got it … The H in the NHS is health.”
Online record access raises “potential for coercion”, warns report: Researchers are concerned about the potential for online patient record access to cause unintended harm, reveals a new report by Integrated Care Today. Following the government’s proposal for all adults to have online access to their health and social care records by 2020, researchers from the Institute of Child Health, QMUL and the University of Bristol have raised their concerns. In a British Journal of General Practice editorial, the researchers recommend that online access to the full medical record should be implemented slowly, in a staged process and with thorough evaluation. While they agree that online access is likely to have a transformative effect on the content and use of health records and also on general practice itself, the researchers are particularly concerned about the potential for coercion: patients unwillingly giving others access to their online medical record. Professor Gene Feder, a GP and professor of primary care at Bristol’s Centre for Academic Primary Care, said: “Coercion may result from overt threats or physical force in an abusive relationship or may appear under the guise of helping a vulnerable relative, especially older people or those with learning disabilities.”
Emergency care to be ‘completely redesigned’ within three years, says Stevens: Simon Stevens used his interview with Health Service Journal (subscription required) to announce the launch of a “vanguard” approach for unplanned care at a number of pilot sites across the country. He also hinted at a change to the way emergency care performance is measured. The work will include an overhaul of NHS 111, GP out of hours services, minor injuries and urgent care centres, ambulance services and accident and emergency departments. It will also look at the “division of labour” between A&E departments and major trauma centres. Major A&Es have seen an increase in emergency admissions in recent years and have failed to meet the target to see, treat, admit or discharge 95% of patients within four hours for 97 consecutive weeks. Stevens said the NHS would be “actually getting going” with the work that has come out of the urgent and emergency care review, led by NHS England director for acute episodes of care Keith Willett and medical director Sir Bruce Keogh since 2013. The pilot sites will each cover populations of around 2 million. Stevens said the pilot sites would be used to “create facts on the ground” on what a redesigned urgent and emergency care system should look like. This model will then be rolled out across the country over the next two to three years, he said.
NHS chiefs warn of impact of social care cuts: A poll of more than 300 NHS chief executives has found that nearly all believe that reductions in social care funding are leading to increased pressures on the health service, Public Finance reports. The poll of 313 senior managers across organisations including hospital trusts, clinical commissioning groups and commissioning support units, also found over two-thirds (71%) agreed with the statement that the current financial pressures were “the worst they have ever experienced”. Almost all of those surveyed (91%) for the NHS Confederation’s annual conference, said financial pressures had worsened in the last year. Chief executive Rob Webster said that the government must address the headline messages, and back delivery of NHS England’s Five Year Forward View integration plans. Despite rising demand driven by an ageing population, fewer people will qualify for state-funded care while those who continue to receive a service may have to accept lower levels of support and a worse quality of life, reported the Guardian. Ray James, president of the Association of Directors of Adult Social Services (Adass), which produced the report, called on ministers to reverse five years of cuts and invest “sustained and substantial” extra funds to care for and protect older people. “Short-changing social care is short-sighted and short-term. It must also be short-lived if we are going to avoid further damage to the lives of older and vulnerable people who often will have no one else but social care to turn to. It is vitally important these care and support services are protected,” he said.
Call for health spending to be diverted to elderly care: Health spending should be frozen and funds diverted to improving care for the elderly, according to the body representing independent care services. Scottish Care said investment in better social care for older people would improve their lives and help to cut emergency hospital admissions, reported the BBC. It has called on politicians to tackle the “taboo” of NHS expenditure. The Scottish government has committed to getting people “the right care, in the right place, at the right time”. Scottish Care has published the findings of research that it commissioned ahead of its annual conference in Glasgow. It found that in 2012-13, the average emergency hospital admission for over-65s lasted for 11.8 days, at an average cost of £4,846. The umbrella body’s report said that amount could fund either care at home for a week for 27.7 older people or 9.28 weeks in a residential care home for one pensioner. Speaking on BBC Radio Scotland’s Good Morning Scotland programme, Ranald Mair, chief executive of Scottish Care, said: “If we’re going to manage to keep more people out of hospital, to maintain them in their own homes and also to prevent them going into long term care at an early stage, then we actually have to invest in home care. The danger at the moment is that we’re continuing to invest in hospitals and as you know, all politicians want to be the defenders of the NHS. This isn’t an attack on the NHS, let me be clear. If people need to go to hospital that’s where they should be.”
Stevens warns NHS on cash and change: NHS England has turned three areas with persistent financial and service challenges into ‘success regimes’ to receive greater central support, said Simon Stevens speaking at the NHS Confederation conference this week. North Cumbria, Essex and North East and West Devon had been identified by all six of England’s NHS national bodies as areas that needed to be put on a “sustainable footing”, reported DigitalHealth.net. “We all know there are parts of the country that are in systematic imbalance in terms of either the quality or structure of their services or their ability to make money work. And they have been imbalance for years if not decades,” he said. Stevens told the conference that NHS England had “tested to destruction” previous methods of improving failing NHS economies – such as replacing chief executives and short-term bailout funding – and a new way was necessary. “The idea is that we are going to collectively, both locally and nationally, bring to bear our full range of flexibilities and say what is our holistic diagnosis of what needs to change in this individual health economy, not just go in and inspect individual institutions.” Stevens made it clear that the implementation of success regimes was just one of a number of tough measures that would have to be taken by the NHS as it looks to implement the Five Year Forward View to address a gap between demand and funding that could reach £30bn by 2020-21.
Nurses and doctors demand urgent action over NHS: Scottish medical and nursing leaders have issued an unprecedented call for a change in direction if the NHS is to be sustained for future generations, reported The Scotsman. Calling for an end to “political point scoring”, the Academy of Medical Royal Colleges and Faculties in Scotland and the Royal College of Nursing (RCN) Scotland have united to demand changes to targets, more public debate, new ways of delivering care and better collaboration between health professionals. The joint statement called for “bold and visionary” action to face growing challenges, such as an ageing population, budget pressures and rising public expectations. The colleges also highlighted Scotland’s “persistent health inequalities” as a further burden on the struggling health service. The statement said: “This is the first time that the health professions have spoken with a single voice, emphasising the importance of joined-up action and the serious and urgent nature of the choices we face on the future of the NHS.”
NHS 111 commissioning standards set for September revamp: New national commissioning standards setting out the core requirements and qualities of future versions of NHS 111 will be released in September as work continues on trials of a new online iteration of the service, reported Government Computing. NHS England has said it was presently engaging with clinical commissioning groups (CCGs) and a number of other stakeholders on setting out standards to support NHS 111. Arrangements for the long-term provision of the 111 services had been uncertain following NHS Direct’s confirmation in July 2013 of its intention to withdraw from all of its service provision contracts over financial concerns. While it is ultimately the responsibility of individual CCGs to choose how to implement the standards, NHS England is continuing to try and set out policy to ensure “consistent” provision of the service across the country. Based around the wider aims of encouraging more integrated and interoperable health and social care under NHS England’s ‘Five Year Forward View’ plan, authorities have now pledged to focus on improving the “111” service. Speaking at last week’s NHS 111 Focus on Futures event in Manchester, Dr Ossie Rawstorne, national medical adviser to the service, said key efficiency aims remained to simplify the overall process of patient referrals.
Lewisham and Greenwich trust to work on personal electronic health record: Lewisham and Greenwich NHS Trust and Lewisham Clinical Commissioning Group (CCG) are to partner with Orion Health to deliver a person-centric electronic record, reported Government Computing. Working with local commissioners and having gained funding support from NHS England’s Safer Hospitals Safer Wards fund, the trust has approved a full business case to deploy Orion’s Cross Community Care Record (CCCR) to integrate key information relevant to the acute services provided at both the Lewisham and Queen Elizabeth hospital sites, as well as community services provided by the trust, and Lewisham primary care services. The electronic record is intended to provide health and social care professionals across parts of south-east London with information at the point of care, enabling them to make better, faster, and more informed clinical and care related decisions. The work will see around 4000 users being provided with secure, appropriate, online access, and an opportunity to improve the coordination of services and the delivery of improved care outcomes. Elisa Steele, director of IT at Lewisham and Greenwich NHS Trust said: “Our drive to integrate care records reinforces our ambition to truly unite services and staff in Lewisham and Greenwich. In addition, integrating our systems and patient information will help us to coordinate care with our colleagues in local government, supporting the NHS’ objective to be fully integrated with social care by 2018.”
University Hospital Southampton NHS Foundation Trust and NantHealth partner to deliver precision medicine for cancer patients: University Hospital Southampton NHS Foundation Trust (UHS) and NantHealth have announced a strategic partnership. Its aim is to transform cancer services using the most advanced molecular genomic and proteomic diagnostics, treatment decision support and unique IT integration capabilities which will enable better informed precision treatment selection and care coordination, reported Yahoo Health. Under the three-year programme, NantHealth will enable UHS to rapidly transport raw data from the sequencing machines to NantHealth’s UK based supercomputing infrastructure through the NantTransporter. This will provide acces to NantHealth’s automated NantOmics Analytics Platform (NantContraster) which allows genomics sequencing interpretation and annotation. In addition, NantHealth will generate rapid and timely clinical reporting to support personalised treatment decision making for cancer patients, based on evidence-based outcomes among patients with a similar genetic signature. “As an accredited NHS Genomic Medicine Centre, this partnership with NantHealth will allow us to take an important next step in the use of molecular medicine for the benefit of our cancer patients across the Wessex region,” said Fiona Dalton, chief executive officer at UHS.
Worcestershire markets eConsent tool: Worcestershire Acute Hospitals NHS Trust is commercialising a new electronic system to support the delivery of patient consent to care and treatment. The trust will work with e-Health Innovations, part of the Wellbeing Software Group, to market the eConsent tool, which was conceived by consultant surgeon Stephen Lake and has been in place at the trust for nearly eight years. Speaking to DigitalHealth.net, Lake said the initial aim of eConsent was to reduce the paper workload of doctors, saying it was “ridiculous” that the forms had to be handwritten, “I explained to my IT team that ideally I would just sign my name and everything else would be automatic,” he said. The trust’s IT department developed a system that uses standardised templates that can pull data from the patient administration system and create pre-populated forms based on the patient and the procedure. Patients also receive a related information leaflet. Lake believes now is the right time to market the product due to growing pressure from the Care Quality Commission and other bodies regarding the number of handwritten forms that do not contain full information on consent.
NHS SBS takes on McKesson HR business: McKesson has continued the disposal of McKesson UK with the sale of its McKesson Shared Services business to NHS Shared Business Services (SBS) DigitalHealth.net reports. The deal will see business support service NHS SBS take control of all HR, payroll and pensions services provided by McKesson UK for an undisclosed fee. NHS SBS will take on an additional 44 employment services contracts, expanding its existing employment services unit, which works with 82 NHS organisations to provide various HR functions. The company has gradually wound down its UK arm, including the sale in 2014 of most of its European healthcare software business to private equity firm Symphony Technology Group. This included its UK health and social care business, featuring System C and its electronic patient record Medway and the Liquidlogic social care system. Referencing the acquisition, NHS SBS’s managing director said: “We have already proven our capabilities in this respect and now with this acquisition we can broaden the support we provide across the NHS that can ultimately free-up more funds and resource for frontline care.”
Sanctions target ‘rip-off’ NHS temps: The government has announced measures to clamp down on “rip-off” staffing agencies used by the NHS to plug gaps in nursing and doctor rotas as reported by the BBC. It will set a maximum hourly rate for temps and cap the amount trusts that are struggling financially can spend. The agencies’ body says they are being scapegoated “for the NHS’s own mismanagement of workforce planning”. NHS foundation trusts in England spent nearly £2bn last year on agency staff – more than twice the planned amount. Health secretary Jeremy Hunt said the cost of agency and contract staff across the entire NHS in England last year was £3.3bn and staff costs had spiralled out of control. On one occasion, an agency nurse cost the NHS £2,200 for a 12-hour shift, and a doctor £3,700 for a 30-hour shift. In some instances, more than half of the money went to the agency itself. And hospitals are increasingly hiring expensive management consultants, which cost the NHS nearly £600m last year.
Opinion
Give staff the tools to deliver NHS change
TeleTracking Technologies vice-president and former paediatric specialist surgeon Dr Julia Fishman discusses how technology can help meet the challenge of delivering change in the NHS.
“In times of such austerity, hospital providers are looking at transformation programmes that can include drastic measures such as reducing staff numbers and selling land to create desperately needed savings. This approach requires hospital managers to perform a constant balancing act to ensure that any organisational cutbacks do not impact the quality of patient care. Savings in one area can have a detrimental impact on another; resources to support care provision need to be agile, responsive, and cover more than one care setting, especially as we move to more integrated care.
“Caregivers need the right tools to help them deliver change. For nursing staff, this could mean providing the status and location of each patient, and delivering information about them to manage and prioritise care in a timely manner. For social care staff, this may mean speeding up discharge processes and making sure the right services are notified. For carers and relatives, this could mean ensuring their loved ones are cared for by the right staff, who have the time to show the right standards of care. We need to help NHS staff progress patients through the hospital and back into the community in a safe, compassionate and efficient way. Such tools do exist.
“Data is an important tool to help support change. When I worked in the NHS, I recall receiving management data that was a week or a month old, and using it to try and make changes to the way we worked. In a few instances, this kind of data is useful, but the majority of the time, such data is too retrospective to make a significant impact. Caregivers require technology that generates real-time data which allows them to adjust or react to current situations and make forward plans. They need the ability to make clinical and management decisions at the frontline, using real-time data to inform and support changes in working practices.”
Care.data loose ends need tying up now
The inquiry into how the NHS handles patient data must be completed if people are to receive the reassurances they need, writes Liz Little on Health Service Journal (subscription required).
“Starting early last year, the inquiry was initially set up to look at the implications of the care.data programme, the NHS’s flagship project to bring about better integration, digitisation and interoperability of patient records across care settings. It was subsequently broadened to look at how the NHS handles patient data more generally.
“The inquiry was critically important. Care.data has become mired in controversy following its attempted introduction early last year. There was criticism that a leaflet drop to patients failed to properly explain the rationale of the project or patients’ right to opt out of having data stored by their GP shared beyond the surgery.
“Sharing the data we all generate helps to make the dataset on which important research depends very much stronger; linking data across care settings gives a much fuller picture of where there may be gaps in primary or secondary care today.
“So it’s essential that concerns around how data will be used are fully addressed in a final report from the new Health select committee. This is too important an issue to be a loose end.”
Workforce challenges will define the government’s record on the NHS
The NHS must plan for the workforce of tomorrow while managing the workforce of today, writes The King Fund’s director of policy Richard Murray in a blog this week.
Now faced with pressures to reduce agency spending, and ambitions like seven day working, Murray says the interplay of pay, recruitment and managing down agency costs all needs to be done while delivering on the government’s own priorities of high-quality and safe care.
“With the NHS five year forward view re-emphasising the need to develop new services in new settings, the NHS must also plan for the workforce of tomorrow while managing the workforce of today. This may mean making better use of the skills of existing staff such as pharmacists and physiotherapists. But it will almost certainly mean developing new skills and developing new staff roles. With the long lead times in training the clinical workforce, the NHS cannot afford to wait until 2020 to re-think the workforce that it will need or to start implementing changes.
“The NHS needs a comprehensive workforce strategy that meets all these challenges – immediate operational and financial issues, new policy commitments and the need to place the NHS and its workforce on a sustainable path for the future all at a time when money is in very short supply – and that understands the inter-relationships between them.”
Industry view: Paul Cooper
In June, the National Information Board should release its roadmap to give patients read and annotation rights to their record; a luxury not to be provided to them until 2018. Paul Cooper, research director at open source electronic health record vendor IMS MAXIMS, argues this is too little too late. The NHS has failed to provide integrated electronic health records so far. Now is the time to let patients control their own data.
“When it comes to delivering a cradle-to-grave comprehensive electronic health record for the citizen, the NHS has failed. The NHS cannot be criticised for not trying. The NHS Summary Care Record is one example of how it has not only done this but courted a huge amount of controversy in the process. The SCR is a huge central database that contains a range of basic information. Yet in setting it up, the NHS discovered that the population did not want a large database of their health information over which they had little control.
“So what do we have now? We have GP records, hospital records, dental records, pharmacy records… we are heading down the path towards integrated care across health and social care and yet we have not even solved the problem of one NHS organisation sharing information with another.
“New technology offers new opportunities to use health information. Who is best placed to use this data? Will your hard-pressed GP have the time or inclination to monitor the daily steps taken by a COPD patient? Or will family members be making sure they meet their health goals? The patient-held record should be the master record. Patients should be the ‘data controllers’. They can then give consent for access by people such as social workers, psychiatrists, and others, such as a helpful neighbour who comes in and change dressings once a day.
“The benefits of personal health records are emerging. There is growing evidence to show that personal health records can empower an individual to track, assess and manage their own health, and improve outcomes. The doctor-patient relationship can be transformed into one of co-production and shared decision-making. The door to integrated care is opened.
“The NHS has tried; we have all learned valuable lessons. And the chief lesson is that patients should be put in the driving seat.”
Blog
Everything from carefully procured bathroom consumables to hospital chains are needed to save £22bn, said Jeremy Hunt at the annual NHS Confederation conference. Matthew D’Arcy reports.
