News in brief
Treasury signs off £260m technology fund: The Treasury has signed off NHS England’s £260m technology fund, the body’s technology chief has announced. NHS England director of strategic systems and technology Beverley Bryant revealed via Twitter that chancellor George Osborne had rubber-stamped the spending. Health Service Journal (subscription required) has asked NHS England for further details about which organisations have been awarded funding. The fund, outlined in the Safer Hospitals, Safer Wards policy document in July, has been set up to help trusts at all stages of their clinical digital maturity progress towards achieving full electronic patient record systems. The document cited integrated care digital records within and between organisations; e-prescribing and open source technology as areas trusts could potentially secure funding for. It also outlined plans to rate and rank hospitals’ digital clinical maturity. NHS England last month established the integrated digital care records group to drive this agenda, which among other programmes, will oversee projects aiming to integrate health and social care records by March 2015.
Cameron trumpets healthcare deals with China: David Cameron on Monday trumpeted a series of UK/Chinese healthcare deals – the fruits of a concerted government drive to market Britain’s health expertise to the world’s most populous country, reported the Financial Times (registration required). Among the latest deals is one struck by Sinophi Healthcare, which signed contracts for hospital management and hospital investment worth £120m.These included a joint venture with Huai’an First People’s Hospital, one of the biggest hospitals in Jiangsu Province in East China which has a population of 80m, and an agreement to build a 1,000-bed oncology hospital. The Prime Minister said that the deal highlighted “the enormous opportunity” that the growing Chinese healthcare market represents for British companies. UK health and care services represent 10% of the British economy yet many believe that successive governments have been slow to grasp its export potential. The OECD and Bric nations are set to increase spending on healthcare by 50% between 2010 and 2020 to $7.5tn, according to estimates cited by the health department, which it said demonstrated “the size of the opportunity for UK firms”. Healthcare UK, a joint initiative with UKTI, the Department of Health and NHS England, was established this year to help healthcare providers do more business overseas. Health secretary, Jeremy Hunt who has accompanied Cameron on the trip, highlighted both countries’ “similar challenges” in caring for an ageing population and said UK companies had “much to offer in the Chinese elderly care market”.
GP extract to care.data starts in March: The extraction of GP data as part of the care.data programme will begin from March next year, reported eHealth Insider. The programme will take a monthly dataset from GP practices, covering patient demographics, referrals and prescriptions. This will be linked with data from secondary care to create a new set of Care Episode Statistics. An update on the care.data programme, due to be presented to the Health and Social Care Information Centre’s (HSCIC) board meeting this week, says that the preparations are “well underway”. “A phased roll-out is being readied over a three month period with full extractions anticipated in May 2014 (first extraction from March) allowing time for the HSCIC to assess the quality of the data and the linkage before it is made available to commissioners in anonymised form,” says the paper. “In addition, the board’s feedback on the data controller position is being picked up in discussion with the Information Commissioner’s Office.” The care.data programme was approved by an Independent Advisory Group in April this year, and NHS England’s business plan, also released in April, said it planned on 75% of GP practices to provide data extracts to care.data by September.
GPs told to offer SCR information to patients online ‘as a minimum’ by 2015: GPs will only be obliged to offer patients basic information from their records by 2015, in a significant row-back on previous promises from the government of a ‘revolution’ in the way patients access their healthcare information online. NHS England told Pulse that by April 2015 GP practices in England will only be required to offer patients access to the information contained in their Summary Care Record (SCR) upload. But managers stressed that this would only be the ‘minimum’ required and that they would be encouraging practices to go further and offer access to further information online to patients from their records in guidance to be published next year. The General Practitioner Committee said the move came after they raised ‘huge concerns’ about patient safety regarding the government’s pledge in 2011 as part of their ‘Information Revolution’ to ensure ‘all NHS patients can access their personal GP records online by the end of this Parliament’. Earlier this year, the RCGP raised concerns over plans to allow access to full patient records, warning of the ‘unintended consequence’ of an increase in queries from patients when allowing access to patient records online. The patient access online DES – which was due to be expanded in 2014/15 to incentivise practices to enable patients to access their medical records online, including test results and letters, has been scrapped for next year and responsibility for offering online access to information included in the GP contract. MPs have warned that the health secretary’s proposals do not go far enough and that Britain is destined to become a backwater for personalised medicine despite the government’s flagship plans for online-accessible electronic records in England. Instead, a group of MPs are urging Hunt to go much further, by allowing patients to update their own medical records online, reported UKAuthority.
NHS patients should have right to see records online, says Andy Burnham: The NHS Constitution needs to be expanded to give patients new rights, including a right to see their medical records online and to be cared for in the home if it is safe, Andy Burnham, the shadow health secretary, has said. He explained the rights would help rebuild the NHS to better provide integrated care which blends health, social care and mental health services, reported The Guardian. “We have to make whole-person care a reality,” he told The Guardian, adding he did not believe such a goal was possible under the coalition’s NHS reforms. He predicted his vision of whole-person care would be the dividing line between parties at the election. “You cannot put the patients and the individual at the heart of the fragmented system,” he said. Burnham was responding to a pamphlet by the Institute for Public Policy Research thinktank calling for an integration of health and social care including an alignment of incentives. The pamphlet warns: “The current NHS system of paying hospitals for activity and paying community-based services under a block contract creates a financial incentive to treat as many people as possible in hospital and as few as possible in the community.”
Open Data measures in the Autumn Statement: The Chancellor of the Exchequer, George Osborne, as part of the government’s Autumn Statement, this week announced that world-leading commitments by the government to open up public sector data will make travel easier and healthcare better, and create significant growth for industry and jobs in the UK, reported the Department of Health. The Open Data measures will boost investment in medical research and digital technology in the UK, including many small and medium sized enterprises. This will help realise the Prime Minister’s ambition to make Tech City one of the world’s great technology centres and create an environment where the next Apple or Skype could come out of the UK by making useful and valuable transport, health, weather and house price data available. The measures will specifically improve medical knowledge and practice with world-first linked-data services which will enable healthcare impacts to be tracked across the entire health service and improve medical practice; the service is expected put the UK in a prime position for research investment and empower patients through individual access to their personal GP records online and encourage the market for education data management and learning platforms.
HP plans open source offer for NHS: Hewlett Packard is planning to provide a fully electronic patient record system on the open source framework being developed by NHS England, reported eHealth Insider (EHI). The system is called ‘NHS Healthcare Information System’ and will include complex scheduling, e-prescribing, requests and results reporting and an A&E admissions system. EHI reported earlier this year that NHS England is working with four organisations to make their products available on an open source framework being developed for NHS trusts. The other three are: IMS MAXIMS; University Hospitals Birmingham NHS Foundation Trust with its in-house PICS e-prescribing system; and the US Veterans Association system, VistA. Up to £20m of the first £260m ‘Safer Hospitals, Safer Wards: Technology Fund’ will go towards open source development and a similar amount in the second fund, worth £250m. A spokesperson for HP told EHI it is working with NHS England on the “possibility of joining the open source framework”, but would not confirm which product it will offer. EHI understands that the system will only be available open source to the ‘community’ of NHS trusts that decide to use it in the UK, as it is already in use in around 100 Spanish hospitals.
Biggest risk to care.data scheme is potential loss of GP ‘confidence’ in benefits of scheme: A major risk to their programme to extract data from GP records is that clinicians may not have ‘confidence’ in the benefits of the scheme say NHS leaders, in a document seen by Pulse. The updated programme issued last week flags up a number of risks, which may potentially jeopardise the scheme. It also confirms that extractions of data from GP records are planned to begin in March 2014, with the full-rollout of the scheme to all practices three months later in May. It comes as Pulse spoke to another GP who was planning to opt all their patients out of the care.data scheme – in defiance of legal advice from the General Practitioners Committee (GPC). A publicity campaign was announced in October by NHS England after widespread disquiet that GP practices were solely responsible for informing the public about the scheme and calls from GPC to be more transparent with patients about the ‘fundamental’ shift in how NHS will be using their data. The care.data scheme will see the Health and Social Care Information Centre (HSCIC) routinely extracting identifiable patient data from GP practices and hospitals, which can then be shared in identifiable or de-identified forms to other sections of the NHS and to third parties, such as researchers or private companies.
CCGs seek responsibility for GP services: Following the first major survey by clinical commissioning group (CCG) organisations, representatives have called on NHS England to support CCGs in taking a greater role in primary care, reports Health Service Journal (HSJ, subscription required). NHS clinical commissioners this week published the results of its survey of CCG leaders’ on working with NHS England. Overall, they were positive. However, asked whether NHS England worked effectively with them as commissioner of primary care, 55% disagreed and only 19% agreed. In a letter to NHS England chair Sir Malcolm Grant, NHS clinical commissioners said many group leaders believe primary care responsibility should “sit with CCGs”. The letter, shared with HSJ, said: “This is an area which is ripe for change. We know that CCGs are frustrated by the lack of progress and… there is a growing sense that movement on this is both necessary and possible. We would urge you to support such a change and ensure that CCGs are given both the responsibility and the resources they need.” NHS England has previously indicated it is considering how it could work more closely with CCGs on primary care, but has not made it clear whether or how it would hand over responsibility in an area. The survey involved 272 CCG chairs, chief officers and chief finance officers.
Kent Trusts partner to deliver £40m worth of helpful IT: Two big NHS trusts say they want to combine forces as they seek to implement new joint IT systems, reports the British Journal of Healthcare and Computing. The partners – East Kent Hospitals University NHS Foundation Trust and nearby Maidstone and Tunbridge Wells Trust – plan to invest in two major new platforms: a Patient Administration System (PAS), which they see as providing an automated, paperless document system, plus a set of new applications to help boost IT support for their Maternity and Accident and Emergency (A&E) functions. The plan is to deliver against this vision by a ten year investment of somewhere between £10m and £40m, with a possible two-year extension on the other end of that, say the pair. At the moment the trusts are looking for IT service partners to help them achieve the desired modernisation, with bidders invited for the two separate ‘lots′ that the work′s been split into (the PAS and A&E work and data migration and professional services for the rest of the scheme). In practical terms East Kent and Maidstone and Tunbridge Wells say they are looking for expertise in designing and implementing medical information systems, data storage and management services, plus installation and associated consultancy services. It is believed around six partners may eventually be asked to work together.
94% of CCGs believe mobile technology is critical for integration of health and social care: Using mobile technology can help healthcare professionals have access to the up-to-date information they need to be able to efficiently and effectively deliver care, and CCGs are beginning to embrace the new technology, reported Commissioning GP. The Department of Health’s National Mobile Health Worker Project: final report has revealed that using mobile technology brings huge benefits to both healthcare professionals and patients. The report found that using mobile technology results in significant increases (up to 142%) in productivity can be achieved, as demonstrated by huge increases in contact activity and an up to 104% increase in the amount of time spent with patients can result. Journeys can also be reduced by up to 11%, meaning that time spent travelling can be reduced by up to one third. The use of mobile technology can also create significant savings in referrals (up to 34%) and admissions (up to 91%). The report reads, “From the information collected during the 15 month period of the project, it is clear the adoption and long-term use of appropriate mobile solutions has the potential to significantly improve productivity, efficiency, safety and assist services to continue to provide good quality care and achieve good outcomes.” Alongside the report, a survey conducted by TotalMobile, an organisation that provides mobile technologies to healthcare and local government, has found that 94.1% of CCG respondents acknowledged that mobile technology is a critical success factor to better health and social care integration.
GP surgery manager pleads guilty to illegally accessing patient data: A former manager of a GP surgery has pleaded guilty to charges of unlawfully obtaining personal data using the doctors’ patient records program, reported Computer World UK. The Information Commissioner’s Office (ICO) found that Steven Tennison, 37, had accessed the medical records of about 1,940 patients registered at College Practice GP surgery in Maidstone, breaching the Data Protection Act (DPA). Many of the records viewed by Tennison, who oversaw the finances of the surgery, related to women in their 20s and 30s. The records of one woman – believed to be a school friend of Tennison – and her son were accessed repeatedly. The offences were uncovered in October 2010 when the practice manager at the surgery reviewed Tennison’s attendance file, which included looking at his use of the patient records program. The manager found that Tennison had accessed records 2,023 times between 6 August 2009 and 6 October 2010. During this time, the GP practice said that Tennison was only authorised to access the records on three occasions when the practice manager was on leave and he was responsible for investigating a complaint. Stephen Eckersley, ICO head of enforcement, said: “We may never know why Steven Tennison decided to break the law by snooping on hundreds of patients’ medical records. What we do know is that he’d received data training and knew he was breaking the law, but continued to access highly sensitive information over a 14-month period.” Tennison was fined £996 at Maidstone Magistrates Court and ordered to pay a £99 victim surcharge and £250 prosecution costs.
Trust Development Authority calls for more funding: The NHS Trust Development Authority is seeking more funding from the Department of Health to cope with an increased workload in the aftermath of the Francis inquiry, it has emerged. The authority, which performance manages and assures providers as they seek to attain foundation trust status, said a lack of capacity was its greatest strategic risk and could compromise its ability to “maintain effective oversight and support of trusts”. The capacity gap is partly the result of an increased workload following the Francis, Berwick and Keogh reviews and the need to support the new Care Quality Commission inspection regime, the authority’s most recent board papers state, reported Health Service Journal (subscription required). At the authority’s board meeting last week, director of finance Bob Alexander said it faced two key strategic “inherently linked” risks. These were “capability and capacity of the [TDA] itself” and “the ability of some of our [trusts] to appropriately deliver in the challenging times that we have”. The authority has drawn up a business case for extra funds from the DH in the 2014-15 spending round to help it meet increased demand from trusts for support on clinical and quality issues following the Francis report. Its 2013-14 budget is £33.5m.
ASH data breaches to attract fines: Accredited Safe Havens (ASHs) will be subject to significant fines if they breach their requirements for handling patient data under Health and Social Care Information Centre (HSCIC) proposals, reported eHealth Insider. The creation of ASHs was recommended in the 2013 Caldicott Review report – To Share or not to Share – to handle ‘de-identified for limited access’ data for some commissioning functions. This DID4LA data will contain a single identifier, probably the NHS Number, and so could be re-identified if linked to patient confidential data, creating a data breach. A paper being presented to the HSCIC board this week recommends new regulations to ensure that a breach of ASH requirements would be seen as a breach of the Data Protection Act and therefore could attract a significant fine. It explains that while data sharing contracts should be used to impose the necessary controls on an ASH, NHS contracts are not enforceable between NHS bodies. New Section 251 regulations could be created to ensure legally binding controls are in place and should be applied to every ASH, the paper suggests. “A breach of the ASH requirements would therefore be seen as a breach of the Data Protection Act, not just of the contract, and potentially attract a significant fine,” it says.
Better data and priority for young mental health issues needed: The majority of joint strategic needs assessments (JSNAs) do not give enough priority to children and young people’s mental health, according to a coalition of charities, youth workers and health professionals. The Children and Young People’s Mental Health Coalition, hosted by the Mental Health Foundation, has conducted a review which found that two out of three JSNAs do not measure these mental health needs locally, and that old data is used to estimate the prevalence of mental illness in this age group, reported National Health Executive. The coalition wants more focus on early years mental health support to prevent problems worsening and to deliver more cost-effective care. It recommends that health and wellbeing boards (HWBs) should include children and young people’s mental health as a priority with outcomes to measure impact, while the Department of Health should commission a national survey to get a clearer picture of the scale of the problem. Outcomes within the NHS Outcomes Framework should be adapted and extended, and Public Health England should update guidance and tools, ensuring these are easily accessible to HWBs and commissioners.
Opinion
Why NHS trusts should slow down to move more quickly towards a paperless NHS
In Building Better Healthcare this week, Dr Andrew Litt, chief medical officer at Dell, discusses why trusts should become paperless, how the NHS can assess its technology use, and why paperless is important to patients.
“Health secretary, Jeremy Hunt, has laid out a vision for a paperless NHS by 2018. That’s a laudable goal, because moving from paper to digital record keeping will increase access to information for both patients and healthcare providers and improve both patient health and patient care.
“In response to this vision, many local trusts will look to new technology to meet that goal. But there is an important reason that local trusts need to hold off making decisions about new technology investments – limited budgets.
“Before making technology investments, local trusts should optimise the technology they currently use. The first step in this process is to do a thorough assessment of current technology, led by a joint team from the clinical and technical staffs. It is critical that this assessment NOT be done solely by the technical staff or solely by the clinical staff.
“A joint effort by clinical and technical professionals offers the broad perspective of clinical needs and technological capabilities. This is a powerful force in the pursuit of an optimised technology environment. Clinical staff members almost always learn about technology capabilities in the system that they didn’t know were there, and technical staff members almost always learn about unintended consequences that the technology causes in clinical workflows.
“Whatever system you use to do the assessment, by taking the time to gain this understanding you will move much more swiftly toward the goal of a paperless NHS.”
Failure regime is no guarantee of success
This week in Health Service Journal (subscription required), Crispin Dowler explains that leaders of NHS organisations are confident they will avoid being pushed into the failure regime which he says has so far been unfit for purpose.
“I have spoken to the commissioners or leaders of several NHS providers with serious financial problems. The circumstances of these providers vary greatly but they share certain characteristics: they are in deficit and dependent on bailouts, and expect to be so for some time.
“Their financial problems probably cannot be solved without reconfiguration, or continued subsidy, or both. They are simultaneously grappling with serious quality issues, for which the obvious solutions come at increased costs. In most of these cases, the providers have recognised the need for major changes and are working on plans accordingly. But the problems they are dealing with are so complex, and the solutions so far from obvious, you must inevitably question their chances of success.
“In every case I have asked: what are the chances that Monitor or the NHS Trust Development Authority will push the organisation into the failure regime? Pretty much everyone I spoke to acknowledged it was a possibility but was optimistic it wouldn’t happen in the near future.
“ ….it was only last year that the King’s Fund warned there was “a risk that the failure regime will become the first, rather than last, resort if planned reconfigurations of services ahead of financial failure are not made easier and quicker. That this scenario now seems unlikely shows just how difficult using the failure regime has been. I would expect it to remain so despite ministers’ attempts to make the regime “fit for purpose”. The proposed changes might make “special administrators” less susceptible to judicial review but they will not make their decisions less contentious.”
The rise and fall of telehealth in 2013
In this week’s Guardian, Dick Vinegar, the ‘Patient from Hell’, tracks telehealth’s rollercoaster ride over the last twelve months, from its initial high expectations, but questions whether its demise is apparent in all corners of the UK?
Vinegar sets the scene by explaining that low uptake and reports that the service did not save money or improve quality of life, has resulted in a bleak outlook for telehealth. The service has been described as a fad, however both Cornwall and Kent have retained their telehealth infrastructures, and continue to offer telehealth to their COPD, heart failure and diabetes patients.
Vinegar concludes his article by arguing that telehealth has not been given sufficient time to be adopted properly, especially given the incredible speed of which technology develops: “The thing about technology is that it evolves and gets cheaper quickly. To make judgements in 2013 about a technology installed in 2008 is ridiculous.
“And it takes time and practice for humans to get used to a new technology and a system which hangs on it. In 2008, telehealth system designers and nursing staff were struggling to learn the ropes. And, most critically, patients also had to learn what it is all about, and use the monitoring gadgets successfully. To make judgements at that stage of the game is rather like saying that Gareth Malone’s choirs were hopeless after their first rehearsal. Indeed they were, but, they soon got better. The same is true of telehealth.
“I commend therefore the guts of the authorities in Kent and Cornwall to put two fingers up at the findings of the academics, and follow their own instinct that telehealth is both patient-friendly and cost effective. And I applaud the frontline nurses, who save the lives of their telehealth patients.”
European healthcare sector goes virtual as NHS focuses on innovation
On The Information Daily this week Mark Clark, VP at Imprivata says virtual desktop infrastructure is transforming the way clinicians access patient information at the point of care, unlocking the full potential of new technology investments in Europe.
“Research shows that the adoption of VDI, or desktop virtualisation, stands to be one of the most important technology trends in the European healthcare community. VDI reduces the cost of delivering IT services by provisioning entire desktop environments from the datacentre and makes it easier for clinicians to access applications and data from any device.
“A recent survey of European healthcare IT professionals, conducted by Imprivata, finds that virtual desktop solutions are used in 42% of healthcare organisations today. Moreover, what is particularly eye-opening from the survey results is the forecast use of these technologies – with desktop virtualisation expected to increase 74 per cent in Europe over the next 24 months. If this is realised, then adoption of desktop virtualisation of healthcare in EMEA will surpass the U.S. in that timeframe.
“With a workforce constantly on the move both in and out of the hospital environment, virtualised desktops suit the mobile working patterns of clinicians.
“Oxford University Hospitals NHS Trust, for example, one of the UK’s largest hospital Trusts utilises VDI and single sign on in its fast-paced A&E department.
“With clinicians constantly moving from location to location to treat patients in different areas of A&E and beyond – all while using different equipment – there was a vast amount of switching between workstations, which initially required clinicians to repeatedly enter the same authentication credentials to access applications and patient details.”
Highland Marketing blog
In this week’s blog Sarah Bruce looks at whether the Tech Fund might finally change the way the NHS looks at ROI.
