News in brief
NHS England in talks over government funding to deliver digital: NHS England is in talks with the government ahead of next month’s spending review about the need to invest in the deployment of technology and the capabilities to do so in the NHS, according to its national director for patients and information, Tim Kelsey. Speaking at EHI Live in Birmingham, he said there is a need to develop a “vigorous culture of entrepreneurial response to enable the technology”, which he hopes the government will prioritise in the coming spending review, reported Computer Weekly. “We are currently in a really important conversation with the government about the degree to which it now needs to commit in a way that has not been true before, recently at least, to a significant level of capital investment in the health service for the deployment of technology, particularly locally,” said Kelsey. He added that there is also a need for a “significant level of investment in developing the capability we need locally not only to ensure that the technology is successfully deployed but that value is obtained from it. I really hope the government will prioritise this in the spending review.”
NHS England aims for GP IT systems integration by March 2016: NHS England aims to give third-party access to GP IT systems for new software and app providers by the end of March 2016, according to its director of digital technology, Beverley Bryant. NHS England and the Health and Social Care Information Centre (HSCIC) have been working to open up the GP Systems of Choice (GPSoC) framework – which funds IT systems for most GP practices in England – to third-party suppliers that provide a range of services such as apps, patient record access and transactional services. When the GPSoC contract was signed in 2014, four main suppliers – Emis, TPP, INPS and Microtest – all had to promise to provide interfaces to allow third-party suppliers to integrate with them through a pairing process. Speaking at EHI Live, Bryant said the process had felt difficult, but that a lot of progress had been made, reported Computer Weekly. “We now have 50 organisations in the pipeline working with our primary care system suppliers, covering a range of functionality,” she said. “We think that by the end of March [2016], 20 of those software providers will be accredited, will have passed all the clinical validation, have technological validation, and will be available to start opening it up.”
Kelsey: lives ‘ruined’ by lack of data: People’s lives are being “ruined” by the NHS’ inability to join up patient information, according to NHS England’s Tim Kelsey. Speaking at EHI Live 2015, in one of his final speeches before leaving for a new job in Australia, the national director of patients and information told the story of a mother of a child with learning difficulties, reported DigitalHealth.net. He said she had to give up her job as a nurse partly because of the time it took to transfer her child’s care between different parts of the health system. “The one thing she said to me was; ‘Will you please make the NHS remember who I am’ – and I have not achieved that,” he said. “We have said we will achieve it by 2020 – but every day that passes people’s lives are being ruined by the experience of engaging with our most valued institution, this health service. That is a deficiency of the pace of our technology adoption.” Kelsey used the speech to set out several technology priorities for the NHS to focus on following his departure at the end of the year. Near the top of his agenda was the need to lose “anxieties” about maintaining distinct parts of the care system and to move to deliver care collaboratively. To support this, Kelsey said interoperability was “fundamental”. “What we must not do is what the Americans did, which is build fantastic electronic hospitals in the sky – and not the ability for them to speak to each other.” Kelsey said that Dr Robert Wachter, author of “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age”, had been appointed to lead a review into how the UK can “avoid the pitfalls of digital screw-ups.”
£3m invested in Scottish digital health tech: The Digital Health and Care Institute (DHI), which is celebrating its second anniversary, has awarded over £1.1m for approved projects to fund academic research and input to projects exploring the use of new technology and information services that will improve health and care for Scotland’s communities, reported The Scotsman. In addition, DHI has facilitated contributions from private and public sector companies and organisations in time, resource, product and licensing costs to the value of £1.9m, providing a total project portfolio worth in excess of £3m. The DHI is one of Scotland’s eight Innovation Centres and was set up to bring together individuals and organisations in the health and social care, charity, technology, design and academic sectors to develop new ideas for digital health and care products and services that will meet current and future demographic challenges and improve the delivery of health and care services for Scotland’s communities. Justene Ewing, chief executive at DHI said: “Our first two years of operation have been hugely successful, with above target projects currently being developed and tested and we have ambitious plans for the future, including the development of a purpose-built simulation facility to allow projects to be quickly prototyped and tested in realistic environments such as GP surgeries, hospital wards, pharmacies, care settings, back office support and patient homes.”
In-year public health cut confirmed: The Department of Health (DH) is to press ahead with its planned blanket in-year cut to public health budgets, despite the majority of local authorities backing alternative options, reported Health Service Journal (subscription required). The announcement came almost five months after the chancellor first revealed plans for the £200m cut and two months after a consultation on how the cut should be applied closed. It means all top-tier local authorities will face a cut of 6.2% to their public health budgets. This is equivalent to a cut of almost 25% to the public health grant for the final quarter of 2015-16. Nicole Close, chief executive of the Association of Directors of Public Health, said: “It’s going to be hard and in some places it’s going to be very hard. Some will have had the opportunity to recommission contracts, where a contract was due for renewal anyway. Other places it will be the more easy to cut services such as weight management, public mental health and the smaller services like breastfeeding support.” The 6.2% was the DH’s preferred option, as it argued it would be the “simplest and most transparent option to implement”. It was backed by just a quarter of respondents. The most popular option among local authorities was to take a greater proportion of cut from those areas that receive more than their target allocation.
NHS trusts to self-assess their digital maturity: NHS trusts will begin to self-assess their digital maturity in November as NHS England launches its digital maturity assessment. In September 2015, NHS England announced plans to put clinical commissioning groups (CCGs) in charge of developing local digital roadmaps on how to achieve a digital NHS by 2020 in their local areas. As part of the plans, NHS England is developing a Digital Maturity Index (DMI) to measure the digital maturity of NHS providers. Speaking to Computer Weekly ahead of the launch of the digital maturity assessment at EHI Live in Birmingham, NHS England director of digital technology Beverley Bryant said the assessment will look at how trusts are using technology in a meaningful way. “The assessments will be undertaken by the trusts locally and we will use those assessments to create the DMI, which will be published next year,” she said. NHS England plans to publish the DMI in March 2016, ahead of the submission deadline for the CCGs’ digital roadmaps in April 2016. The roadmaps will cover the entire local health and care economy – secondary care, social care, community, mental health and primary care – to ensure interoperability and access to patient records across the service. By the end of October 2015, all CCGs had to submit a footprint detailing, as Bryant put it, “who’s in their gang”, as well as submitting governance templates for the programme.
Code4Health interoperability site launch: NHS England has unveiled a new web tool to encourage people to discuss and define a list of key application programming interfaces needed to enable new models of working across health and social care. Inderjit Singh, head of enterprise architecture at NHS England, told DigitalHealth.net that the Code4Health community “was about bringing together localities, suppliers and national organisations as a group of peers and being clear about clinical priorities and needs for clinical interoperability and getting suppliers to deliver against that.” Many projects – from integrated care pioneers to Prime Minister’s Challenge Fund sites and vanguards – are now underway; and are finding they need systems to share information between health and care teams. A recent evaluation of the Prime Minister’s Challenge Fund sites set out some of the interoperability issues and attempts to overcome them in some detail; saying more work needed to be done. Singh argued that suppliers knew the general goal, but they needed more specific details about what pieces of work need to be done. Richard Jefferson, NHS England’s head of business systems, said the community will bring together various strands of work on integration. Dr David Stables, founder of interoperability charity Endeavour Health did not believe there would be any issue getting buy-in from the necessary players to participate in the community, saying suppliers and the informatics community were “definitely up for it”.
NHS IT leaders say “paperless” is possible: Two-thirds of NHS IT leaders say they are confident their organisation can meet the goal to become paper-light by the turn of the decade, reported DigitalHealth.net. Health secretary Jeremy Hunt said the NHS should go “paperless” by 2018 in a speech to the Policy Exchange think-tank in January 2013. His ideas were refined by the latest NHS IT framework, “Personalised Health and Care 2020”, which said that clinicians working in key care contexts should be working “without the use of paper records” by 2018. It added that patients should have read/write access to their records by the same date, while “all care records should be digital and interoperable” by 2020. The first Digital Health Intelligence NHS IT Leadership Survey asked leading clinicians and digital health IT leaders about these goals. Some 67% said they were either ‘quite confident’ or ‘extremely confident’ their organisation will be paper-light by 2020. Only 14% of those surveyed said they were ‘not at all confident’ or ‘not very confident’ of achieving the target. However, they were less confident about the wider target to have “integrated health and care records, enabling effective co-ordination of health and social care, by 2020.” Some 56% said they were “extremely confident” or “quite confident” of achieving this, but a quarter (24%), said they were “not at all confident” or “not very confident”. Only 28% said they were confident of giving patients read/write access to their records, while 53% said they were not confident. The NHS IT Leadership Survey was sent exclusively to members of the CCIO and Health CIO networks, and was completed by 67 of their members.
CCGs lead creation of ‘around 100 digital footprints’: NHS commissioners and providers have teamed up to form around 100 “digital footprints” to develop technology strategies for their health economies, an NHS England director has announced. The strategies will map out how local health economies will be paperless at the point of care by 2020, reported Health Service Journal (subscription required). NHS organisations, led by clinical commissioning groups (CCGs), were told to form clusters across local health economies to draw up their “digital roadmaps” by October. The groups are due to submit their roadmaps, which will be “refreshed annually”, by April, according to National Information Board guidance. NHS England’s director of digital technology, Beverley Bryant told the EHI Live conference in Birmingham that 194 out of 209 CCGs had “absolutely finalised” their plans and that there would be “about 100 footprints”. She added: “Some CCGs are just on their own with providers in their patch. Others have clustered together.” The digital footprints involve CCGs, all NHS providers, local authorities and voluntary organisations. NHS England is due to publish further details on which organisations are in which digital footprints.
techUK wants new funding models for digital care: Representatives of the IT industry have said there is a need for new funding models for personal digital care, along with a reassertion of the case for its adoption and more collaboration and integration between organisations. IT industry association techUK has made the call in a Personal Digital Care Paper published this week. It says a number of barriers are in the way of wider adoption and that steps need to be taken in three areas to provide a fresh momentum to take-up of the technology, reported UKAuthority.com. One of these is to provide adequate funding models and appropriate commissioning, with new options such as giving clinical commissioning groups the ability to change pricing and payment tariffs to encourage use of the technologies. It cites the example of NHS Scotland’s Integrated Care Fund and says it could apply to local government as well as NHS organisations. There should also be more outcomes based commissioning, giving healthcare professionals more scope for new ways of delivering care, and a use of existing financial incentives to make use of the technology. This could include exploring the use of Commissioning for Quality and Innovation indicators to encourage integrated care and link it to patient outcomes. Existing government initiatives such as the Better Care Fund and Vanguards for New Models of Care could also be used, and there should be more evaluation and monitoring of patients.
UK healthcare ‘lagging behind other rich nations’: Standards of healthcare in the UK are lagging behind many developed nations with thousands fewer doctors and nurses being employed, a report said. The Organisation for Economic Co-operation and Development (OECD) review of 34 countries found the UK was behind in key areas such as stroke and cancer, reported the BBC. It also found spending was lower per head and there was less equipment. The Department of Health (DH) said there was room for improvement and money was being targeted in those areas. The report found the UK has 8.2 nurses per 1,000 people compared with an OECD average of 9.1, while it has 2.8 doctors per 1,000 compared with 3.3. Experts said 26,500 more doctors and 47,700 nurses would be needed to match the OECD average. In terms of equipment, the number of MRI and CT scanners was well below average. Spending, it said, had seen “zero growth” per person in real terms between 2009 and 2013. Countries such as France, Canada, Belgium, Germany, New Zealand and Denmark were all spending more. A DH spokeswoman said the extra investment being made in the NHS this Parliament would help improve services. “We know there are areas where the NHS can improve which is why we have prioritised investment in the front line.”
Hunt approves HSCN: N3 replacement: An integrated network to replace the NHS’ existing N3 network has had its outline business case approved by health secretary Jeremy Hunt, reported DigitalHealth.net. Speaking at EHI Live 2015 in Birmingham, the interim programme director at the Health and Social Care Information Centre (HSCIC), Patrick Clark, said the decision means that the organisation can now begin to make real progress on delivering the Health and Social Care Network (HSCN). The original contract for N3 was due to end in April 2014, but was extended by three years because no successor had been put in place. The nature of the N3 contract is also problematic, Clark said: “Like all large, monolithic contracts they often look good from outset when you bundle lots of services together. But more often than not, when you get further down the line, those prices don’t looks so good – and you are tied into very large contract that is difficult to flex and get out of.” He said this approach will help the HSCIC cope with the March 2017 deadline to exit the N3 contract, as it can take apart the N3 provision bit-by-bit rather than doing a large-scale replacement.
Patients to finally have data-sharing objections honoured: The Government has acted to ensure that patients who have opted out of their GP data being shared will now have their objections honoured, after Pulse’s revelations that potentially millions of opt-outs were being overridden. Pulse revealed earlier this year that the Health and Social Care Information Centre (HSCIC) was forced to ignore patients’ objections to data being shared that were made before the calamitous roll-out of NHS England’s care.data initiative. But this has recently been rectified, and GPs have been urged to accept the extraction of patient data-sharing opt outs. However, it became clear that one of the options – which would prevent HSCIC from sharing the data with other NHS organisations – would have seen patients missing out on invitations to cancer screening. This meant that the HSCIC has been forced to disregard these opt outs for almost two years. Now, the GPC has asked practices to allow the extraction of data. A GPC email alert stated: “GPC strongly recommends practices participate in this collection to allow the HSCIC to uphold patient objections to their data being shared.” A HSCIC spokesperson said: “The HSCIC has developed a system which will allow us to uphold the… opt-out that patients have registered to the HSCIC sharing their identifiable data for purposes other than their direct care. It will be operational by January 2016.”
Older people with multiple conditions should have named care coordinator, says NICE: Older people with multiple long-term conditions and social care needs should have named care coordinators to ensure that services join up around them and their needs are met promptly, reported CommunityCare. That was among the recommendations made to local authorities, providers and the NHS by the National Institute for Health and Care Excellence’s (NICE) in a guideline issued this week on older people with social care needs and multiple long-term conditions. NICE said that the care coordinator’s roles would include: playing a lead role in the assessment process, liaising with all health and social care services working with the person, including those delivered by the voluntary and community sectors and identifying unmet needs and discussing with the person how these could be met. NICE’s guidance is voluntary though the Care Quality Commission takes it into account when assessing adult social care services. But much of the guideline reflects what is required or expected of local authorities under the Care Act but extends this across health and social care. For example, the guideline says that assessments of and care planning for older people with multiple conditions should always involve the person and, if appropriate, their carer, and take account of their strengths, needs and preferences, in line with the Care Act.
Wales pledges £250,000 to improve telehealth: Health minister Mark Drakeford has pledged £250,000 to improve telehealth technology in Mid-Wales as part of plans to make patient care more cost effective, reported Pulse. The region is largely rural and is sparsely populated, and so telehealth is very important in ensuring that patients receive the care they need, he said. More patients will have access to dermatology services in which images and patient details can be examined by specialists remotely. There will also be an expansion in the use of electronic transferral of X-rays. Plans to improve telehealth services are being led by the Mid Wales Healthcare Collaborative, a partnership of healthcare organisations across Mid Wales which includes GPs. Professor Drakeford said: “Telehealth already means orthopaedic specialists in Abergavenny can look at X-rays from Brecon to avoid unnecessary travel for patients. This investment will take stock of all practices which use telehealth across NHS Wales and look at how, within the Mid Wales Healthcare Collaborative region, we can scale these projects up to benefit more patients.” The £250,000 is part of a £10m ‘efficiency through technology’ fund designed to bring more efficient ways of working.
Bennett: Government ‘micromanagement’ creating ‘dependency mindset’ among leaders: The chief executive of regulator Monitor has accused the government of attempting to “micromanage” NHS organisations in a way that damages motivation and creates a “dependency mindset” among leaders. David Bennett made the comments in an exclusive exit interview with Health Service Journal (subscription required), in which he was critical of the approach taken by health secretary Jeremy Hunt. He warned that the government was withdrawing “more and more” freedoms from public sector chief executives in the service of austerity; he dismissed Hunt’s argument that “better quality care costs less”; expressed scepticism that the NHS would get the government support needed to deliver £22bn savings and said the ministers were “failing to support their own legislation” on health service competition. Bennett stepped down from his post last week, ahead of a planned merger of Monitor and the NHS Trust Development Authority to form NHS Improvement. Asked why he had not wanted to become chief executive of the new organisation, he said he had been at Monitor for nearly six years and there came a point in any such role where it was beneficial to have a change of leadership.
Juniors offered 11% pay rise on eve of strike ballot: The government has offered junior doctors an 11% pay rise, in the latest bid to settle the long running dispute on new contract negotiations — the day before the ballot on strike action was set to go ahead, reported OnMedica. Around three quarters of junior doctors moving to the new contract will see an increase in pay, with the remainder getting pay protection, the government said, adding that the offer builds on the “cast-iron guarantees” that the government has already set out on pay, working hours, and patient safety. Health secretary, Jeremy Hunt commented: “We again make the guarantee that no junior doctor working within the current limits will see a pay cut compared to their current contract. As we have consistently said, we will reduce the maximum number of hours that can be worked in any one week and are putting in place better safeguards, meaning the firm offer gives the best protection junior doctors have ever had against working long, unsafe hours.” Rob Webster, chief executive of the NHS Confederation, commented: “It is positive that we can now see some of the details of a new contract and be able to move this conversation on. Working together to agree a final contract is now the best way forward for all parties – and most importantly for the NHS.”
Opinion
The biggest cost to healthcare is not learning from best practice
The cost of the variation in healthcare provision in financial and human terms is becoming increasingly well-known, but technology can address this key challenge, says Vivek Patkar, cancer informatics expert, practicing oncoplastic breast surgeon and chief medical officer at Deontics.
“Too often there is a focus on short-term cost cutting measures. We should not focus on cutting costs, but rather focus on improving care. This can mean that short-term costs go up, but in the long term patients and the NHS will benefit.
“If you are using effective drugs for people with diabetes, for example, and are screening the patient and detecting something early, your short term costs will go up. You are, however, preventing long-term complications. This saves money in the long run.
“Unexplained variation is a symptom of inappropriate care. A recent study examining the treatment patterns and breast cancer survival rates among patients treated in ten east England hospitals, reported significant inter-hospital variation in five-year survival (ranging from 68 per cent to 77 per cent). It concluded that variation may be attributed to a lack of information.
“Variation is not always bad, of course. Sometimes there is good variation, and people need care specific to their condition. The crucial issue is to separate the bad variation from the good, and we have the technology that can handle that. By providing real-time access to best practice at the point of care and as part of clinical workflow, we can support the clinician in making the best decision to support an individual’s care needs.
“The evidence is out there; we can deliver better value in the NHS by reducing unwarranted variation. Technology and a paperless NHS can help make this a reality.
Fixing 111 is a matter of life and death
Non-emergency care responses must be better, says the editorial team at The Daily Telegraph and The Sunday Telegraph.
“If there were a train crash in which 25 people were killed, a major inquiry would be held into the causes and the event would be the subject of media speculation for days. Yet when the deaths are attributed to a scandal in the NHS the response is far more muted.
“Earlier this week, the Telegraph disclosed that as many as 25 patients may have died unnecessarily because of failings in the NHS 111 system. A leaked report found that South East Coast Ambulance Trust (Secamb) authorised a secret operation which resulted in thousands of calls – including those classed as “life-threatening” – being downgraded, thereby forcing patients to wait twice as long. Call handlers themselves were kept in the dark about the protocol and assured patients that an ambulance was on its way, unaware that it was not.
“Under NHS rules, calls designated as life-threatening are supposed to receive an ambulance response within eight minutes. But the trust allowed itself an extra 10 minutes to deal with some calls by “re-triaging” patients in the 999 system. The NHS watchdog Monitor has criticised the managers for failing to make a proper assessment of the policy’s potential impact before proceeding. An internal investigation is under way though, as usual, much of the detail is shrouded in secrecy.
“But this is not really about Secamb. The whole 111 system is in need of urgent reappraisal. Its principal weakness is that it encourages the sort of risks that the trust took in order to meet targets, a culture the Government wanted to abandon because it produces perverse outcomes. Additionally, this particular trust was facing “unprecedented call volumes” and “serious hospital handover delays” and was trying to adapt, albeit by endangering people’s lives. Effectively Secamb’s policy penalised patients for calling the non-emergency number.”
Redefining Technologies in the Quest for Patient Centricity
The role of PACS is accelerating away from being solely departmental specific, to being one that must serve cross enterprise needs and flows of both information and images, writes Sectra’s Chris Scarisbrick.
“It is true, some PACS vendors have historically used proprietary compression and communication, linking the software to specific modalities,” he writes. “Forward thinking PACS developers are however not going down this route, instead creating non-proprietary technologies that embrace standards in a very similar way to the vendor neutral archive (VNA).
“PACS is quite simply being redefined around customer needs so that specialities can still retain the specific functionality that they need to do their jobs, but so that the technology can also be accessed across the enterprise to allow patient centric ways of working.
“As the typical patient makes multiple trips around the hospital enterprise to various departments, most of these visits now have some manner of imaging or document attached to them. If we can pull all of that data into a single unified platform and display it as part of a common viewing toolset, then we can offer an incredibly powerful tool.”
Blog,
In this week’s blog our CEO Mark Venables reflects on EHI Live left many good impressions on what technology could and should achieve. Now the health IT community waits for the promise that 2016 may deliver.
