News in brief
Additional £240m for NHS IT: The Department of Health (DH) has announced that it has increased the size of the technology fund for improving access to electronic patient records, from £260m to £500m, reported Health Service Journal, (subscription required). Hospitals, GP surgeries and out-of-hours doctors will be able to access details with the aim of improving care, something the DH said it hoped would relieve pressure on accident and emergency wards. The cash will also be spent on systems to ensure all patients can book GP appointments and order repeat prescriptions online by March 2015, as well as giving patients access to their online GP record. The DH said the £500m, from the department’s existing capital budget, will be used to match local funding for the schemes over the next three years. Health secretary Jeremy Hunt said the failure of the National Programme for IT should not deter the NHS from taking steps to keep up with technological advances. He said: “The public are rightly sceptical about NHS IT after the failures of the past. But we can’t let past failures hold patients back from seeing the benefits of the technology revolution that is transforming services all around us. It is simply maddening to hear stories of elderly dementia patients turning up at A&E with no one able to access their medical history. That’s why I’ve set the NHS the challenge of going paperless by 2018.”
Better IT can reduce face-to-face GP appointments ‘by 30%’: Improved technology will help GPs reduce their face-to-face appointments by up to 30%, the deputy medical director at NHS England has claimed, reported Pulse. Dr Mike Bewick, warned that it would be expensive, but the other main barrier to increased technology – the low usage by very elderly patients – could be rectified. Speaking at the ‘Federations – the final frontier’ event, Dr Bewick said that by increasing access to good advice online, we could ‘transform the landscape of primary care’. He told delegates: “I estimate that you could reduce the appointments that you would do face to face by up to 30%. It would cost a lot of money. But if patients had access to the right advice online for many of the conditions we treat – especially the long-term and minor conditions – I think we could transform the landscape of primary care by doing that one thing well.” He said much of opposition to more technology came from the problems associated with Connecting for Health, the previous government’s project to increase the use of IT in the NHS.
NHSmail2 procurement this year: The procurement of NHSmail2 will start this year, using the Public Services Network (PSN) Framework. NHS England’s chief technology officer, Alex Abbott, told eHealth Insider that the organisation has extended its contract for NHSmail with Cable and Wireless until June next year. It expects to start a procurement for version two of the mail service towards the end of 2013. This will most likely be done by creating a secure email ‘lot’ on the PSN framework. The team leading the re-procurement had considered using the G-Cloud framework, however Abbott said current thinking was that PSN would be more appropriate. Suppliers will apply to be accredited for the secure email lot and NHS England will run a competition between them for the NHSmail replacement. “The PSN team will define the lot that will appear on the catalogue, and that will potentially be open to other government departments to use as well,” he said. The outcome is likely to be a single supplier for the new service. However, Abbott said that NHS England has done a lot of work with NHSmail users to find out what they want from the new service.
NHS England to publish trust-by-trust ‘never events’ list: NHS England is to publish quarterly lists of all the “never events” – the worst preventable mistakes – recorded in the NHS, broken down by trust, reported Nursing Times (subscription required). It will produce its first online list recording the number and type of incidents at each trust this October. Data has been collected from trusts since the start of 2013-14 financial year. The Department of Health has defined 25 types of never event, including surgery on the wrong area, misplaced nasogastric tubes and “maladministration of insulin”. Mike Durkin, NHS England’s director of patient safety, said the idea was to offer more detail on top of existing annual data that records the number of never events in different types of care setting. “NHS England intends to begin publishing more detailed data on never events on a more regular basis very soon, providing more frequent information on the numbers and kinds of never events that occur in the NHS as part of its wider commitment to transparency, but also to stimulate more learning and preventative action,” he said. Previously the BBC has reported that between 2009 and 2012 there had been 762 never events across the NHS, including 214 categorised as “wrong site surgery” and 322 as “retained foreign object post operation”.
GPs told to warn patients of imminent extraction of data from GP records: GP practices in the north of England have been told to warn patients that information from their GP record will be extracted in November, reported Pulse. NHS England has told practices to begin making patients aware that patient identifiable information will be extracted from their record through General Practice Extraction Service and made available in identifiable and de-identified form to commissioners, researchers and third parties such as private companies. The practices have been provided with guidance on the extracts and posters and leaflets to put up in the practice to inform patients of the changes, including their right to opt out of having their data extracted. NHS England said practices in other areas will be contacted in successive weeks. Once NHS England has written to practices they will have eight weeks to raise awareness among patients before the data is physically extracted, though an NHS England spokesperson said that they may allow longer for the first extractions to ensure patients are aware the extractions are happening. The news comes after the Information Commissioner’s Office announced that practices who fail to take reasonable steps to make patients aware of the changes could leave themselves open to legal action under the Data Protection Act.
3millionlives industry group axed: NHS England has axed the 3millionlives industry group as it “redefines” its vision for the campaign to have three million patients using telehealth and telecare by 2017, reported eHealth Insider. The industry group was set up to promote the government’s effort to recruit patients. It has 19 contributors, as well as four trade associations, including Intellect and the Telecare Services Association. The organisations have all committed financial resources to the 3millionlives initiative. The industry group will be replaced by a new group, called the Integrated Care for 3millionlives Stakeholder Forum, which will focus less on the technology industry. Dr Martin McShane, domain director for long term conditions at NHS England said the organisation had decided the industry group would no longer “operate in its current form”, but that representatives from the technology industry would still have a “significant presence”. He said: “A rapid review of its delivery to date has shown that stakeholders, including those in industry, felt the industry group’s existing model needed to change, to enable the 3millionlives brand to be associated with a much broader range of technology solutions and organisations.” 3millionlives was set up by the Department of Health, but responsibility for the scheme was transferred to NHS England shortly after the April shake-up of the NHS.
Nurses and midwives set to face three-yearly checks: Nurses and midwives in the UK look set to face three-yearly checks from the end of 2015 under proposals being put forward, reported the BBC. The Nursing and Midwifery Council (NMC) wants to see patients, colleagues and employers give feedback on performance. Those deemed not up to scratch face being barred from working, under the plans drawn up by the NMC. A similar system – albeit carried out every five years – was introduced last year for doctors. Currently it is up to nurses to declare themselves fit to practise. This is known as renewal. The proposals – known as revalidation – for the 670,000 nurses and midwives on the UK register have been under discussion for years. However the NMC, which has been struggling with a backlog of disciplinary cases over recent years, has struggled to push ahead with the change. Following the uproar over standards of care in the wake of the Stafford Hospital scandal, the NMC committed itself to coming up with firm proposals. These – set out in a board paper drawn up by the NMC’s leadership team – will now be discussed at a meeting of the regulator’s governing body next week. Health minister Dr Dan Poulter said: “I support the introduction of nurse revalidation, particularly in the wake of the Francis report, but recognise that any scheme must be tested to make sure it works for nurses and improves safety and quality of care for patients.”
George Eliot hospital takeover plans approved by government: Plans which could see a private firm run a Warwickshire hospital have been recommended for approval by the Department of Health, reported the BBC. The NHS Trust Development Authority (NTDA) said the George Eliot Hospital in Nuneaton could be taken over by “a non-NHS organisation” or another trust. It was put in special measures earlier this year because of major failings. The NTDA will decide whether to advertise for bids for the running of the hospital at a board meeting. If the hospital was to be taken over by a private company, it would become the second in two years after Circle Health took over the running of Hinchingbrooke Health Care Trust in Cambridgeshire in February 2012. The NTDA board paper said it would be “prudent” for services at the George Eliot hospital to be run by a “strategic partner” by April 2015. It said that “an open procurement process” should take place in order to attract proposals from another NHS trust or private companies. A statement on the trust website said: “We are not in the position to achieve foundation trust status as a standalone organisation, due to financial and clinical considerations.” It said merging with another trust or a private company was “the most appropriate option”.
Quarter of GPs offer Patient Access: A quarter of GPs in England are now actively using EMIS’ Patient Access, which can be used to give patients access to their records and transactional services such as online booking, reported eHealth Insider. EMIS said more than 385,000 patients are now using the service. This is a rise of 40% over the past year. Many more practices are using the booking and repeat prescription functionality than the access to records functionality. Take up for this has been very low so far, despite repeated government pledges to provide access for all patients who want it by 2015, and new financial incentives for doing so. EMIS managing director Neil Laycock told eHealth Insider there are some “hotspots” where GPs are offering patients access to their records, but “it’s very much about whether people switch it on or not and thus far in the journey people are looking more for transactional services. EMIS said the boost in Patient Access registration has been helped by the launch of a Patient Access app, which has had nearly 30,000 downloads since March. Dr Anant Sharma, a partner at Bilston Health Centre in Wolverhampton said: “We make 100% of our appointments available each day for online booking. It saves on trips to the surgery to request and pick up repeat prescriptions. Patients can also securely message the practice with non-urgent queries and requests, avoiding phone calls or a GP appointment. Age is no barrier. Our oldest Patient Access user is 91.”
Legacy of care claims liabilities threatens CCGs’ finances: Department of Health (DH) records show that clinical commissioning groups (CCGs) may have inherited unfunded liabilities for hundreds of millions of pounds worth of continuing healthcare claims made before they came into being, reported Health Service Journal, (subscription required). The net value of the “contingent liabilities” in primary care trusts’ accounts rocketed to £660.5m in 2012-13, up from just £55.6m in 2011-12. According to the DH’s annual accounts, in which the figures are revealed, the Primary Care Trusts’ (PCTs) contingent liabilities are “mainly in respect of continuing care liabilities”. The news is likely to prove controversial with clinical commissioners, who warned last year that PCTs should not be allowed to record significant contingent liabilities in their final year before abolition. A spokeswoman for NHS England said there were “no indications at this stage of a systematic shortfall” in the provisions PCTs had made for care claims, but the organisation would be “continuously monitoring this through the year.”
Misleading the PAC ‘very serious’: A member of the Public Accounts Committee (PAC) is looking at whether the Department of Health (DH) provided it with misleading information about the release of a final benefits statement on National Programme for IT (NPfIT), reported eHealth Insider. eHealth Insider revealed this week that the DH website says it released its final report on the benefits of NPfIT in June, six days before it told the PAC that it would not be available until September. The statement is the DH’s response to a request by the committee for it to release the promised statement that was made in August 2011. At a meeting on 12 June this year, PAC chair Margaret Hodge and member Richard Bacon questioned Tim Donohoe, the DH’s senior responsible owner for the local service provider programmes, about when the benefits statement would be made public. “We are working through to validate because we do not want to put in the public domain information that is incorrect. I think that we are probably three months away from being able to publish,” he answered. Bacon told eHealth Insider this week that it is “very odd” that it looks as if the DH had already published the report when Donohoe said this. He said he would talk to Hodge about how to proceed, adding that putting forward incorrect information to the committee, or failing to mention that information is available, is a very serious issue. “It’s the kind of behaviour that one has come to expect from what’s left of the national programme. To say they were a model of clarity and honesty would be stretching the point,” Bacon said.
Dr Joel Ratnasothy joins Caradigm as medical director for EMEA: Caradigm, an international healthcare IT company founded as a joint venture between GE Healthcare and Microsoft, has appointed Dr Joel Ratnasothy as medical director for EMEA, reported Building Better Healthcare. “Dr Ratnasothy will play a vital role in supporting Caradigm across the EMEA region in line with our strategy to create a sustainable international business,” said Dr Brandon Savage, chief medical officer and senior vice president of product strategy. “But more importantly,” he added, “we will be able to draw on his broad knowledge, accumulated both through clinical practice and healthcare industry experience, to increase clinical engagement and to ensure our customers receive the most-advanced solutions to deliver against the challenges they face.” Dr Ratnasothy said of his appointment: “I have long believed in the potential of technology to improve the way we diagnose, treat and prevent disease. My previous experience as a doctor in the NHS and as an academic research fellow at Imperial College London has given me valuable insights into how technology can improve the quality and efficiency of clinical care.”
Personal health budgets to drive decommissioning of NHS services, says think-tank: Clinical Commissioning Groups (CCGs) will need to decommission unpopular services to make personal health budgets work when they are rolled out to all patients with long-term conditions in 2015, The Nuffield Trust has warned. The leading think-tank says services that are not chosen by budget-holders will have to be decommissioned, but done at a pace that prevents the market from shrinking, reported Pulse. The new report, entitled personal health budgets: challenges for commissioners and policy-makers, also says there will need to be new infrastructure around budget setting and care planning, but this will need to be found in existing budgets. The personal health budgets scheme is due to be rolled out by April 2014 to 56,000 patients on continuing care and be offered to anyone with a long-term condition who could benefit by 2015. However, it has proved controversial, with pilots of the scheme drawing criticism after a Department of Health report revealed that patients were using their budget to buy theatre tickets, ready meals and complementary therapies. The Nuffield Trust report said that pilots have ‘barely exceeded 100 people’ using the scheme and that using them at scale will present new challenges for CCGs.
McKesson UK to be sold before New Year: McKesson’s sale of McKesson UK, including the business it acquired with System C and Liquidlogic, is due to be finalised by the end of the year, reported eHealth Insider. The US company announced its intention to sell its International Operations Group business in May this year. A senior McKesson spokesperson told eHealth Insider that the company hopes to finalise the sale of the group, which is made up of three divisions – McKesson UK, McKesson France and McKesson Netherlands – before the New Year. The company is also making structural changes to its health and social care services business, which has led to “some redundancies”. However, the spokesperson insisted these were unrelated to the sale. “There have been plans in place for a while to make some structure changes to better respond to customers and bring them together under a single chain of command,” he said. McKesson is one of the biggest patient administration system suppliers to the NHS with its legacy Totalcare and Star systems. These systems are deployed at 26 trusts, many of which have used the system since the late 1980s and early 1990s.
Opinion
Councils need to build on their successes in integrated health care
In the Guardian this week Simon Morioka, managing director at PPL and senior adviser at Integrating Care, discusses how health and wellbeing boards will fix the gaps between shared objectives and separate structures in health and social care.
“Another week, and another report provides a reminder of how local government is changing. The report In Sickness and in Health from the independent thinktank Localis, reflects the growing recognition of local government’s role – working hand-in-hand with health commissioners, healthcare providers and local communities – in driving better health outcomes.
“However, the report also recognises many of the difficulties faced by those responsible for making this work in practice. To understand the opportunities and the challenges involved, it is important to understand the broader context within which these changes are happening.
“This summer saw the launch of the Local Government Association’s support for health and wellbeing boards seeking to integrate care at scale. Working with partners, including NHS England, Monitor, the Department of Health and Integrating Care, this is about providing practical help to identify opportunities, overcome barriers and implement the new models of working that promise the biggest improvements for service users and organisations alike.
“At the heart of the association’s work is the recognition that many local authorities and their partners have already made good progress in bringing together services. Learning from what has been achieved, and making it the norm, is our best chance of meeting the challenges ahead.”
‘The tectonic plates of healthcare are moving’
In the Guardian this week, Dick Vinegar, the Patient from Hell, discusses the delicate path that the new chair of the General Practioners Committee, Dr Chaand Nagpaul must tread.
“The tectonic plates of healthcare are moving, whether individual clinicians like it or not. Patients are getting older and more demanding and the younger ones are adopting ever unhealthier lifestyles. Hospitals will be reconfigured, A&E departments will be “consolidated” (ie closed). Drop-in centres will spring up; the private sector will come up with innovative ideas (mixed in with dollops of snake-oil). Social care and general practice will converge. GPs will have to learn new skills, like diplomacy and how to work with other people, to cope with it all. Dr Nagpaul has to show real leadership to point his unruly members forwards not backwards. Then there is the pressure of money (saving £30bn) and time.
“There is another challenge for Dr Nagpaul. Healthcare technology is moving fast, but GPs – and clinicians in general – have historically been obstructive. In these columns, I have often deplored the lack of email between doctor and patient, when the rest of the world uses email pervasively. When I see how dependent my GP is on my electronic patient record (EPR), I am shocked that out of hours practitioners are not given access to the GPs’ records. This is a recipe for inappropriate treatment. And similarly, the opposition by clinicians on doctor/patient confidentiality grounds, to the summary care record, seemed to me to delay the adoption of electronic patient records by five or more years. Some senior doctors are currently trying to rubbish telehealth, without realising the benefits.
“IT people get mad ideas from time to time, and need a restraining hand, and there are security problems with EPRs, but it is up to clinicians to engage with IT people to sort them out in pursuit of the greater good. Dr Nagpaul must somehow persuade GPs to engage positively with technology. He must get a new generation of young IT leads to help him. Everybody under the age of 35 is a digital native nowadays. And older GPs should get some training.”
Government procurement strategy is blocking NHS value for money
Also in the Guardian this week, Malcolm Preston, associate director of procurement at County Durham and Darlington NHS Foundation Trust asks why should trusts seek to collaborate when they are placed in competition over provision of health services?
“If we pooled all of the expertise within the NHS, we would have one of the best-equipped and most capable procurement teams in the world. It would hold all the cards to find cost savings while improving services for patients. The problem is that we don’t pool expertise.
“NHS procurement needs more than a makeover. It requires fundamental changes in attitude to cope with the conflicting priorities of competition and collaboration. The entire clinical strategy is geared up to seek best value services in a competitive market, but the national procurement strategy says we should be collaborating. Why should trusts seek to collaborate with each other when they are increasingly in competition on the provision of health services?
“We should be pooling information and working together to drive best value and standardised quality through supplier contracts. This would give the entire NHS a quality baseline in terms of the services they deliver. Competition then comes into the equation in terms of service and specialisation in different trusts, but not in terms of price and not at the cost of squandering quality standards. My personal approach to NHS procurement would be to split the strategy on an 80:20 basis between single national contracts and areas that remain open to competition.
“Until the NHS as a whole has a level of visibility through its systems and software it will be difficult to build a strategy that delivers simply because could be founded on inaccurate information. As a sector, we need a change of culture to affect a strategy led first by quality standards and second by selective competition. Until that happens, the NHS procurement makeover will prove little more than skin deep.”
More money isn’t enough
Mike Farrar, chief executive of the NHS Confederation argues in his latest blog that money alone is not enough to relieve the intense pressure being put on NHS A&E departments.
Farrar gives a brief insight into an NHS Confederation survey due out in the coming weeks, which provides a snapshot of the pressures facing NHS organisations in urgent and emergency care.
“Winter is coming and there are growing concerns among our members that many emergency departments will buckle under the strain….If we are going to tackle these problems, we need change across the whole service. Anything else is just papering over the cracks.”
He highlights that the government’s recently announced £500 million to help struggling emergency departments prepare for winter is likely to be too little, too late.
“Extra money from the government to help ease these pressures is of course welcome. But on its own this cash won’t be enough. For one thing, our members tells us that the winter funding money they receive is often given too late in the year to allow them to plan effectively. Allocating this funding earlier in the year would be a simple way to make a big difference.”
Farrar adds that any investment must be spent on things that reduce the demand for urgent or emergency care.
“That could mean better help for people with long-term conditions, like diabetes, to manage their condition effectively. Or it could mean money for falls services, which help prevent vulnerable, older people from falling over in their own homes – a big cause of many emergency admissions.
“A key part of this will be creating incentives for NHS organisations to focus on prevention, and to invest in services outside of hospital, which are better suited to people’s changing needs. “
Highland Marketing blog
In this week’s blog Sarah Bruce asks whether or not clinical engagement in NHS IT should have an end point?
