News in brief
NHS will be dependent on EHRs – Hunt: The health service will become “totally dependent” on electronic health records (EHRs) over the next five years, health secretary Jeremy Hunt has said. Speaking at a Cambridge Health Network event this week alongside NHS England’s director of patients and information Tim Kelsey, Hunt said 2013 had been a tough year for the NHS, but he is feeling “very optimistic and very encouraged” about the strides made in terms of transparency, reported eHealth Insider. He said three things will become an “absolute given” over the next five years. The first is that the health service will become totally dependent on electronic health records and people will wonder how they ever lived without them. “You’ll be able to talk to an NHS 111 operator or email a GP you haven’t met before who will know enough about you to make it a meaningful interaction because they will have your medical history,” Hunt explained. He promised that by the end of 2014, at least one third of A&Es should be able to see the GP records of their patients and at least one third of 111 services should be able to access the GP record of callers. The second big development is that “care.data will be absolutely massive”. The care.data programme will link an expanded set of Hospital Episode Statistics with a new monthly collection of GP data to create Care Episode Statistics and the third big change will be patients taking charge of their own “health destinies”. Giving patients access to their own records will push forward the self-care agenda and there is a lot of excitement about the opportunities that will bring, Hunt said. “Put those three things together and we should be a lot more excited and optimistic and hopeful,” he told attendees. “The trigger is that money is tight and when used well, technology can help use resources much more effectively.”
NHS admits it should have been clearer over medical records-sharing scheme: The NHS has conceded that it should be clearer about how patients can opt out of a controversial scheme to share their medical records in a single English database, reported The Guardian. Patients have until March to opt out of the system, which is aimed at improving research into the outcome of treatments, and will allow drug and insurance companies to buy “pseudonymised” medical information about them. Last month, all 26m households in England were sent leaflets about the care.data scheme as part of an information campaign. On Tuesday, the information commissioner’s office criticised the campaign for failing to adequately explain what data was involved and how patients could avoid their medical records being shared. Speaking on the BBC Radio 4’s Today programme, Dawn Monaghan from the commissioner’s office said: “At the moment we don’t think it is clear enough on the website, or on the information that has been sent out, exactly what data is going to go and what is not going to go. What it says is that you can object to your personal confidential data leaving the GP surgery. We are not sure that without further explanation… people will understand what the means.” Tim Kelsey, the NHS national director for patients and information said: “Maybe we haven’t been clear enough about the opt-out; I agree with that. Let me be absolutely clear now,” he told Today. “People who don’t trust the NHS to manage their data securely now have a new right to opt out of this scheme. To be honest, all they need to do is contact their GP to opt out.”
‘Francis Effect’ on NHS care one year on from Mid Staffs Inquiry: Figures show that NHS care has changed for the better just one year on from the Francis Inquiry into Mid Staffordshire, health secretary Jeremy Hunt said at a conference in London. He spoke about the ‘Francis Effect’, with improvements including failing hospitals being put on the road to recovery, more nurses on the wards, more doctors, and feedback direct from patients changing the way hospitals work, reported The Department of Health. Jeremy Hunt said: “Twelve months on, we cannot expect to have solved everything or to have completely transformed the culture of the country’s largest and finest institution. But we have seen a real shift in priorities – new inspections, more nurses and a stronger voice for patients, with compassionate care starting to replace tick-box targets as the major focus on boards and wards. Our goal is safe and compassionate care as the hallmark of every hospital and experience of every single patient and family.” The health secretary highlighted a number of changes since the Francis Inquiry, including: An extra 2,400 hospital nurses hired since the Francis report, with over 3,300 more nurses working on NHS hospital wards and 6,000 more clinical staff overall since May 2010, 14 hospitals in special measures are being turned round, with 650 extra nurses and nursing assistants hired in those hospitals, strong leaders installed, and 49 board level managers replaced and nearly 1.6 million patients have given direct feedback on what they thought about their treatment through the Friends and Family Test.
Tech fund money released this week: The first release of money from the £260m ‘Safer Hospitals, Safer Wards: Technology Fund’ was expected this week. NHS England’s head of technology strategy Paul Rice, told eHealth Insider that the first trusts are a “whisper away” from getting their money and urged the rest to get their memorandum of understanding (MoU) signed and returned. “The first trusts should be getting the resources within the next week and everybody else who has been approved should be getting MoU signed and in time to release the resource,” he said. Projects worth around £210m have been approved by NHS England in the first round of funding and £90m of this money must be spent in this financial year. However, trusts and suppliers have expressed concern about the tight timescales involved in getting £90m spent by April. Rice confirmed that a significant number of projects are still awaiting final sign-off from the Treasury as they had to re-submit their ‘value for money’ (VFM) cases before Christmas. Rice said these trusts have draft MoUs so they can move forward quickly as soon as they get the nod from the Treasury. However, he said that trusts that have received approval for projects will not simply lose out if they cannot spend their assigned funding by April. The vast majority of successful projects are getting money in both this and the next financial years and cannot simply be abandoned. “We need to agree implications of what happens to organisations that haven’t spent the money,” he said.
Information centre strategy signals ‘turf war’ with NHS England: The Health and Social Care Information Centre is drawing up a technology strategy in a move predicted to put it on a collision course with NHS England. The move was outlined in the information centre’s business plan for 2013-15, discussed by its board in October and formally published this week. The document said: “Over the next 18 months we will develop, with our partners, a national technology and data strategy… to be published in summer 2015.” The information centre’s goals include ensuring integrated digital care records become universal at the point of care and helping care providers select IT systems. The document said the technology strategy would be “developed with our partners”. However, a well informed source told Health Service Journal (subscription required) a “turf war” was intensifying between the two bodies over NHS technology. The source said it was being referred to as “the battle of the two Ks”, referring to NHS England’s national director for patients and information, Tim Kelsey, and the information centre’s chair, Kingsley Manning. NHS England’s business plan for 2013-14 to 2015-16, published last May, said it was producing a technology strategy that would “set the direction for NHS technology and informatics… in co-production with key strategic partners.” The information centre’s plan said its mandate is to manage “any programme or technical services for the health and social care system as directed by the secretary of state or NHS England”. While NHS England is its commissioner, it directly answers to the Department of Health.
New streamlined patient safety warning system for NHS launched: NHS England has launched a new streamlined patient safety warning system in a bid to speed up the dissemination of emerging risks across the NHS. Trusts who fail to act within the timeframes set for action will be named and shamed, revealed OnMedica. Until now, information about risks identified through the National Reporting and Learning System (NRLS) has been issued through a range of different channels, including Patient Safety Alerts and Rapid Response Reports. However the development, consultation, and agreement process was lengthy, which inevitably sparked delays. The new National Patient Safety Alerting System (NPSAS) has three stages and is based on those used in other high-risk industries like aviation. A Stage One “warning” alert is issued to ensure healthcare staff are made aware of the potential issue at the earliest opportunity. This allows hospitals, clinics and other healthcare organisations to assess similar risks, and take immediate action. If the Stage One alert requires further action, a Stage Two “resource” alert will follow, with more in-depth information and advice. Stage Two alerts will include examples of good practice to mitigate the risk; access to resources to help introduce new measures to reduce risks; and access to relevant training. If necessary, a Stage Three “directive” alert will be issued, requiring organisations to confirm that they have undertaken specific actions and introduced specific processes to mitigate the risk. Providers will be issued with a checklist of required actions, tailored to the individual issue, and will need to confirm these actions have been taken within a set timeframe.
Better info needed for Francis response: NHS trusts may be struggling to collect and process the information they need to respond to the Francis Inquiry into the scandal at Mid Staffordshire NHS Foundation Trust, reports eHealth Insider. A report by the Nuffield Trust, published this week to mark the first anniversary of Robert Francis QC’s second report into high death rates and poor care at Mid Staffs, says managers have recognised the need to collect both hard and soft data about what is happening at their organisations. The report, based on interviews with unnamed senior staff at unidentified trusts, says they were concerned with implementing Francis’ recommendation to collect real-time data from wards and clinical specialities, and to make better use of complaints and ‘soft intelligence.’ However, it says they are struggling to obtain hard, quantitative data and to decide how to balance it with less formal reports. At one trust, interviewees complained there was a danger of “information overload”, particularly for boards, which tend to demand streamlined performance reports. The Nuffield Trust also notes that the increased scrutiny of trusts by regulators has also created new data collection problems. “In some cases, the collection and validation of data needed by these external bodies was proving onerous for hospitals.”
Councils boost care fund pools: Several councils are planning to pool their entire adult care budget with the NHS in one of the biggest boosts to the integration of care between the two sectors to date, it has emerged. The plans – uncovered by Health Service Journal’s (subscription required) sister title Local Government Chronicle – would result in the value of the government’s better care fund, designed to boost care integration, rising by up to 849% in individual areas. Birmingham City Council, Sunderland City Council and Oxfordshire County Council have all developed proposals to share their adult care funding with the health service, with clinical commissioning groups (CCGs) adding to the shared pot. The London “tri-borough” area – featuring Westminster City Council, Hammersmith and Fulham London Borough Council and Kensington and Chelsea London Borough Council – is planning to take similar steps, over a longer time period. It is understood that the Department of Health is not yet aware of the councils’ plans, which are due to be submitted to NHS England by next Friday, the deadline for draft submissions under the £3.8bn fund. Under the fund – details of which were outlined in December – councils and CCGs must share a £3.8bn pot – about 3% of total health and care spending – and work together to protect social care and reduce hospital admissions.
Scottish healthcare professionals access patients’ Key Information Summary through clinical portal: A third of Scotland’s NHS health boards can now view more comprehensive information about their patients’ condition, treatment and choices following the integration of the Key Information Summary (KIS) with their clinical portal, reported Building Better Healthcare. The integration will enable organisations that are part of Scotland’s South-East Consortium which includes NHS Lothian, NHS Dumfries and Galloway, NHS Fife and NHS Borders, to improve communication between primary, secondary and out-of-hours care and enable key information and patient wishes to be more easily and quickly available to the appropriate healthcare professional. The clinical portal, provided by Capita Managed IT Solution’s and Harris Healthcare, has already brought together disparate electronic information held within an acute care setting such as treatment plans, clinical letters, results and observations into a single, intuitive screen. The latest development means that the entire KIS created by a patient’s GP can be viewed seamlessly alongside this information. David Lawson, project manager at Harris Healthcare, said: “We are keen to support Scotland’s eHealth strategy. Integrating KIS with the portal will help to improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve the quality of patient care. This development demonstrates how easy it can be to improve the patient experience by sharing information about their current medical status and, of equal importance, ensuring they have choice through having their care-related wishes recognised.”
HSS management backed by Elysian: Wellbeing Software Group, a healthcare technology provider formed of three business units, including HSS, has been taken over by its management with the backing of Elysian Capital, reports eHealth Insider. Wellbeing’s management – chief executive Craig Smith, Chris Yeowart and Steve Avery – secured the buy-out with the backing of the private equity firm. HSS, whose principal product is a radiology information system (RIS), is the biggest of Wellbeing’s three business units. In the recent refresh of RIS and picture and archiving communication systems to the NHS in England, HSS won contracts to supply its RIS product to 59 trusts. Wellbeing’s other two business units are EuroKing, which supplies hospital maternity systems, and Apollo, which provides a primary care data extraction service. Elysian Capital is an independent, private equity firm that specialises in investing in the UK lower mid-market in deals of between £10m and £100m. It is investing alongside Wellbeing’s management team. Smith said: “We are very pleased to have concluded this acquisition with Elysian Capital, who share our vision for the future growth and development of our suite of market leading businesses. Wellbeing and its software products provide a critical service to support the delivery of healthcare in the UK. We believe that, with the help of Elysian Capital, we can expand the range of products we offer and improve the services we provide to our customers. Smith added that it was very much a case of “business as usual” for Wellbeing customers.
Low opinions of local authority health integration revealed: Public health professionals claim decisions made at local authorities are being based on politics rather than evidence, and that ring-fenced health budgets are not being reserved for healthcare, revealed The Commissioning Review. Three quarters of respondents to a survey conducted by the Royal Society of Public Health (RSPH) also suggested that financial restrictions are impacting their team’s ability to deliver health improvement initiatives. Views were mixed about the role of health and wellbeing boards. Only 15% of professionals believed the change to providing public health in local authorities has had a positive impact on health improvement outcomes and over half did not believe in the potential of the new system to improve health or reduce health inequalities. The report raises concerns and highlights the cultural shift being experienced by public health teams with over 80% of respondents suggesting additional influencing skills would help them demonstrate their effectiveness within this new environment. The respondents had a sense of ‘business as usual’ with limited evidence of any innovative approaches being used. Shirley Cramer, RSPH CEO said: “It is widely understood that the transition of public health into local authorities has great potential to provide improvements in the public’s health and particularly on health inequalities and while we recognise that it will take time for a new system to be fully functional, this report has highlighted some areas of concern. We want to ensure that public health remains at the top of local authority agendas if we are to make a dent in health inequality.”
England’s largest NHS Trust rolls out cloud-based workforce management system: England’s largest NHS trust with over 15,000 staff is consolidating a number of existing workforce management systems into one new cloud-based platform provided by Allocate Software. Barts Health formed in 2012 when six hospitals with a variety of tracking and rostering tools merged. The trust aims to replace existing paper records and spreadsheets to rota all staff groups including nurses and medics, reported ComputerWorldUK. It believes that the new system will help to reduce expenditure and reliance on Bank and Agency staff, with the aim of employing 95% permanent staff going forward. Human Resources Director at Barts Health NHS Trust, Michael Pantlin said: “The trust believes its employees, our staff, are our most valuable resource. By integrating how we manage staff and patient numbers across our hospitals we will have greater visibility and control of our staff groups, ensuring we have the right staff to care for patients in the right place and at the right time. “The online software will also give teams instant access to real-time staffing levels, patient numbers and the acuity and care needs of these patients, as well as schedules of clinical activity such as clinics and theatres.”
Top 5 high-tech health trends to watch in 2014: As the world of mHealth continues to grow, so does the sundry of medical apps, programs, gadgets and gear being created as a result of the technological-health push, reports Healthcare Global. It is no doubt that the release of Nike’s FuelBand and the Fitbit, the market is projected to grow 100 million units by the end of 2014 alone. Mashable recently reported the numbers of mobile health technology from 2013, demonstrating the pull that mobile technology maintains over the development of healthcare needs. “According to mobile tech consultancyResearch2Guidance, there are now close to 100,000 mobile health apps in 62 app stores, with the top 10 apps generating over 4 million free downloads every day.” 2013 will forever be marked as the year of the wearables and health apps. In 2014 things to look out for include: personal health monitoring, smart clothes (more wearables), augmented nutrition, virtual health calls (general telemedicine) and health rewards.
Opinion
The six challenges of joint working
In the Guardian this week, Bob Hudson explains that service users want better joined-up care and frontline staff are keen, but problems lie further up the policy food chain.
“We could be forgiven for thinking we are entering a healthcare partnering nirvana in England these days, with the arrival of various initiatives such as the Better Care Fund, the integration pioneers, health and wellbeing boards and the rest. There is no doubt that there is a need for better joint working, but these initiatives and structures have to be set against the scale of the challenges – and there are six big ones.
- “Moving from horizontal to vertical integration
- “Moving from institution-centred to community-centred relationships
- “Moving from an economic to a quality focus.
- “Moving from an organisational to a user-centred perspective
- “Moving from structural change to cultural change
- “Moving from statutory to inter-sectoral partnerships
Hudson concludes: “that partnership working is not just a technical task, but the reflection of an ideological stance. A commitment to partnership working is also a belief in planning and in the idea that it is possible to work in a “whole system” way as long as there is some degree of stability, knowledge, support and commitment to doing so.
“Instead, we are seeing apartheid between commissioners and providers. Legal threats to in-house contracts and competition law are being used to outlaw even talks about service rationalisation.”
Commissioners are the bridge builders for integrated care
In this week’s Health Service Journal, Charles Waddicor, an independent health and social care consultant, explains that bold collaboration between different players in the system is urgently needed for integrated health and social care to work.
“Across the world, too many people are going to hospital for treatment because it is too late for other community interventions to work. Patients often stay in hospital too long and primary and community services struggle to provide adequate support to keep them well in their own homes. Most policymakers recognise this position is unsustainable and that some form of collaborative working between system players is urgently needed.
“Efforts by Norman Lamb, minister of state for care and support, to bring this about through integrated care pilots are to be sincerely welcomed. However, unfortunately the evidence base for health and social care collaborating to achieve good outcomes for patients within the shrinking funding envelope is weak.
“Collaboration is liked by patients but the impact of integrated services on reducing emergency hospital admissions, which is the key to resourcing extra capacity elsewhere in the health and social care system, seems to be very limited.
“Social care needs additional resources to be able to afford the capacity to support patients at home. In the current economic and political environment this must come from within the existing health and social care system.
“We should see the review of personal medical services contracts by NHS England as an opportunity to push for change. So for the system to reform it needs to draw in primary care delivery as well as the other players in the system.
“Commissioners need to be bold and have the support of policymakers. Whilst Mr Lamb’s efforts are welcome, they are unlikely to be enough in scope or urgency on their own.”
Another view – Dr Neil Paul
In eHealth Insider this week, Dr Neil Paul, full time partner at Sandbach GPs, weighs up whether suppliers to GPs and other healthcare providers who become too monopolistic should be broken down.
Paul questions the impact on access and ownership of data by current GP suppliers: “For years now, they have been migrating practices onto the so-called ‘enterprise’ or ‘cloud’ version of their systems. And there are clear advantages to having one, big, scalable server in the sky to thousands of servers in every practice.
“However, this does mean that companies that should be concentrating on delivering usability and functionality are spending a lot of their time delivering scalability, reliance, performance; and all the other server type stuff.”
Paul concludes by discussing the impact of the new GP Systems of Choice, or GPSoC2: “They are not planning to break up the existing IT companies. But they are demanding a common, consistent application programming interface framework that all future suppliers will have to sign up to.
“To begin with, this will cover basic functionality. But, in theory, it should be rich enough to allow third parties to interact with any system, encouraging the development of a richer third party market.”
Will the NHS start to put the patient first in 2014?
There is much talk about the need for cultural change in the NHS. This week Dr Mark Newbold, Chief Executive of Heart of England FT, asks what might this mean in practice?
“In my trust we asked Sir Ian Kennedy to examine how harm to patients was allowed to continue despite numerous warning signs and significant investigative activity. He reported in December, and it makes salutary and compelling reading. A key message is that we have some way to go before we can claim to have a culture in which the patient comes first. Sir Ian’s review describes how concerns raised by senior doctors were heard but not acted upon, and when they were the action taken was to investigate the professional concerned, rather than to protect the patient. The harm continued and, as the process was a disciplinary one, it was confidential so that staff members who had raised concerns were unaware of what, if any, action had been taken.
“The investigative focus was on technical aspects, when actually the behavioural and probity aspects were more alarming. Non-Executive Directors were largely unaware, because of the confidentiality around the process, so there was no ‘lay’ scrutiny. And in the absence of good data, recall of patients for individual review was very limited. In short, the benefit of the doubt was given to the professional and to the organisation, and not to the patient.
“After 60 years, our health service still has a professional culture. Hospitals are structured around medical specialties, usually based on a single organ. Specialists are recruited according to technical and academic criteria, with little or no regard paid to team working skills, or empathy, or even safety awareness. Once appointed, doctors may prefer to identify with a specialty body, rather than with their employing organisation. Some feel they work ‘at’ the hospital rather than ‘for’ it.
“Few will disagree with the sentiment, but the actions are challenging because they will mean changing working practices that have become established over 60 years. This may present a financial risk, and targets and standards may be missed, with all the regulatory consequences that follow. But the genie is out of the bottle, so there is no turning back now. We must embark on this path, for the reasons that Francis, and Berwick, and now Kennedy (again) describe so clearly, and because it is the right thing to do.”
Highland Marketing blog
In this week’s blog, Kimberley Robinson asks whether naming and shaming underperforming hospital trusts is really the way to improve patient safety.
