News in brief
Info revolution to transform NHS: The promised ‘NHS information revolution’ could be the biggest driver for change in the health service, NHS Confederation chief executive Mike Farrar told the organisation’s conference, reported eHealth Insider. Giving the first keynote speech at the event in Liverpool, Farrar said the NHS was under immense strain. A quarter of respondents to the organisation’s annual survey said the financial situation was “the worst they have ever seen” and pressure was showing up in over-stretched A&E departments. In response, he urged managers and politicians to step-up and make some of the reconfiguration and integrated care changes that have been talked about for many years, but not carried through. Farrar said the NHS Confederation would support change, not least by putting money into the system. This week, it will launch an equity fund that could be worth up to £250m to support the development and spread of innovations, including IT systems. He also argued that the NHS transparency agenda would help to make the case for change that, at the moment, was often hotly contested locally. “The most important thing to come out of the Francis report is the call for transparency,” he said. “Transparency is a great thing. It will expose variation and will make the case for reconfiguration more effectively than years of public consultation.”
Sir David Nicholson announces major review of NHS strategy: NHS England chief executive Sir David Nicholson has told HSJ (subscription required) it is time to question whether “the straightforward commissioner-provider split” is the best way to organise care for some communities. He also called for the “cookie cutter” policy of all NHS providers becoming foundation trusts to be abandoned. Sir David announced a major review of NHS strategy in an exclusive interview with HSJ in the run up to this week’s NHS Confederation conference. Sir David, who has announced he will retire by March next year, insisted he would not be reaching for his “pipe and slippers” in his remaining months in the post. He said NHS England’s strategy would seek to “liberate” the service to “experiment” with a range of solutions to challenges faced by the NHS. “The idea you could have one model in a sort of Stalinist way driven from the centre seems out of kilter really with the kind of NHS we want to create,” he said.
Confed finds venture capitalists to fund innovation: The NHS Confederation is working with a venture capitalist firm to seek private backing for innovations in the NHS, reported HSJ (subscription required). In an exclusive interview with HSJ, Mike Farrar, NHS Confederation chief executive said: “NHS Confederation’s health innovation directory initiative has appointed a fund management firm to attract investment for the “90-plus” ideas which had already registered with it. The directory is intended to get private backing for NHS innovations which could later be sold outside the UK.” Mr Farrar said the directory was now working with venture capitalist firm Apposite Capital, which specialises in healthcare investments.
Hunt talks up NHS IT projects in US: The government’s plan to sequence 100,000 human genomes and link these to electronic health records will be “as significant as the founding of the internet”, health secretary Jeremy Hunt said at a US conference this week, reported eHealth Insider. Hunt was speaking at the Health Datapalooza event in Washington to an audience of policy makers and technology companies. He said: “If a person has bowel cancer in his 70s and you have EMR data about what that person was doing in his 40s and 50s, you can unlock an incredible amount of information.” He told the audience that the UK was in the third stage of technology’s transformation of health care.
98 per cent NPfIT benefits unrealised: Ninety-eight per cent of the estimated benefits of several high-profile National Programme for IT (NPfIT) programmes are yet to be realised, according to the National Audit Office, reported eHealthInsider. However, the Department of Health (DH) believes that benefits will slightly exceed costs over the whole life of the systems implemented. In a note for the Commons’ Public Accounts Committee, the National Audit Office says that 98% of estimated benefits of the London Programme for IT, the South Programme for IT and the Electronic Prescription Service and Summary Care Record programme, were still to be realised at March 2012. The note, which reports on a much-delayed review of the benefits of the programme demanded by the Public Accounts Committee when it investigated NPfIT in August 2011, says that in March 2012, the DH put the total cost of the programme at £7.3 billion. It put the total benefits at that point at £3.7 billion. It estimated that by the end of the programme, the total costs would be £9.8 billion and the benefits £10.7 billion.
Integrated care remains a long way off, say NHS managers: Little progress has been made on integrating health and social care services in England, which risks making services financially unsustainable in the future, senior NHS managers have warned, reported Public Finance. In a survey by the NHS Confederation, 93% of 185 NHS chief executives and chairs said only ‘slight progress’ or ‘no progress’ had been made towards integration with social care services provided by councils. A majority (61%) warned this could lead to services becoming unsustainable. This follows the pledge to better integrate care signed by the Department of Health, the NHS and local authorities last month. The survey also found that a quarter of respondents (26%) were not confident of meeting their savings target over the next 12 months. As part of the Quality, Innovation, Productivity and Prevention programme (QIPP), the NHS in England needs to make £20bn of productivity improvements by 2015. Confederation chief executive, Mike Farrar said the results showed ‘serious concern about the underlying challenges facing the NHS and the pressures building on services’.
Link between doctors and patients is broken, Jeremy Hunt says: The problems facing overstretched Accident and Emergency services are “scandalous”, the health secretary admitted, suggesting one way to save the NHS is to make family doctors take more responsibility, reported The Telegraph. His comments come after Professor Clare Gerada, chair of the Royal College of GPs, proposed that GPs take back 24 hour care of the neediest patients who put disproportionate strain on the NHS. Hunt has been locked in a bitter dispute with medical professionals over his proposals to save the health service, and an increasing number have warned him that the situation is out of control. “It is scandalous, the number of people who are using emergency services when actually, if they had a better alternative, they wouldn’t,” he admitted on ITV’s Daybreak this week. The health secretary said that one of the ways to solve this was make sure there are viable alternatives, adding “at the moment it’s just too difficult to see a GP.”
NHS number to be mandated from 2014: Trusts will be contractually obligated to use the NHS number as their primary patient identifier from April 2014, reported eHealth Insider. Tim Kelsey, NHS England’s national director for patients and information, wrote on his blog post on NHS Voices that using the NHS number was one of the “urgent steps” needed to “make the data revolution real. We will require all NHS providers funded by NHS England to use the NHS number as their primary identifier so that all data can be linked and patients identified, with accuracy. From April 2014, this will be a contractual obligation for providers.” One of the key targets in NHS England’s Business Plan for 2013-14 – 2015-16, ‘Putting Patients First’, is to have 95% of trusts using the NHS Number as the prime identifier in clinical correspondence by January 2015. EHI Intelligence recently interviewed 16 heads of IT at NHS acute trusts for a new report, ‘Routes to EPR’, and only three were using the NHS Number as their primary identifier.
Urgent care integration threatened by constant change, warns RCGP: ‘Constant change’ in the NHS is undermining integration, RCGP chairwoman Professor Clare Gerada has warned MPs, reported GP Online. Speaking to the House of Commons health select committee’s emergency care inquiry, Professor Gerada said there were good examples of urgent care services run by integrated primary and secondary providers, and that ‘the will is there’ to join up different parts of the system. But the development of such services was hampered, she said, by the ‘ever changing landscape’ of the health service, and differences in commissioning arrangements. She said: “Dare I say that no sooner does one form relationships with the commissioners and the providers across the system, then they face change. That does cause huge organisational difficulties, when the burn of developing these kinds of services can be a year or two years and if you’ve got an ever changing landscape it become very difficult.” Professor Gerada warned MPs that general practice was under similar pressures to emergency care, and had seen a 100% increase in workload over the past decade.
NHS to come under Data Protection spotlight, warns business consultants: NHS trusts will come under the spotlight as Data Protection regulations undergo significant changes in order to protect sensitive patient information, consultants, The Business Company have warned. Private companies are subject to compulsory ICO audits under the Data Protection Act unlike the NHS, where data audits are currently only consensual, reported Shropshirelive.com. The Business Company said that could soon change following a consultation paper which could see them move to the Clinical Commissioning Group model. Mark Harris, managing director of the consultancy firm, said: “The Information Commissioner can come in and audit a private company for data protection and check they have the correct framework and sufficient controls in place at any time. However, this is not the case with the NHS. As a public body the ICO can only request an audit, often these requests are made as a result of patient complaints or data protection breaches meaning this type of audit request is more about remediation activity rather than the more desired preventative approach seen with compulsory audits. The NHS historically does not have a great track record in terms of Data Protection compliance.”
Jeremy Hunt rejects Tory proposal to limit GP appointments: Health secretary Jeremy Hunt has vowed to ‘never’ limit the number of appointments patients can make with their GP, after Conservative Party members were asked their opinion on the controversial idea to make savings, reported Pulse. A policy discussion document distributed by the Conservative Policy Forum (CPF) had asked party members to comment on a number of controversial statements regarding GP care, including whether there could be an annual cap on the number of times patients can see their GP in a year. But commenting this week via his official Twitter account, the health secretary said: ‘It IS NOT and WAS NEVER going to be Conservative policy to limit GP appointments.’ The comment also referred to an online public petition by campaign group 38Degrees, which received 180,000 signatures in just 48 hours after a number of national newspapers had picked up the story and the GPC had branded the suggestion as ‘absurd’.
Virtual wards scheme saves NHS bosses £3.5m at Southampton General Hospital: The number of patients being readmitted to hospital in Southampton has dramatically fallen thanks to a pioneering virtual wards scheme that is set to revolutionise the NHS and has saved cash-strapped hospital bosses £3.5m, reported Southern Daily Echo. New research has revealed that just 1.9% of city patients sent home to recover rather than endure long stays in Southampton General Hospital have been readmitted – compared to an NHS average of 9%. The Recovery at Home programme has proved such a success – freeing up vital bed capacity – that it has been dubbed “a model of healthcare for the future” that could provide a solution to the relentless pressures facing the NHS. It is believed that the service could create 5,800 “virtual beds” in people’s homes to help hospitals cope with bed shortages and overcrowded emergency departments, which has been a major problem in the city.
NHS trusts not learning from their mistakes, report says: NHS trusts are failing to learn properly from patient complaints, with most needing to make significant improvements on how they learn from mistakes, according to researchers commissioned by the health ombudsman for England in the wake of the Mid Staffs hospital scandal, reported The Guardian. Some trusts are failing to do even basic checks on identifying and mitigating risks or to see how they are performing against other trusts, says a report from IFF Research. They are also failing to share information that could prove vital in improving safety. The results of 165 mainly online interviews with chief executives, board chairs, and non-executive directors at 94 hospital, ambulance, mental health and community trusts suggested only 20% reviewed learning from complaints and took resulting action to improve services. A similar proportion said the information was “ineffective” in identifying and reducing risks to patient safety. In addition, fewer than half the trusts measured patient satisfaction with the way complaints were handled. There was no recognised standard for complaints analysis by NHS boards, added the researchers.
Warrington CCG and Warrington & Halton NHS Foundation Trust select HCS and Net.Orange: Warrington CCG and Warrington & Halton NHS Foundation Trust have formed a partnership with HCS, the trading arm of HFMA, to help it deliver protocol-driven care for high-risk patient groups in the local population, reported eHealth News EU Portal. As part of a joint and system wide approach being run across all Warrington service providers, the HCS Care Coordination service will work with local community and acute clinical staff to provide expert guidance and advice. Jason DaCosta, director of IT at the CCG and Warrington & Halton NHS Foundation Trust explained: “Warrington CCG’s Long Term Conditions (LTC) and Frail Elderly Improvement Programmes aim to improve services for patients and their carers by shifting from a reactive, hospital-based system of unplanned care to a preventive, anticipatory, whole-person approach. The net result of developing this kind of fully integrated sustainable model of patient care is to significantly reduce the financial impact of these patients on overall health and social care spend in the area, while allowing us to maintain or improve outcomes and patient experiences.
Devon’s NHS 111 health line postponed until September: The launch of the NHS non-emergency 111 number in Devon has been postponed until September, reported the BBC. It was first set to be launched on 1 April and then on 18 June. The helpline, which replaces NHS Direct, has been dogged by problems elsewhere in England with calls going unanswered and poor advice being given. Service commissioners said they wanted to “learn from the issues in other parts of the country to get things right for patients in Devon”. Last month, the head of the Devon family doctors’ organisation, the Local Medical Committee, said it had “huge anxieties” about the phone line’s launch. In some areas of England where the service has been introduced – run by a variety of organisations, including private firms and ambulance crews – high demand has left thousands of callers unable to get through. Critics also said inappropriate referrals by 111 staff had put huge strain on ambulances and hospitals in some areas.
Scotland’s NHS spending more on private healthcare: Spending on private healthcare by Scotland’s NHS has risen dramatically since the health service’s waiting time scandal emerged, newly released figures have revealed, reported The Scotsman. The amount of NHS funds spent on private treatment for patients rose by nearly 60% last year to more than £40 million, compared with £25m per year in the two previous years. Figures released under freedom of information laws show that most of the increase in spending was driven by just two health boards: Lothian and Grampian. The sharp rise in private healthcare expenditure came during the period that saw audits carried out by health boards across Scotland after the discovery of manipulation of waiting lists and misreporting of performance by NHS Lothian in 2011. Practices included offering patients appointments in England and taking them off the waiting list when they declined. Figures on private health spending showed that NHS Lothian had predicted it would spend £10m clearing a backlog of patients waiting for treatment. However, the health board actually spent £12.5m last year sending patients for treatment privately.
EHI Live 2013 launched: Paperless working, a zero harm NHS and EHI’s Big EPR Debate are high on the agenda at this year’s EHI Live conference and exhibition held in Birmingham. For the first time, entry to the EHI conference streams will be entirely free with modest fees charged for some co-located, independently-produced meetings. Held at the NEC, Birmingham on 5-6 November, EHI Live 2013 will bring together popular features from previous shows with new meetings and activities. EHI director Linda Davidson said: “We’re adopting the good NHS QIPP principle of improving the quality while reducing the cost to our participants. EHI Live has developed over the years as the place where the eHealth community meets and our big tent is now free to enter…Bookings for the exhibition are running at record levels but there is still room for more as we have a bigger hall this year. New faces and old hands are all very welcome.”
Opinion
Ask questions first, shoot later
In HSJ this week, Chris Hopson, chief executive at the Foundation Trust Network raises concerns that the need to be seen to be doing the right thing is resulting in a ‘shoot first, ask questions later’ culture developing.
“Instant responses often lack consistency, tend to scratch the surface of concerns and run the risk of destabilising the NHS front line, which can feel exposed to random judgements it does not understand.
“In the months following the Francis Report we have seen three different events involving concerns over quality at NHS providers. First, Sir Bruce Keogh’s review of 14 hospitals with high mortality rates. Second, the review of mortality coding at Royal Bolton Hospital. Third, the review of paediatric heart surgery patient safety at Leeds General Infirmary.
“What linked all three were: instant responses to the emergence of incomplete or partial data; a set of behaviours best summarised as “provider presumed guilty until proven innocent”; and a bunch of lurid media headlines partially driven by the need for the system to be seen to be doing something.
“Before there were answers, there was action.”
Hopson continues by explaining the fallout of this action: “There is no question NHS trusts should be scrutinised, problems identified and solutions implemented. Sir Bruce Keogh, who deserves our full support, is right to call for the adoption of precautionary principles and the need for quick and effective investigation where there is a suspicion of avoidable harm being caused.
“However, appearing to jump to early presumptions of guilt, having the media lynch mob run loose and leaving trusts with rushed, ill thought out processes are not sensible ways to proceed.”
Hopson concludes by saying that better processes need to be put in place and a more mature reaction from all concerned to ensure the NHS prioritises doing the right thing over being seen to do the right thing.
Healthcare innovations in the United States: what lessons are there for the NHS?
The chief executive of The King’s Fund Chris Ham, asks what lessons the NHS can learn from the health care innovations in the United States. Ham visited the US to understand how the US organisations provide high-quality, person-centred care and lessons that can be learnt.
“Among the many innovations we saw, five stood out for me. The first was the use of technology to improve the quality of care and the experience of people using services. All the organisations we visited had electronic medical records that were instantly available wherever a patient was seen. Patients were able to email their doctors for advice, make appointments online, and access test results.
“The second innovation that impressed me was the redesign of primary care by Group Health in Seattle. Faced with growing pressures on GPs, and increasing waiting times for patients, this organisation encouraged patients to make greater use of telephones and emails to consult GPs, and drew on the skills of all members of the primary care team. These changes made it possible for GPs to spend more time with patients who really needed to see a doctor in person, with benefits both for patients and for those providing care.
“A third impression was the significant part doctors and other clinicians played in leading change in these organisations. Everywhere we went we were struck by the visibility and commitment of clinical leaders and their obvious passion for quality improvement.
Ham continues and concludes: “The fourth lesson was the benefit of working in an integrated delivery system in which GPs can communicate easily with specialists and provide care in the right place at the right time.
“The work done at Intermountain Healthcare underpins the fifth and final lesson I took from the week, namely the importance of standardising how care is provided when the evidence on good practice is clear. Standardisation does not occur through clinicians being told what to do or being required to comply with externally imposed targets and standards. Instead, it results from their commitment to provide the best possible care within available resources. To return to an earlier lesson, this would not happen without well-developed clinical leadership at all levels, and it works because doctors take responsibility for actively managing the care of patients at all stages.”
Commissioners need to be able to use patient data
In this weeks’ HSJ (subscription required) Anthony McKeever, chief executive at MedeAnalytics, explains how commissioners oversee scarce and costly resources and need access to patient-level data to do their job. He says that anything less is a disservice to patients and taxpayers.
“I welcome Dame Fiona Caldicott’s information governance review for its commitment to striking a more appropriate balance between promoting data sharing and safeguarding patient confidentiality. However, in relation to commissioning, I am concerned that it is not forward looking enough.
“If fledgling commissioners are denied access to patient-identifiable data, some gains made in recent years will be lost before the new clinical commissioning groups find their feet. Specifically, it could hamstring their efforts to redesign care and would get in the way of measures to unlock efficiencies, which are there for the taking.
“Today, the NHS does not routinely disguise patient-identifiable data when compiling the datasets used for commissioning. Introducing this technique − known as psuedonomysation − would meet all the concerns expressed in Caldicott’s review by ensuring that individuals’ personal details cannot be shared accidentally.
“Confidential data used by commissioners for purposes other than treating patients must remain subject to stringent security. However, while the NHS may not yet have universal standards like the requirements enforced in the US under the Health Insurance Portability and Accountability Act, imagining that difficulties should be airbrushed away by removing all “confidential” data from the system would be folly.
McKeever concludes “Any debate about data sharing in the NHS must focus on treating the patient and protecting the person; but it should also be about ambition, not lowest common denominators. Cutting off the very source of intelligence for commissioners − patient-level data − should be seen for what it is: a disservice to patients and taxpayers alike.
“Commissioners need to get specific; not personal, because they are guardians of scarce, precious and costly resources that we expect them to manage on our behalf. They need insights based on hard facts to do their job.”
GPs are not to blame for all that is wrong with the NHS
This week, Dr James Kingsland, national clinical lead for NHS Clinical Commissioning and Graham Roberts, CEO of Assura Group, speak up for GPs in light of recent criticism.
The pair say that reforms have been driven by government policy, something that GPs had no involvement in, citing the implementation of the non-emergency 111 number: “…pinning all blame on the 2004 GP contract, which saw doctors able to opt out of out-of-hours care, only acknowledges one small part of the wider picture. Since 2004 there has been an eight-fold increase in out of hours activity in some areas, which suggests that there are other issues that need to be addressed aside from an alteration in working hours.
“The overuse of walk-in centres, which were wrongly lauded as a means of reducing pressure on A&E units, has certainly played its part in the current state of emergency care. The centres were never meant for urgent care. They were originally created for people experiencing access disadvantages, or who were without a GP, and they served this purpose very well. However, the expected immediacy of care at a walk-in centre has served to dissuade people from visiting their GP as a first step. In reality, this is not the case and has simply redistributed the primary care burden away from GP surgeries to other services.”
The pair continue by suggesting it would be better to focus on lack of resources and an inability to increase service provision: “Ultimately, Jeremy Hunt’s speech at the King’s Fund leadership summit was discouraging and unhelpful for GPs across the country who have been ill-informed and operating at full capacity for a number of years. Rather than making criticisms and laying blame, he should instead analyse how to create the investment needed to support A&E departments, and allow GP surgeries to deliver the best possible service to their patients.”
Highland Marketing blog
In this week’s blog, HM account manager Chris Marsom reflects on #NHSConfed13 and whether suppliers should look at niche events versus general.
