News in brief
Don’t be gun shy of IT – Stevens: Simon Stevens has told the NHS not to be “gun shy” of technology after its experience with the National Programme for IT, reported eHealth Insider. In a brief presentation to launch a new Clinical Leaders Network Informatics Forum ahead of his first speech at the NHS Confederation annual conference, Stevens said that technology would be vital if the NHS was to meet the challenges over the next five years. Stevens, who recently took up the job of chief executive of NHS England after a decade of working for the US healthcare giant United Health, said no other industry had met these challenges without adopting IT to radically change its working practices. “We did manage to make some investments from the debacle of the National Programme for IT,” he said. “But because of that we have become a bit gun shy and we need to move forward.” In his main speech at the conference in Liverpool, Stevens outlined a familiar set of challenges for the health service; focused on the gap between funding and demand caused by an ageing population. His predecessor as chief executive of NHS England, Sir David Nicholson, warned this gap could reach £20 billion by 2015 and £30 billion by 2020 if action was not taken to close it. He called for a “national conversation” on what a sustainable NHS should look like. But Stevens said there would be no “five year plan” and no further management reorganisations. He also said that while he supported NHS England medical director Sir Bruce Keogh’s call for a reorganisation of acute and emergency services into 40-70 centres, there would be no whole-sale reorganisation of other hospitals.
Confederation chief calls for 10 year NHS funding settlement: NHS Confederation chief executive Rob Webster has outlined a package of commitments which he wants politicians of all parties to sign up to before the 2015 general election, reported Health Service Journal (HSJ subscription required). The package includes: a 10 year funding settlement, the creation of a “transition fund” to pay for service change and parity of esteem between physical and mental health. Kicking off the 2014 NHS Confederation conference in Liverpool, Webster said the service found itself on a “burning platform”. Unless radical change took place the NHS would experience “longer waits, rationing, failing organisations, a loss of public support, decline and decay”, he said. Webster continued by saying that heading into the 2015 general election politicians needed to be frank with the public about this need for change, and that the NHS Confederation was developing a set of “specific asks” in time for the party conferences in the autumn. He said the NHS Confederation would ask for politicians to sign up to a 10-year funding settlement – the “decade deal”. This would involve real terms growth of the NHS budget over the decade “to take money off the table and allow local leaders the room to plan for the future”. Webster also asked for a £2bn annual “transition pot” to meet the short term cost of developing the “new, sustainable models of integrated care”. Saying that it was “vital… upfront investment is made to support hospitals and ensure the safe transfer to new models of care”. His third request was for parity of mental and physical health. He specifically called for a commitment to extending the rights of mental health patients to access services “within a specified timeframe” and from a provider of their choice, and a commitment to fund over the next parliament the Time to Change campaign to end mental health stigma.
New duty will force all health organisations to share patient records: The government will soon release guidance which introduces an obligation for health and social care organisations to have the same duty to share patient records that GPs currently have, reported Pulse. Speaking at the NHS Confederation conference in Liverpool, Norman Lamb MP, minister for care and support said that recent care ‘scandals’ had often been linked to a ‘failure of communications’ between different organisations. He also said that he wanted the Liberal Democrats to make a manifesto pledge, to introduce a legal requirement for commissioners in health and social care to pool budgets. Responding to a question from the floor on sharing information between the health and care sectors, Lamb told the conference the government was frustrated by technological barriers to information sharing. He said: “We’re very close to issuing guidance, that we’re hoping everyone will sign up to. Which in effect gets across the message that there’s a duty to share, it’s not an optional extra. To provide good care, there’s a duty to share, and we know that all of the scandals that happened, where there have been complete failures of care. It’s so often because of the failure of communication between organisations.” GP experts said this was a positive step. Dr Andrew Mimnagh, a GP in Sefton, Merseyside, said: “We’ve been in the position where it would have been useful to give partner care organisations information about patients, but we could be challenged under confidentiality rules. They have then taken the approach of “we’ll show you ours, if you show us yours”. So if there is a level playing field, this is fine.” Lamb also called for health and care budgets to be pooled.
Labour commits to ‘rolling back’ competition in the NHS: Labour has pledged to roll back the dramatic extension of competition in the NHS that has occurred under the coalition if it wins next year’s general election, reported the Guardian. Andy Burnham, the shadow health secretary, will commit to scrapping Section 75 of the Health and Social Care Act as part of a dismantling of rules which Labour claims waste vital resources. Section 75 forces GP-led clinical commissioning groups to put local care services out to tender, even when existing NHS providers are doing a good job. In a speech to senior NHS managers attending the annual conference of the NHS Confederation, Burnham also promised that Labour would remove the duty on Monitor, the NHS’s economic regulator, to promote competition in the health service. Figures obtained by Labour under freedom of information laws show that hospitals in England are spending about £20m a year in order to ensure they are complying with the much more onerous rules on competition that the legislation brought in. Hospitals now spend on average more than £90,000 each a year on staff and external expert advice to deal specifically with competition issues, such as possible mergers, acquisitions or changes to services, the figures show. For example, the hospital trusts in Bournemouth and Poole in Dorset between them spent £6.5m on a planned merger, including £1.3m on the competition issues raised. But the move was blocked as anti-competitive by the competition authorities, in a decision that prompted serious concern in the NHS as it was seen as blocking a number of much-needed mergers intended to improve care. Competition is the wrong approach when the demands of dealing with an increasingly elderly population mean the different parts of the NHS need to be working ever more closely together, Burnham said.
NHS’s ‘ridiculous’ £1bn savings demand sparks care fund worry: The NHS will expect health and wellbeing boards to prove they can save £1bn by joining up health and social care services next year – £300m more than currently anticipated, revealed Health Service Journal (subscription required). NHS England is understood to have identified the larger figure as financial scrutiny on local plans for the government’s better care fund project mounts. These plans are required to set out how budgets will be pooled between councils and clinical commissioning groups. HSJ understands that an intensified “assurance programme” run by NHS England will focus on checking each plans’ forecasts of savings they claim could result from closer working, particularly by reducing demand for hospital services. Current plans to spend the pooled budget, approved by health and wellbeing boards nationwide, predict savings totalling £700m in 2015-16. However, there is uncertainty in both local government and the NHS that these savings will materialise. The assurance process is expected to demand evidence to back up these forecasts and seek ways in which further savings could be made. This tougher approach has attracted criticism from local government. One senior council figure said: “As a policy initiative the better care fund is the right thing to do, but it’s ridiculous to suggest it will save £1bn in its first year. When you change the way you deliver services you can often create more demand.”
Mixed interest in tech fund open source: There is mixed interest among NHS IT directors in the open source focus of the Integrated Digital Care Fund. eHealth Insider (EHI) reported last month that the focus on open source systems in the second round of NHS England’s technology fund was welcomed by suppliers who expect “significant interest” from trusts. However, speaking to EHI, several NHS IT directors said they were not sure they would pursue open source in the second round. Some also expressed concerns around the money on offer being only capital funding. Will Smart, joint director of IM&T at Royal Free London NHS Foundation Trust and Barnet and Chase Farm Hospitals NHS Trust, which plan to merge, said the trusts are reviewing their programme portfolios to identify projects that “may fit the requirements of the fund”, but that there are “no plans at this stage” to put in an open source bid. University Hospitals of Bristol NHS Foundation Trust’s clinical systems programme director Steve Gray, told EHI that the main problem with the fund is that it is only capital funding, which makes it difficult for the trust’s budget constraints. “The problem we have, is that with this round it’s still only capital funding that’s on offer. It’s rather unfair thinking that when we have a lump of capital we have to pay depreciation and interest on it. The depreciation can come to £100,000 a year on a big project.” The first round of the tech fund was criticised for very tight deadlines for submitting bids, and NHS England promised more time in the second round. When it opened for bids last month, trusts were given exactly two months to get their bids in for the fund, with a 14 July deadline. Unlike the previous round, trusts can only submit one bid, as well as a joint bid with social care or local authority organisations.
Better Care Fund hits £5.4bn: Councils and healthcare providers plan to pool £5.4bn as part of their efforts to integrate health and social care for the government’s Better Care Fund, the Local Government Association (LGA) has revealed. This new figure was revealed by the LGA as it urged the government to commit to the integration project for five years – four beyond the current spending review period, reported Health Service Journal (subscription required). Such an extension would avoid councils’ care services “spiralling towards a deeper crisis”, the local authority umbrella body said. According to the LGA, £5.4bn has already been pooled for Better Care plans for 2015-16, 40% more than the £3.8bn minimum required by the Department of Health (DH). The association has also called for a separate “transformation fund” to ease the initial impact of the changes. LGA chairman Sir Merrick Cockell said: “It is indisputable that in order to improve the lives of older and vulnerable people in this country there is a need for significant changes to the way that social care is funded. The Better Care Fund is a good start, but it would be short-sighted to expect it to solve the problems of the health and social care system overnight. Health and social care partners have shown their confidence in joining up their funding by putting in additional money over and above what was required by the DH, but despite this there has still not been any indication that funding will be extended beyond this first year.”
Salford plans integrated care system: Salford Royal NHS Foundation Trust wants to create a single integrated care organisation in the area, underpinned by its Allscripts electronic patient record (EPR) system. Almost a year after the trust went live with the Sunrise Clinical Manager from the American supplier, the trust’s chief executive, Sir David Dalton, told eHealth Insider that the system is in full use across the trust, with new functionalities being developed regularly. “What we have in Salford Royal now is a system which allows our clinical staff to have immediate access to patient data. The system that we have lends itself to one of the values we have in Salford Royal, which is the value of accountability and responsibility,” he said. “If we don’t get things right, to be able to interrogate the record and see immediately those things that should’ve happened that perhaps didn’t, is very useful, so the EPR suits us very well.” He said that one of the trust’s future plans is to create “further integration and development within the city of Salford. “This is, I hope, creating a new integrated care organisation, and at the heart of that will be our ability to share information about people that we are supporting,” said Sir David. “We will look at how we develop our system with the partners in health and care in Salford to build something which allows us to be one of the leaders in population health improvement.” The trust is also looking at a project, working with “partners in Wigan, Bolton and Central Manchester as we design new systems which allow patients to move across organisational boundaries. The thing that glues it all together will be our electronic patient record,” he said.
NHS hospitals to be given bonuses for treating patients well: NHS hospitals will receive financial bonuses for how well they treat patients, under new schemes linked to feedback from those they treat, reported The Telegraph. Simon Stevens, the new NHS chief executive, announced the plans yesterday as he set out a five-year vision for the health service, to improve the quality of care delivered in local communities, and give patients “more clout”. Stevens, a former advisor to Tony Blair, promised changes in the way NHS services are funded, so that those which deliver the best outcomes receive extra funds. He told the NHS Confederation annual conference in Liverpool: “Across all NHS-funded services, we’ll be pushing for a steadily increasing proportion of payments tied to performance, quality and outcomes.” A spokesman for NHS England said the future schemes would include patients’ feedback on the quality of care they received, with details yet to be drawn up. Currently around £2.3bn a year is allocated to NHS organisations via “performance incentives” but Stevens is keen to ensure that clinical outcomes, and the views of patients about how they are treated get sufficient focus.
Allscripts to create 100 jobs after launching European HQ in Manchester: Allscripts has announced it will be creating more than 100 jobs after launching its new European headquarters in Manchester, reported the Manchester Evening Times. Allscripts, which works with NHS bodies, specialises in technology that will help the NHS meet a number of its national objectives. It provides electronic patient record technology that enables NHS organisations to deliver critical information where it needs to be while allowing better sharing of patient information between medical professionals, so that they can deliver more effective care to patients. The system also enables the NHS to provide patients with access to their own medical records. The group, which will take up office at Oxford Court, chose Manchester as a regional flagship location over a number of other European cities due its international links as well as strong ties with the NHS and local academic centres. The company has already delivered electronic patient record systems to Salford Royal NHS Foundation Trust and Liverpool Heart and Chest Hospital NHS Foundation Trust. Stuart Miller, managing director of Europe for Allscripts, said: “Our decision to make Manchester Allscripts permanent European home reflects our commitment to the UK healthcare and technology communities. With Manchester’s excellent transportation links we can easily service the healthcare IT needs of not only the United Kingdom but also Europe. We look forward to working with NHS and other healthcare providers in continuing to help improve their clinical and financial outcomes though the use and adoption of healthcare IT solutions.” The company plans to take on 100 staff over the next three years and will be looking to fill roles in research and software development, sales, project management and implementation services.
NHS chief calls for GPs to work within community hospitals: GP networks could provide care from small, local hospitals through funding from a joint primary and secondary care budget, the chief executive of NHS England has said. Speaking at the NHS Confederation conference in Liverpool, Simon Stevens said there ‘is now real momentum building in favour of testing some new models of general practice and extended primary care’ and that this could include groups of GPs and community-based care providers ‘teaming up’ with their local community or acute hospitals funded by ‘delegated multiyear budgets’, reported Pulse. Stevens put forward a series of ‘potential new variants’ to the current models of healthcare, but emphasised that NHS England would not force GPs to work in any such models. He told delegates: “What if in a few parts of the country – rather than perpetuate the increasingly arbitrary boundary between GP and community-based care on the one hand, and hospital-based outpatient, diagnostic and even some inpatient care on the other – these health professionals and perhaps even social services wanted to form new multi-specialty provider groups? Perhaps taking delegated multiyear budgets to manage defined populations, while committing to use the dividend from more efficient team working to put the local NHS on a sustainable financial trajectory?” It comes as last month Stevens invited CCGs – which hold the local secondary care budgets – to bid to co-commission primary care with NHS England.
Unveiling industry’s first open, intelligent Clinical Operating System: NantHealth, a company converging science and technology through a single integrated clinical platform, unveiled the industry’s first, open Clinical Operating System (cOS) for value-based, coordinated care at this year’s NHS Confederation Annual Conference and Exhibition, reported Business Wire. cOS is an intelligent cloud-based platform integrating clinical, financial, operational and environmental data that’s empowering clinicians, providers, patients, commissioners, social care workers and researchers to transcend the traditional barriers of today’s healthcare system and allow health and social care integration to be truly realised. “NantHealth’s mission is to solve the chief problems plaguing our healthcare system, which is the lack of truly personalised, coordinated and pro-active care models that connect patients and their care providers,” said Dr Patrick Soon-Shiong, MD, NantHealth’s founder and the pioneer of pharmaceutical treatments for both diabetes and cancer. An open, standards-based technology platform, cOS integrates data from existing legacy systems, such as electronic patient records, patient administration systems from multiple platforms, imaging, GP systems, diagnostics, research, medical device data, patient level costing and service-line reporting, in real-time, to enable care that is personalised, coordinated and proactive. When cOS capabilities are combined with NantHealth’s applications such as advanced molecular diagnostics and care coordination applications, informed decisions can be made in seconds, and patients matched to the right treatment protocols – ultimately saving lives and reducing cost of delivery. Health and care delivery becomes transformative for both care givers and the people they serve.
Symphony buys McKesson UK health ops: Private equity firm Symphony Technology Group (STG) is to acquire most of the European healthcare software business of McKesson Corporation, according to eHealth Insider. STG will buy McKesson operations, including the UK health and social care businesses, covering System C and Liquidlogic, plus McKesson’s software operations in France and the Netherlands. The Palo Alto, California based private equity firm says it expects to complete the acquisitions in late June early July. The price and terms of the deal were not disclosed. McKesson Workforce, which provides the NHS Electronic Staff Record (ESR), is not included in the deal and will remain part of McKesson International Operations Group. The subsidiary has now withdrawn from the re-tender of ESR. McKesson had previously said its PACS business will not be covered. The UK counts for about 50% of the revenues of the businesses being sold. STG specialises in developing technology businesses in enterprise and business-to-business markets. It has over $2 billion in investments across a portfolio of 14 global companies. It says it plans to operate the acquired businesses as independent companies, and that it intends to support the continued expansion of each “both by creating new, innovative products and through selective acquisitions.”
Orion Health shares vision for coordinated care at HIMSS Turkey: Orion Health, a global provider of healthcare integration solutions, recognises Turkey’s commitment to improve its healthcare sector and recommends the scope for coordinated care be expanded to meet the needs of people living with long-term conditions, reports eHealth News EU Portal. “Turkey faces similar healthcare challenges as other developing economies including rising healthcare costs, a sharp increase in its elderly population and the growing issues around management of long-term conditions,” said Dr Beyza Akbasoglu, Orion Health country manager for Turkey. “The country’s unparalleled investments in its healthcare providers and professionals will help improve the quality and safety of healthcare services to its growing population. With healthcare spending expected to triple over the next decade, the forecasted USD 63 billion investment will help respond to the need for more than 95,000 new hospital beds by 2024, supporting the growing requirements of Turkey’s acute sector. As Europe’s fastest growing economy, Turkey will need to rely on the provision of homecare, remote monitoring and advanced coordinated care if it wants to keep healthcare costs to a minimum and the quality of care at a high standard,” said David Hancock, head of strategy EMEA at Orion Health. Orion Health participated in a workgroup that supported HIMSS Europe in the development of a new HIMSS model that addresses the importance of such provisions across healthcare organisations.
The Highland Marketing Healthcare Roundup team cannot resist a cheeky ‘selfie’ photograph in the press box at #confed2014 whilst waiting for Jeremy Hunt to arrive on stage – Chris Marsom sums up the day’s main political keynotes in his blog this week.
Opinion
A better NHS demands freedom for leaders
The health service needs to learn how to let go and liberate staff if it is to improve patient experience, says Tim Kelsey, director of patient involvement at NHS England.
“In the heart of London’s Olympic village is another symbol of transforming social leadership: a new health centre, home to a pioneering general practice that is offering some of the most challenged communities in East London a new standard of personalised care.
“Patients here are offered a range of digital services – of the sort they would expect as 21st-century consumers in other areas of their lives: they register online from home, for example, which most do by preference. But the real innovation is in the way in which Dr Arvind Madan and his colleagues at the Hurley Group – an NHS organisation that runs a number of practices and GP walk-in centres across the capital – have developed a service that allows patients to consult their GP using an online tool that captures a safe, structured history which the GP can use to triage remotely.
“More than 60% of the 1,250 patients who opt to consult online solve their problem without the need to visit their GP in person, and 78% of the patients who have participated (from the Olympic village practice and other participating practices around London) said it saved them time. “Pretty important for the self-employed in deprived communities,” says Madan. There is evidence that it also saves GPs’ time and improves the safety of their diagnoses because of the systematic nature of the patient questionnaires, which have been developed for more than 100 conditions.
“Like me, Madan believes that leadership is about liberating people. The NHS is not good at letting go, allowing people to experiment; it’s not good at encouraging the kind of leadership that advocates change in the interests of patients – as he is doing. He wonders – as many do – why the NHS, with its wealth of talent, seems so poor at embracing the kind of innovations he is introducing.
“My success as an NHS leader will be judged by how much I have helped to liberate Dr Madan and other leaders in our NHS.”
Sharing and caring
In the first feature of eHealth Insider’s new series of case studies Lis Evenstad and Lyn Whitfield look back at the history of information sharing projects, and question what we have actually learned from these various attempts.
“As national interest in information sharing has waxed and waned some healthcare communities have got on with their own projects. The result is a patchwork of initiatives, some of which have made more progress than others, while coming up with different answers to key questions, such as who should hold the record, and what technology should be used to provide access.
“Yet there is widespread agreement that a critical mass of patients must be covered, and that a significant amount of clinical information must be available for these projects to take off; otherwise clinicians are unlikely to spend valuable time checking whether a record is available.
“While information sharing may be essential for creating more ‘joined up’, efficient and high quality health and social care services, it is not a quick fix; just as the cash-strapped NHS and even more cash-strapped local government could really do with one.
“Another, big issue is the one that effectively stalled the SCR for many years; patient information and consent. The SCR was planned on an ‘opt-out’ model, with patients given the chance to say ‘no’ to having an SCR created, after a local patient information campaign.
“One reason that information sharing projects take so long is sorting out information sharing agreements.
“Patients, for example, may consent to their records being shared, but they don’t seem to be able to do much else with them; more access, and more usefulness might create an additional ‘push’ for their creation. And there is surprisingly little published evaluation of what works, and what it delivers. Despite this, the commitment and enthusiasm of those involved remains impressive.”
Local leaders unleashed? What to expect from Simon Stevens’ reign.
Helen Crump, fellow in health policy at the Nuffield Trust comments on the expectation of NHS England’s chief executive Simon Stevens’ appointment following his first interview with HSJ.
“The response to NHS England chief executive Simon Stevens’ first interview says as much about the challenges facing the NHS as the content of the interviews themselves.”
“Stevens’ message – to be pragmatic, to decide what’s right locally, to be bold, and to look beyond current bricks-and-mortar configurations – quickly transmuted under the media spotlight into one of harking back to a bygone age of cottage hospitals.”
“Previous attempts at a national policy level to encourage local solutions to what often feel like intractable local problems have had mixed results. Some providers have used foundation trust status to good effect, but the model and its freedoms appear increasingly underpowered.”
“So what is different this time? Stevens’ message that managers should look beyond regulatory and policy-based barriers to change is a significant cultural shift. In his first interview with HSJ, Stevens said commissioners and providers should not be hidebound by current regulatory or policy designs.”
Highland Marketing blog
In this week’s blog, Chris Marsom reflects on this year’s NHS Confederation Conference and Exhibition.
