News in brief
NHS Shared Business Services develops shared framework to reduce cost of buying clinical data systems: NHS Shared Business Services (NHS SBS) has developed a framework to help NHS trusts buy clinical data systems, reports Computer Weekly. The framework – which the NHS values at £1.25bn over six years – will save NHS trusts time and money by avoiding the long traditional tendering process when buying healthcare information systems. Trusts can look for local suppliers on the framework and hold small competitions, so suppliers can compete for work over a shorter time and at a lower cost. Suppliers will benefit from reducing the costs incurred in submitting individual tenders. The framework is divided into six lots: theatre clinical systems, integrated emergency care clinical systems; child health systems, maternity systems, and specialist electronic prescribing clinical systems. NHS SBS director of procurement, Peter Akid said the organisation had collaborated with clients to understand the needs of specialist information systems. “Precisely because these are expensive specialist systems, trusts need to have the confidence that their chosen suppliers will deliver,” Akid said. “With this in mind, we will manage the framework, including rigorous supplier testing, to ensure complete governance and a compliant route to market. This initiative represents how a more strategic approach to procurement frameworks, based on a thorough examination of what trusts will actually need in the future, can deliver far greater savings and benefits.”
Cerner buys Siemens’ Soarian business: Cerner has announced a definitive agreement to buy Siemens’ health information business, Siemens Health Services, in a £770m cash deal. eHealth Insider reports, that Siemens has said it is selling its hospital information system business because it failed to consistently keep up with competitors. However, in a press release the two companies say they will now form a strategic alliance to bring new solutions to market that “combine Cerner’s health IT leadership and Siemens’ strengths in medical devices and imaging”. Neal Patterson, chairman of Cerner, said in the statement: “Siemens’ healthcare IT assets provide additional scale, R&D, an impressive client base, and knowledgeable and experienced associates who will help Cerner achieve our plans for the next decade. “The alliance we’re creating will drive the next generation of innovations that embed information from the [electronic medical record] inside advanced diagnostic and therapeutic technologies, benefitting our shared clients.” The move will increase Cerner’s revenues to £2.7bn annually, and give it approximately 18,000 healthcare clients internationally. Cerner says that it will continue to support Siemens Health Services core platforms. Cerner plans to support and advance the Soarian platform for at least the next decade. The merged company will employ 20,000 staff in 30 countries and have a combined annual R&D investment of £385m.
Healthcare UK reports significant progress in its first 18 months: Managing director Howard Lyons has announced that Healthcare UK far exceeded its targets for last year, reported Gov.co.uk. British organisations have secured £556m of healthcare contracts during 2013 to 2014, £200m more than the target set for the year. Healthcare UK has assisted over 600 organisations, double the target, and has organised more than 60 missions, high level meetings and events. Speaking at the recent Healthcare UK Business Forum, Lyons commented: “With such an encouraging start, confidence is high that UK healthcare organisations will capitalise on the £10bn pipeline of healthcare opportunities identified over the last year. The UK is set to play a leading role in the development of health systems and infrastructure, improving the quality of healthcare delivery for our valued international partners in China, Brazil, India, and the Middle East.” Over 80 participants from private companies, NHS organisations and public bodies attended the business forum. They discussed the plans for Healthcare UK in the coming year, including opportunities in China and the potential for UK organisations in South America and Indonesia.
Public Health England targets mobile innovation: Public Health England has reaffirmed its commitment to work with entrepreneurs and academics to develop mobile health applications and products as a reflection of what it believes is the huge potential for smartphones and similar devices to revolutionise public services, reported Government Computing. Professor Kevin Fenton, Public Health England’s national director for health and wellbeing, said that the organisation was aiming by 2016 to support a million people annually through mobile products by developing a portfolio of services in conjunction with use of behavioural science frameworks. In addition, the organisation announced it will also seek to promote the availability of mobile services and make use of social media as both an analytical and engagement platform. With mobile phones now thought to be the most widely-adopted technology in human history, Fenton added that there was significant potential for further innovation in health. He said that an estimated 62% of UK adults currently use smart phones, he said. “So, what does this mean for public health? I believe that digital public health and in particular mobile health – the use of mobile communication and devices for achieving health outcomes – is at a tipping point,” said Fenton. “Mobile has some unique assets – not least availability, affordability, interactivity, accessibility and portability – that open up new possibilities for supporting people to protect and improve their health.” Public Health England is already working with experts from across the private and education sectors to try and find innovative mobile health services, with the organisation pointing to the launch earlier this year of its Health X competition designed to encourage start-ups to put forward prototypes.
Telephone triage ‘creates more work’: GP consultations over the phone rather than face-to-face appointments do not reduce pressure in busy surgeries, a new study shows. An analysis in 42 practices, where 13 practices offered GP triage, 15 nurse triage, and 14 providing “usual care”, found telephoned patients also needed further contact with their GP. It was hoped that triage would relieve some of the burden on GPs, reported OnMedica. Writing in The Lancet the report’s authors from the University of Exeter Medical School said phone consultations had a role, but were “no silver bullet”. Their research revealed that rather than easing workloads, the number of patients being dealt with by practices increased by 33% when a doctor called back, and by 48% when a nurse was on the other end of the phone. The study showed that telephone conversations led to more people needing a second consultation. If the first meeting was in person, 50% of patients needed a second visit, but 75% of GP and 88% of nurse calls required a later visit in person. Lead researcher Prof John Campbell said: “This is not the silver bullet to dealing with workload. Introducing it in some settings will be very useful, but it needs to be introduced with caution.” He said phone calls were still a valuable and good service, especially for people who could not get away from work. But equally they could harm the relationship with patients who like to come into the surgery.
Key care.data letters ‘not sent’: The care.data programme could be further delayed because ‘expression of interest’ letters have not been sent to potential pilot sites, reports eHealth Insider. Care.data is the government’s flagship NHS ‘big data programme’. It is intended to expand the Hospital Episode Statistics, link them to GP and other data sets, and release the information to researchers. However, it became enveloped in controversy this spring, when medical and privacy groups objected to a public leaflet campaign that failed to include a clear account of the programme or an opt-out form. The latest idea is for 500 GP practices to trial care.data in a phased roll-out starting this autumn. Clinical commissioning groups (CCGs) were due to receive ‘expression of interest’ letters earlier this month. However, eHealth Insider understands the letters have not yet been sent; casting doubt on an autumn start. A spokesperson from NHS England refused to deny or confirm whether the letters have been sent. They said the commissioning board is continuing “to select CCG pathfinders and the pathfinders stage will continue through autumn 2014”. Sam Smith from patient privacy campaign group MedConfidential, said “it was a continuing indictment of care.data” that NHS England will not confirm if letters have been sent. “No one has reported receiving one, so we can only assume they didn’t,” he said. Since the programme ran into problems, NHS director of patients and information Tim Kelsey has said he is listening to concerns about it. Kelsey and the commissioning board both insist they are no longer bound by “artificial deadlines” while this happens. A paper presented to the National Information Board earlier this month says the pathfinder project will “only launch when the board is happy for it to [do so]”. It also says a decision to proceed will be made on advice from the Independent Information Governance Oversight Panel and the care.data advisory group which was established earlier this year.
PM: genome project will transform cancer care: Tens of thousands of NHS patients are to be invited to donate their DNA for research as part of a project that aims to make the use of genetic data routine in the health service, according to the Guardian. About 40,000 patients with cancer and rare diseases will have their genomes sequenced during the four-year project, which David Cameron claims will transform how serious diseases are diagnosed and treated. Cancer patients will have DNA from healthy and cancerous tissues read so that doctors can work out which mutations are driving the growth of their tumour cells. The information could help medical teams decide which drugs will be most effective in a patient, but will also identify groups for targeted trials of new therapies. Beyond cancer, the 100,000 Genomes Project hopes to improve diagnoses of rare diseases caused by genetic mutations. Though rare individually, they take a huge collective toll on public health. More than 5,000 rare diseases, which affect more than three million people in the UK, have been identified. Rare diseases are often spotted in children, but to diagnose a condition the project will read the DNA of the patient and both parents. The project aims to have sequenced 100,000 genomes by 2017, but the Guardian understands that Cameron intends to extend the project beyond that date and to broaden its reach to other diseases.
Waiting times in NHS at worst for six years: Waiting times in the NHS are getting worse, with targets missed and more than 3.2m people waiting for treatment, officials have admitted. Earlier this week, health secretary Jeremy Hunt ordered 100,000 extra treatments and operations to be carried out this summer at a cost of £250m to bring the problem back under control. He warned that targets would be missed in the short-term as staff had been told to concentrate on those who had been waiting the longest, reported The Telegraph. The latest official waiting times data bears that out as the target to treat 90% of people who need to be admitted to hospital within 18 weeks of their GP referring them was missed in June. It meant 32,500 people waited longer than this. The estimate of the total number waiting for treatment has been revised up from just over three million to 3.2m as five hospital trusts failed to submit the numbers waiting on their books. Andy Burnham, shadow health secretary, responding to new NHS figures showing the government has missed the operation waiting time target, thousands more patients waiting too long for treatment and 160,000 missing patients, said: “The prime minister promised to keep NHS waiting times down but these figures show he has failed the test he set himself. Under his government, there are more people on NHS waiting lists and those patients are waiting longer for treatment. In June, the NHS missed its waiting time target with 32,500 people who waited longer than 18 weeks – the highest in six years. Under David Cameron, people are seeing a return that old Tory choice of suffering in silence or paying to go private.”
NHS whistleblowers urged to share experiences of poor patient care: NHS staff are being urged to share their experiences of blowing the whistle on incidents of poor patient care, reported The Telegraph. Sir Robert Francis QC, who led two major inquiries into failures at Mid Staffordshire NHS Foundation Trust, has launched a call for evidence for his review of whistleblowing in the health service. The aim of his independent review, commissioned by health secretary Jeremy Hunt earlier this year, is to recommend how staff can be best supported to raise concerns about poor patient care. Sir Robert said: ”We need a culture where ‘I need to report this’ is the thought, foremost in the mind of any NHS worker that has concerns – a culture where concerns are listened to and acted upon. The Mid Staffordshire Public Inquiry showed the appalling consequences for patients when there is a ‘closed ranks’ culture. We need to hear from as many people in the NHS as possible, so we can learn more about what we need to do to support staff to raise concerns, and support the NHS to listen to them.”
Minority of patients are offered choice of provider, say Monitor and NHS England: Less than 40% of patients are offered a choice of provider when referred by their GP for an outpatient appointment, according to a survey report published by NHS England and Monitor. Just over half of patients polled were aware of their legal right to choose a hospital or clinic for an outpatient appointment, according to Health Service Journal (subscription required). Patients have a right to be offered a choice of provider, with help from their GP, under the terms of the NHS Constitution. The study also found that 53% of those referred for an outpatient appointment first had a discussion with their GP about where to receive treatment. NHS England national director for commissioning strategy, Ian Dodge said in a statement: “While patient choice of first outpatient appointment is a reality for some patients in England, the challenge now is to ensure that everyone enjoys their legal right, for example, to choose hospitals or clinics with shorter waiting times, if that’s what they want, in both mental health and physical health services.” Monitor co-operation and competition director Catherine Davies said: “This survey gives us some helpful insight into how patients have experienced choice in England. Some of these results are encouraging and suggest that many GPs are having helpful conversations with patients about decisions that affect their care. But it also suggests the NHS needs to do more to make sure patients are aware they have a choice and are offered that choice. We will continue in our efforts to make sure this happens, and to help patients feel involved and in control of their healthcare.”
Sussex NHS Trust signs electronic patient record deal with ACS: Sussex Partnership NHS Foundation Trust has awarded a contract to Advanced Computer Software (ACS) for its electronic patient management system ‘Carenotes’, reported ComputerWorld UK. The new system will make the trust’s data available in real time and allow clinicians to update and review records via mobile devices. Dr Kay Macdonald, clinical academic director, Sussex Partnership NHS Foundation Trust said: “Clinical staff have been closely involved in selecting the patient information system, which is both of high quality and cost-effective. Carenotes is robust, innovative, and flexible enough to meet the demands of the different types of services we provide.” Patients will eventually be able to access their own care records online, ACS said. Managers can use the data to ensure processes are efficient and safe, and commissioners will be able to use service activity information to inform their decisions. The system will interface ‘seamlessly’ with the Summary Care Record and the trust’s legacy systems and will manage the records of more than 100,000 patients across Sussex, Kent, South London, and Hampshire. It will be used by 5,000 staff across the trust, which is one of the biggest mental health trusts in the UK, and is due to be rolled out over the next two years.
Health boards get extra funding to reduce patient time in hospitals: An extra £5m is to be invested in seven health boards across Scotland to reduce the amount of time patients remain in hospital, reported the BBC. The Scottish Government estimates £100m a year is wasted on acute services when social and community care would be more appropriate. About 1,000 people are stuck in hospital because they need additional care which is not yet in place. The funding is to improve patient flow in health and social care services. It will be targeted in Lothian, Grampian, Fife, Lanarkshire, Highland, Forth Valley, and Greater Glasgow and Clyde health board areas. It is designed to help people stay in their own homes, return home from hospital quicker, and reduce the time people from accident and emergency wait for an appropriate bed to become available. Health Secretary Alex Neil said: “We’ve already legislated for health and social care integration to come into effect from April next year, but I am clear that we must make further progress now. This investment will help improve the journey of many patients through hospital and back home, supported by appropriate care services, so they can leave hospital as soon as they are able.” He added; “Improving flow through hospitals not only benefits the individual patient, but also helps improve the performance in frontline services like A&E and planned operations.”
Awards
Healthcare IT Champion – the final six: The final round of voting has opened in this year’s Healthcare IT Champion of the Year award – and you now have two weeks to decide who will be unveiled as the winner in October. The Healthcare IT Champion of the Year is a special category of the eHealth Insider (EHI) Awards 2014, that is decided by the readers of EHI and the people who work with those nominated.
This year, there were more than 20 nominations for the award, and the final six are: Mark England, director of re-engineering at Luton and Dunstable University Hospital NHS Foundation Trust; Kerrie Darvill, deputy director of IM&T for Greater Manchester West NHS Trust; Rowan Pritchard-Jones, consultant plastic surgeon and chief clinical information officer, St Helens and Knowsley Health Informatics Service; Darren Holmes, head of ICT, St Barnabas Lincolnshire Hospice; Andy Kinnear, chair of the Connecting Care board and director of business intelligence and informatics, South West Commissioning Service; and Dr Rick Jones, formerly specialist advisor to the NHS England National Pathology Programme, deputy director of the Yorkshire Centre for Health Informatics, and consultant chemical pathologist for Leeds Teaching Hospitals NHS Trust. Sadly, Dr Jones has passed away since his nomination and EHI have maintained his nomination for a posthumous award at the request of his friends and colleagues.
Linda Davidson, director of EHI, said: “The competition for Healthcare IT Champion of the Year is tougher than ever. This year’s first round attracted more than 1,000 more votes than last year’s and it is up to EHI’s readers to decide who should emerge as the final winner.” The second round of voting closes at 4pm on Friday, 15 August, and the winner will be announced at the annual awards dinner in central London on Thursday, 9 October.
Opinion
With choice comes responsibility
Malcolm Senior, director of informatics at Taunton and Somerset NHS Foundation trust, comments on the announcement that the trust he works for could be the first to implement an open source EPR and what responsibilities and benefits that decision brings.
“Lessons learnt from NPfIT suggest that a one-size-fits-all approach for EPRs has its limitations, as every trust made the case, rightly or wrongly, that it was somehow different. This is why we believe that open source provides another way of delivering those clinical benefits; trusts can take ownership of the code and develop it alongside clinicians to their requirements.
“But open source is not for everyone. Each healthcare provider has varying degrees of IT maturity; some may be close to becoming paperless or have systems in place that just need to be built on, some may decide that a new approach is right for their organisation.
“From an IT perspective, we have a responsibility to work closer with clinicians, to understand their processes, but also to challenge their thinking. At Musgrove Park Hospital (part of Taunton and Somerset NHS Foundation Trust), we have clinicians driving this change, rather than IT – an approach we have been committed to from the start of our EPR procurement. We made sure clinicians were involved in the procurement and we now have a real momentum going with the frontline staff playing a significant part.
“Just because a trust has taken an open source approach does not mean you have to take all that work, control, ownership immediately – you can save as much as time as you want to develop those abilities. Also, with a community interest company to support the management of the code, there will be a structure in place for clinicians to really input into the way the system is developed, whilst maintaining the integrity of the code for better patient experience and outcomes.”
NHS waits: Getting the excuses in early?
Nick Triggle, the health correspondent for BBC News, analyses the patient waiting times and the targets set by the NHS and asks what is the cause of Health Secretay Jeremy Hunt’s speech and the sudden interest in the matter.
“The devil – as always – is in the detail. The pledge by Health Secretary Jeremy Hunt to end year-long waits for routine treatment seems to make perfect sense. After all, the NHS has already made great strides on this issue. Three years ago the numbers of patients waiting over 52 weeks were hovering around the 20,000 mark. Now there are fewer than 600. So what could be wrong with the health secretary giving the NHS a last little shove over the line? Nothing, of course. But it is important to see this in context of the wider pressures on the system.
“Apart for February and March when it was missed ever so slightly, the 90% target has been met this year – as it has for most of the time since it came into place under Labour. But within the health service it has been widely acknowledged that this achievement – met despite the squeeze on spending and rising demands – could only be maintained for so long. That threat – I am told – has been causing a lot of angst at the Department of Health. So the acknowledgement that the 18-week target will be missed in the coming months in a “managed breach” is a critical detail.
“This is unheard of. The 18-week target is enshrined in the NHS Constitution and was personally committed to by the prime minister in June 2011 when the controversy over the government’s NHS reforms were at their peak. What is more, the big improvements made from late 2011 through to early 2013 when the number of year-long waits fell 40-fold did not lead to a breach in the 18-week target. Instead, by making it clear the target is going to be missed at this stage and pinning it to the desire to tackle long waits the government – it could be said – has got its excuses in early.”
Privatisation is ripping the NHS from our hands
The notion that competition promotes excellence and market forces breed efficiency is a myth says Deputy chair of the British Medical Assosiation (BMA), Kailash Chand, in this week’s Guardian Healthcare Network.
“Last year, a majority of new contracts to provide NHS services went to private companies. Most of these private companies hide behind the NHS logo but siphon off a profit. Collectively, such providers received more than £10bn from the public coffers in 2013. And according to the Financial Times, around £5.8bn of NHS work is currently being advertised to the private sector, a 14% increase on a year earlier.
“Clinical commissioning group (CCG) leaders do not consider that privatisation is their main agenda. They do admit, however, that they face difficult decisions regarding the need to tender which, in a nutshell, is a tool for commissioners to facilitate competition. Promoters of the concept of Any Qualified Provider who indulge in marketisation do so under the false belief that this achieves better health outcomes, which flies in the face of both the theory as well as overwhelming evidence that equity, efficiency, and equilibrium of the NHS are adversely affected.
“In my view competition is nonsense when it comes to healthcare, and choice is an illusion; delivering them on the back of commissioning private providers is hoodwinking the British public. These are businesses that are run for shareholders and they work on the basis of profit margins firstly, and then promotion of health. From the perspective of patients and taxpayers this bias is undesirable – a recipe for overcharging, over-treatment, and corner-cutting on safety. There are no evidence-based examples of successful healthcare relying on the principles of the free market.
“Do we really want an NHS that is obsessed with private companies tendering for the work? Or do we want a health service that is passionate about caring for the seriously ill and vulnerable? It doesn’t have the ability to do both, and given its roots and origin, the Health and Social Care Act has created a schism that is causing turmoil.”
Power to the people on testing times
Paul Hodgkin, founder and chief executive of Patient Opinion, examines the mathematics of testing for disease, and concludes that professionals and patients are going to need some very clever apps to guide them through the results.
“So we can get our DNA tested with no questions asked. If you want to know if your spouse, teenage son or direct reports are taking drugs, send off a hair sample and screen them to see what substances they’ve been consuming. Self-evidently the technology is running way ahead of the ethics here. But ethics can get messy can’t it? So let’s cut to the science because right there, at the heart of testing, there is a show stopper that should make us all pause before reaching for our credit cards to order that online test.
“Here is a topical if grim example – Ebola. Suppose that there is a test for the infection that takes seconds to perform and gives an answer that is correct 97% of the time. And suppose you have 10,000 people per day arriving in the UK from at risk destinations, of whom 1% are infected with Ebola. Does it make sense to start testing these 10,000 people at the port of entry? The point is that interpreting test results is counter intuitive. ‘Common sense’ may tell us that it is better to be safe than sorry, that any test is better than none. But all tests, indeed all clinical information, has an error rate. In technical terms, the sensitivity and specificity of much clinical information is surprisingly low.
“So what does this mean for an age in which people can finally side-step all those pesky doctors and get their mitts on any test they want because “prevention is better than cure”? First off, it is unlikely that the powers that be will be able to regulate us out of this problem. The nature of the web means that if people want stuff there will always be a Silk Road that will purvey it to them. Secondly, like lots of clinicians I found the relationship between sensitivity, specificity and prevalence hard to grasp and even harder to get over to patients. As a result, almost all clinicians tend to place undue certainty on the tests and information they have to hand. Patients often end up mistakenly thinking they can’t have their chosen test for financial reasons rather than because it will not yield any useful information.
“What would help is to make sure that anyone ordering a test or a scan in the UK always gets the result via an app or an interface that has all this complex information already built into it. Many kinds of data that used to be expensive are now cheap or free. This shift is beginning to apply to our biology. From Fitbit to direct OTC testing and imaging, our biological self is becoming transparent and measurable. Making sense of this will take good software as well as professional advice.”
Highland Marketing blog
In this week’s blog, account director Sarah Bruce asks whether you want the good or the bad news.
