Caldicott report roundup
Dame Fiona Caldicott’s latest review of data security and consent has proposed new measures to strengthen security of health and care information and help people make informed choices about how their data is used. Below is a summary of the news surrounding the report:
NHS England closing Care.data: NHS England is closing the much-criticised Care.data programme, reported Health Service Journal (subscription required). Life sciences minister George Freeman said: “In light of Dame Fiona’s recommendations, NHS England has taken the decision to close the Care.data programme. This work will now be taken forward by the National Information Board, in close collaboration with the primary care community, in order to retain public confidence and to drive better care for patients.”
Tough penalties and better data control: The Caldicott report said NHS trusts should make security control as high a priority as financial control, and recommends a tougher Information Governance (IG) Toolkit for trusts, reported DigitalHealth.net. “The leadership of every organisation should demonstrate clear ownership and responsibility for data security, just as it does for clinical and financial management and accountability,” the report said. “People’s confidential data should be treated with the same respect as their care.” National Health Executive noted that report author Dame Fiona Caldicott said that much more must be done to improve public trust with regards to data sharing. She said that there should be a new consent model to allow people to opt out of their personal confidential data being used for purposes beyond their direct care.
Obsolete NHS IT to be scrapped as security risk: The government has indicated that there will be a blitz on removing obsolete technology from the NHS that poses a security risk, reported DigitalHealth.net. George Freeman said: “We are working with suppliers, including Microsoft, to help health and care organisations update their systems and make sure they are safe to use and store data.” He said that the Health and Social Care Information Centre (HSCIC) “will launch an initiative to support this work later this year”. The involvement of Microsoft is likely to be significant, since health is known to have a particular issue with the Windows XP operating system.
CQC revamps health and social care data security guidance: In addition to the Caldicott review, the Care Quality Commission (CQC) has set out six recommendations to be undertaken by health and care organisations across the UK in order to protect systems against potential data breaches and ensure patient information remains confidential, reported Government Computing. According to the commission’s findings, clear organisational leadership on who leads data security, training and the availability of required tools, as well as a need to move away from outdated technology are some of the key recommendations. Under the terms of its review, the CQC said it had not undertaken an examination of IT systems as this was the subject of a separate HSCIC review. However, the commission said it defined data security around how patient information is available when needed for care, how it is protected from damage or loss, and the methods for keeping it confidential and free from unauthorised tampering.
News in brief
Junior doctors reject proposed new contract as BMA demands fresh talks: Almost six out of 10 junior doctors have voted to reject the new contract agreed by British Medical Association (BMA) and government negotiators after emergency talks earlier this year, reported GPOnline. The vote is a devastating blow to negotiators from both sides who had hoped that a deal struck through the mediation service Acas could finally draw a line under a dispute that had sparked a wave of unprecedented strikes by thousands of junior doctors. BMA junior doctors’ committee chairman Dr Johann Malawana, who recommended the deal to the profession after the last-ditch Acas talks, stood down from his position. A total of 58% of junior doctors voted against the new contract and 42% in favour, on a turnout of 68% – around 37,000 junior doctors and medical students. In a statement after the referendum result, Dr Malawana said: “The result of the vote is clear, and the government must respect the informed decision junior doctors have made. Any new contract will affect a generation of doctors working for the NHS in England, so it is vital that it has the confidence of the profession.” Health secretary Jeremy Hunt said: “It is extremely disappointing that junior doctors have voted against this contract, which was agreed with and endorsed by the leader of the BMA junior doctors’ committee and supported by senior NHS leaders. The BMA’s figures show that only 40% of those eligible actually voted against this contract, and a third of BMA members didn’t vote at all. We will now consider the outcome.” Just the next day The Guardian reported that Hunt gave an oral statement in the House of Commons, and rejected holding any further talks with the BMA, the doctors’ union, pointing out that three years of talks on new terms and conditions for junior doctors had failed to produce a final agreement. Junior doctors accused Hunt of deliberately choosing the day of the Chilcot report’s publication to confirm that he was pushing ahead with a contract that is deeply unpopular with doctors. One leading junior doctor, who did not want to be named, said Hunt had selected “a good time to bury imposition”.
NHS finance heads fear for patient care quality: A significant portion of NHS finance directors believe that the quality of patient care will deteriorate in 2016-17 while many are questioning the likely success of financial support measures, according to findings of the latest NHS Financial Temperature Check survey, reported the Pharma Times. More than one in five finance directors – 21% of clinical commissioning group (CCG) chief financial officers and 23% of trust finance directors – believed the quality of patient services will take a downturn this year, and a one third of provider trusts are expecting it to decline further. Waiting times (76%), access to services (69%) and enabling a range of services being offered (61%) were cited as being the most vulnerable aspects of patient care. For the third year in a row, the financial performance of the NHS worsened, with both NHS trusts and NHS foundation trusts reporting a deficit and CCGs also reporting an overspend for the first time 2015-16. “The scale of the NHS deficit continues to reach unparalleled levels, and it is unlikely the provider position will be in balance at the end of 2016/17, as originally planned,” noted Paul Briddock, director of policy at Healthcare Financial Management Association (HFMA). “Fears around the impact the current financial turmoil in the NHS could have on quality are also a real cause for concern and we may start to see more of these predictions come true in the year ahead. To avoid this, there is a need for NHS organisations to work together to address these financial and operational pressures by the efficient redesign of services and to put an end to the shifting of financial problems between sectors”, he said.
Health boards could go in radical shake-up of NHS in Scotland: Tayside and Fife’s health boards could be axed under a radical NHS shake-up being considered by the Scottish government, The Courier understands. In its manifesto for the 2016 Holyrood election, the SNP outlined its plans to review the number of regional bodies in charge delivering medical care for communities in a bid to improve services and save money. Such a move, according to senior sources in the health service, is likely to lead to a reduction in the number of local health boards from the current 14 to possibly three or five. That would favour mergers, with the likes of Tayside and Fife almost certain to be consumed into a larger body. This larger body could potentially lead to concerns about staff numbers and patient services. However, senior figures in the Scottish government said that cross-border working is already occurring and is focused solely on ensuring those who need treatment get it as close to home as possible. The SNP manifesto said: “In implementing the National Clinical Strategy, we will make sure the existing boundaries between health and integration bodies do not act as barriers to planning local services effectively. The number, structure and regulation of health boards – and their relationships with local councils – will be reviewed, with a view to reducing unnecessary back room duplication and removing structural impediments to better care.”
Brexit may hit NHS’s nurse ‘pipeline’, says regulator chief: The “pipeline” of nurses coming to the NHS may be constrained because of likely changes to the approval process for those coming from the European Union, according to the UK’s nursing and midwifery regulator. Jackie Smith, chief executive and registrar of the Nursing and Midwifery Council (NMC), said there would be a major impact of the regulator’s ability to process applications if it were required to apply its current approval procedures for nurses from the rest of the world to those coming from the European Union (EU). It would also mean additional costs for the NMC, she told Health Service Journal (subscription required). She said at present 10 times more nurses came to the UK from the EU than the rest of the world. “There would be an issue with the pipeline,” she said. “If you look at the process that is in place for those coming from non-EU countries there are a number of requirements that need to be met. Not least all their documentation and verifying it all and getting their visa and coming here and taking a skills test. EU nurses have to verify documents with us and take an English language test, where it is appropriate, but they don’t have to get a visa. There are bound to be things that make the process longer.” The NHS is heavily reliant on the supply of nurses from EU countries, with around 4% of the present workforce having come from union nations. The service has also struggled to fill nursing posts in recent years, leading to widespread efforts to recruit from abroad, as well as high agency costs.
Rise in Northern Irish and Welsh health complaints as English Ombudsman resigns: Northern Ireland Ombudsman Marie Anderson has said that 45% of the total complaints she received in 2015-16 were about patient experiences in the health and social care sector, reported the BBC. Having risen from 41% in 2014-2015 and 38% in 2013-2014, Ms Anderson said health and social care trusts in Northern Ireland must work together more and share information to improve outcomes for patients. In Wales, complaints made against NHS bodies to the Public Services Ombudsman for Wales have also risen over the past year, Wales Online said. The Ombudsman’s 2015/16 annual report showed that there were 798 health body complaints in the past year, a rise of 4% on last year, with local health boards and NHS trusts accounting for 661 of them. It also revealed that in the past five years, complaints against Welsh NHS bodies increased by more than 50%. Meanwhile in England the Parliamentary and Health Services Ombudsman (PHSO) Dame Julie Mellor has resigned over the way she handled correspondence about the PHSO’s former managing director Mick Martin, noted Civil Service World. Writing to Public Administration and Constitutional Affairs Committee chair Bernard Jenkin to inform him of her resignation, Mellor wrote: “I have accepted and taken responsibility for the mistakes I made.”
A powerful panel has started scrutinising Google’s work with the NHS: A panel comprised of government tech leaders and healthcare experts has started scrutinising the work of Google DeepMind’s healthcare team. DeepMind, a British artificial intelligence (AI) start-up acquired by Google in 2014 for £400m, is processing NHS patient data through a new division called DeepMind Health. Mustafa Suleyman, DeepMind cofounder and head of DeepMind Health, told Business Insider that the review panel met roughly four to five weeks ago. The board includes the likes of Tech City UK chair Eileen Burbidge, former government chief digital officer Mike Bracken, and The Lancet editor-in-chief, Richard Horton. It is unclear at this stage what was the panel discussed at the meeting but it is likely that addressed Google DeepMind’s partnership with the Royal Free London NHS Foundation Trust, which was criticised by privacy campaigners. They are also likely to have spoken about Google DeepMind’s partnership with Moorfields Eye Hospital, which was announced on Tuesday. The partnership will result in one million anonymised eye scans from Moorfields Eye Hospital used to train the AI system from Google. Machine learning algorithms will scour the images for signs of diseases such as macular degeneration and diabetes-related sight loss. “How it plays out over time remains to be seen,” Sam Smith, a co-ordinator at patient data campaign group MedConfidential, told the BBC. “But you do have organisations involved that aren’t principally concerned with DeepMind – they care about blindness in the case of RNIB and long term medical research in the case of the National Institute for Health Research.”
DH restructure brings digital, local government and social care under one roof: As part of a cost-cutting drive the Department of Health (DH) has reorganised and merged its digital, technology, local government and social care directorates into a new single community care category, reported National Health Executive (NHE). The restructure, which went live on 1st July, saw four new directorates under Chris Wormald. A DH spokeswoman said that the department will have four big groups of work managed by four directors general: global and public health; community care; acute care and workforce; and finance and corporate services. Most Whitehall budgets were cut in last November’s spending review, and the DH is attempting to make efficiency savings of 30% in the next five years, including plans to cut about 650 jobs by April 2017. The new community care directorate, which will be led by Tamara Finkelstein, will cover a broad range of different issues, including mental health, seven-day services, medicines and pharmacy, and the chief social worker. “The directorate reshuffle, that will see the newly formed community care directorate absorb technology as part of its remit, signifies another move in the ambition to deliver integrated care across public services,” Natalie Bateman, policy and communications director at IMS MAXIMS, told NHE: “By including digital as part of this directorate, the Department of Health is reinforcing its recognition that technology is central to delivering new models of care outlined in the Five Year Forward View.”
All 44 “initial” STPs now with NHS England: All 44 sustainability and transformation plans (STP) have been lodged with NHS England, but what they mean for funding and IT projects could take months to untangle, reported DigitalHealth.net. Thursday 30th June was the deadline for submitting both the 44 STPs, and the 83 local digital roadmaps to NHS England. The plans are considered an important part of closing the £30bn gap between funding and demand that is projected by 2020-21. They are also central to unlocking funding to help reach these goals. On Friday 1st July, a NHS spokesman confirmed that all 44 footprints had submitted an “initial” STP by the deadline. However these plans did not “yet have a formal status, and are subject to change based on local and national conversations and further development”. Instead they would form the basis for meetings this month, between national health organisations, such as NHS England, and local footprint leaders. These meetings would cover whether these initial STPs were “ambitious, robust and rigorous” enough health to close the health, care and financial gap by 2020-21, and how well they aligned with national priorities. Once a plan was agreed this would again go back to the footprint areas for further local consultation.
Metrics on NHS digital transformation to be made public, says National Information Board: The Department of Health is to add metrics on digital transformation, integrated health and care and seven-day services to its My NHS website, reported PublicTechnology.net. In a letter to health secretary Jeremy Hunt, John Newton, the interim chairman of the National Information Board – which is responsible for NHS data and technology and oversees My NHS – set out proposals for improvements to the site over the coming months. This included “firm plans” to add metrics on seven day services, digital transformation, integrated health and social care, cancer, GPs, clinical commissioning groups, hospital efficiency and home care. Newton said that this would start in the summer with hospital data. He also said that the work done to identify which sets to add in had highlighted missing or poor quality data, with data on community services and social care being “generally weak and frequently incomplete”. However, Newton said: “We should not automatically press for new data collections to fill perceived gaps.” He added: “The aim should be to use existing data better wherever possible, without imposing new burdens on the health and care system. Mobilising information already within the system to answer our needs should be the first priority.” Netwon also said that the site was due for a “major refresh” during the summer, and that there would also be a programme of direct engagement with the people who use the site. This would help to tailor it to users’ needs, promote understanding of the site and develop a network of champions for what is described as intelligent transparency.
578 operations cancelled in Scotland due to lack of beds, staff or equipment: The number of hospital operations cancelled in Scotland due to factors including a lack of beds, staff or equipment rose in May, reported Care Appointments. Official figures show there were 31,213 scheduled operations across NHS Scotland during the month, of which 2,845 were cancelled either by the patient or the hospital. The overall cancellation rate of 9.1% was down from 9.4% in April, but 578 (1.9%) operations were cancelled by the hospital due to “capacity or non-clinical reasons”, up from 467 (1.6%) the month before. Reasons can include the unavailability of beds, staff and equipment as well as employee illness, dirty equipment and theatre sessions overrunning. Public health minister Aileen Campbell said: “The number of operations cancelled for non-clinical reasons remains a very small percentage of the overall number of scheduled procedures taking place in the NHS in Scotland. However, decisions to cancel planned operations are never taken lightly and we are always working with health boards to make sure we manage capacity and planning, to keep all cancellations to a minimum. Health boards work to ensure disruption to patients is always kept to an absolute minimum, and any postponed procedures will be rescheduled at the earliest opportunity.” Scottish Labour’s health spokesman Anas Sarwar said: “The SNP government must not allow themselves to be so distracted by the fallout from the EU referendum that they take their eyes off of the day-to-day running of our NHS. This increase in cancelled operations, because our NHS can’t cope, must act as a wake-up call that SNP ministers can’t forget about the day job.”
Senior appointments announced to drive NHS technology: NHS England and NHS Improvement have announced three key appointments following recommendations in the forthcoming review on the future of the NHS information systems by Dr Bob Wachter, reported Health IT Central. Rather than appoint a single chief information and technology officer, consistent with the Wachter review, the NHS has decided to enroll a senior medical leader as NHS chief clinical information officer (CCIO) supported by an experienced health IT professional as NHS chief information officer (CIO). The first NHS CCIO will be Professor Keith McNeil, a former transplant specialist who has also been in many senior roles in healthcare management around the world. The new NHS CIO is Will Smart, who currently holds the role of CIO at the Royal Free Hospital. These post-holders will act on behalf of the whole NHS to provide strategic leadership, also chairing the National Information Board, and acting as a commissioning ‘client’ for the relevant programmes being delivered by NHS Digital, formerly the HSCIC. In addition, Juliet Bauer has been appointed as director of digital experience at NHS England. She will work on the transformation of the NHS Choices website and the development and change in digital technology for patient ‘supported self-management’.
East London pilots technologies to support older people: Innovative technologies to support older people with long-term conditions or dementia are to be piloted in East London, reported DigitalHealth.net. The Care City Innovation Test Bed, a collaboration between local NHS trusts, CCGs, local authorities and academics, will cover Barking and Dagenham, Havering, Redbridge and Waltham Forest. Katharine Langford, test bed project manager, said the project would be an extension of work carried out in the past three years to create an integrated approach to health and social care for frail, older people: “The test bed is going to look at how we could accelerate this if we used the best technologies that the NHS has identified.” Three clusters are piloting the technology: older people with long-term conditions; older people with dementia; and families and carers. A staged rollout will begin this summer, with each cluster assigned three different technologies. For those patients with long-term conditions, the technologies are: Health Navigator, which uses nurse-led coaching over the telephone to help people manage their own care; AliveCor, which detects irregular heartbeats to improve diagnosis of atrial fibrillation; and Kinesis, a device to assess people’s risk of falling and make sure they have access to the right services. Both Kinesis and AliveCor will be used in clinical settings, rather than in people’s homes.
New partnership for Scotland’s DHI as CEO Ewing departs: Justene Ewing is to step down as CEO of Scotland’s Digital Health and Care Institute (DHI) in August as the University of Strathclyde becomes the lead strategic partner of the innovation body alongside the Glasgow School of Art, reported the DHI. Ms Ewing, who told Highland Marketing in October 2015 of her mission to drive Scottish healthcare innovation across the globe, will continue to serve as CEO of the organisation until the end of August, to oversee the smooth transition of DHI from University of Edinburgh to Strathclyde as DHI’s new academic host. “Justene has created a culture of excellence, dynamism and drive in the team and we thank her for putting DHI in an ideal position for continued growth and success,” said DHI chairman Professor George Crooks OBE. Ms Ewing posted on Twitter: “I’ve been so deeply honoured & privileged to have been a part of something so inspiring and unique.” DHI supports the emerging digital health and care sector in Scotland working with industry, Scotland’s enterprise agencies, health, social care and third sector partners, as well as academic partners from 15 of Scotland’s 19 higher education institutions.
Opinion
A new and powerful relationship with patients
Marcus Powell, director of leadership and organisational development at The King’s Fund, discusses one of the founding principles underpinning the NHS at its best: ‘of the people, by the people and for the people’.
“Now, more than ever, this is becoming true – not because the Five Year Forward View says it but because it’s demanded by patients, communities and the overall population the NHS serves. Simon Stevens recognised this changing relationship when he talked about the NHS as a social movement. This can’t be controlled or mandated – it’s happening and it should be embraced and celebrated as a force for good and renewal.
“In a digital world, information and knowledge is freely accessible to everyone – which challenges the traditional notion of leadership and power. Everyone becomes a leader and everyone becomes powerful. This is a fundamental challenge to the old paradigm and enables patients to truly embrace the opportunity to become partners and share in the decision-making that affects their care.
“With the aim of supporting new and positive innovations in this space, the team at The King’s Fund has been nurturing this changing patient relationship for the past 12 months by supporting a number of projects where patients have worked in ‘collaborative pairs’ with health professionals. One way of providing this support is seeing patients as partners recognising that the pathways for development of patient and community-based leaders is historically under resourced and undervalued in comparison to the investment in leadership for clinicians and managers.
“Central to this is a move away from a ‘them and us’ way of relating to a much more collaborative approach, and that this will need a shift from all of us in the way that we think about our leadership roles and the validity of the different perspectives and expertise that we each hold. With a view to tackling this, The King’s Fund runs a programme on leading collaboratively with patients and communities, and is also looking to build up a national network of previous attendees that will put a name to this new relational dynamic.
“Working in partnership with patients has and will continue to be a journey for the Fund. We also know that there are many other people and organisations who are doing great work and who have championed this agenda over the years. By making a new commitment to working in this way, we hope to encourage others to do the same.”
Understanding Scotland’s review of NHS targets
Getting the elective targets right is important, but balancing activity against demand matters more, writes Rob Findlay, founder of Gooroo Ltd.
“The Scottish government is reviewing its targets for the NHS, including those for elective waits which are having a pretty turbulent time. What should Scotland do? As it happens, Northern Ireland asked the same question only a couple of years ago. I suggested some answers at the time, and think they apply just as well to Scotland now. So here goes:
“Stage of treatment, or referral to treatment? A common waiting list pathway for surgery is: referral by GP; wait for first outpatient appointment; wait for diagnostic; wait for review outpatient appointment (perhaps more than one); and finally the inpatient or daycase wait.
“Set the target at 100%, or around 90%? There will always be some patients who want to delay or rearrange their treatment. It is better to set a target around 90%. Then patient choice is catered for by the tolerance, and the thicket of complicated rules around unavailability pauses and clock resets can be swept away.
“Measure waiting times as patients are treated, or while they are still on the waiting list? Waiting times targets have perverse incentives when applied to patients as they are treated. For instance, say the target is that 90% of patients treated must have waited less than 18 weeks. This is easy for hospitals to achieve: they simply ensure that, for every long-waiter they treat, they also treat nine short-waiters. So fewer long-waiters are treated, there is large-scale queue-jumping, and real waiting times go up. For safety, it must be understood throughout the system that clinically urgent patients always take precedence over routine patients, even if that means breaching a waiting times target.
“How many weeks should it be set at? I suspect this is the question that will generate the most heat. Let us come at the question a different way. What matters most is not the absolute waiting times of patients on the list, but whether the trend is up or down. If waiting times are steadily going up year on year, then any given target will eventually be breached. So the most important thing is the direction of travel. The long term trend should be for waiting lists and waiting times to get smaller.”
The NHS is on the brink of success with integrated care – here’s why it could fail
The NHS is on the brink of success for integrated health economies. This must not be undermined by avoidable security risks, writes Dr Saif F Abed, EMEA medical director at Imprivata.
“The realisation of genuine integrated care does carry inherent new data security challenges. The only way we can manage the health of entire populations is if we have a more mobile workforce, but we still need to have the same elite standards of security, while providing professionals with the right information, at the right time, wherever they need it.
“So how can a balance be struck? Mobility, clinical workflow and security are the three key elements to creating any integrated care strategy, whether that is one at a local level or one being driven nationally.
“Technology is not the biggest weakness in data security, it is the human factor, one of the reasons why we are still seeing data breaches and fines imposed on the NHS from the Information Commissioner’s Office. In reality, the way people handle data and how they access devices is often the main challenge. The vast majority of data breaches take place because of humans mishandling information, not because of a cyber hack.
“But it’s the human element that also offers the answer to data security risks, including the new challenges presented by integrated care. But the NHS must now empower the right people in order to tackle security challenges.
“CCIOs need to be given the executive powers to lead. The same is needed for SIROs, so that clinical flows, mobility and security are not addressed in isolation. The NHS must not pigeonhole clinicians and information security leads to clinical or security matters. Each deals with the whole picture from different angles. There must be collaboration between them and without executive powers, the train goes nowhere.
“Most importantly, health economies need to understand where they are deficient, where they are strong, where they need to invest and where they don’t have enough resource. The first step is for all the component organisations to come together and understand what they are capable of – and what they are not. Only an integrated approach to security can work for integrated care.”
Highland Marketing news
Informa appoints Highland Marketing to lead on EHI Live 2016 communications: One of the world’s largest organisations for events, conferences and publishing has appointed Highland Marketing to manage communications at EHI Live 2016, reported eHealthNews.eu. Informa Life Sciences Exhibitions has selected Highland Marketing to support the promotion of the event, fully manage media attendance and to help attract even more innovators to demonstrate technologies that can make a real difference to the lives of patients and the future of the NHS. Simon Page, managing director, Informa Life Sciences Exhibitions, said: “Highland Marketing has an unrivalled reputation for communicating technological innovations in the NHS and UK healthcare market. The company’s knowledge and understanding of the rapidly changing healthcare environment makes it the perfect partner to help us communicate both the value of exhibiting and attending EHI Live, and the messages and success stories of our exhibitors and speakers.” EHI Live will be held at the NEC Birmingham on 1st and 2nd November and will explore crucial issues for the health service, including integration across health and social care, cyber security, mental health, big data and more. Mark Venables, CEO of Highland Marketing, said: “EHI Live 2016 comes at a crucial time of change for the NHS, when digital technologies are more important than ever to ensure health and social care services across the country remain sustainable into the future and deliver better outcomes for patients. Once again, we look forward to working with Informa to ensure that technological innovations that can make a real difference are noticed by the people working to deliver the best possible care.”
