News in brief
One giant step for NHS Citizen: The NHS Citizen project has reached its initial aim – developing a design for how NHS England can improve citizen participation and accountability, reported NHS England. This design is a huge step forward for NHS England, said Tim Kelsey, NHS England’s national director for patients and information. “As we have said before, the NHS is more than a care-and-repair organisation; it is a social movement. It relies not just on the professionalism and hard work of staff, but also on the love that many millions of people feel for this great institution. For the NHS to survive and flourish in the future, it is this love and dedication that will drive the organisation forward. That’s why NHS Citizen is important: it sets out a blueprint for how everyone – patients, staff and the public – can take part in decision making and help hold the NHS to account.” The blueprint has now been delivered and can be seen on the NHS Citizen design microsite. It describes how citizens can have a genuinely active voice in NHS England decision-making. Once built, citizens will have a way of raising their healthcare issues, concerns and ideas with NHS England and a say in how they are addressed by the NHS.
Vanguard sites will not access full £200m transformation fund: Some of the £200m transformation fund to support the development of new care models will be spent on projects not connected with NHS England’s ‘vanguard’ sites, Health Service Journal (HSJ, subscription required) has learned. The fund was allocated to the NHS as part of a “down payment” to implement the NHS Five Year Forward View. NHS England’s Forward View Into Action planning guidance document, published in December, promised “a £200m would-be investment in new care models”. When it identified the 29 vanguard sites developing new care models in March, the authority said the project would be “backed by a £200m transformation fund”. HSJ understands that NHS England has now committed the funding to a number of projects, but not all of it will be spent implementing the new care models, while some will go to schemes unconnected to the forward view.
Advanced advises care providers to ensure IT is Care Act compliant: Advanced Health & Care (Advanced) is advising care providers to ensure they have the right technology to support compliance with new legislation following changes to the Care Act, reported Integrated Care Today. From April 2015 care providers are required to deliver personalised and integrated services and be transparent about the cost of providing care. The revised Care Act, described by the minister for care as “the most significant reform of care and support in 60 years”, requires every person entering the care system to have an assessment of their needs and a personalised plan for integrated care. It is vital that the right technology is in place to enable care providers to deliver these personalised plans and help to give service users more control over their care. Jim Chase, managing director, Advanced, said: “The role of technology in supporting care providers to deliver the standard of personalised service prescribed under the revised Care Act should not be underestimated. Solutions and mobile technology created specifically for the care industry can help care workers to create bespoke plans that can be easily updated and offer more transparency for the service user. With solutions like these in their toolkit, care providers can feel confident that they are not only meeting their legal obligations under the Care Act but also delivering truly individualised care.”
Local GP data sharing schemes ‘open practices up’ to legal challenges: Local Medical Committee’s (LMCs) have had to block attempts by commissioners to open up GP records to social care and out-of-hours groups because of data security issues that “blow the concerns about care.data…out of the water”, Pulse has learned. Local leaders across England have advised their members not to sign up to the schemes over fears that practices will be liable to data protection laws. The General Practice Committee has warned that such data sharing schemes are “cropping all over the place” and “leave GPs open to legal challenges”. Pulse also reported that the Health and Social Care Information Centre has said it did not have the resources to implement opt-outs from 700,000 patients to their data being shared. The local data sharing schemes are being proposed across England. Berkshire, Buckinghamshire and Oxfordshire LMCs chair Dr Paul Roblin said he had to “immediately” write to Buckinghamshire GPs urging them to avoid signing up to a scheme which would share records with social care crisis teams, as well as out-of-hours and acute care. The LMC has raised several potential problems, including: “A lack of informed consent, assumption of implied consent, lack of clarity about who will have access and how that will be safeguarded, the amount of data being shared, and the plan to advertise data sharing in the surgery, on the sides of buses and on the radio and internet.”
Oxford trust appoints new chief executive: Oxford University Hospitals Trust has appointed Dr Bruno Holthof as its chief executive, reported Health Service Journal (subscription required). Dr Holthof joins the trust from ZNA, a network of general and specialised hospitals in and around the Belgian city of Antwerp, where he has been chief executive for 10 years. Dr Holthof will begin in his new role from October, taking over from Sir Jonathan Michael who is retiring as chief executive, a position he has held since 2010. Commenting on his appointment, Dr Holthof said: “I am honoured to be appointed as chief executive of Oxford University Hospitals Trust. Oxford has the talent and technology to create breakthrough innovations that will improve the health of the local population and also have a global impact. Over the next decade we will see unprecedented change in the way healthcare is delivered, through the application of digitalisation, robotics and personalised medicine. Together with colleagues at Oxford University Hospitals, Oxford University and other partner organisations, I look forward to ensuring these technologies are used to support the trust as we continue to provide compassionate and excellent care to our patients and service users.”
Britain ranked 28th out of 30 countries in health rankings: According to a damning report, the UK has fewer doctors, nurses, hospital beds and crucial medical equipment than most other wealthy nations, reported the Telegraph. Research comparing Britain with 30 wealthy Organisation for Economic Co-operation and Development OECD countries places it 28th on the league table. There were just 2.8 doctors per 10,000 population in the UK in 2012, compared with an average of 3.2 doctors in other wealthy OECD countries. Meanwhile, the UK has 8.2 nurses per 10,000 population, compared with an average of 8.9 nurses among the 30 countries examined. The UK also had less than half the amount of equipment – such as computerised tomography (CT) scanners and magnetic resonance image (MRI) units – than the average, at 6.8 and 8.7 per million population. Dr Peter Carter, chief executive of the Royal College of Nursing, said: “This thorough report spells out what has been painfully clear to frontline staff for some time: the UK health service desperately needs more resources, more equipment, and more staff.” He urged the next Government to increase NHS spending substantially.
NME 180 trusts turning to SBS framework: NHS Shared Business Services (NHS SBS) has received 69 expressions of interest from NHS trusts in regard to its framework to support the procurement of clinical information systems. The framework, which was launched in February and could be worth up to £1.25bn, is intended to help NHS trusts save money and time when buying new clinical systems. Trusts using it will only need to hold “mini-competitions” from a list of 26 suppliers, instead of having to go through a full OJEU procurement process. One of the main purposes of the framework is to support trusts in the North, Midlands and East of England (NME) that need to move off contracts for systems agreed as part of the National Programme for IT. Speaking to digitalhealth, Tom Slater, provider procurement manager for NHS SBS, acknowledged that there was a sense of “urgency” from trusts looking to move off national contracts. He said 69 had been in touch with NHS SBS since the launch of the framework, although he didn’t give specific numbers for the NME.
Northgate Public Services unveils new integrated care web portal solution: A new Integrated Care web portal solution from Northgate Public Services (NPS) will help people to manage their own care by giving them access to self-assessment, advice, support planning, community networking and purchasing tools, reported Integrated Care Today. It will also enable them to find out if they are entitled to funded care through an online financial assessment facility. NPS Integrated Care allows people to create a support plan, manage personal budgets and care accounts and purchase equipment and services. It will also help to reduce social isolation by connecting people with each other and with relevant services – all from a single portal. Trevor Hampton, director of local government and housing solutions, said: “Integrated Care is being launched at a time when local authorities are committed to meeting all the requirements of the new Care Act. By enabling people to assess their own care needs on-line through a joined up facility, we can help to meet the needs of the Care Act and enable people to play a bigger role in managing their own support.”
BSI and Innovate UK launch advice for health app developers: BSI and Innovate UK have developed a code of practice for health and wellness apps, reported Computer Business Review. The guidance, titled PAS 277, gives recommendations for the quality criteria of health apps, aiming to help them meet the requirements of healthcare professionals, patients and carers. Covering the entire app lifecycle, including development, testing, releasing and updating of apps, it is aimed to help app developers and publishers create apps for devices that are fit for use in a health context. Anne Hayes, head of market development for Governance at BSI said: “There is huge scope for advancement in the area of wellness innovation, and we are thrilled to be pioneering work in the healthcare arena. It is therefore also our responsibility to safeguard the consumer and healthcare professional by governing the apps that are developed in the future. We can only do that by arming app developers with guidance such as PAS 277.”
King’s Fund calls for better staff data: In a report issued last week, the think-tank says there are significant gaps in the data available on the number of staff who work in the NHS, what they do, and where there are shortages or skills gaps, reported digitalhealth. The report’s authors, led by Rachel Addicott, say this lack of data makes it difficult to determine whether these areas are facing recruitment challenges, and whether these reforms have improved the care delivered. It is widely believed that the Francis Report and subsequent targets for ward staffing have led to an increase in recruitment and in the use of bank and agency staff, and that this has been a significant cause of pressure on trust finances. In a blog post, Addicott writes: “We urgently need a more comprehensive and systematic dataset that captures information on the whole workforce delivering NHS-commissioned services. It is only through doing this that we can build an understanding of the entire clinical workforce, including those in temporary roles, and including those employed by non-NHS providers. This will give us all a better chance of identifying emerging issues before they become major problems. Unless the right workers are recruited to the right places, it will be impossible to address these costs, or deliver the new models demanded by the ‘Five Year Forward View’ plan to deliver savings of £30 billion by 2020-21.”
Servelec buys Aura Healthcare: Servelec has acquired Aura Healthcare, a software developer set up by two former senior figures in iSoft (now CSC). Servelec, which developed and sells the RiO and Oceano electronic patient records, will pay £900,000 for £1,121,000 of debt held by Aura and just £1 for equity, reported digitalhealth. There is a maximum further consideration of £350,000 based on performance over a three-year period ending April 2018. Aura was created in 2012 by Adrian Stevens, former managing director of iSoft UK, and Mark Hindle, former professional services director at iSoft, the company behind the Lorenzo EPR. This was meant to be introduced in all NHS trusts in the North, Midlands and East before the dissolution of the National Programme for IT. The company’s main products include Flow, a piece of software intended to support the control of bed management and patient flow across hospitals, clinics and primary care centres. The software is used in several hospitals in both the Republic of Ireland and Northern Ireland.
Coordinate My Care selects InterSystems HealthShare to enhance coordination of urgent care plans Coordinate My Care (CMC) has selected InterSystems to provide innovative solutions for the coordination of urgent care, reported eHealth News EU. CMC will enhance and extend services using InterSystems HealthShare. It will include the newly released Personal Community patient engagement solution to allow patients to access and read their urgent care plans as required. CMC will initially focus on delivering new HealthShare solutions for urgent care, encompassing a wide range of stakeholders with complex information-sharing needs. A new CMC Integrated Care Exchange, using HealthShare for information sharing, will facilitate interoperability across NHS and social care providers throughout London and beyond. The CMC service integrates fully with the NHS 111. Authorised users include emergency departments, ambulance services, and out-of-hours GPs.
Opinion
Keeping the NHS alive
Radical change must come from the bottom not the top, is the consensus of Richard Smith, chair of the board of Patients Know Best, in a BMJ blog this week.
“The broad formula laid out in the Five Year Forward View, the current change manual for the English NHS, is “prevention, invest in new care models, sustain social care services, and over time see a bigger share of the efficiency coming from wider system improvements. Prevention won’t make the savings in the short term and may never if we simply delay our dementia, arthritis, deafness, blindness, and frailty.”
Smith points to improvements in efficiency and recalls a meeting with Penny Dash, a director of McKinsey and Co, who summarised ways of improving the productivity of frontline care: “Technology—particularly universal availability of electronic records and online consultation—can raise productivity, and so can “standardisation and protocolisation” wherever possible, skill mix, and rigorous measurement. Dash advocated “industrialisation” of healthcare with much more standardisation, better use of the workforce (“not training people for three years to do a job that can be learnt in three weeks”) and estates (“every room in the NHS should be used 12 hours a day seven days a week”), and strong encouragement of self-care.
“As I listened to this, I couldn’t help but think that it would feel like an assault to those who cherish the artistry of general practice, even comparing it to conducting a symphony orchestra. Dash also advocated that GPs should “work at the top of their licence,” not seeing routine patients but rather overseeing other staff—perhaps nurses—who deal with routine care, and managing directly only the most complex cases. Later in the meeting it emerged that studies of the work of consultants had shown that they spend only 25 hours a week in direct patient care: the rest is swallowed up by administration, chasing notes and test results (both of which could be replaced by use of IT), research, journal clubs, and a host of activities that do not directly support patient care.”
Tackling bed blocking in the NHS
Julia Clarke, principal consultant at operational efficiency firm, Newton Europe discusses how technology can help to solve the NHS bed blocking.
“The issue of bed blocking in hospitals is a common concern, but it also holds the key to areas of opportunity that could help drive critical NHS savings as well as greatly improve patient experience.
“Elderly patients with complex health needs are particularly vulnerable to delayed discharges, which not only leave them in an acute setting for longer than needed, but can also have increased negative consequences for their mental and physical wellbeing. Day-to-day ward management also suffers. Delayed discharges have a hugely-negative impact on the efficient running of wards – especially surgical and therapy wards, the running of theatre lists, and the management of elective waiting lists.
“Many hospitals rely on handwritten charts, Word documents and whiteboards, which inevitably often contain unclear, inconsistent and out-of-date information. This information is also solely ward-based, meaning it doesn’t extend to other hospital areas like administration, physiotherapy or radiography – which can cause delays from miscommunication or work duplication. A solution is to install a comprehensive information management system that captures, in real time, the current status of each patient in a way that is visible across the whole hospital.
“Using accurate data in the right way can allow staff to create aggregate statistics across different areas of the hospital so they know how much demand there is for certain services. This allows for informed decision-making around how to prioritise workloads to avoid bottlenecks that could keep patients in hospital for longer than necessary.
“The best part is that everyone benefits. It makes life easier for health professionals and saves hospitals money. Most importantly, it creates a far better care experience for the patients themselves.”
Prevention is better than cure if we want to save the NHS
Savings could be achieved by tackling root causes and becoming more preventative, writes Tanni Grey Thompson in the Independent, this week.
“Across the board, I think we need to get much more preventative when it comes to public health. Why wait to give a person expensive gastric band surgery, insulin or radiotherapy when you could have nipped the problem in the bud years earlier at a fraction of the cost? We need to stop complaining about the end results and concentrate on tackling the root causes.
“So the next government needs to step up to the plate to start making it easier for us a society to get more active, more often.
“For a start, I’d like to see a cross-government strategy for tackling physical inactivity. Despite it being a huge cause of premature death, there has never been a coherent strategy for tackling inactivity. That’s pretty shocking when you think of the numerous successful long-term strategies that have dealt with smoking or alcohol.
“Backed up by local action, this could spark a whole host of new measures. For example, why not put staff from the physical activity sector (gyms, trainers, community exercise programmes and so on) on a par with frontline healthcare workers – recognising that they’re performing a key task in preventing ill-health throughout society? Or make physical activity a recommended intervention that GPs routinely suggest to patients with long-term conditions? Or mandating that schools make provision for one hour of activity in every school day, be that in structured PE lessons or simply through play?
“There’s so much more we could and should be doing to address this elephant in the room. If we don’t want the NHS to sink under the pressures, we’ve got to get serious about getting active.”
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