News in brief
Berwick: No new statutory duty of candour for NHS staff: The Berwick Report into patient safety has called for NHS staff who are wilfully or recklessly negligent towards patients to face criminal prosecution, reported CommissioningGP. The report, entitled A promise to learn – a commitment to act: Improving the Safety of Patients in England, was conducted by Professor Don Berwick on the authorisation of the government following the Francis report into the Mid-Staffordshire scandal. The Berwick Report has made many suggestions into how patient safety can be improved and also recommends higher ratios of nurses to patients in hospitals as well as a call for a positive culture change throughout the NHS and a recognition and understanding that the NHS needs to change. However, the report concluded that most problems are not the fault of staff, but of the system and that the report’s authors “do not support the punishment of organisational leaders, boards and chief executives or others, for poor performance that occurs for reasons beyond their control”. Dr Mark Porter, chair of the British Medical Association Council, welcomed the news that the report was not going to enforce a new statutory duty on individuals, but expressed concerns over making negligent care a criminal offence. Commenting on the Berwick Report the The King’s Fundissued its response, as well as key industry commentators.
Private companies set for access to patient data for just £1: Pulse reports that private companies and researchers will be able to access data from GP records for £1, under plans revealed by NHS England to radically reduce the cost and boost the availability of information about patients available outside the NHS. The body’s chief data officer, Dr Geraint Lewis, has revealed he wants to reduce the costs for companies to access NHS datasets, from around £20,000 to £30,000 currently, to just £1. NHS England said the data would be used to identify where improvements and efficiencies could be made in the NHS and that only approved companies would have access to the data. Dr Paul Cundy, chair of the General Practioners Committee (GPC) ICT subcommittee said he had concerns over the plans: “Bona fide research would seem to be OK, but I would have some concerns about private companies getting NHS patient’s data on the cheap.”
Three trusts handed £38m in bailouts: Three NHS hospital trusts have been handed a total of £38m in Department of Health (DH) bailouts, Health Service Journal (subscription required) has learned. Barking, Havering and Redbridge University Hospitals Trust received a £25.8m bailout while United Lincolnshire Hospitals Trust and Portsmouth Hospitals Trust each received £6m. The revelation of the £38m of public dividend capital funding came to light in the DH’s publication of all expenditure over £25,000 for April. A DH spokeswoman said: “We know that some hospitals face persistent financial problems and we need to make sure they are providing the highest quality of care to patients. Barking, Havering and Redbridge University Hospitals Trust and United Lincolnshire Hospitals Trust are currently receiving temporary financial support and separately, Portsmouth were provided with a one-off cash injection to help improve its working capital cycle. Both Portsmouth and Barking have significant private finance initiative deals on which they have to make repayments.
Prime Minister announces £500 million to relieve pressures on A&E: The Department of Health has announced new funding to help alleviate the pressure on urgent and emergency wards (A&E). This comes in light of the fact that over one million more people are visiting A&E compared to three years ago. The new funding will go to A&E departments identified as being under the most pressure and be targeted at ‘pinch points’ in local services. The aim is for patients to be treated promptly, with fewer delays in A&E, and for other patients to get the care, prescriptions or advice they need without going to A&E. Hospitals have put forward proposals aimed at improving how their services work both within A&E and other services away from A&E to help reduce unnecessary visits or longer stays in urgent and emergency wards. Health secretary, Jeremy Hunt said: “This £500 million will help A&E departments to prepare for winter and give patients confidence that they can quickly access safe and reliable emergency care.”
760 applications to Tech Fund: eHealth Insider reports that the government’s new Technology Fund has attracted more than 760 expressions of interest from trusts applying for more than £650m. The £260m Safer Wards, Safer Hospitals Technology Fund was announced by health secretary Jeremy Hunt in May to catalyse the adoption of IT in the NHS. Trusts had until 31 July to prepare their expressions of interest with applications focused on four key areas; adoption of the NHS Number as primary identifier; integrated digital care records including information sharing within and between organisations; e-prescribing; and advanced scheduling. “The level of interest in the Safer Wards, Safer Hospitals Technology Fund underlines the commitment of NHS provider organisations to play their part in helping the NHS go increasingly paperless by 2018,” an NHS England statement says. Guidance issued in June said £90m will be available in this financial year and £170m in the next. Funding must be spent before the end of March 2015 and trusts must match any funding received. The fund is open to acute, mental health and community trusts in England, of which there are around 250.
GP surgeries must inform patients about data plan – or face legal action: According to The Independent, GP practices could face prosecution under the Data Protection Act if they do not take steps to inform patients that data will be taken from their records and used by the NHS and private companies from this autumn. The data will be sent to the Health and Social Care Information Centre (HSCIC) and researchers and private companies will be able to bid to access it. Patients who do not want their data to be extracted can opt out, but the obligation has fallen on GP surgeries to inform patients about the plan – or face legal action. A spokesman for the Information Commissioner’s Office told Pulse: “We’d expect GPs to take reasonable steps to inform patients of the changes. If they fail to do so they leave themselves open to possible action for failure to comply with the Data Protection Act.” GPs have criticised the plan, saying that practices will be caught between their lawful obligation to provide data to HSCIC and their duty to protect patient data. HSCIC said all data would be securely stored in their database in accordance with strict information governance rules and that there would be robust regulations around who can access the data. While private companies are eligible to apply, they must meet a very strict set of rules and regulations and HSCIC is responsible for ensuring there is an appropriate legal basis to permit the release and subsequent processing of data.
New X-ray computer system problems continue in Kent: Patients are still experiencing delays in getting results for X-rays and scans across Kent because of problems with a computer system launched last month reports the BBC. A dedicated phone line, which was established to deal with the problem, received 2,000 calls in the past week as East Kent Hospitals University NHS Foundation Trust said that it is trying to find a solution with GE Healthcare, which provides the technology. The new computer system was set up to book patients in for scans, and then create reports from the scans for doctors to study but currently patients are having to wait up to six weeks for results. Chief executive of the trust, Stuart Bain, said he would be talking to GE Healthcare about its “contractual position”. A GE Healthcare spokesman said: “GE Healthcare is working very closely with the Kent and Medway NHS Trusts to resolve their issues with the newly-installed radiology information system. We know how important these diagnostic tests are, together with the need for prompt clinical analysis and communication of results to patients. We are doing everything we can to ensure that the issues are resolved in a timely manner.”
NHS reforms saving £1.5bn by “reducing unnecessary bureaucracy”: A report into better service procurement for the NHS has concluded that the “scope for improvement is enormous” according to CommissioningGP. Undertaken by NHS England and the Department of Health, the study, Better Procurement, Better Value, Better Care: A Procurement Development Programme for the NHS, sets out details of the NHS Procurement Development Programme and how changes could help the NHS secure savings of £1.5 billion by 2016. The NHS spends over £20 billion every year on goods and services, which typically accounts for around 30% of the operating costs of each hospital. Health minister Dr Dan Poulter has called for “effective management” of the NHS’ resources, with “constant and detailed scrutiny”. In the foreword to the report he wrote: “It is long overdue for the NHS to apply the same standard of excellence to procurement as we do to our clinical services. Procurement must become a priority for all NHS boards. The government’s NHS reforms are already making £1.5 billion of annual back office savings for the NHS by reducing unnecessary bureaucracy, but our NHS can save much more by radically changing the way it buys supplies.”
Expert warns of culture clash in social care and health merger: This week The Herald reported that a culture clash could erupt between health boards and council social work departments as the Scottish Government tries to merge the two. Professor Paul Knight, president of the British Geriatrics Society and a consultant in elderly medicine at Glasgow Royal Infirmary, said there were tensions between the two sides – particularly over money. Noting NHS budgets had been protected from cuts, but not council funding, he said: “Although I think the Scottish Government has an aspiration to link up health and social care a lot more closely, I am not sure any of us know the exact detail of how that will operate. There is a suspicion in health that social care will dump all their large budget deficits on to health and I am sure the reverse will be true (for them).” The growing number of elderly people in Scotland has serious implications for the NHS and some measures suggest hospitals are already struggling to cope with demand. The Herald has highlighted the issue under its NHS Time For Action series and is calling for a review of hospital and community care capacity. There is widespread agreement that more should be done to look after frail pensioners in the community, to prevent hospital admissions and ensure efficient discharge arrangements from wards. Integrating the NHS and social work departments is the major step the Scottish Government is taking in an attempt to progress the situation. However, Professor Knight said at the moment “it is very much silos thinking and it is going to be a bit of a culture clash.”
EMIS Group plc acquires Digital Healthcare Limited: eHealth News EU reports that the board of EMIS Group has announced the acquisition of Digital Healthcare Limited, a leading provider of diabetic retinopathy screening and other ophthalmology-related solutions to community clinics, mobile units, specialist ophthalmology departments and practitioners. The acquisition is in line with EMIS’ stated strategy of providing cross-organisational healthcare systems. EMIS Group says the acquisition provides it with a strong position in a profitable niche market adjacent to EMIS Group’s core presence in GP and community pharmacy systems. The purchase consideration, net of cash acquired, amounted to £3.1 million, payable in cash from the group’s existing resources. Active in many countries, but principally in England and Wales where it has a market share in excess of 75%, Digital Healthcare has deployed over 60 diabetic retinopathy screening programmes, managing in aggregate over 2 million registered patients and over 42 million retinal images. Commenting on the acquisition Chris Spencer, CEO of EMIS Group said: “Diabetic retinopathy is the most common cause of blindness in the UK and it has been estimated that screening services could save more than 400 people per year from sight loss in England alone. As well as the obvious health benefits for those suffering from this long-term condition, we see immediate opportunities for the group in the provision of hosted services and a full end-to-end managed Diabetic Retinopathy screening service. In the medium term we also see further scope to integrate primary, community and acute healthcare and data for those at risk.”
Integration fund can be used to offset social care cuts: Health Service Journal (subscription required) reports that councils will be allowed to use some of the government’s £3.8bn integrated care fund to protect existing social care services rather than fund service transformation, according to new guidance. NHS England and the Local Government Association have published a joint statement setting out how the integration and transformation fund is to be managed. Under the heading of “protecting social care”, the organisations say: “Flexibility must be retained to allow for some of the fund to be used to offset the impact of the funding reductions overall”. The joint statement goes on to say that there is an “excellent opportunity” to align the integration fund with NHS England’s strategy, set out earlier this year in the document The NHS Belongs to the People: A Call to Action. Of the £3.8bn fund, £1bn will be performance related. Half will be paid out on 1 April 2015, which is expected to be based on performance in 2014-15. The rest will be paid in the second half of 2015-16, and could be based on in-year performance. Performance will be judged against a combination of nationally-agreed and locally-agreed indicators.
Guy’s does e-noting: Guy’s and St Thomas’ NHS Foundation Trust is digitising 130 hospital forms to be accessed via a portal being developed by an in-house team according to eHealth Insider. It is reported that the trust is rationalising the number of forms in use and making those that are needed available electronically as part of its move towards paper-lite processes. A transformation team found there were about 1,400 forms in use at the trust and worked to significantly reduce this number. Staff will get access to the 130 e-forms via a portal being built in-house using Microsoft SharePoint software. The portal also brings together read-only feeds from various other systems including the A&E and community systems with just one log-in. Group IT director Scott Sommerville said the e-noting project essentially replaces the blue forms used for collating patients’ paper notes and reduces duplication as forms can be pre-populated with data from the patient administration system. The £7m e-noting project is part of the trust’s wider plans to invest £213m in IT over five years, including the procurement of an electronic patient record system, clinical portals and mobile devices for staff. Sommerville believes the e-noting project will take the trust “all the way” to achieving health secretary Jeremy Hunt’s target of a ‘paperless NHS’ by 2018.
Population boom means ‘5,000 more midwives’ required: Health Service Journal (subscription required) reports that thousands of extra midwives are needed to help hospitals cope with the pressure of a rising birth rate. New figures show that 813,200 births were recorded in the UK between June 2011 and June 2012 – the highest number since 1972. This contributed to the fastest population growth in Europe, with the number of people living in the UK rising by 419,000. Royal College of Midwives chief executive Cathy Warwick said the growing birth rate meant an additional 5,000 midwives would be needed to provide services for new mothers and their children in England alone. She added: “This places considerable pressures on maternity services and we are struggling to provide high quality antenatal and postnatal care.” Age UK director Michelle Mitchell said: “Our society is currently undergoing a demographic revolution as more people enjoy a life expectancy denied to previous generations, but this also demands urgent attention from government and local authorities to ensure that services adapt to embrace these changes.”
Opinion
Berwick review is an important intervention
In this week’s Health Service Journal (subscription required) Chris Hopson, chief executive at the Foundation Trust Network, says that all leaders in the health service should unite in support of the ideas laid out in Don Berwick’s patient safety review.
“The Berwick review into patient safety in the NHS is, unsurprisingly, an impressive and thoughtful piece of work.
“Professor Don Berwick’s keynote address to mark the NHS’s 60th anniversary in 2008 is rightly regarded as a superb intervention in the debate over NHS reform. His work with the Institute For Healthcare Improvement in the US has won international acclaim for improving the quality and safety of healthcare provider settings and putting safe patient care at the centre of health systems. He knows what he’s talking about and it shows in his report, the letters at the end and particularly his “letter to the people of England.
“What I particularly welcomed is the sense that, after six months of lurid headlines, we may now be reaching a balanced, well calibrated, evidence based view of NHS performance on these issues.
“Five particular points resonated with me. First, alongside identifying what has gone wrong, it is important to celebrate the strengths of the NHS, which is a globally important treasure.
Second, the explicit recognition that problems in care occur in every system in the world as healthcare is complicated. Even when staff and clinicians are doing their very best, which they do most of the time, errors occur and problems arise for patients that no one intends.
Third, the job of improving will be much harder if staff in the NHS experience a culture of fear, blame, recrimination and demoralisation. Next, more enforcement is not the real route to the better health service we all want; the only way to get there is to create a system of continual learning and improvement. Finally, without ever forgetting what happened at Mid Staffordshire, the time has come to move on.
“It would be really helpful if all our system leaders could align behind the approach outlined in the Berwick review and, crucially, this tone.”
Shaun Lintern: ‘The real beauty of an A&E is hidden in the small things’
News reporter for the Nursing Times, Shaun Lintern, writes about his emotionally and physically exhausting hands-on, 12-hour shift at Watford General Hospital A&E staff.
In this insightful article, Lintern describes his admiration for the professionalism of frontline staff, and the softer skills when dealing with vulnerable patients: “In just one example of the value Rachel [a healthcare assistant] and other HCAs brought to the department was when we were on our way to a side room to deal with one patient and she suddenly stopped as we past a gentleman sat on a chair waiting to be seen.
“He was not our patient but Rachel had made a mental note of him earlier and could now see he was deteriorating and likely to collapse at any moment. We rushed to get a trolley and helped the man to lie down. He was quickly assessed and moved to the resus area.
“With a smile and chuckle Rachel went back to her job and the next patient, seemingly unaware of the excellent care she had just delivered.”
A forgotten sector?
In the Guardian, Pam Lewis information and regulatory lead at CancerCare argues that charities provide a real and viable option to help reduce the strain on our NHS but says that the technology must be there to support them.
“Providing patients with greater choice by enabling them to choose any qualified provider (AQP) has been at the heart of the government’s reforms and vision for the NHS. The concept means that a wide range of new providers can compete in the new market outside of acute and elective care.
“Our vision of becoming an AQP was part of a bigger opportunity to modernise the way we work. In order to do this we had to get a system in place that could support our workflow. We realised very quickly that our outdated IT system was not up to the job. The big challenge in implementing a new system was that we had an IT-shy workforce, no project manager and limited resources.
“We looked into ways of funding a new system but there is virtually nothing available for smaller charities. Fortunately, a supplier [IMS MAXIMS] who provided patient information systems to the NHS and who had close personal links with CancerCare was able to help.
“The system is already enabling us to increase the quality of care by allowing end users to focus on more direct patient care. Managers and therapists alike have increased their productivity by being able to access and find information at the touch of a button. In seeking to be commissioned by our two local CCGs, North Lancashire and Cumbria, we have needed to get on top of our reporting requirements and minimum data sets. Being able to extract so much information from our system means that senior management can report on patient reported outcome measures as well as patient reported experience measures. In just a few months’ time, we’ll be able to access other NHS services, referrals and use NHSmail.”
Lewis adds that thanks to the new infrastructure, the organisation has hopes of becoming an AQP by the end of 2013.
Predictive risk: an idea whose time has come?
Lyn Whitfield, managing editor of eHealth Insider guest blogs for Nuffield Trust, reviewing the increasing prevalence of predictive modelling to manage population health risks and how, four years on, the Nuffield Trust’s annual conference on predictive risk still attracts a strong audience.
“The mere fact that this was the fourth conference on the subject shows that this is an idea with legs. And, indeed, it has just been given a boost by the Department of Health, which has included a directed enhanced service for ‘risk profiling and care management’ in the latest GP contract.”
Whitfield accounts the many positive revelations from the conference including the appointment of Dr Geraint Lewis, an early pioneer in the area of risk profiling and developing tools for the job, as Chief Data Officer of NHS England, as well as the fact that, “…NHS England is planning to expand Hospital episode statistics (HES), while linking it to data from GP, mental health and community data sets in the new care.data service.”
However, she flags the obstacles too to progress in light of data access restrictions: “On the downside, clinical commissioning groups and their commissioning support units are finding it difficult to operate some predictive risk tools at the moment.
“Unlike the primary care trusts that preceded them, CCGs do not have the legal right to handle patient identifiable data; and they are not likely to get it. Dame Fiona Caldicott’s second review of information governance concluded that pseudonymised data should be sufficient for commissioning.”
She concludes: “That there is still more exploration needed in this area and may be a hard sell for politicians and policy makers, who like to be seen promoting innovation. So it needs further exploration; and will no doubt be a subject for further conferences.”
Highland Marketing blog
In this weeks’ blog Kimberley Robinson looks at the value of sharing patient records for medical research.
