Nine London trusts seek EPR

A flurry of media coverage has followed news that nine London trusts are tendering for an electronic patient record system in a deal worth £250m to £400m. Industry sources believe the chances are high that the deal will go to Cerner, despite the sometimes troubled record of its Millennium system.

Computer Weekly says the collaborative procurement is between Barts and the London, Croydon Healthcare, Imperial College Healthcare, Kingston Healthcare, Newham University Hospital, Royal Free Hampstead, South London Healthcare, St Georges Healthcare, and Whipps Cross University Hospital NHS trusts.

The four-year contract is in three lots according to Information Age. One is to build, deploy and maintain the PAS/EPR systems themselves, another to provide a portal for clinical and patient access, and a third for hosting. EHealth Insider believes it is the largest collaborative procurement for healthcare IT outside the NPfIT.

Conservative loyalists want health bill dropped

A new round of attacks has been made on the health bill – this time by the government’s most loyal supporters. An editorial on the influential Conservative Home website states: ‘The NHS bill is not just a distraction … but potentially fatal to the Conservative Party’s electoral prospects. It must be stopped before it’s too late’.

The Tory-supporting Daily Telegraph has also published a series of highly critical stories. One claims that patients will increasingly have to pay for treatment which is currently free at the point of delivery. It quotes Allyson Pollock, professor of public health at Barts and The London School of Medicine and Dentistry, as saying the bill had ‘a hidden purpose’ which amounts to privatising health services. The Telegraph also says that four English NHS regions have reported that the reforms pose threats to patient care and safety which have been rated as ‘high’ or ‘severe’ in an official scoring process.

The coming days will see more political turbulence with 50 MPs, including Liberal Democrats, calling on the health secretary to release the confidential strategic risk register (subscription required) outlining the dangers posed by his controversial shake-up. The information commissioner ordered Mr Lansley to make the document public last November but he is using legal means to resist publication.

Meanwhile a Greater Manchester GP’s e-petition to have parliament drop the health bill has now passed the 100,000 signature mark, meaning that it must be considered.

DH approves Twitter

The social media revolution has now been given official recognition with the DH recommending that staff get Tweeting. Official guidance has just been issued which states that ‘effective use of social media like Twitter is central to the DH digital communication strategy’.

Indeed it now seems that the 140 character messages sent out by ministers, and others, are being carefully managed and put together to avoid unfortunate mishaps. The departmental advice offers recommendations on how Twitter should be used and suggests that they can look to their communications experts, and private offices, for support on what – and what not – to say.

Department of Health tax deals apology

The Department of Health faces a potential scandal after being forced to reveal that 25 top officials have their salaries paid to limited companies – a route to cutting their tax bills. The news follows assurances from the department that this was not happening and has brought an apology for any ‘misunderstandings’.

The Guardian’s story follows news that senior figures at the government-owned Student Loans Company had been given similar deals. Documents obtained by the newspaper show that some of those involved at the DH are paid over £250,000 a year plus expenses. The payments amount to almost £4.2m in one year.

The department claimed the 25 were not civil servants, or technically even staff. But, internal payroll information details the DH offices in which they work, job titles and email addresses. The people involved work in areas such as policy, strategy and finance directorate, medical directorate, the office of the chief scientific officer, and commercial contracting.

Sources said the department allowed staff to define themselves for payroll purposes neither as civil servants nor payroll staff. The company addresses to which the money is paid tend to be the recipient’s home.

The department has now said: ‘We would be happy to clarify the situation in greater detail with anyone who asks and apologise for any misunderstanding involved. We are currently carrying out a full audit of such arrangements in line with the recently announced Treasury review of tax arrangements of public sector appointments.’

GPs condemn hospital and out-of-hours services

One in five GPs say they would not use their local hospital if they or their family needed substantial specialist care. A survey by Pulse reveals significant worries with some suggesting that care was handled like ‘a production line’. However 64% of GPs rated the clinical care at their local hospital as ‘good’ or ‘very good’.

Dr Martin Wolfson, a GP in Surbiton, Surrey, said: ‘The local hospital is fine if you are young, fit and articulate, but if it was your grandfather, it wouldn’t happen. It’s money-driven and it’s lost the personal touch.’

Nor, it seems, are they impressed by out-of-hours providers with just half regarding them as good. Some 18% believed their patients had received care in the last year that was ‘dangerously sub-standard’, and 3% said they believed one of their patients had died due to sub-standard out-of-hours care.

News in brief

• Delay call over NHS 111 phoneline: Doctors’ leaders say they have ‘serious concerns’ about the rollout of the NHS 111 non-emergency phoneline in England, reports the BBC.
• Appointment delays rise: One in four patients have their hospital appointment moved to a later date, a survey has revealed. The Daily Mail says that last year 23% had their consultation with a specialist postponed, up from 21% in 2009.
• DH works with Medilink: The Department of Health has signed a concordant with Medilink UK to work together to accelerate the adoption of telehealth and telecare technology in the UK, reports British Journal of Healthcare
• Patient feedback reflects hospital quality: The DH has highlighted research suggesting that TripAdvisor-style patient feedback on the NHS Choices website gets it right on hospital quality. One example is that hospitals rated as cleaner by patients turn out to be those shown to have lower MRSA rates in official testing.
• Social enterprise plans fail: Government plans for more services to be provided by social enterprises suffered a blow after a legal challenge forced NHS Gloucestershire to back down over its attempts to move 3,000 PCT staff into a community interest company – Gloucestershire Care Services (GCS).

Opinion

Official claims that NHS productivity has been falling since 2000 have been condemned as a myth by a leading expert in the field. Writing in the Lancet Nick Black, from the department of public health and policy at the London School of Hygiene and Tropical Medicine, argues that a proper analysis would probably show that productivity had risen.

‘Declining NHS productivity in England between 2000 and 2009 is just one recent myth in health-care policy. Many other myths have arisen in the past and many more will do so in the future. We cannot prevent myths developing but we should remain vigilant, spot them as early as possible, and attempt to minimise the harm they can do in distorting understanding and misleading policy makers. Meanwhile, development of accurate and competing estimates of health-care productivity are needed that make use of the burgeoning array of high-quality data and that translate improvements in quality into generic measures, such as quality-adjusted life-years.’

Highland Marketing blog

This week Susan Venables argues that Integrated marketing and communications isn’t just hype.

Forgive my self-indulgence, but after 20 years of working in the world of marketing I sometimes like to reflect and, with a small hint of cynicism, ask if what I do for a living adds value to this world.

When I first started my own business, many years ago, I was determined to tell people that mine was a totally integrated marketing and communications consultancy. Generally I would receive polite replies of agreement and the occasional, but more truthful retort – “Well what on earth is integrated marketing anyway?”

With a degree of humility I would mutter, “surely everyone knows it’s a management strategy and multi-discipline focused on the organisation-wide optimisation of unique value for stakeholders.” * Right, see the problem with reading too many textbooks and spouting jargon. May be with me not really knowing what it was and not being able too clearly define it, how could I expect my prospects and clients to understand and see the benefits. It sounded good anyway!

Now I can speak confidently knowing that, with evidence to back me up, integrated marketing and communications is an immensely powerful tool. No matter how good your products or services, they won’t sell if people don’t know about them or understand the benefit of using them. Look at Apple, Microsoft and Dell, for example, who were quick to grasp the importance of integrating their marketing campaigns, which has been fundamental to their growth. It’s about staying one step ahead of the competition and I truly believe companies that master this integration will achieve that goal.

However, although today the concept appears to be more readily used, particularly with the onset of social media, marketing people are now using it to describe their ability to integrate traditional offline marketing with the new social media channels – of which its effective use, in my mind, is still far from understood by many.

That’s the key, integrated marketing is a good thing, as long as you understand its use. So today my definition is: ‘integrated marketing and communication is the combination of marketing tactics to help deliver one marketing strategy to raise brand awareness, build customer trust and a like of what you offer’.

In this sense then an integrated approach is not a strategy, it’s the tactical delivery of a marketing strategy. I think that distinction is critical, because without the right strategy no amount of talk about integrating multiple platforms and mediums makes much sense. In fact, in many instances integration is simply interpreted as doing more kinds of activity. The problem with more activity is that activity without a central strategy can actually cause one activity to conflict with another.

The key is to get your branding and messages right and ensure that all the forms of communication that you use are carefully linked together and work in harmony rather than in isolation. The sum is greater than their constituent parts – providing they speak consistently with one voice all the time, every time.

I absolutely believe the real integration opportunity, and especially today with the intentional blending of online and offline tools and tactics around a single marketing strategy. Although it requires a lot of effort it delivers many benefits. It can create competitive advantage, enhance your reputation, motivate your staff and ultimately boost sales and profit.

Some tips:

• Get senior management buy-in.
• Integrate at different levels of management. Put ‘integration’ on the agenda for various types of management meetings.
• Ensure the brand book is used to maintain common visual standards for the use of logos, typefaces, colours and so on.
• Focus on a clear marketing communications strategy. Have crystal clear communications objectives; clear positioning statements. Link core values into every communication.
• Specify what you need to do in order to achieve your objectives.
• Think customers first and wrap communications around the customer’s buying process. Identify the stages they go through before, during and after a purchase.
• Build relationships with your customers and brand values. Customer retention is as important as customer acquisition.
• Develop a good marketing information system which defines who needs what information when. A customer database for example, can help the telesales, direct marketing and sales force.
• Share your imagery, artwork. Think how it can be used across all collateral to create consistency and save costs.
• Be prepared to change it all. Markets and customers change so learn from experience, test and look to constantly improve.

*Jenkinson, A. and Mathews, B. (2007) Integrated Marketing and its implications for personalized customer marketing strategies. J Direct, Data and Digital Marketing Practice. Vol 8 No. 3. pp. 93-209. Palgrave Macmillan, Basingstoke, UK

Susan Venables, Client Services Director

Solutions developed to protect patient privacy and
healthcare provider reputations

Highland Marketing has been appointed by FairWarning, Inc., to provide PR support to help the company in its mission to protect patient privacy. With the widespread growth of electronic health record (EHR) data breaches within the UK healthcare sector, FairWarning^® will be campaigning to raise awareness of this issue and educating healthcare providers as to how they can act in order to protect their reputations, patients and staff.

As a pioneering US based company, FairWarning^® has developed the first solution of its kind which enables healthcare providers to monitor their electronic health record systems and detect security breaches. This can be vital in preventing personal information from being stolen and falling into the ‘wrong hands’. By enabling resources to be allocated to the specific task of tackling patient record breaches by staff, healthcare providers will not only be able to meet their legal obligations but will have laid firm foundations on which to build ever-more sophisticated and effective forms of electronic patient care.

The FairWarning^® solution has already been welcomed in Scotland where its surveillance system is being rolled out across the health service after a successful pilot with NHS Lothian. A six-month trial is also underway with the NHS Wales Informatics Service. The company is now targeting to work with public and independent healthcare providers, throughout the rest of the UK, to raise the issue of data security higher up their agenda, highlighting its importance in terms of patient care and their own reputations.

Having been selected, Highland Marketing will focus on delivering an issues based campaign to raise awareness of the need and urgency to identify, and prevent, EHR patient data breaches to uphold healthcare provider reputations. A key objective will be to position FairWarning^® as an ‘industry expert’ and ‘thought leader’ in the monitoring and protection of patient privacy and highlighting the implications for healthcare providers who continue to maintain ‘weak security strategies’.

Kurt Long, CEO and founder of FairWarning, Inc., said: “FairWarning^®’s mission has always been to provide healthcare providers with a tried and true privacy breach detection and prevention solution that ensures the uninterrupted growth of electronic health records. Our continued success and growth is attributable to the growing number of healthcare providers who are committed to ensuring greater patient privacy protections, and effectiveness and efficiencies in patient care.

“Now targeting the UK we were looking for an agency that could quickly generate impact and awareness around protection of patient privacy in electronic health records. We chose Highland Marketing because of the success achieved in a previous campaign they worked on to help FairWarning^® promote its UK country-wide Patient Privacy Outcomes survey (click here for full press release). The campaign resulted in significant media coverage.”

Mark Venables, CEO, Highland Marketing said: “Electronic health records bring enormous benefits to patient care, but there is growing concern about gaps in security. Recent high profile cases of the misuse of confidential patient information have shown the damage and distress that can be caused when sensitive medical information is leaked. FairWarning^® has done a tremendous job in promoting better data security in North America and we believe it can achieve great things in the UK.

“Our introduction to FairWarning^® came through a recommendation from an existing client who positioned us as an ideal partner to help the company create the relevant ‘noise’ in the market through our extensive knowledge and contacts within the healthcare, computing, national and security media.”

End

Notes

About FairWarning, Inc.

FairWarning^® is the inventor and global leader in appliance-based software solutions which monitor and protect patient privacy in electronic health records enabling healthcare providers and health information exchanges to confidentially connect physicians, clinics, patients and affiliates. FairWarning^®’s turnkey privacy auditing solutions are compatible with healthcare applications from every major vendor including Allscripts, Cerner, Epic, GE, McKesson, MEDITECH, Siemens, and many others. Customers consider FairWarning^® privacy auditing solutions essential for compliance with healthcare privacy regulations such as ARRA HITECH privacy and meaningful use criteria, HIPAA, EU Data Protection, UK Freedom of Information Act, California SB 541 and AB 211, Texas HB 300, and Canadian provincial healthcare privacy law. For more information on FairWarning^® visit http://www.FairWarning.com or email Solutions@FairWarning.com.

You can also follow FairWarning^® on LinkedIn at http://www.linkedin.com/groups?gid=4065938 or follow us on Facebook at http://www.facebook.com/FairWarningInc.

About Highland Marketing

• Founded in 2002, Highland Marketing is a leader in tailor-made and flexible PR, marketing and communications solutions.
• It operates in the UK and internationally and has a detailed understanding of the healthcare market.
• The company has a dedicated team of skilled and experienced people all with considerable knowledge and experience within their field.
• It also offers customised business development support geared to help grow client sales
• For further information contact Mark Venables on +44 (0) 7973 172894 or markv@highland-marketing.com or visit www.highland-marketing.com

You can also follow Highland Marketing on LinkedIn Highland Marketing LinkedIn  or follow us on Twitter

Media Contacts
Susan Venables, Highland Marketing
Phone: +44 (0) 1877 339922
Mobile: +44 (0) 7971 166936
susanv@highland-marketing.com

Following a full review of and enhancement to the websites of Illingworth Research, one of the top providers of clinical research services, and ResearchNurses.co, the UK’s leading independent provider of research nurses, Highland Marketing has helped both organisations significantly improve their search engine optimisation (SEO).

Whilst Illingworth Research originally ranked outside the top 100 for all search engines, it has now achieved a number 10 position on Google. ResearchNurses.co originally ranked 58 on Google and 13 on Google blogs. Following the optimisation Illingworth Research ranked at 36 on Google and number one on Google Blogs.

As well as improving the websites, Highland Marketing launched in January a dedicated Twitter campaign for both companies in order for them to interact and engage with their stakeholders in a more targeted way, drive traffic to their websites and continue to improve SEO. The initial launch has also proved very successful, followers of the companies have already increased by up to 25%.

Both Illingworth Research and ResearchNurses.co have seen many of their tweets retweeted by customers, business partners and media organisations, therefore demonstrating the level of interest that has been generated through Twitter.

John Illingworth, managing director of Illingworth Research and ResearchNurses.co commented: “Before Highland Marketing came on board we already had a presence on Twitter but were using it sporadically and we lacked a sense of purpose. Highland Marketing has developed a strategy to help us interact with our clients on Twitter in a meaningful way. So far we have had excellent feedback and we will continue with our efforts. We will also be looking at developing strategies, with the help of Highland Marketing, for other social media channels such as Facebook.”

Susan Venables, client services director, Highland Marketing said: “Whereas in the past social media was perceived as a B2C tool, we are finding that more and more of our clients see the value of social media in a business to business environment. Illingworth Research and ResearchNurses.co have had the foresight to take advantage of this opportunity and they are already reaping the benefits.”

End

Notes

About Illingworth Research and ResearchNurses.co

• Illingworth Research was founded in 1998 as Clinical Development and Support Services Ltd (CDSS).
• By 2010, the company had significantly expanded both its clinical development services and its research nursing provision. In April 2011 it decided to launch two new brands; Illingworth Research and ResearchNurses.co into the marketplace.
• Illingworth Research provides clinical research services from project management to clinical monitoring across the world.
• It is the only UK clinical research organisation to provide medical photography services for clinical trials.
• ResearchNurses.co is the UK’s leading independent provider of research nurses across a whole range of therapeutic areas and a wide variety of settings including homecare.
• Both Illingworth Research and ResearchNurses.co are guided by the same highly experienced management team and together provide clients with the ultimate clinical research partnership.
• For further information visit illingworthresearch.com and researchnurses.co. 

About Highland Marketing

• Founded in 2002, Highland Marketing is a leader in tailor-made and flexible PR, marketing and communications solutions for the healthcare and technology sectors with CSC, IMS MAXIMS, Harris, FairWarning Inc., Ardentia, IBM, Clinical Solutions and InHealth amongst its clients.
• It operates in the UK and internationally and has in-depth knowledge of the healthcare and technology markets.
• The company has a dedicated team of skilled and experienced people all with a proven track record within their field.
• It also offers customised business development support geared to help grow client sales.
• For further information contact Mark Venables on +44 (0) 7973 172894 or markv@highland-marketing.com or visit http://www.highland-marketing.com/.
• Follow Highland Marketing on Highland Marketing LinkedIn and  Highland Marketing Twitter

Watching the progress and witnessing the government’s first defeat on its highly contentious plans to reform the health service, just a few hours after the Prime Minister mounted a passionate defence of the shake-up to the NHS, reminded me of a patient being diagnosed, operated on, discharged and then readmitted for the same condition!

With all the changes and opportunities that previous governments have experienced, the sad reality is that the health service, as it currently exists, is simply unsustainable. Spiraling costs in health and social care provision, due to extended life expectancy, being just one of the reasons as to why this is the case.

So is the bill good for us and should we just put up with the bitter pill in the short term? Perhaps it is just that the communication of the benefits has been poor or maybe it is a case of knowing we have to do something but this is all too much at a time when there are so many other financial restrictions.

The editorial simultaneously published by the BMJ, Health Service Journal and Nursing Times last week says that we shouldn’t accept the bill. It says: “the resulting upheaval has been unnecessary, poorly conceived, badly communicated, and a dangerous distraction at a time when the NHS is required to make unprecedented savings.” The publications suggest that parliament should establish an independently appointed standing commission “to initiate a mature and informed national discussion on the future of our national health system”.

So as the passage of the bill has been battling against ill winds, the focus is now on Andrew Lansley who has been widely criticised for its handling.

A No 10 source was quoted in The Times saying: “Andrew Lansley should be taken out and shot. He’s messed up both the communication and the substance of the policy.”

And so, the bill returns to the Lords, where it faces a mauling by peers despite the Government already making a string of concessions.

Lansley says the reforms will improve patient care, make services more accountable and cut bureaucracy. The changes will hand GPs greater control over the £60  billion budget to commission services and allow the private sector to play a larger role.

Health minister Simon Burns defended the reforms, saying: “By handing responsibility for purchasing services to doctors and nurses, we are shifting decision-making closer to patients and building on the trusted role GPs play throughout the NHS.”

He added: “I have met GPs in London who are looking forward to being able to commission services for their patients.”

However, it’s questionable whether those same GPs at the heart of the government’s policy, will feel it is most unjust if they are blamed for the potential failure of our local hospitals due to the enormous challenges that they face.

Jeremy Nettle, Industry Advisor

Lords defeat for health bill as PM denies wanting Lansley shot

Health secretary Andrew Lansley faces a torrid time with the Lords defeating the government in the first of the latest round of votes on the health bill. At the same time the Prime Minister was forced into what the Telegraph described as a lukewarm defence of Mr Lansley – denying reports that he wanted him ‘taken out and shot’.

Other amendments were debated by the Lords and more votes are on the way. In the House of Commons David Cameron rebuffed calls to drop the bill entirely, while Labour leader Ed Miliband described it as a “complete disaster”.

Health Service Journal reports that the Faculty of Public Health (subscription required) has become the latest professional body to call for the bill to be scrapped. The BMA has redoubled its own opposition with calls for both the bill and Mr Lansley to go. At the same time a survey of BMJ readers has indicated that over 90% want the legislation dropped.

One piece of positive news for the government was that 53 hospital bosses signed a letter to The Times supporting the plans to allow foundation trusts to get up to 49% of their income privately.

However, the pro-reform NHS Confederation has now joined attacks on the bill, saying it is unlikely to encourage much-needed service integration. This view reinforces the findings of the latest report by the Commons’ own – Tory led – Health Select Committee.

Electronic record success brings cheer amidst IT worries

The introduction of an electronic record viewer has been greeted by emergency doctors at Scarborough Hospital as like ‘turning on a light’. EHI reports that lead A&E consultant Dr Andy Volans says staff can barely remember how they coped before TPP’s new CRV went live in January. The viewer, which allows clinicians to access a read-only view of the patient’s full electronic record, will soon be rolled out to other departments.

By contrast University Hospitals of Morecambe Bay NHS Foundation Trust is working through a backlog of 14,000 patients who failed to receive follow-up outpatient appointments because of administrative and IT problems linked to Lorenzo. EHI says a report into the backlog paints a damning picture of failures at the trust.

In a warning of potential future problems, responses to the government’s open data plans have raised a variety of concerns – including doubts about whether IT systems will be able to deliver patients with the information which they will have the right to see. The report contains a whole section on IT, and there is substantial discussion of the need to create patient portals.

Billions in savings linked to mental health

The King’s Fund claims that billions of pounds are wasted because mental health conditions go undetected where there is a co-existing long-term physical condition. The fund and the Centre for Mental Health say that people with long-term conditions, such as diabetes or heart disease, are two to three times more likely to face mental health problems than the general population.

The problem is that the mental health problems can often go unidentified – even though they exacerbate the physical condition and make treatment more costly. The organisations also claim that where a mental health problem is identified, it is often treated separately, when it would be more efficient to gear treatments to patient needs.

An estimated £1 in every £8 spent on long-term conditions is linked to poor mental health, equating to £8-13 billion of NHS spending each year. Large savings could be made by taking a fresh approach. This, say researchers, would cut hospitalisation rates, increase outpatient service use and improve patient outcomes.

PFI nationalisation and bailouts

The second-ever PFI hospital, Carlisle’s Cumberland Hospital, may be nationalised as part of a deal to take over the troubled North Cumbria University Hospitals Trust. HSJ (subscription required) reports that the bid for control, by Northumbria Healthcare Foundation Trust, would create a trust stretching the breadth of England, from Whitehaven on the west coast to North Shields in the east.

The idea of taking the hospital, which was built under a deal dating to 1997, into public hands has been sparked by huge PFI charges of £21.3m last year – nearly 10 per cent of its turnover. It is also suffering falling income and historic deficits.

The government has also announced that £1.5 billion will be made available to seven NHS hospital trusts to help pay mounting PFI debts. BBH News said the DH has announced that they made need help for up to 30 years.

The trusts affected are Barking, Havering and Redbridge NHS Trust, Dartford and Gravesham NHS Trust, Maidstone and Tunbridge Wells NHS Trust, North Cumbria NHS Trust, Peterborough and Stamford Hospitals NHS Foundation Trust, South London Healthcare NHS Trust and St Helen’s and Knowsley NHS Trust.

Worries about private providers and finance have led the regulator Monitor (subscription required) to propose a debt ceiling. It also wants to restrict their ability to either use essential assets for security or to make payouts to shareholders if this would push their resources below a critical level for services.

News in brief

• Millions lost in translation: The NHS spends £60,000 a day on translating documents, according to think tank 2020Health (subscription required). It suggests that much of the work repeats what has been done elsewhere and could be saved by creating a central pool of translated documents.
• Two Yorkshire trusts can EPR procurements: According to EHI, Sheffield Children’s NHS Foundation Trust and Doncaster and Bassetlaw Hospitals NHS Foundation Trust both recently informed suppliers that their EPR tender notices have been cancelled.
• NI’s electronic future: Northern Ireland health minister Edwin Poots has announced closer links with North America and Europe in order to develop better electronic healthcare. He told an audience at the Connected Health conference in Finland that the province’s £18 million tele-monitoring service shows the way ahead.
• Call to publish more GP data: GP online reports calls to publish more data about which practices offer what treatments such as knee replacement or bariatric surgery. The Quality, Innovation, Productivity and Prevention (QIPP) Right Care Team claim it would address the postcode lottery over access to some forms of care.
• First artificial jawbone transplant: An 83-year-old woman has been implanted with the world’s first 3D printer-created jaw. The titanium jaw is a major advance as the creators faced many technical challenges, such as how to incorporate the nerves necessary for normal movement of the jaw.

Opinion

Ivan McConnell of PA Consulting argues that the NHS is missing out on major financial benefits and opportunities to improve patient health by not rolling out telehealthcare and telecare on a larger scale. Indeed, the latest DH evidence highlights that over 90% of people with long-term conditions say they want to be more active self-carers.
‘Patients who suffer from long-term conditions make up 31% of the population, but 69% of primary and acute care budgets in England are spent on them. They account for more than half of GP appointments and nearly two-thirds of all outpatient appointments. The 5% of patients who have one or more long-term conditions account for 49% of all inpatient bed days.
‘Telehealth and telecare provide opportunities for delivering care more efficiently. They deliver both cost savings and improved care to patients with long-term conditions. The benefits have primarily been in preventing unplanned hospital admissions and facilitating early discharge.
‘Additionally, taking their own readings can provide patients with a greater understanding of their condition thereby promoting improved self-management.’

Blog

Are patient choice and market competition the best way forward for the NHS? Recent reports and government initiatives have emphasised the potential benefits. Catherine Foot of the King’s Fund says that its new book suggests that another route may be better.
‘Several of the National Service Frameworks (NSFs) of the early Labour years have been shown to have had significant impact on the quality of services. In our book looking at the effect of Labour’s market reforms we argue that some of the more direct clinical strategies like the NSFs had considerably greater impact than some of the major policy levers like choice or competition.’

Highland Marketing blog

Industry advisor, Jeremy Nettle takes a look at the latest health bill developments.

Health bill concessions after days of ‘panic’

Several days of ‘panic’ and an unprecedented attack on the health bill by three key health sector publication editors has been followed by 137 further amendments. The government has proposed the extra changes as it battles to advance the bill through the report stage, which begins in the Lords next week.

The proposed amendments come after more sustained criticism, including a joint editorial by the editors of the British Medical Journal, the Health Service Journal and the Nursing Times who say it is ‘an unholy mess’ and ‘so badly thought out’ that it will leave ‘an unstable system that is only partially fit for purpose’.

Pulse claimed that scrapping the bill would save £1 billion in 2013 alone. Reports in the Guardian claimed that a threatened Lords revolt had led to a ‘sheer panic’ in which the government threw together a hasty series of amendments and the BBC reports that health minister Simon Burns has said that he found the criticism from GPs ”baffling”.

Health minister Earl Howe said the changes simply reaffirmed the government’s commitment to putting patients at the heart of the NHS and handing power to GPs and nurses. The proposed amendments include:

• Asserting the Secretary of State’s responsibility and accountability with respect to a comprehensive health service.
• The NHS Commissioning Board and clinical commissioning groups having stronger duties to promote patient involvement in their own care.
• The NHS Commissioning Board and CCGs having new responsibilities to support education and training.
• Annual reporting on progress in tackling health inequalities.
• Ensuring that Monitor can require providers to promote integration of services.

NHS in good shape says quarterly health check

English NHS performance against key indicators, including waiting times and infection rates, shows that a decade of continuous improvement is ongoing.

The latest quarterly monitoring report from The King’s Fund shows that the number of patients experiencing delayed transfers of care has fallen to its lowest level since this data has been collected. Fifteen of the 23 finance directors, who contribute to the survey, expect their organisations to meet productivity targets, despite concerns about the financial position of the service as a whole.

However, the Academy of Medical Royal Colleges (AMRC) suggests that if the NHS is to achieve the very best for patients a consultant-led service is required, demanding a significant increase in numbers. The AMRC says the key benefits of consultant-delivered care include rapid and appropriate decision making, improved outcomes, more efficient use of resources and better access for GPs to the opinions of fully trained doctors.

New shape of NHS IT control

The future control of IT developments in the NHS has become a little clearer. EHI reports that the Chief Technology Office and some functions of the DH Informatics Directorate will transfer to the new NHS Commissioning Board.

The Patient Engagement, Insight and Informatics’ Directorate will have at least 91 staff, with up to 70 more transferring from the DH and DHID. It is likely to have a budget of around £40m.

However, a report on the funding of the NHS Commissioning Board states that funding is going to be halved – raising concerns about its effectiveness. The future funding and positioning of NHS Connecting for Health (CfH), and some of the functions CfH took over from the old NHS Information Authority, remain unclear.

Mergers and takeovers

Several key developments have taken place in the accelerating number of health service mergers and takeovers.

• A leaked email revealed that Northumbria Healthcare NHS Foundation Trust is to take over the running of Cumberland Infirmary in Carlisle and the West Cumberland Hospital in Whitehaven from the troubled North Cumbria Hospitals NHS Trust.
• Circle has now formally become the first private firm  to start running an NHS hospital – Hinchingbrooke Hospital, Cambridgeshire, which had been threatened with closure as it grappled with £40m of debt.
• St George’s Healthcare Trust in south London has withdrawn its bid to take over St Helier Hospital (subscription required), part of Epsom and St Helier Hospitals Trust – throwing the future of £1bn of services into doubt.

Meanwhile private acute health providers are failing to prosper according to Laing & Buisson’s Healthcare Market Review. Revenues for independent hospitals providing medical treatments in 2010 were flat at £3.84bn. However, competition is increasing. There are now 515 independent medical hospitals compared with 454 in mid-2010.

Competition versus collaboration – rival models for the NHS

Two reports out this week look at the rapidly diverging models of healthcare north and south of the border. Public Service covers a two-year study by Nottingham University Business School into the Scottish NHS, where services have been brought together to increase collaboration.

The authors state that a ‘mature and positive’ approach to industrial relations has helped underpin NHS Scotland’s ‘commitment to high-quality patient care’. Not only that, but the health service north of the border represents a ‘leading-edge example’ and offers ‘important lessons’ for public services throughout Britain.

The report claims that NHS Scotland’s decision to engage staff as fully as possible by developing partnership agreements at national and board level had been key to its success. As a result, all levels of the organisation had a common agenda that helped deliver better healthcare.

HSJ (subscription required) covers a report from the Office of Health Economics which looks at the pros and cons of greater competition in England. This states that the use of fixed prices to prevent competition driving down care quality could become ‘increasingly problematic’. It says that some price competition might be beneficial – but warns that it could lead to falling standards of care and to cherry picking of lucrative areas.

The Royal College of Nursing in Scotland has just accused the Scottish Government of breaking its promises, with further large cuts in nursing numbers.

News in brief

• Scottish Council Fined: Midlothian Council has been slammed with a £140,000 penalty after disclosing sensitive data on children and their carers to the wrong recipients five times in just a few months reports Public Service.
• EMIS unveils new patient.co.uk: EMIS has re-launched its patient information website with a new look and plans for a series of apps; including one that will let patients book an appointment from their smartphone, reports EHI.
• GPs want 111 pilots scrapped: Doctors have called for the suspension of NHS 111 urgent help services after leaked DH data revealed a sharp rise in emergency hospital admissions in pilot areas. GP online says that in four pilot sites, ‘non-elective’ admissions rose by up to 7% in the last quarter of 2010/11.
• Pathology transformed: The electronic requesting and reporting of pathology tests is about to be revolutionised, says the Guardian Healthcare Network, by the National Laboratory Medicine Catalogue (NLMC). This unique data set will standardise systems and address a series of safety and quality issues.
• Nokia mobile wellbeing advance: Finnish trials have shown a positive response to a mobile Wellness Diary App by Nokia, which offers decision support for patients and members of high risk groups to help promote a healthier lifestyle.
• Humber wants mobile Lorenzo: According to EHI, Humber NHS Foundation Trust has put its hand up to be one of the first to trial the mobile version of Lorenzo.

Blogs

The latest blog from Dr Jennifer Dixon, director of the Nuffield Trust aims to continue building momentum in its campaign for integrated care, and payments reform. She highlights new case studies of organisations trying to develop integrated care as ‘accountable care’.

‘They are striking in that all are trying to do similar things: case management; care co-ordination; disease management; predictive risk modelling; use of hospitalists; developing the electronic health record across providers; close analysis of utilisation cost and quality at patient level; clinical leadership; developing easy access electronic portals for patients; bearing more financial risk appropriately; and pay for performance based on quality and shared savings models.

‘All not wildly new, but very instructive on the extent to which infrastructure is being developed as well as the methodical and serious way it is being implemented.’

Where have all the tech savvy hospital doctors gone asks Dick Vinegar – aka the Patient from Hell?

‘Something happens to deprive doctors of their appetite for being the champions of technical change. It may be they are blocked by the obstruction of administrators and superiors …. The system gets them down in the end. Since 2002, they have probably felt that all IT systems are imposed on them by Connecting for Health, and there is nothing they can do to object to bad IT, let alone devise better systems themselves.’

Highland Marketing blog

Matthew Shelley considers the vast technological tsunami rolling across the Atlantic.

Stand still for a moment, point one ear westwards, and you’ll hear the low rumble of a vast technological tsunami rolling across the Atlantic. Start reading US healthcare IT publications and the sound resolves into an excited chatter about how mobile apps are going to transform our lives for the better.

While the UK is doing well in developing mobile health apps, the momentum building up in America is of an entirely different order. The very excited Daniel Kraft MD predicts that ‘in the future we might not prescribe drugs all the time, we might prescribe apps’. Alternatively peruse Healthcare IT News which discusses the ‘stealth health’ techniques which ‘gamify’ data gathering and make it fun. There are abundant articles about how we will soon be photographing each welt, mole or mark and shooting the image off into the cloud for an instant $5 diagnosis.

There is no harm in wide-eyed enthusiasm (I still yearn for the solar-powered hover cars that Tomorrow’s World suggested would be ubiquitous by the year 2000). But we must limit the room for scams. Plenty of charlatans use the web to make false health-related offers (paternity testing, transplants, treatments for terminal illnesses). Mobile technology opens up the field even more. Imagine the harm that a dodgy remote cardiac monitoring service could do! Effective regulation is essential if we are to avoid scandals of a scale that could bring a catastrophic loss of trust.

Another problem is bedazzlement with fads and fantastical dreams when what we urgently need are effective ways to deliver better care. Mobile technology is a Godsend not a panacea. Dotcom enthusiasts confused the two and suffered the consequences.

Anyone who’s serious about getting the best out of mobile technology needs to take a hard look at what the health sector is currently struggling to do, and identify how it can be done well. That means sidestepping the temptation to produce stuff because it’s cool and focusing squarely on what the market needs.

Clinicians increasingly use mobile technology to access, share and analyse patient data. The expectation is that four billion more smart phones will be sold worldwide by 2014. This adds up to a huge potential market in the exchange and monitoring of data among care teams, and between patients and clinicians. One small example is the way that skin sensors, providing basic physiological information, could help with the care of certain autistic children who find it tough to express how they feel.

In the year ahead it will be fascinating to watch how the mobile healthcare apps market progresses. There is so much that can be achieved – Edinburgh University recently announced that it is developing iPhone apps in game form to help autistic children with common problems like following a pointing finger or recognising where someone else is looking. Hopefully the emphasis across the sector will be on genuinely delivering for clinical needs and on ensuring that patients can regard this emerging technology as something they can trust.

Matthew Shelley, Writer and Communications Consultant

Call for new body to oversee patient records

Fifteen leading organisations have called for the setting up of a body to oversee the development of patient records in health and social care. The Joint Working Group (JWG) believes that a Professional Record Standards Development Body (PRSDB) is essential as the patient record ‘is likely to become the single most important unit of information in the NHS.’

Membership of the JWG ranges from the Royal College of Physicians to the DH Informatics Directorate, and the report has earned backing from nine additional organisations such as Cancer Research UK and the Wellcome Trust. The report recommends that the PRSDP should include bodies such as Intellect.

EHI reports that the JWG was concerned that while the NHS is ‘awash with information’ there are major frustrations because it is stored in so many different ways. JWG chair and DH national clinical director for informatics, Charles Gutteridge, says information can only flow more freely if standard formats are in place. HSJ (subscription required) claims that this is likely to occur through the mandating of new standards by the NHS Commissioning Board.

The need for new information standards and governance requirements have been identified as a key risk to the health service in a new document on the design of the NHS Commissioning Board.

Select committee cuts warning wins wide support

The Tory-led Commons Health Select Committee has warned that the health bill is threatening efforts to achieve £20 billion in efficiency savings. The committee, led by former Conservative health secretary Stephen Dorrell, claims in its new report that ‘salami slicing’ cuts are being made to services rather than the introduction of structural changes needed if the NHS is to do more with less.

Powerful and respected organisations lined up to support to the committee:

• Director of the Nuffield Trust, Jennifer Dixon, said: ‘The report is spot on … the bill has been a distraction. It has also been divisive.’
• Foundation Trust Network: ‘The health service needs fundamental reforms to make effective long term savings.’
• King’s Fund chief economist, John Appleby, said: ‘The report should serve as a wake-up call for ministers and the NHS about the magnitude of the task ahead.’
• Dr Hamish Meldrum, chairman of BMA Council, said: ‘We would agree with many of the committee’s observations, particularly about the disruptive impact of the reforms.’
• RCN CEO Dr Peter Carter said: ‘The dual impact of the reform process and the full extent of the efficiency savings is seriously destabilising the NHS.’

In addition 19 out of 20 royal colleges, representing almost the full might of the British medical establishment, have come out against the health bill.

Double trouble for Cerner Millennium

Two trusts have blamed performance problems on ‘issues’ with Cerner Millennium. North Bristol NHS Trust has had to return to paper processes to deal with some outpatient appointments. Wirral University Teaching Hospital NHS Foundation Trust says the system is responsible for its seemingly poor performance on long waits.

EHI says that the figures for the Wirral trust appeared to show that in November it had 700 patients waiting more than a year for treatment – putting it among the worst performers in the country. However, director of information, Luke Readman, claimed the figures were ‘inflated’ because of an issue with the way staff were using the electronic patient record system.

North Bristol says that it is working to fix implementation problems, which include patients being given non-existent appointments or not being informed about scheduled operations. This should be completed by early February. In the meantime 40% of outpatient activity is being handled on paper or with other applications.

On the plus side Homerton University Hospital NHS Foundation Trust has ended its run with the National Programme for IT in the NHS and signed a contract directly with Cerner for its Millennium electronic patient record.

European data protection laws toughened

The entire legal framework for companies whose products or services deal with personal data is about to change. EU justice commissioner Viviane Reding has set out new plans which include a citizen’s ‘right to be forgotten’ and an obligation for organisations to report data breaches as soon as possible.

While much of the coverage is concerned with the consumer business the implications for the healthcare sector are profound. Principles of the new legislation will include:

• Explicit rather than assumed consent to data collection.
• Deletion of data when there are no grounds for its retention.
• Easier access to one’s own information.
• Stronger data protection authorities.

The announcement of new legislation comes shortly after an EC-sponsored Eurobarometer survey on attitudes to data protection across member countries. This revealed that most Europeans regard health information as profoundly personal and sensitive and wanted it well protected. It also suggested high levels of trust that healthcare organisations were committed to privacy.

GPs left out of NHS 111 development

GP commissioners feel left out of the development of 111 services. According to GP online the findings come from an NHS Alliance survey of members of its clinical commissioning federation.

The service is a hotline for patients with urgent, non-life threatening health problems set up as an alternative to calling 999. Despite clinical commissioning groups (CCGs) being key to its implementation in 2013, they feel disengaged and are concerned that it will not improve patient care.

Sixty eight per cent of the 51 CCG leads who responded to the survey disagreed with the suggestion that NHS 111 would ensure that patients got the right service more quickly. Just 23% were confident that 111 would be a success in their area.

Results also revealed that despite CCGs being told they could choose whether to pilot or procure NHS 111, or set up a service using existing providers, very few had such a choice. Nearly 80% of commissioners whose CCG had procured the service said they had done so because the decision was made by their SHA or PCT cluster.

News in brief

• IT fraud investigation: Police are investigating allegations of fraud at the Royal Surrey County Hospital. HSJ (subscription required) says concerns surround £200,000 of unbudgeted spend on one IT project and £400,000 relating to other informatics projects.
• Genome report: The Human Genomics Strategy Group has released a new report, Building on our Inheritance, which sets out recommendations for realising the potential of genomic technologies within healthcare, and for the UK economy.
• Diabetic weight loss research: Randomised controlled trials reported in BMJ have proved promising for the treatment of obese patients with type 2 diabetes. Agonists of glucagon-like peptide-1 receptor (GLP-1R) were found to result in weight loss in overweight or obese patients with or without type 2 diabetes mellitus.
• New company to run NHS estate: Ownership and management of much of the NHS estate is to be handed over to a government-owned company. HSJ says its objectives will include cutting costs, and the disposal of surplus land and property.
• DH staff confidence plummets: Pulse reports that the latest DH staff survey reveals that only a third believe the department is well managed while less than two thirds now feel it is doing a good job for health in England.

Blogs

Look after the pennies and the pounds will look after themselves – a new paper from the King’s Fund shows how using patient-level data to identify small amounts of waste can yield huge costs savings. Lara Sonola looks at how service-line management can make efficiencies add up.
‘Two examples stand out in my mind … in the first case, the team found that some patients were undergoing duplicate tests. One unfortunate patient had one test more than 40 times, during a hospital stay in which the result could not possibly have changed from the first occasion.

‘In the second, staff found an anomaly when they compared the quantity of tests ordered by clinicians within a department. One clinician appeared to be ordering a £50 test far more frequently than the rest. Was this due to differing clinical opinions? No, the doctor in question mistakenly believed that the test cost £0.50 rather than £50.’

Opinion

Does tele-health really deliver for patients? GP online (registration required) talked to two south London GPs about their experience with projects designed to raise efficiency and cut costs.
Dr Raza Toosy, whose project saved £55,000, said: ‘All too often there is a gap between the vision and the application of holistic services, and time and again we have found that when considering the effectiveness of patient care, the system fails when patients do not engage or are unwilling to change, despite help from service providers.’

Highland Marketing blog

Mark Venables looks at what the Health Select Committee report means for the NHS and the drive for efficiency savings.

This week has been another big week for the NHS. Following the news that the Royal College of Nursing and the Royal College of Midwives had been added to the ever-growing list of bodies opposing the health bill, a highly critical report from the Health Select Committee raised concerns of the Service’s ability to cope with the challenge of driving efficiency in tough economic times while dealing with the biggest restructuring process since its inception.

The findings of the report were clear, ‘salami-slicing’ will not help to deliver the £20 billion in efficiency savings to meet the Nicholson Challenge.

It added that many NHS organisations dealing with staff revolts, an increase in drug prices, an ageing population and of course wide ranging NHS reform are already falling behind on the challenge. A fifth of organisations (19%) failed to deliver their planned efficiency savings last year, and a quarter (23%) of the savings that were achieved were made on a non-recurrent basis.

The document raises concerns that around 40% of savings are coming from reductions to the tariff as well as management restructuring and less than 20% are coming from innovation, which the reforms are meant to drive.

One of the key drivers of innovation, and in turn efficiency savings, is now more commonly recognised as technology. Streamlining back office functions, as well as aiding clinicians to be better equipped with the correct information in order to speed up and improve patient care, are just typical examples of how technology can be utilised beneficially.

Although NHS organisations are steadily getting to grips with the reality that a significant one off investment (or even using a software as a service model) can help yield return on investment in the long run, progress is often still too slow.

And who can blame the NHS for sometimes being slow on the uptake of innovation when the mechanisms to spread the word appear few and far between.

At an industry event I attended not so long ago, a member of the Department of Health briefly mentioned the QIPP Digital Initiatives Register. The audience, suppliers and NHS staff, who were typically experts in their field had never heard of such a register, which was meant to provide a repository to view proven initiatives of best practice to meet targets on the QIPP agenda – with patient portals being cited as such an example.

This no doubt raises concerns whether the rest of the NHS who are traditionally less tech savvy are aware of pilots and proven innovation that could help their organisations meet the challenges that they face.

The issue not only seems to be the scale of unprecedented transformation that the NHS is going through, but also the lack of communication to both senior NHS figures and frontline staff on how this change can best be dealt with.

Mark Venables, CEO Highland Marketing

Nurses call for health bill withdrawal

The Royal College of Nurses and the Royal College of Midwives have called on the health bill to be dropped, claiming their repeated efforts to help make it workable have been ignored. Health secretary Andrew Lansley raised media eyebrows by claiming that the organisations support the principles of the proposed legislation. Shadow health secretary Andy Burnham said it was time for the government to listen to what the NHS is saying.

Peter Carter, general secretary of the RCN, told the Guardian that: ‘The RCN has worked with the government at every possible turn.’ He added: ‘Despite all this, our concerns have not been listened to and the genuine anxieties we have on behalf of patients in England have been, to a large extent, ignored.’

Among the RCN’s principal concerns is the recent announcement that foundation trusts would be allowed to raise 49% of their income from private care – which it claims will push NHS patients to the back of the queue.

Mr Lansley said to the Telegraph that he believed: ‘the trade union aspect of the Royal College of Nursing has come to the fore, they want to have a go at the government … And the RCN and the RCM are very clear that they support the principles of the Bill. What they are unhappy about is pay, pensions and jobs.’

Prompt payments faster but treatment slower

The DH is setting the pace for prompt payment of suppliers with figures showing that 95%, or more, were paid within five days between July and December 2011. At the same time the department has announced an additional £100 million for Clinical Commissioning Groups to spend on improving local services. The money is also to reduce pressure during the colder months.

Patients, however, are having to wait longer for treatment with the number exceeding the 18-week limit having rocketed by 43% since the coalition came to power. This means that by November last year more than 29,500 people had not been treated within the required time – 13.9% higher than the same point in 2010.

The Guardian says the revelations cast serious doubt on David Cameron’s personal pledge to keep patient waiting times low and are the direct consequence of Andrew Lansley’s moves to relax targets.

In a bid to cut NHS costs the Audit Commission and Monitor have jointly published a guide called Delivering sustainable cost improvement programmes. The document is aimed at acute, ambulance, mental health, and specialist NHS trusts and foundation trusts. It summarises how successful organisations approach cost improvement. Many of the examples emphasise the need for effective data gathering and analysis.

Reshaping of health services

Credit ratings agencies, including those accused of failing to spot the financial slump, may be used to measure hospital finances. Monitor wants trusts to achieve an investment grade rating (BBB by Standard & Poor’s, Baa3 by Moody’s and BBB by Fitch).

The system would be like that of the electricity market, giving the regulator warning of financial difficulties building up. But critics claim the idea will mean that money and the markets are put ahead of patients and the quality of their care.

Elsewhere, HSJ reports that plans for England’s biggest ever health and social care provider have been approved in the Midlands. The Staffordshire and Stoke-on-Trent Partnership Trust will take on a 907-strong social care workforce and an annual budget of £153m from Staffordshire County Council. The new organisation will have a turnover of £350m and provide for one million residents.

The trust will be four times larger than the next biggest health and social care provider, Sirona Care and Health in Bath and North East Somerset. There are currently just six organisations providing a similar model of integrated community health services and social care.

Doctors and industrial action

One of the biggest issues of the week is the threat by doctors to take industrial action over proposed changes to their pensions. The BMA is on the verge of balloting members, while the government says there will be no concessions. Both sides claim that the issue could have far-reaching effects on the country, the medical profession and patients. You can make up your own mind by clicking here to see what the BMA has to say and here to read the government version from Pulse.

Research integrity under scrutiny

Thirteen per cent of doctors or scientists have witnessed colleagues altering or fabricating data during their research for the purposes of publication, according to a survey cited in Hospital Doctor. The news comes as the wider integrity of medical research came under sharp scrutiny.

The survey highlights the need for better systems to deter, detect, and investigate research misconduct. Dr Elizabeth Wager, chairman of the Committee on Publication Ethics, said: ‘This survey chimes with our experience from COPE where we see many cases of institutions not co-operating with journals and failing to investigate research misconduct properly.’

At the same time the BMJ reports that in the USA Prof. Dipak Das, a leading researcher on the beneficial properties of resveratrol, a compound found in the skin of red grapes, has been found guilty of 145 counts of fabrication and falsification of data. The University of Connecticut Health Center reached its conclusion after a three year investigation of Prof. Das.

News in brief

• Tele-care concordat: The 3millionlives project, aimed at rolling out tele-health and tele-care technology on ‘an industrial scale’ has been formally launched by the DH. EHI says a concordat has been signed between industry and government which will allow local decision-makers to determine how it is delivered in their areas.
• Cloud gives NHS trust storage performance a boost: St Helens and Knowsley Teaching Hospital NHS Trust has turned to the cloud to support its growing demand for storage, reports the The Guardian.
• Bacon calls a halt on Millennium: EHI reports that Richard Bacon MP has called for a halt to all Cerner Millennium deployments following appointment problems and delays at the latest trusts to go-live with the system – North Bristol and Oxford. He said the two hospitals had been “brought to their knees” by the implementation of the new electronic patient record system.
• Edible chips: GP online reports that Lloyds Pharmacy is to start selling pills with soluble microchips that monitor heart rate, respiration and temperature. The data is then sent to the care team which can monitor patients’ response to treatment.
• Data encryption: The Information Commissioner’s Office has secured a promise from Praxis, a care provider for patients with mental ill health, to encrypt patient data after the loss of a memory stick with 160 sets of personal details.
• Cutting missed appointments: A mobile phone texting service which not only reminds patients of appointments but allows them to cancel or reschedule has cut non-attendances at Barts Hospital, London, by 20%, says EHI.
• GPs regularly breach confidentiality: GPs regularly breach patient confidentiality in computer generated referral letters. Pulse says irrelevant histories are sometimes contained in correspondence, such as parasuicides and abortions from 30 years before.

Blogs & opinion

Despite 25 years researching health systems, including writing over 30 books and 500 academic papers, Prof. Martin McKeefrom the London School of Hygiene and Tropical Medicine says he can’t understand the government’s plan for the NHS. Hospital Doctor wonders if anyone else can either.

‘His [The professor’s] first problem is in understanding what the changes are trying to solve. The government argues that reform is needed because the NHS is performing badly. Yet the evidence it has produced, such as deaths from heart attacks, has been totally discredited, while independent reports show that the UK is now improving at a faster rate than almost anywhere else. His second problem is to understand what is being proposed. “The prime minister has reassured us that he will not privatise the NHS. Yet management of one hospital has just been handed over to what is essentially a private equity consortium”.’

The emergent Clinical Commissioning Groups (CCGs) are central to the ongoing NHS reforms and have come in for a great deal of criticism. Dr Michael Dixon, writing in Primary Care, has come to their defence and claiming they can potentially deliver an NHS led from the front line.

‘An NHS which involves its patients as full partners in improving population health; this has been hard won – but for future generations of clinicians it promises liberation on a grand scale. Allowing them to make a real difference to the services each patient receives and the health each enjoys outside the consulting room. Only by extending the role of clinician from care of the individual to care of all local people, in this way, can we create a better, fairer and more cost effective health service.
‘We are now about to reach the point of no return. Clinical commissioning is here to stay. We must press ahead, impatiently without delay…’

Tony Eardley of the UK Council for Health Informatics (UKChip) expresses concern that the use of unqualified people to handle medical information could be fatal.

‘Would you trust an unqualified surgeon to replace your hip? Then why do we persist with unregistered staff managing clinically critical health systems and crucial and confidential medical information? The same goes for health informatics. We need people with specific qualifications subject knowledge, skills and tools to collect information, manage and share it to support the delivery of healthcare. In an age where medical research and delivery of health services depend on reliable computer-based systems and accurate and up-to-date information, health informatics staff should be encouraged if not required to demonstrate their competence through professional registration.’

Events

The annual eHealth Week takes takes place on 7-9 May in Copenhagen, Denmark. eHealth News EU carries details of the event which includes an eHealth conference co-organised by the European Commission. The event brings together industry partners and providers from across Europe with government and regional decision makers.

Of interest to some vendors will be sessions designed to give CIOs the tools to justify IT investment, inspirational speakers on cutting edge hospital IT and a special symposium on the potential and challenges presented by mobile health. There will also be an SME village for businesses to showcase their products and new ideas.

Highland Marketing blog

This week Ravi Kumar looks at the NHS reforms one year on and explores what the consequences may be.

About a year ago, our government unveiled plans to radically shake up the NHS and proposed a pro-market reform agenda. This pro-market radical reform was meant to shake up the hospital network, private health providers and family doctors. By doing so it proposed to establish a new system to compete for patients who would be able to choose treatment and care while reducing bureaucracy and save billions of pounds of taxpayers money.

One of the fundamentals to this reform is the focus on patient choice. However, it has become clear that by allowing private firms to get involved in the business of looking after the health of the nation, providing greater choice may have a significant price.

Perhaps one of the most radical departures from the idea of a state run structure is the concept of a publicly financed healthcare system -a system that will allow up to 50% of income to be generated privately.

We have seen so much turmoil in the NHS over the past year as the Health and Social Care Bill has passed through various voting and motions in the House of Commons and the Lords.

The British Medical Association is opposing the bill, The Royal College of Nursing and The Royal College of Midwives have this week called for the bill to be scrapped, and questions are being asked by key professional associations, not supporting the reform, about how the changes will impact patient care.

Yet, whilst all this is happening, the NHS is continuing to change on the ground. The planned devolution of power to GPs is happening with more than 250 clinical commissioning groups being formed to purchase and take control of the budgets and patient care. In the press we are already seeing talk of a shift in the patient doctor relationships, with examples of these changes in behaviour being quoted by hospitals.

Now the NHS Future Forum headed by GP Prof Steve Field has made another number of recommendations, which the government says it has accepted.

With all this, the NHS remains in flux with the key questions still unanswered: will the main professional associations change their mind and support the reform agenda? Will there be a compromise? Will the dream of integrated care be achievable? What will be the role of the NHS in the public’s health?

One thing is for certain, the role of information is becoming increasingly more important for frontline professionals who are trying to keep up with the pace of change, whilst at the same time maintaining high standards of patient care. As we all know change is never easy, but the right kind of leadership is essential to get the NHS through this reform.

Ravi Kumar, Industry Advisor

Following a successful year and to support growth, Highland Marketing is looking to recruit.

Says Mark Venables, CEO Highland Marketing:

“With ambitious plans for 2012, its exciting times ahead for the company. As a result we are looking for a dynamic individual who is ambitious, has a desire to be hands on with a determination to produce great work both for clients and Highland Marketing.

“We look forward to receiving replies from individuals wanting to get involved in the healthcare and technology sectors and work at a fast pace!”

Read more about the job

Future Forum declares that health data belongs to the patient

A new report by the NHS Future Forum has urged the government to transform the access and sharing of information – with integration focused on the patient. The document, which includes a well-trailed suggestion that all patients should be able to see their GP records by 2015, declares that there is a strong consensus that ′it′s the patient′s data′ not ′the system′s data′.

The British Journal of Healthcare Computing identifies key recommendations including:

• The NHS must use its IT systems to share data about individual patients and service users electronically in the interests of high quality care.
• Government should set a clear deadline within the current Parliament by which all information about clinical outcomes is put in the public domain.

Forum chairman Prof. Steve Field declared that the barriers to change are ‘much more cultural than they are technological’. EHealth Insider highlights his call for every organisation to identify a clinician to be responsible for organising information in support of better patient care. This is in line with EHI’s campaign for every NHS provider organisation to consider appointing a chief clinical information officer to lead on IT and using information to improve patient care.

The DH, which has accepted the forum’s report and recommendations, has also announced that the long-awaited NHS information strategy is to be published in April.

First NHS trust to be fined for data protection act breach

Brighton and Sussex University Hospitals NHS Trust faces a £375,000 penalty – making it the first trust to be fined by the Information Commissioner’s Office for breaching the Data Protection Act. The move follows the discovery that a contractor paid to destroy hundreds of hard drives instead sold 200 of them, with large amounts of patient information, on eBay.

EHealth Insider quotes trust chief executive Duncan Selbie as saying the trust was the victim of a crime and was going to challenge the fine. The ICO was given powers to impose fines of up to £500,000 for breaches of the Data Protection Act in April 2010. Nine fines have been imposed – seven of them on councils – ranging from £1,000 to £130,000. No fines have yet been handed down to an NHS organisation.

• The ICO has just published its new Information Rights Strategy, which promises a tough line on the confidentiality of patient information – see blog below.

Breast implant controversy hits health bill

The ongoing controversy over how to tackle the issue of faulty and sub-standard breast implants has brought stinging criticism of the Health and Social Care Bill. Richard Horton, editor of The Lancet, argues that Health Secretary Andrew Lansley’s inability to force private sector companies to provide appropriate care and treatment for the 40,000 UK women with Poly Implant Prostheses (PIP) implants, provides a foretaste of what the bill will bring.

He argues that the proposed legislation, which opens up the NHS to more private providers, fails to provide adequate powers to force them to sort out any problems which they cause. All Mr Lansley has been able to do is ask private companies to take similar action to the NHS, which will remove and replace implants it provided.

Some leading cosmetic surgery companies such as Transform are reported to be refusing to meet the government’s request to remove the implants for free.

At the same time GP reports that 98% of Royal College of GP members have called for the entire bill to be scrapped.

Genetic sequencing goes mainstream

A US company has announced the $1,000 genome – pointing towards a potential transformation in medical care tailored to the fundamental make-up of the patient. The Telegraph reports that Ion Torrent can now produce a person’s entire gene sequence in a day, rather than the six to eight weeks required just a few years ago.

The £650 cost is a third of the price charged at present just to test for mutations in the genes that raise the risk of breast and ovarian cancer. Reduced costs open up the possibility of widespread testing of children for their predisposition to future conditions of all kinds, such as Alzheimer’s.

Mental health trusts failing on data quality

Serious doubts over the quality of data used by England’s mental health trusts have been raised by the Audit Commission. The Guardian Healthcare Network says a third have problems and compare unfavourably with their acute sector counterparts.

Mental health trusts were also found not to adhere as closely as acute trusts to the indicators set down by Monitor. Of the 24 indicators tested, only 14 were those specified in the guidance.

Electronic patient records generate 35,000 US jobs

Evidence from the USA challenges long-held workforce worries that electronic records systems threaten jobs. Healthcare IT News says US firm, Career Quest Learning Centers, has introduced a Health Information Technology programme to meet employer needs resulting from government demands for records to be digitised.

Estimates from the Bureau of Labor suggest that the digitising of patient records across the country is creating 35,000 jobs nationwide as staff are now needed to work with and manage the patient health records.

News in brief

• Building cancer detection into GP IT: Early cancer detection algorithms may be integrated into GP IT systems, according to EHI. The idea involves supplying QCancer templates to fill in for every patient with a relevant symptom. The method was successful in predicting two thirds of ovarian cancers in the women most at risk.
• Tablet risks warning: NHS Connecting for Health has warned that tablet devices are “inherently less secure” than traditional IT equipment and that this means they are not necessarily suitable for accessing sensitive and patient identifiable data.
• Commuters choose GPs: A pilot has been launched allowing commuters to join a GP practice close to work rather than home. The primary care trusts (PCTs) involved are Westminster, City and Hackney, Tower Hamlets, Manchester, Salford and Nottingham City.
• Regulation worry drives software sales: More than 1,000 GP practices have bought ‘unnecessary’ new software to show whether they are Care Quality Commission compliant ahead of registration next year. Pulse says the move reflects widespread apprehension about signing up to the regulator.

Blogs

Dr Judith Smith of the Nuffield Trust looks at the organisation’s newly-published report entitled ‘Can NHS Hospitals do More for Less?’ The report champions the use of IT to improve hospital processes and as holding significant potential for reducing costs and increasing productivity. But it expresses concern that here, and elsewhere, progress is patchy.

‘This study reaffirms the importance of good management in general and certain management practices in particular when it comes to achieving greater productivity without compromising quality. It sets out robust evidence about the most promising areas where efficiencies might be made. This includes the reminder of keeping attention focused on the basics of length of stay, day case rates, and back office functions … and using IT to streamline administrative processes within hospitals.

‘If managers and policy-makers are to have any legitimacy trying to persuade the public of the need for difficult rationing decisions, the NHS will need to be well on the way to closing the gap between the most and least efficient hospitals (and indeed other providers). Otherwise the message from voters is likely to be “think again”.’

Information Commissioner Christopher Graham says 2012 marks a pivotal moment for data protection and freedom of information. The ICO is now promising to get tough on security breaches while the EU Commission’s is about to reveal proposals for the future legal framework for data protection.

‘I believe that individuals are increasingly aware and concerned to assert their information rights. But just because rights are talked about doesn’t mean they are respected in the cold climate of austerity, with cuts in the public sector, cut-throat competition in the private sector – and an element of both in the voluntary bodies/charities sector. The danger is that rights are seen as a nice to have in the good times, but a bureaucratic inconvenience when times are hard.

‘It’s in the tough times that we most need to defend the rights of the individual against abuse of power by organisations, both public and private. And information rights are under pressure right now – a victim primarily of the economic climate.’

Highland Marketing blog and news

A lack of Information in the information report
Sarah Bruce looks at the implications of the new report on patient information from the NHS Future Forum.

Highland Marketing joins Intellect
This week Highland Marketing announced its membership of Intellect UK, making it the only healthcare and technology specific marketing and PR company to become a member of the organisation Highland Marketing becomes part of major technology association.

This week the NHS Future Forum published its latest report spurring on headlines from the tabloids such as ‘NHS staff lacking compassion and ability to do their job’ and ‘doctors and nurses told to slim so patients listen.’

But for those IT and NHS professionals waiting for the long over due Information Strategy there were few headlines that could provide even a little direction on where their efforts should best be placed. In summary the report on information, needed…more information.

The report, much of what was leaked before Christmas, provided little that was new.

The key recommendations of the report around information were:

Patient ownership of data – a requirement for patients to be able to access their records online by 2015 and for the British Medical Association, Royal College of General Practitioners,  NHS Commissioning Board and patient organisations to help to deliver a plan to roll this out, which includes an ethical and concrete consent process.

Data sharing - A move away from the National Programme for IT to interoperability and a call for the Information Strategy to clearly set out what is expected for providers of NHS services as well as a deadline.

• For contractual agreements to be put in place so ensure that the entire NHS has systems that allow full electronic data sharing against set standards.
• For hospital discharge summaries to be made available to the GP and patient at the point of discharge, and GP referral letters to be made available at the point of referral.
• For the universal adoption of the NHS number at the point of data capture across health and social care by 2013.

Information governance – The Government should commission a review of the current information governance rules and of their application, to report during 2012 to ensure appropriate balance between the protection of patient information and the use and sharing of information.

Using data to drive quality - A clinician who is responsible for organising data should be identified within every NHS and social care organisation.

Transparency - The need for a clear deadline for all information about clinical outcomes is put in the public domain and the need for the Information Strategy to emphasis the importance of patient‐generated comments through social media and for the NHS to use these to improve services.

Although there is little that is new, there are a couple of interesting points. Firstly, that the medical bodies will be asked to consult on the plan to allow patients to access their records online. However, there is no mention of suppliers/providers of the technology. The lack of communication between the technology world and the clinical world was one that led some of the major failures under NPfIT, could this be at risk of happening again?

A number of additional deadlines are set out, such as the adoption of the NHS number by 2013 (which was introduced 15 years ago) and for information about clinical outcomes to be placed in the public domain, but there is little information on the mechanisms that will drive these deadlines.

Perhaps more interestingly is the call for an emphasis on social media to improve services. While an innovative and forward thinking idea, this in itself needs an entire document and a huge amount of education aimed at the industry and NHS, considering only around half of NHS organisations actively use Twitter, for example.

The recommendations appear to provide a vague brief to build on and leave questions that it seems can only be answered by the Information Strategy, which  will allegedly arrive in the spring.

Sarah Bruce, Communications and Digital Media Consultant

Highland Marketing has joined the leading technology trade association Intellect.

The association, which was formed in May 2002 to give a single powerful voice to the UK technology sector, represents more than 800 SMEs and multinational corporations.

As well as having a number of industry programmes, such as central and local government, education and transport, Intellect has an increasingly popular healthcare group.

As the only healthcare and technology specific marketing and PR company that is a member of the organisation, Highland Marketing will look to gain insight and knowledge from the workshops and meetings often led by senior industry figures in this area.

This will ensure that Highland Marketing continues to provide the best advice to its growing customer base, as market conditions change, and enable its team to apply their expertise to individual client campaigns.

In addition to utilising Intellect to sharpen its industry knowledge, Highland Marketing will offer its services to Intellect members, many of whom are new to the UK technology sector and require a tailored marketing and PR strategy,

Mark Venables, CEO of Highland Marketing said: “Intellect’s objective to develop the UK’s capability to support a strong and growing technology sector aligns with the work that Highland Marketing continuously delivers for its clients, that is to ensure companies of all sizes have the best route to market.

“We look forward to participating in the lively debates and social events that Intellect holds as well as getting to know the other members and how we can assist them within the changing landscape.”

About Highland Marketing

• Founded in 2002, Highland Marketing is a leader in developing tailor-made and flexible PR, marketing and communications solutions for the healthcare industry with CSC, IMS MAXIMS, Carefx, Ardentia, IBM, One Health Alliance, Illingworth Research and AxSys Technology amongst its clients.
• It operates in the UK and internationally and has in-depth knowledge of the healthcare market.
• The company has a dedicated team of skilled and experienced people all with a minimum of 10 years experience within their field.
• It also offers customised business development support geared to help grow client sales
• For further information contact Mark Venables on +44 (0) 7973 172894 or  markv@highland-marketing.com or visit www.highland-marketing.com.

Media contacts

Sarah Bruce, Highland Marketing
Phone: +44 (0)1877 339922
Mobile: +44 (0)7557 265473
Email: sarahb@highland-marketing.com

Last week, as Big Ben chimed out midnight and the fireworks erupted around the London Eye spectacularly, my mind went back to the chimes of Big Ben welcoming the Millennium.

We all waited with bated breath to see whether every computer in the land would come to a standstill as predicted. Intensive care units doubled their staff, emergency services were at the ready and many government departments and local authorities had contingency plans dusted off and ready to mobilise.

Due to a lot of planning and a huge investment in IT (an opportunity to replace elderly PCs) thankfully the Millennium had little impact. Twelve years on and dramatic changes in technology have occurred with the introduction of the ‘iPhone era’ where information, such as our friends’ relationship status to the latest headlines, is delivered to us in real-time through the internet, social media and mobile technology.

The ‘iPhone culture’ means that we can get instantaneous information about almost anything, like from Trip Advisor on how good a holiday destination might be and on trains, buses and planes, through to traffic congestion reports. But sadly we still can’t get information about which surgeon and or hospital has, for example, the best outcome for joint replacements.

The reality is that we behave as if the same technology we use within our everyday life is as equally pervasive within our healthcare. However, there is a silo infrastructure, which we have been unable to join up in any meaningful way despite the fact that it would release massive savings and enable real choice through patient involvement. Embracing such technology could not only support the ‘information revolution’ but create an ‘information evolution.’

What is questionable is the unidentified cost for becoming ‘E-dependent’, particularly in a world where technology projects costs are 60-70% infrastructure and support costs.

Budgets are being cut as users, in both the public and private sectors, demand more for less. Periods of rapid change in the way both enterprises and consumers use technology create not only huge threats for those wedded to old models, but also huge opportunities for new ventures and existing businesses capable of capitalising on the new trends.

As we reorganise and restructure the NHS, we must look at new ways to reduce costs, such as moving to Software as a Service (similar to the Pay as you Go tariff on a mobile phone). In addition, the NHS is increasingly seeing more organisations embracing shared services, outsourcing and even cloud computing. Interestingly the NHS has more shared service contracts than any other government department covering finance, HR and clinical functions. Could this be just what the newly formed Clinical Commissioning Groups might need?

2011 brought a lot of uncertainty, predominantly due to changes to the National Programme for IT, the continuously disputed Health and Social Care Bill and the absence of an Information Strategy. Let’s hope that 2012 brings more clarity so that organisations can work to bring in today’s technology into tomorrow’s NHS.

Exciting times ahead I believe and of course we have both the Jubilee and the Olympics to look forward too.

Jeremy Nettle, Industry Advisor

The past year has been marked by the unraveling of grand plans. It’s also seen a real buzz emerge in the UK’s healthcare IT sector. And as far as patients are concerned, 2011 might be remembered as the tipping point, when politicians put their weight behind viable projects to use technology and data in the transformation of care.

Perhaps the most dramatic change has been the collapse of much of the National Programme for IT (NPfIT). I remember its birth, when it looked fresh and full of promise. Over the years it has been painful to watch the project being undermined by so many disasters. The final disintegration reminded me of one of those slow motion movies of a tower block being demolished. An edifice that had looked so huge simply crumpled back in on itself, leaving a heap of rubble and, in this case, recriminations. Indeed, the rush to blame the vendors involved, has been a worry. We simply cannot afford a situation to emerge where healthcare IT suppliers are viewed with suspicion.

A similar sense of instability afflicts Andrew Lansley’s Health and Social Care Bill. We were presented with a vision of a simpler, more effective NHS in which the business-like and patient-focused GPs commissioned services on behalf of patients. An indication of how badly awry this has gone is that a whole army of GPs has signed an e-petition to scrap the Bill. In fact, the shrieks of anger and dissent have come from just about every part of the NHS and far beyond. The government’s response has been to make amendments on the hoof. As a result the original vision may be lost, and we risk getting another unwieldy commissioning system which the next government will overturn.

NPfIT and the Health Bill underline the dangers of imposing big visions on the NHS. And what has been so promising about 2011 is that all the smaller innovative IT firms that had been marginalised by NPfIT have begun to re-emerge. There is so much creativity and ability out there, and a pragmatic approach in which providers choose suppliers to suit their needs, will help it flourish. This is excellent for the economy as we have so many companies which, after proving themselves in the UK, have the potential to make a big impact on the world market.

Likewise, it’s been great to see the government announce its plan to make anonymised patient data readily available to the life sciences and pharmaceutical industries. Once again, it’s an area where the public and private sectors can collaborate to bring benefits for all.

Perhaps the highlight of the year was the PM’s announcement that three million patients will benefit from telehealth and telecare services. This would be a huge vindication of modern technology and its ability to bring a closer and more effective relationship between patients and care teams. The worry is that it might go the way of other grand plans. But the new willingness of the Department of Health to co-operate with industry, and representative bodies like Intellect, will hopefully mean it is pushed forward in a pragmatic and sensible fashion. If this happens then 2012 could be a time when the UK healthcare IT sector gains confidence and technology starts to be recognised as central to the delivery of top quality care.

Merry Christmas!

Susan Venables, Client Services Director

Last week, the Department of Health finally announced the headline findings of the Whole System Demonstrator project, a wide scale telehealth pilot that has been taking place over the past three years in England.

For many, the initial findings gave the NHS and industry what they had been waiting for, an evidence base which says that telehealth gives greater power to patients and reduces costs through early intervention.

The results say the correct use of telehealth can deliver; a 15% reduction in A&E visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days and an 8% reduction in tariff costs.

These top-level findings at first glance appear fantastic but are they really enough for the government to commit to deploying three million more telehealth systems into homes over the next five years as also announced last week?

My initial response is no. While I have great faith in telehealth and yet great frustration at the rate it is being deployed these findings for me are still not enough to give the go ahead on a national roll-out.

For me the words ‘correct use of telehealth’ rings alarm bells. What is the ‘correct’ use and how can we ensure it is carried out? Moreover, is it even feasible that within five years, three million people will enroll on the scheme, given that during the early stage of the WSD pilot only one in ten of those who were asked actually signed up.

The concept of widespread telehealth is a great one but these findings alone along with the government’s promise to only invest in proven technology is simply not enough.

While a fuller report may do this, the report currently released to the public merely provides an overview of the benefits and lacks the real, hard data that commissioners need to decide whether telehealth could work in their area and how.

In addition to this it appears that there is far more to be done to find out what does and does not work in health outcome terms, how will hospitals be paid, who are the best patients to enrol and also how GPs will be engaged with data sharing among all the other challenges and responsibilities they are about to take onboard due to the reforms.

Therefore, while I’m all for the spreading of innovation, the conclusions so far drawn from this report appear only to serve as a basis for where more work could be done and more data could be revealed rather than a foundation for a national roll-out.

Sarah Bruce, Communications and Digital Media Consultant

Huge funding problems and record-breaking job losses loom
Large numbers of English hospital trusts face financial difficulties in the year ahead according to the latest report from the all-party Commons Public Accounts Committee. The PAC found that four in five of the 113 hospitals which have not yet achieved Foundation Trust status are expecting problems.

The report adds that most face strategic challenges, performance issues and governance problems. Twenty have declared that they will never make foundation status in their present circumstances.

The PAC states that: ‘London is in a particularly shocking state and nobody has got a grip on long-standing problems. We remain to be convinced that combining struggling hospitals into larger trusts – as with South London – will somehow produce viable organisations offering good quality, accessible healthcare.’

The BBC’s coverage suggests that mergers may lie ahead. The King’s Fund think tank has called for the government to work closely with failing hospitals to find solutions, adding that in some cases closures may be the only answer.

Meanwhile HSJ reports that the NHS foundation trusts plan 35,000 job cuts – the largest number since records began. It also says the trust sector as a whole could be heading for a £201m deficit in 2011-12.

IT is the key to Northern Ireland healthcare
An independent review into the future of healthcare in Northern Ireland puts IT centre stage. A future model, unveiled by health minister Edwin Poots, emphasises a shift of services from hospitals to nursing homes, social and community services and GPs.

EHI says the devolved government sees a significant role for technology, and describes it as ‘a key enabler of the delivery of the new model of care’. A forum is likely to be set up to ‘take forward how technology will support the new model of care, linking the service to industry and academia to ensure the optimum and best value for money solutions are taken forward.’

Specific proposals include plans to create an electronic care record (ECR) for every patient that will include data from GP records, community information systems, pharmacy and hospital records, and be shared through a common ECR platform.

Lifestyle issues still blighting Scottish health
Scotland’s chief medical officer Harry Burns has warned that obesity, poor diet and excessive drinking are still causing unacceptable levels of ill health. On a more positive note, the BBC says his annual report pointed out that deaths from the ‘big three’ killers – cancer, heart disease and stroke – were continuing to fall.

Figures from the Scottish Health Survey indicate the scale of the problems and suggest that a quarter of Scots ate poorly, did not get enough exercise, drank too much and were overweight

Dr Burns stated that the proportion of men who reported that their drinking exceeded the recommended daily limits rose from 43% to 45% between 2003 and 2010. There was also a steady increase in the number of overweight or obese adults between 1995 and 2010, with the numbers aged 16-64 increasing from 52.4% to 63.3%.

Cancer survival rates threatened
Cancer survival rates could fall because of a rise in the cost of diagnosis and treatment over the next 10 years. A report sponsored by Bupa says that by 2021 the number of new cancer cases will rise to 383,000 per year at an increased cost of care of £15.3 billion.

Bupa suggests that this increased need could be met by focusing on:
• improving patient understanding and treatment choice
• changing how and where cancer patients are cared for, including treatment at home
• making the most appropriate use of diagnostic techniques and treatments

BMJ says that Cancer Research UK is cutting its spending on research by 10% over the next three years because of a dip in income brought on by the economic climate.

UK children get fatter
More than one in three children aged 10-11 are now officially overweight or obese. The figure has risen from 31.6% in 2006-07 to 33.4% in 2010-11. According to the Telegraph the problem seems to emerge during school years, as there is a decline in the number of pre-school children who are obese or overweight.

Children tended to be fatter in urban and deprived areas, the figures revealed. Paul Sacher, paediatric dietitian at MEND (Mind, Exercise, Nutrition … Do it!), said: ‘The government must intervene to protect the health of our nation’s children and prevent this crisis from continuing to spiral out of control.

‘With the health consequences of obesity including type 2 diabetes, heart disease and some types of cancer currently costing the NHS £5.1bn per year, the significant financial and human costs associated with obesity has never been clearer.’

News in brief
■ Who cares for London?: The King’s Fund wants the government to say who will be responsible for improving Londoners’ health after the abolition of the strategic health authority. It points to potential chaos as the city already faces problems over GP performance, health inequalities and the scrapping of valuable services.
■ Renal first: North Mersey, the Isle of Man and North Wales are planning the UK’s first region-wide information exchange for renal patients. CyberREN, already live at sites such as Royal Liverpool, will allow information to be shared across hospitals and satellite sites, with the potential for including home monitoring.
■ Diabetes deaths: Diabetes UK claims that 24,000 deaths a year could be avoided with basic health checks, a good diet and regular medication. Up to 75,000 of the 2.3m people with diabetes in England die every year – about 15% of all deaths.
■ New PACS plan: EHI says NHS Connecting for Health hopes to have a framework to help trusts re-procure picture archiving systems established by the end of 2012. The goal is to help trusts exercise local choice over their future systems.
■ TB research hope: Researchers believe a new drug regime could cut the treatment of latent Mycobacterium tuberculosis from nine to three months, and increase the completion rate, by using rifapentine in addition to isoniazid.

DH news
The latest issue of The Week, the DH’s own publication on health sector news, is now available. It’s a handy opportunity to get up to date on key issues like the NHS Outcomes Framework 2012-13 and the Any Qualified Provider Map of Services.

Opinion
The latest British Social Attitudes Survey shows public satisfaction levels with the NHS at a record high of 70% – with just 18% expressing discontent. John Appleby of the King’s Fund looks at the reasons behind our changing views.
‘We know from past surveys that people who have had recent contact with the NHS tend to express greater satisfaction than those with little or no contact. We also know that there seems to be a link between expressions of satisfaction, the political party in power and the political allegiance of those surveyed: if the party you support is in power, you tend to be more satisfied with the NHS.’

Life sciences report
How can the NHS do its upmost to support innovation and change in the life sciences? A new report entitled Innovation Health and Wealth; accelerating adoption and diffusion in the NHS looks at the actions the health service needs to take. It also quantifies some of the huge benefits the NHS brings to society.

Blogs
Questions are being asked about the future of healthcare in Europe. The EU has warned of a one million shortfall in healthcare workers by 2020. Tessa Richards, analysis editor of the BMJ, considers the factors that are driving people away from careers as nurses and doctors.
‘Discontent is less about numbers or poor wages, the study suggests, than difficult and discouraging work environments. Older, sicker, heavier patients who are being propelled ever more rapidly through secondary care have made the job of being a nurse more stressful, and management takes too little notice of nurses concerns. Fewer would leave and more might be attracted to the profession if their concerns were addressed, the meeting agreed.

Highland Marketing blog
This week Sarah Bruce asks Are ‘three million lives’  really ready for telehealth?.

Millions to get telehealth support
Prime Minister David Cameron has announced a telehealth drive in which three million patients with chronic illnesses will get hi-tech equipment to monitor their conditions at home. The London Evening Standard said the move, pioneered in partnership with Intellect (which represents the UK technology industry), will be rolled out over the next five years.

The telehealth scheme has been designed so that vital health checks can be carried out and sent electronically to GPs without the need for the patient to make an appointment or visit a clinic. Mr Cameron said: ‘This is going to make an extraordinary difference to people. Dignity, convenience and independence for millions of people.’

HSJ reports that commissioners and providers have also been told that they will suffer significant financial penalties if they fail to meet government standards for innovation in six ‘high impact areas’ including the introduction of new technology, of tele-health projects and of best practice on dementia care. Incentives will be available for those which excel. The DH has told trusts that the 2.5% of their £60bn income which is related to commissioning quality and innovation is at stake.

Many cancers caused by lifestyle – more action demanded
Better lifestyle choices could cut cancer cases by 130,000 a year. A Cancer Research UK study identifies smoking as the chief worry, causing 23% of cases in men and 15.6% in women.

The BBC coverage says 100,000 cancer cases are linked to cigarettes, alcohol, obesity, poor diet and lack of exercise. Salt is a cause of stomach cancer, while with oesophageal or gullet cancer, half the risk is from eating too little fruit and veg.

Royal College of Physicians president Sir Richard Thompson said: ‘These stark new figures are a wake-up call to take stronger action on public health. The “carrot” approach of voluntary agreements with industry needs to be replaced by the “stick” approach of legislative solutions.’

The RCP has called for:
• higher prices and reduced availability of alcohol
• banning smoking in cars
• plain packaging for cigarettes.

Doctors’ fresh attack on Health Bill
The whole stability of the NHS is under threat, according to the BMA, as chaotic and uncoordinated change sweeps the health service. The ruling council of doctors’ union has voted for total opposition to the Health and Social Care Bill.

Dr Hamish Meldrum, Chairman of BMA Council, said: ‘There has been a growing level of unease about how the reforms are panning out – we hear repeated concerns from doctors about mounting chaos on the ground.

‘We want the government to rethink its reform package and withdraw the Bill. It should be focusing on delivering high-quality, coordinated and integrated health care, not side-tracking staff with major structural reform.’
The BMA says its main concerns are that the timetable is overambitious, the reforms are adding to complexity rather than making things simpler, and that doctors will not get the promised freedoms to deliver better services.

GP data released
The DH has published GP practice data to provide the public with information on services they access on a regular basis. The idea is to make doctors more accountable and to encourage patient choice.

A tool to allow easy comparisons between practices is due to be launched next April. The DH says the information, available through NHS Choices, will drive up standards. Pulse, though, carries claims that the system could mislead.

Dr Richard Vautrey said: ‘What’s completely absent is the local context. Two neighbouring practices may start with very different populations. If you bombard patients with information out of context, it becomes meaningless.’

Life science strategy launch
The government has launched its Life Sciences Strategy, to support the growth of the industry in the UK. The strategy offers incentives to business, researchers and clinicians to work in Britain. It aims to make the UK the ‘global hub’ for life sciences.

Key elements include:
• an enhanced web-based UK Clinical Trials Gateway providing patients and the public with authoritative and accessible information about clinical trials
• an investment of £310m to support the discovery, development and commercialisation of research
• consultation proposals for a new Early Access Scheme to increase the speed and efficiency of routes to market approval for new therapies.

Go live for iSOFT e-prescribing
A second NHS trust has gone live with iSOFT’s electronic prescribing system (ePMA) and its pharmacy system. University Hospitals of Leicester NHS Trust has introduced the systems as part of its move towards a full end-to-end electronic patient record.

EHI says the solution covers stock control and dispensing in the bone and marrow transplant unit and the oncology and haematology wards. Electronic prescribing is expected to reduce the risk of adverse interactions and clinical errors.

Clinicians’ love of mobiles is a security risk
Mobile devices may soon be the preferred computing devices in healthcare, replacing desktops. But Information Week suggests there are major security risks.

The feature highlights many potential security threats – often to do with patient confidentiality. PricewaterhouseCoopers privacy and security practice experts are quoted as saying of US patient health data breaches issues that: ‘it’s astounding to note that mobile devices are involved in many or most incidents.’

GPs braced for surge in workload
PCTs plan a 25% increase in GP workload by 2014/15 as hospitals shift more care into the community. Recently published efficiency plans suggest the transfer of care is becoming central to the ongoing NHS cost-cutting drive.

GP magazine says the proposals have raised fears that practices will have to cut referrals, while staff work longer hours and offer more consultations per session.

NHS Confederation deputy CEO David Stout said the challenges facing the health service are enormous – and insisted that this kind of planning is essential.

News in Brief
Surgery care unacceptable: The care of high-risk surgery patients is falling short of acceptable standards, an independent review says. Four in 10 patients, from 20,000 cases reviewed, got poor or inadequate treatment. There were particular failings in pre-op checks and use of critical care facilities after surgery.
Top US EHR suppliers named: CPSI, Cerner, GE Healthcare and Picis have emerged as the vendors whose inpatient EHRs are most favoured by customers in a four-month user poll. See Healthcare IT News for complete results.
Post-surgical speed: The James Cook University Hospital in Middlesbrough has developed a new system called RADS (recovery arrival departure screen) to improve patient flow following surgery. HSJ reports that it shows everything from likely recovery time to surgeons’ estimates of when an operation will finish.
60 care measures: The government is producing 60 indicators relating to how patients fare during and after treatment. HSJ says they include a focus on better cancer survival and a zero tolerance of hospital-acquired infections.

Opinion
The NHS has been in fear of new media for many years – but now it is being embraced as a power for positive change according to James Munro, director of research and informatics at Patient Opinion.
‘Social media offers the NHS an invitation to a different kind of relationship with patients and carers – one which is more equal, more collaborative and yes, more transparent. Just as relationships with healthcare staff in the real world have the power to heal, or harm, so we are learning that the way that the NHS responds online can also have a powerful impact, for good or ill.’

Blogs
Patient data leaks are not all from tabloid hackers – hospitals need to look to their staff according to Sarah Burnett-Moore, a consultant radiologist in London.
‘You may imagine that patient details are sacrosanct, but they are not. A good friend of mine is a well-known actress and national treasure. She was admitted to a private hospital for a fairly major operation. Within hours she had a call from her surgeon, to say that a red-top journalist had called on his home number asking for details.
The hack knew what the operation was, her room number, and the pseudonym under which she had booked. She hadn’t used her mobile phone once, so clearly a member of staff was quite happy to sell details to the press.’

In the UK, women doctors are set to outnumber men by 2017. Maham Khan believes it could be a change for the better – despite a persistent gender gap in some areas.
‘Women dominate in specialties such as general practice, paediatrics, and palliative care, but some branches of medicine, such as cardiology and general surgery, remain closed or unattractive to women. Despite fears propagated by the media, more women could lead to safer practice. A review of complaints received by the National Clinical Assessment Service (NCAS) shows women are less likely to be subject to disciplinary hearings.’

Highland Marketing blog
This week Mark Venables discusses making patient information available to private companies for clinical trials.

Back in the spring I wrote one of my first blogs on something that I have always been passionate about – an IT enabled convergence between different areas of healthcare.

In the blog, I detailed how service providers, the NHS and patients are finally starting to work collaboratively to share information resulting in less duplication, reduced costs, sharing of best practice and improvements to service delivery and care across the healthcare spectrum.

In light of this, the announcement made by David Cameron this week outlining that he would consult on changing the NHS Constitution so that all patients’ data could be used for medical research, was a breath of fresh air.

For me, there could be no greater example of end-to-end information sharing from the laboratory to the treatment of a life threatening disease.

Critics and privacy groups are of course claiming that data protection mechanisms in this country are not robust enough to support this type of move and that data is just as easily identifiable as it is anonymised in these circumstances.

While the announcement means that “every patient will be a research patient” there are a number of key things to remember here.

Firstly, the patient information is anonymous. If the correct protocols, information governance and standards are put in place, many of which are already well established within the pharmaceutical industry and the NHS, the issue around prying eyes should be eradicated.

Secondly, patients still have the opportunity to opt out of their data being passed on. This follows a similar consent model to that of the summary care record where identifiable patient information is passed from one GP practice to another without patients actively consenting to them doing so.

Thirdly, the NHS has the second largest workforce in the world. There is just as much chance of those working within NHS organisations inappropriately accessing information as commercial companies doing so.

If the fear is truly around who will be accessing these records and that they might on the off chance fall into the wrong hands due to their flexibility of being electronic and in more than one place at one time, then perhaps we should revert back/continue to use paper. This would of course have far greater implications such as delays to patient care, confidentiality and a far greater likelihood of information being destroyed, among many other limitations.

Very few people appear to have a problem with providing huge private financial organisations with a wealth of information about precise details of their income, expenditure, loan and mortgage agreements that can be accessed anywhere across the world.

Allowing private companies such as research organisations to access anonymous health records does not mean that it is a free for all to look at your health records, but it does mean that by having faith in our NHS and industry you could help save thousands of lives by aiding medical breakthroughs.

Mark Venables, CEO Highland Marketing

Strikes and pay fears sweep NHS
The NHS faced one of its most strife-torn weeks in decades as strikes over pensions were fuelled by fears over pay cuts and capping. Hospitals cancelled 7,000 of the 30,000 scheduled non-urgent operations while ambulance services in many areas were reduced to 999 cover only.

Despite widespread industrial action, the BBC reports that unions and management agreed contingency plans to maintain emergency services and ensure that those needing cancer care, or nearing the end of their lives, were unaffected. Unions claim 400,000 NHS staff walked out – a figure disputed by government.

While the BMA and RCN did not take part in the strike, both expressed fury at the Chancellor’s announcement that pay will be capped at 1%. Many RCN nurses attended meetings and marches outside their working hours.

Pulse reported fears that national pay agreements are under threat after the government said it is looking at “how public sector pay can be made more responsive to local labour market”’. The mood was not helped when Future Forum chair Professor Steve Field attacked the quality of general practice, claiming the NHS has ‘lost the plot’ on primary care.

All patients to have access to GP records by 2015
Ministers are pledging that everyone in England will have online access to their GP record by 2015. HSJ states that the measure was included in a document launched by Chancellor George Osborne this week, but without any public statement.

Ministers believe that allowing patients more control over their records will lead them to become more actively involved in their healthcare, and will enable them to hold GPs to account. It is also hoped that it will spur GPs to keep more accurate records, leading to higher quality information being recorded.

Dr Paul Cundy, vice chair of the BMA’s GP IT committee, said: “This is not something I’m aware that patients want,” adding that patients did not need access to their records to book appointments, request prescriptions or contact their doctor electronically.

Weekend hospital care can be risky
A survey of hospital trusts shows a 10% jump in deaths at the weekends. The research, by Dr Foster Intelligence, suggests that the higher mortality rates could be avoided with better staffing and access to services such as diagnostics.

The data, reported by the BBC and EHI, was published in the group’s Hospital Guide, which has been produced yearly for the past decade. In total, 42 trusts had higher than expected mortality rates – these are named in the report.

Richard Hamblin, of NHS standards regulator, the Care Quality Commission, said it was ‘too simplistic’ to conclude high death rates were definitely down to poor care. NHS medical director Prof Sir Bruce Keogh is asking trusts to look closely at weekend services.
● See below for comment article by Roger Taylor, Director of Research at Dr Foster Intelligence.

Call for all clinical research data to be fully shared
There are growing international demands for the full sharing of results from all clinical trials involving animals or humans. BioMed Central has issued a paper which argues that it is essential for all information to be freely available, whether the research is funded publicly or privately.

The paper argues that data sharing would lead to tremendous benefits for patients, progress in science, and rational use of healthcare resources based on trustworthy evidence. It also claims that the current situation, with selective reporting of favourable research and biased data analyses, is harmful to patients.

Similar calls have come from the Organization for Economic Cooperation and Development (OECD), the World Health Organization (WHO), and the European Commission.

Inflation figures yield extra £610 million for NHS
The King’s Fund has announced that new economic forecasts mean far less of the NHS budget will be eaten up by inflation. Government statistics show that if spending plans remain unchanged, £13.85 billion rather than the predicted £14.84 billion will disappear due to price rises – leaving £610 million more to spend.

The result is that over this Parliament (2010/11 to 2014/15) NHS spending in England will grow in real terms by 1% over five years instead of 0.4%. Over the period of the spending review (2011/12 to 2014/15), real growth will be 1.5% over four years instead of 0.98%.

Tabloid used NHS staff to get patient data
The former features editor of the News of the World has claimed that NHS staff, rather than record hacking, were the tabloid’s main sources of confidential patient data.

An EHI report on the Leveson Inquiry into press ethics says it was told by Paul McMullan that it was acceptable to take or ‘blag’ medical information. “There is a difference between answering the phone to somebody that has seen a pregnancy test for some big star and paying somebody to go into the office and flick through the medical records,” McMullan said.

News in Brief
HIV all-time high: Calls are being made for universal HIV testing after figures revealed that 20% of sexual health patients refuse the offer. The BBC reports growing concerns as infection levels are rising and cases diagnosed among gay men are at an all-time high.

Indian healthcare gets social media savvy: Hospitals in India, especially those serving specialist markets, are leading the way in adopting social media to grow their businesses. DX says Apollo Hospitals have 37,651 Facebook Fans.

New data release: The DH has announced the release of new data to stimulate medical research. It claims that The UK can lead the world as a location for data-enabled health research via the Clinical Practice Research Datalink.

Oxford IT launch delay: The much-heralded launch of the new Cerner Millennium EPR at Oxford University Hospitals NHS Trust has been delayed after all parties agreed that “additional time is needed to ensure a smooth implementation”.

Private healthcare enquiries surge: More than 25% of GPs have seen a rise in the number of patients asking about private care, a Pulse survey says. It also found that 59% of the public believe that those who can pay for treatment should do so.

Targeting slow care: The DH is to pilot ways of informing patients of their right to be treated elsewhere if the 18-week target is missed.

IT to end waste: Guardian Healthcare Network looks at some of the best examples of projects where the NHS is using IT to cut waste.

Opinion
Roger Taylor, Director of Research at Dr Foster Intelligence, wrote in the Telegraph about his views on research showing that hospital patients are more likely to die at the weekend – and on the benefits of reorganisation.
‘Plans to re-organise hospital services are usually greeted with scepticism by the public. It is easy to understand why. Too often, the financial case is well made but the argument in terms of benefits to patients may be less convincing. Until recently, there were 24 A&Es in London treating stroke patients. Many did it poorly – especially when patients arrived out of normal working hours. Today, only eight hospitals handle these patients. But they do it very well …’

Social media
For those who enjoy online discussions (and getting some useful exposure for their business) there’s one that’s really taken off on the Innovations in Health group – and there’s lots of input about IT. The extract below tells you what it’s all about.
‘As a fun exercise, pretend you have been appointed to the new World Health Commission. You have absolute power to determine health strategy. What is it that patients, providers and society seek from healthcare? Why can’t they get that now? Starting with a blank canvas, what would be the objectives of the new system?’

Alternatively the well-respected NHS Contract Professionals group is asking members where in the world they would most like to live and work.

Highland Marketing blog

This week Sarah Bruce discusses the Intellect and Department of Health Informatics Directorate’s plan on how they intend to revive the healthcare IT market.

This week saw the closing date for responding to the Intellect and Department of Health Informatics Directorate’s plan on how they intend to revive the healthcare IT market following the demise of the National Programme for IT in the NHS.

At Highland Marketing, we encouraged our clients to respond to the initiative, in order to get their voice heard, be involved in the changes from the outset and ultimately make a difference.

The objective of the plan since its inception last month has been to “foster the right conditions to enable a healthy and vibrant healthcare IT market within England.” The joint plan aims to demonstrate how this can be achieved through a partnership between the NHS informatics “customer” community and the IT “supplier” community.

For the most part IT suppliers agreed with the concepts at the heart of the plan, which include a renewed focus on standards, data sharing and procurement with many claiming that “it couldn’t have been written better themselves.” But of course, the true purpose of this consultation exercise is not only to ensure Intellect/DHID are on the right track but that they haven’t missed anything out.

The most prominent message that has shone through from our clients has been around procurement. As a communications agency that gets very close to our healthcare technology customers we know that this has been an issue for suppliers for sometime. This issue has now resulted in a feeling of utter frustration among vendors that have a great and proven product but don’t have a big balance sheet behind them. Many vendors have been shut out in the cold for too long and the culture of risk and mentality that “if you’re not big enough to sue then you are highly unlikely to win any major contract” has to be changed in order for the innovative, more flexible companies to grow.

Another key theme reiterated by our clients is the distinct lack of focus on evaluation in the joint plan. At present, no one really knows what success looks like in an IT deployment, there is no solid evidence base or real approach to evaluation or benefits realisation in IT programmes and that this plan could be an opportunity to address this.

Overall, the plan appears to have addressed most of the major concerns of healthcare IT providers and the collaborative approach seems to be the way forward. Incorporating the views of end users with those who design and provide systems is crucial and part of the reason why the National Programme for IT has not delivered in its full capacity.

Despite this new plan being “owned” by the DHID, it is essential that this remains a true partnership throughout its lifespan, ensuring that the DHID and Intellect find the right way to keep the NHS community engaged with suppliers in order to create a healthy and vibrant IT market. The DHID and Intellect are being given a huge opportunity to really find out what the NHS needs and how it can be provided, let’s hope they make the most of it.

Sarah Bruce, Communications and Digital Media Consultant

Healthcare providers face 1.5% price cut
A 1.5% cut in prices is to be imposed on NHS healthcare providers while commissioners have been told to enforce financial penalties strictly and to clear their own debts. HSJ’s coverage of the newly published DH operational plan for 2012-13, aims to accelerate its £20bn savings programme.

Observers were surprised when the expected encouragement for PCTs to move away from payment-by-results, and a reversal of the harsh new fines for emergency readmissions, failed to materialise. PCT clusters will be able to use contractual penalties to punish providers if they are not satisfied with the completeness and quality of their data.

Pulse reports that the operational plan is likely to bring a wave of CCG mergers after the management allowance for patients was set at £25 a head, at the lowest end of the expected range. This comes after a government-backed paper from the NHS Alliance and NAPC warned that funding at that level would mean CCGs would need to cover at least 100,000 patients in order to manage clinical and financial risk.

Patchy progress towards better cancer survival rates
Some cancer survivors in England and Wales are living nearly six times longer than 40 years ago according to new figures from Macmillan Cancer Support. But the BBC quotes the charity as stating the data highlights a ‘woeful’ lack of progress for some types of the disease, such as lung and stomach cancer.

Macmillan analysed median survival times and estimates for 20 cancers, drawing on research by the London School of Hygiene and Tropical Medicine. The results showed that more cancer patients are living longer, yet many struggle with long-term problems caused by their treatment. These include fatigue, infertility, and damage to the lungs and heart. Some cancer survivors also need psychological support.

Reverse loss of psychiatric beds
The NHS needs an extra 3,000 psychiatric beds according to a professor who is challenging the inane chant of ‘community good, hospital bad’. Hospital Doctor reports that Peter Tyrer, Professor of Community Psychiatry at Imperial College London, believes the shift from hospital to community care has now gone too far.

Prof. Tyler says that throughout the history of psychiatry there has been conflict between the administrative and clinical aspects of psychiatry. The former, the ‘out of sight, out of mind’ policy of the Victorian era has now been replaced by an ‘out of hospital, do not mind’ one. He concludes that we need to get ‘good in-patient care back on the agenda and fight the continuing urge towards bedlessness’.

Better model for predicting NHS commissioning
A new model for predicting GPs’ future spending could mean a major change in the funding formula for commissioners. Pulse reports that a DH-commissioned study used data from 2005-6 and 2006-7 to predict costs in 2007-8, then later compared them to actual spending.

The researchers developed a model which performed well by international standards, predicting 77% of hospital costs per practice, with subsequent analysis increasing this figure to 85%. The NHS Commissioning Board could use the new model to set CCG budgets. But they warned that the best formulae tested could only predict about 12% of next year’s hospital costs per individual, suggesting the model should be used only to guide allocations to practices, and not for use at an individual level.

Sick leave can’t be left to doctors
GPs in England should be stripped of much of their responsibility for deciding whether people with long term illness are fit to work, according to a new review. The Independent Review of Sickness Absence says the current system pushes people away from work and provides little support for them to return.

BMJ and PublicNet cover the story which advises that a new independent service should sign off people for long term sick leave rather than their GP. The report also states that the longer people remain on sick leave the harder it is to get back into work and that work is good for health and can aid recovery. Each year 300,000 employees start claiming health-related benefits. This costs the taxpayer £13bn a year and the country as a whole is misses out on £15bn in economic output.

Trials point to DES reduction of repeat revascularisation
Trials suggest that drug-eluting stents (DES) with controlled release of anti-proliferative drugs from durable polymer surface coatings reduce the risk of repeat revascularisation compared with bare-metal stents (BMS).

Early generation, durable polymer DES, however, are associated with an increased risk of very late stent thrombosis (ST) compared with BMS. This has raised concerns about the long-term safety of DES. It has been argued that the persistence of durable polymer material on the stent surface after completion of drug release is a potential trigger for chronic inflammatory responses that lead to very late ST.

News in Brief
Medical imaging boom: The global market for 3D medical imaging is forecast to reach $5.9 billion by 2017, with Europe as the largest regional market, according to a Global Industry Analysts.

Can CCGs cope with complex cases?: Practical Commissioning carries a report warning of doubts over the ability of CCGs to commission complex and specialist care. Among those raising concerns are Prof. Chris Ham of the King’s Fund.

Quicker EPR brings delays: Oxford University Hospitals Trust has warned outpatients of administrative delays while staff get used to a new £15.7m Cerner EPR. The trust says the system will be more streamlined than the old one and will make the right information more accessible for the staff.

Emergency readmissions rise: Around 55% of commissioners have seen an increase in emergency readmission rates despite the imposition of new penalties that are set to cost providers more than £400m this year, claims HSJ.

Killing the ghosts: The DH is planning a national list-cleansing campaign to remove up to 2.5 million ‘ghost patients’ from GP lists across England, says Pulse, in a move that could cost an average practice as much as £30,000.

Cancer Study Gears Up: Some 240 people have joined Cancer Research UK’s Stratified Medicine Programme. This will evaluate the new approach to therapy in 9,000 patients. Phase one is a small pilot study to demonstrate how the NHS can provide molecular diagnosis for all cancer types routinely.

Opinion
An opinion article by Michael Thick, Vice President, Clinical Strategy and Governance at McKesson, in Primary Care Today says far-reaching changes are essential to achieve the government’s ambition for patients of ‘no decisions about me without me’.
‘For too long, informatics has had the clinician as its primary customer, but as patients begin to take more responsibility for their health and shared decision-making becomes the norm, it is clearly time for a rethink. In the NHS of the future, the end-user is as much the patient as it is the doctor. And in order to correct the imbalance, the tools being used must change to reflect this. Making the patient’s needs central to the process – and building that patient’s needs into every stage of the development of a service – its design, implementation and evaluation, has to be the way forward.’

From the blogosphere
Victims of media misrepresentation or simply smug? The Patient from Hell explains what happened when he challenged doctors’ leaders over the need to improve aspects of the NHS.
‘I get very uptight when NHS panjandrums try to claim that everything in the NHS garden is lovely. My fury came to a head earlier in the month at the Westminster Health Forum’s seminar on the future of the NHS. On the platform were Dr Hamish Meldrum, chairman of the British Medical Association council, Dr Claire Gerada, chair of the Royal College of GPs, and Howard Catton, head of policy at the Royal College of Nursing. They were saying things like “the NHS is the envy of the world”. OK, healthcare in the UK has come out quite high in recent international league tables, but “the envy of the world”, no way! And they never mentioned any of the scandals, or what they were doing to fix them.’

Highland Marketing blog
This week Jeremy Nettle asks the question is the UK leading global innovation?

Susan Venables, talks to Media Bulletin about Highland Marketing’s approach to PR http://www.featuresexec.com/bulletin/news.php?newsid=XmLEL

This week I had the pleasure to attend the eHealth 2011 conference in Malaga. Driving in the fog to Gatwick, I was feeling slightly boyish that soon I would be walking along the sunny pavements of Malaga and getting my dose of vitamin D. How wrong could I have been. I arrived in one of the worst rain storms that Andalucía had seen in some months. Perhaps Spain isn’t so different from the UK after all.

However, what I heard this week simply endorsed my understanding that healthcare globally is going through major reforms to improve performance, such as the measurement of clinical outcomes and encouraging patients to take more responsibility in decisions around their own care. A bit like finding the Holy Grail I have often thought. But what I discovered is that the route many countries are taking is not to dissimilar to our approach in the UK and more specifically in England with the Information Revolution.

One of the key messages at almost any conference in any country I attend is that there is unanimous agreement that by involving the population in their own healthcare, significant reductions in costs can be made. In fact some researchers estimate that costs could be reduced by almost 20%. If these estimations are true, ensuring people take ownership of their health would certainly make the £20 billion savings over next four years – often know as QIPP or more frequently ‘the Nicholson Challenge’ – more realistic and achievable whilst simultaneously improving patient care.

So, what is the driver to make this happen and what will push forward the QIPP agenda? History tells us that in austere times innovation will be key.

Research recently carried out by Professor Sir Brian Jarman, into hospital mortality rates in England, found that the number of deaths in hospitals are more closely related to the number of GPs in the area it serves, than to the number of doctors in the hospital itself. Surely this is proof that it is time to grasp innovative thinking and extend support for the case to develop the virtual hospital – sometimes known as a hospital without walls.

In addition, if we want to see better health outcomes, improved equity, patient involvement, access and lower costs, then we need to focus more resources on primary and social care as well as general practice. Health systems dominated by specialist secondary care ‘have higher total costs and reduced access’, a recent World Health Organisation report says. There is clearly room for innovation here.

Given that there is no extra cash in the system, I eagerly wait to see how innovative we can become in order to improve the quality and access to healthcare in this country. After recently witnessing and enthusiastically applauding the winners at the recent HSJ Awards and eHealth Insider Awards, it is clear that there are examples of great innovation scattered across the country. My plea is that we can develop a way in which this good practice is disseminated across a federated NHS.

Jeremy Nettle, Industry Advisor

In this interview Susan Venables, Co-founder and Client Services Director of Highland Marketing explains how the agency has developed an insider’s perspective by building an experienced team to service its clients within the healthcare and technology sectors. She also explores how to ensure clients get the right coverage in the right press, demonstrating this through a current campaign being run for FairWarning, and gives her view on the growing importance of social media.

http://www.featuresexec.com/bulletin/news.php?newsid=XmLEL

Payment by Results to be abandoned
NHS leaders expect the 2012-13 operating framework to endorse ‘bundled’ and block payments in a bid to control costs. HSJ claims that the document, due out this month, will allow trusts to abandon Payment by Results.

Some PCTs and acute trusts have already moved away from the Payment by Results tariff for some services. A formal endorsement by the DH would be a response to growing concerns that, under the current system, increasing numbers of commissioners could run out of money as demand and activity continue to grow.

It is argued that the change would also encourage providers to increase productivity rather than trying to put the brakes on demand.

1.2 million hospital follow-ups axed
GPs faced a huge extra burden of work as hospitals cut back the number of follow-up appointments they carried out by 1.2 million last financial year. An investigation in Pulse reveals the ratio of follow-up appointments to surgical procedures fell by 4.3% in the last year, and 5.9% over the last two years, as managers impose efficiencies.

The overall drop included steep falls at Pennine Acute Hospitals NHS Trust, where the ratio fell from 2.87 in 2008/9 to 1.78 in 2010/11, and at Ealing Hospital NHS Trust it fell from 2.51 to 1.84. In a separate development Pulse claims that GPs in the north east fear being ‘overwhelmed’ by extra work after North Tees and Hartlepool NHS Trust announced a £40 million cost cutting drive to stay financially viable.

Stem cell research for repairing hearts
Stem cells from patients’ own hearts have, for the first time, been used to repair damaged heart tissue. More clinical trials, starting in 2012, will further-investigate the potential of the technique. A study in the Lancet reported that small-scale trials had been encouraging, improving the ability of damaged hearts to pump blood.

The procedure, pioneered by the University of Louisville, involved taking stem cells from patients as they were being operated on. These were cultured for 100 days until there were around two million, then injected back into the patient.

The BBC reports that large-scale trials are underway in Britain using stem cells from bone marrow to repair hearts. Clinicians from Barts and the London School of Medicine and Dentistry are investigating the effect of giving patients stem cells from their own bone marrow within six hours of a heart attack.

Waiting list crackdown brings return to targets
Ministers are ordering a crackdown on ‘hidden’ waiting lists. They are demanding that NHS managers reduce the number of long waiters by about 50,000 by April. According to the BBC hospitals there are nearly 250,000 who have waited for longer than the current 18 week limit. More than 100,000 have waited for more than six months and 20,000 at least a year.

The waiting times initiative has raised eyebrows in the NHS as the government pledged to move away from Labour’s target-based approach, and announced that the 18-week limit was being relaxed. Health service insiders regard the new move as the reintroduction of targets but in a new guise.

Nine ways that IT transforms healthcare
When many people think of healthcare IT, what springs to mind is medical records. Healthcare IT News covers a US report by Booz Allen Hamilton which highlights nine far more diverse ways in which information technology is transforming care.

The report notes that IT has tremendous potential to make healthcare patient-centred. Among the nine areas of transformation listed are the reduction in medical errors and the increased speed of emergency care. The authors are especially impressed by the way mobile technology can provide clinicians with real-time patient information.

Health records made Simpl
England’s first integrated health and social care patient record system has been procured in a £3.8m deal between Torbay Care Trust and IT firm Simpl. HSJ says it will enable staff to access a single record for each patient receiving community health and social care services.

The record will also be accessible remotely via smartphones or tablet computers, allowing the trust’s staff to capture more information closer to patients at home, and giving greater access to information when they are out of the office.

News in Brief
Longer GP training: The NHS Future Forum wants GP training extended to ensure better care for older patients with complex needs. Dr Clare Gerada, chairman of the Royal College of GPs welcomed the proposal. GP magazine says the change will be recommended in a report to the DH on education and training in December.
Better diabetes care needed: The NHS has been criticised over its ‘reluctance’ to improve outcomes. The BMJ reports that Rowan Hillson, England’s national clinical director for diabetes, said that 10% of the population will have diabetes by 2020 but that current care is variable and inconsistent.
Games to cut violence: Free wi-fi in A&Es could cut attacks on staff. The Telegraph says the winners of a bid to redesign three A&Es believe access to online games and entertainment would keep potentially disruptive patients occupied. There are 36 assaults a day on general hospital staff, costing the NHS nearly £70 million.
Risk information will be made public: BMJ reports that health secretary Andrew Lansley has been ordered by the information commissioner to release a document outlining the risks that his controversial reforms could pose to the NHS.
CCG funding uses obsolete data: The Commons Public Accounts Committee says some of the data used to decide on funding for NHS commissioners is a decade old and has called for urgent action to bring it up to date.
NHS consultancy cut by £200m: DH figures show a 39% decrease in NHS spending on consultancy services from £503.2m in 2009-10 to £304.9m in 2010-11.

Better care through information
Effective integration: The King’s Fund is recommending that care providers adopt a case management approach to deliver good integrated care. Its report Case Management: What it is and how it can best be implemented examines how the strategy can benefit those with long-term conditions. A key finding is that information must be available for all care team members, across organisational boundaries.

The fund says case management is a well-established way of integrating services around the complex needs of people with long-term conditions. It is a targeted, community-based and pro-active approach that identifies those at high risk of hospital admission, produces a personal care plan, and ensures co-ordination of care.

Carers on the web: The internet must be developed as a tool for helping carers, according to two leading charities. The Princess Royal Trust for Carers and Crossroads Care looked at how carers use the internet and the barriers that limit them. They call on health and social care providers to become more web-friendly.

The charities’ report, How Can the Web Support Carers, explores the advantages of online carer support, as well as the pros and cons of current web services. Its contents may be of value to companies involved in telehealth and other innovations in home-based care. Among the findings are that 14% of net-using carers have online networks of support. Some 30% have taken part in elearning.

Online resource promotes remote care: The Health Foundation has launched an online self-management resource centre with information and practical tools that can be adapted locally to enable services, and health professionals, to develop their own patient support programmes. It builds on the foundation’s Co-creating Health programme and a wide range of national and international evidence.

Highland Marketing blog
Maps, apps and mortality rates Matthew Shelley wonders whether we will ever be well-enough organised to exploit the full benefits of mobile technology in healthcare.

What’s in a word? I was looking at the entries for the DH’s Maps and Apps project which invited people to submit ideas for improving health with mobile technology – it had a great with response with nearly 500 entries. A showcase event is soon to be held where a distinguished panel will choose their favourites.

Among the apps put forward are ones that help people find and access local NHS services, give advice on self-checking for breast cancer, support families with a member suffering from psychosis and allow patients to share information on their experiences. Impressive stuff.

I’ve also been filled with admiration for how mobiles are helping to beat malaria in the developing world. For example texts to rural Kenyan healthcare workers brought a 25% improvement in adherence to national treatment guidelines. Getting that level of improvement in anything is a big achievement, and even more so if it just takes a bit of organising and the use of something as cheap as SMS.

Oh dear! As soon as I wrote ‘a bit of organising’ my heart sank – which takes me back to my opening question. If I was asked whether mobile technology can make a real difference to UK health I’d give a confident ‘yes’. Asked if it will make a difference I’d mutter ‘perhaps’ or ‘maybe’.

There are some positive examples, like the use of texting to tell sexual health patients about test results – not just a convenience but a way to sidestep stigma. But then again, here we are, one of the richest countries on the planet, with the best technology in history and a healthcare IT industry full of talent, yet we can’t find an effective way for medical data to follow patients round the NHS. In fact it was oddly disheartening to read how Julie Moore, CEO of University Hospitals Birmingham FT, was trumpeting a 17% cut in mortality rates now that her organisation has started sharing data with primary care organisations. Good news, but the whole country should have reached this point years ago. Instead we have an information patchwork.

It’s the age old issue about how things should be organised and at what level. My worry about the Maps and Apps type of initiative is that we’ll get lots of back patting but the mechanisms will not be created to ensure that everyone who can benefit will do so. For that to happen this needs organisation and co-ordination between government, industry and the NHS. If not we end up with initiatives that either stop at particular postcode boundaries or are only adopted by certain social groups. One of the biggest potentials for mobile technology is to help hard-to-reach groups. Again, this needs high level organisation or the chances are that those who can gain most will get least.

I know, how about a National Programme for Mobile IT? OK, maybe not. But as a nation we wobble, at irregular intervals, between decentralisation and grand plans. Neither seems fully satisfactory for delivering healthcare. But surely it can be different with mobile technology which is becoming a truly ubiquitous force? Sadly I don’t know what the solution is. Suggestions gratefully received.

Matthew Shelley, Writer and Communications Consultant

Upbeat prospects for NHS IT market
Market forecasts suggest that that English hospitals are to increase their IT spending in the next three years. The EHI Intelligence 2011 NHS Market Forecast Report predicts that trusts will raise their spend by 3.7%, creating a market worth £883m by 2014-15.

The news reflects the swift opening up of the NHS IT market with the dismantling of much of the National Programme for IT (NPfIT). EHI says some trusts are pursuing strategic IT projects to achieve greater gains in delivering patient care and making the organisation run more efficiently. Others are less committed or convinced.

Three broad groups of trust are identified in the report:
• Innovators – see the real value of IT and are pursuing strategic projects in support of trust goals.
• Make do and menders – investing in essential upgrades and bolt-ons, keep existing systems going and add tactically to their IT estate.
• Laggards – deferring investments and extending maintenance and service contracts, eking out IT budgets and accepting cutbacks.

Private firm’s £1bn deal to run NHS hospital
Hinchingbrooke is to become the first NHS general hospital fully run by a private company. The 10-year deal with Circle is worth £1 billion. The BBC says Circle claims that services will be maintained at the struggling Cambridgeshire hospital.

The deal, which starts in February, will see £40 million of debts remain with the NHS, though Circle – which provides the NHS with services such as hip replacement centres – will take on future financial risks. Hinchingbrooke is one of about 20 hospitals in England facing an uncertain future because of deep financial problems.

If Circle maintains the range and standards of care at Hinchingbrooke, but cuts costs, it could put pressure on NHS managers at other hospitals to do the same. Unions, however, predict job cuts and describe the takeover by a new team with no prior experience as ‘an accident waiting to happen’.

Lansley backs chief clinical information officer campaign
Health secretary Andrew Lansley has endorsed the E-Health Insider campaign to encourage trusts to appoint chief clinical information officers. CCIOs would provide a strong clinical lead on IT projects. A series of Highland Marketing clients are already supporting the campaign, which is seen as an excellent way to improve patient outcomes through the best use of clinical IT.

Mr Lansley declared his backing for CCIOs during the annual EHI Live event. He said: ‘Clinical leadership is critical to making health service information available as a tool for improving outcomes.’ The backing came as two new CCIO appointments were confirmed in London and Manchester.

Sharper focus needed for cancer research
Future research into oesophageal cancer should focus on individual therapy strategies such as genetic receptor mutations, according to a new study. This was the conclusion of a review of clinical trials using second-line chemotherapy and/or targeted therapies which has been published in the Journal of Clinical Oncology. The work, which covers 25 published trials from 1996-2011, says treatment response rates tended to be low and overall survival disappointing – at 4-11.4 months.

US medical record security worries
Worrying levels of medical identity theft, plus widespread failure to carry out security audits, have been revealed by a new survey in the USA. The fourth annual HIMSS security survey also shows that a quarter of survey respondent fail to carry out an annual risk assessment. Many healthcare organisations are looking at investing in new security systems to prevent loss or ensure that data is encrypted. Spending on information security, however, was low at around 3% of overall IT budgets.

News in Brief
NHS is best: The Commonwealth Fund ranks the NHS among the world’s best for chronic and serious illness. The Telegraph says a new survey finds that Britons have about the fastest GP access, best co-ordinated care, and fewest medical errors. This is despite health spending being the third lowest of the 11 high income countries surveyed, at £2,170 per head compared with £4,950 in the US.

Painful price of painkillers: The NHS in England spent £440m last year on painkillers. Some doctors spent thousands prescribing over-the-counter painkillers like Anadin according to the BBC. On average, trusts spent £8.80 per head of population on analgesics, but in some northern towns it was as high as £15.

Bed blockers up 11%: DH figures show an 11% rise in hospital days lost to bed blocking, with numbers hitting 128,517 for September and October. The Telegraph claims this means a daily bill for the NHS of £537,000 or £255 per patient.

Online ache-buster: Sheffield GPs are referring musculoskeletal patients to a new website with information to manage their condition. HSJ reports that the Sheffield Aches and Pains online tool, and associated sites, had 5,000 hits in the first month.

Data sharing saves millions: The sharing of electronic patient information across major emergency departments in Memphis, USA, is saving $2 million a year according to Healthcare IT News. Clinicians only use electronic system in around 7% of cases, suggesting far more could be achieved if use increased.

Integrate to save: The NHS Confederation and Faculty for Public Health have issued a report calling for a whole person and community-wide integrated approach between the NHS and social services. This, they claim, is the key to better health and higher savings.

In praise of the programme: DH director general of IT, Katie Davis, has called for a fair appraisal of the progress made in the last decade thanks to the National Programme for IT.

Health blogs
The Patient from Hell blog in the Guardian Professional Network fears that the Government’s Information Revolution may turn into a damp squib – GP commissioners just have too much else to worry about.
‘I can’t quite see GPs being willing or able to drive large information projects. They are too busy curing patients for a start. And few of them have the imagination to dream up and see through innovative uses of information. Nor will they have the clout to build the cooperative networks among themselves, local hospitals and social care organisations that will lead to sunny integrated uplands.’

As the results of ambitious £30-million telehealth and telecare field trials are being published, Nick Goodwin of the King’s Fund looks at what has been learned about using new technologies to support the remote management of long-term conditions.
‘A cultural shift is required away from ‘evidence-based practice’ towards accepting the value of ‘practice-based evidence’, enabling organisations to implement technologies on a larger scale. Producing evidence on the clinical benefits and cost-effectiveness of telehealth is never going to be enough to formulate a strong business case for change. Rather, what is needed is a clearer understanding of the operational processes that are required at an organisational, clinical and service level that will ensure commissioners and providers make the right decisions.’

Europe-wide SME contest
The search is about to begin for Europe’s best SME e-health solution. TICBioMed, supported by the EC’s ICT for Health Unit, is setting up a competition which will select the best entries from participating countries before choosing an overall champion. Winners will benefit from raised visibility plus valuable marketing opportunities. Email jorge.gonzalez@ticbiomed.net for information.

Highland Marketing blog
Read Susan Venables’ reflections on this week’s EHI Live event which saw the healthcare IT sector gather for two days in sunny Brum.

It was with some trepidation that I arrived at Birmingham’s NEC on
a damp Monday morning for the start of EHI Live 2011. I’ve been attending
healthcare IT events and conferences for 15 years now, and recently they have
seemed to be in serious decline.

Once you could barely move along the aisles because they were
packed with senior NHS delegates who had a clear vision of what healthcare IT
could achieve for patients, and the budgets to make it happen. More recently
I’ve attended events where the loudest noises were the faint squeak of vendors
crushing stress balls, and the murmuring as they visited one anothers’ stands
to compare woes. Camaraderie in gloom!

Highland Marketing used to advise clients on choosing which events
to attend. These days it’s about whether to turn up at all. Having looked at
the advance material for EHI Live 2011, I gave a guarded recommendation that it
was worth a go. Being an exhibitor involves a substantial investment, so my
fingers were firmly crossed when I walked through the doors.

Relief. It was great. Lots of high-ranking NHS folk and a genuine
buzz of enthusiasm in the air. The organisers reckon that they had 1,535
delegates and visitors (up 43% on last year) mixing with 718 exhibitors at 122
stands. At the same time EHI Intelligence has published a market forecast which suggests that English NHS hospital and mental health trusts will increase their IT spending by 3.7% over the next three years – creating a market worth £883 million.

Perhaps the NEC event was an early tangible sign of an upturn.
Certainly the feedback we had from vendors was that it yielded some genuine
business opportunities. My own sense is that there is a feeling of real
expectation among vendors and potential customers alike – but that there are
still uncertainties to be negotiated. Will the Information Revolution ever
materialise? What will happen to the remnants of the National Programme? What
form will NHS commissioning end up taking? How much real freedom will trusts
have to decide their own IT packages? What national guidelines and standards
will they have to meet? Once we have clarity trusts can press the ‘go’ button.

The danger remains that the success of EHI Live 2011 may not be
replicated at other events. Indeed, organisers should be coming up with ways to
refresh their formats and offer something new. Too many events are basically
exhibition + conference. Nonetheless, there’s clearly life in the old dog yet.
So even if long winter months lie ahead for most of us, let’s hope that the
healthcare IT market has finally begun to thaw.

Susan Venables, Client Services Director