Maudsley launches PHR while QEHB plans summer deployment

South London and Maudsley NHS Foundation Trust has launched a personal online health record for its patients, using Microsoft’s HealthVault platform.

According to EHI, the records have already gone live across five clinical teams and two GP practices in the hope it will improve patients’ engagement in their care and the use of outcome measurements across the trust.

Mike Denis, director of information strategy at the trust, said: “This is not just giving view access – that’s not empowering enough – we want to take this to the next level. We’re hoping that patients will be able to become co-producers/designers of their care.”

Meanwhile University Hospitals Birmingham NHS Foundation Trust has told EHI that it will roll-out of its in-house developed myhealth@QEHB patient portal.

From July, patients receiving treatment in specialties such as diabetes, long term liver conditions and prostate cancer will have access to the web-based system.

The portal will enable users to log-in from any location and view information such as their medication, test results, discharge letters, and details provided in clinical appointments. The portal also allows patients to interact with other members of the system, in what Birmingham describes as a prototype “social network for the NHS”.

One-year extension for Accenture PACS

The Department of Health has signed a one-year extension of the picture archiving and communications systems (PACS) contract with Accenture. Approximately 31 trusts in the North, Midlands and East have decided to remain with Accenture until at least June 2014.

ComputerWorld reports that under the contract extension Accenture will also continue to manage the central data store, which provides NHS trusts in the NME region with a centrally-hosted and long-term image archive, until June 2016. The company has provided a 24/7 managed PACS service for the NHS since 2005 under the National Programme for IT.

Patients treated in corridors where units are too full

A new poll by the Royal College of Nurses has found that one in five nurses and health care assistants said patients were receiving care in corridors or other unsuitable areas every day due to units being too full.

The Telegraph says that the figure rose in A&E departments, where more than half of staff said it occurred daily, and one in five said it happened every hour.

Health service figures show the number of people attending A&E departments has risen by 60 percent in the past decade. Over the same period, the total number of hospital beds has fallen by 22 percent. Hospital managers say the reductions in bed numbers reflects increasing efficiency, and improvements in medical treatment so patients can be discharged more quickly, but the RCN says changes have gone too far.

Lessons learnt from Denmark and Canada

Often Denmark is cited as a good example of how healthcare can be delivered using innovative methods and this article provides further evidence of that. It looks at what can be learnt from Sygehus Lillebaelt, rated the best hospital in Denmark for the past five years. It has taken an innovative approach to IT, placed more importance on porters, ensuring a smooth experience for patients moving around the hospital and encouraged creativity among staff by testing ideas in small pilots.

Kenneth Seerup Joergensen, the hospital’s chief information officer is quoted as saying: “We like fiery souls who have good ideas and space to be able to think creative thoughts. When we find good new ideas, we try them out in a corner of the hospital, so we don’t risk the whole business.”

Looking across the ocean a question is also asked ‘what can the NHS learn from healthcare in Canada?’, as they have used innovation to support primary care integration across areas including Quebec, Ontario and Alberta.

Dr Anne Snowdon, chair of the International Centre for Health Innovation believes that the question for healthcare leaders is: “How do we learn from the success and failures of innovative health initiatives across jurisdictions to adequately address challenges within our own health systems?”

News in brief

• DH publishes corporate plan 2012-13: The DH has published its corporate plan, which sets out its priorities for the year ahead. The plan said a key priority will be the “successful change”, in delivering the transition to the NHS new system. It added that another priority was working with partners – building on what the DH does now and recognising that in the new system the department will be working differently. Finally, the DH will focus on transforming itself. The plan also elaborated on how the DH will help Andrew Lansley deliver his five strategic objectives.
• Leading teaching hospital moves to standardised directory: Leeds teaching hospitals, one of UK’s largest NHS trusts, has shifted to Microsoft Active Directory as part of its £37m informatics strategy. Moving from a Novell platform, Eileen Jessop, the trust’s deputy director of informatics, told Guardian Government Computing: “We want to standardise with other NHS organisations and pull Leeds out the dark ages.”
• Royal Berks sticks to May go-live: EHI reports that Royal Berkshire NHS Foundation Trust is planning to go live with Cerner Millennium this month. The trust has confirmed the go-live despite the publication of board minutes that reveal concern about its financial position and the management of such a major project.
• Information Commissioner concern at risk register veto: Following the over-ruling last week by ministers to veto publication of the NHS transition risk register, National Health Executive has reported on the concern expressed by Christopher Graham, The Information Commissioner. He has said that the decision was “unjustified and against policy”. The veto – used for only the fourth time since the FoI laws came into force – “was used in the public interest”, according to Health Secretary Andrew Lansley.
• Digital service launced for new parents: The DH has announced the NHS Information Service for Parents. Launched by the Prime Minister, this will give new parents information and advice covering a wide range of issues related to good parenting. By signing up to the service, parents-to-be and new parents will receive regular emails and text messages containing relevant and timely NHS approved advice as their pregnancy develops and as their child grows.
• Numbers slashed around 18 week waiting times: According to figures published today by the Department of Health, almost 50,000 fewer patients are waiting longer than 18 weeks to start treatment since May 2010. The latest referral to treatment waiting times statistics also show that 59 hospitals now have no patients waiting longer than a year and 106 hospitals have less than 10 patients waiting longer than a year.

Opinion

In the last of three lectures supporting the King’s Fund Review of Leadership, Richard Bohmer, professor of management practice at Harvard Business School and international visiting fellow at the Fund gives his perspective on clinical leadership for service improvement. Watch the video to catch up with why he thinks it is important for clinicians to be involved in leadership roles and how clinicians should lead.

Awards

It’s that time of year again to submit an entry to the EHI 2012 awards. This year there are twelve categories and the closing date for entries is Friday 1st June 2012. Nominations have also opened for the Healthcare IT Champion of the Year with 20th July as the deadline. So time to think who should proceed last year’s winner, James Norman, IT director of Royal Liverpool and Broadgreen University Hospitals NHS Trust. All the winners will be unveiled at this year’s awards dinner, which will be at the Grand Connaught Rooms in Covent Garden, London, on 4th October.

Highland Marketing blog

This week Laura Steward appeals for clarity around the use of acronyms in the world of healthcare IT.

…But when it comes to healthcare IT can the same be true and are the terms really interchangeable?  I am referring in particular to the use of acronyms such as EHR, EPR, PAS and HIS and how each one is used. For example, can we clearly differentiate which supplier in this arena sells a full-blown HIS, versus an EPR, versus a PAS with clinical/department modules as add-ons? …Or if in actual fact, they  all have the same thing and it’s just a case of different suppliers expressing them in different ways?  Perhaps it’s the American influence creeping in again, brought about by those companies who in the USA do not have PAS’, referring to them instead as an EHR?

Argh, I can feel myself getting confused even as I write!

I discussed this with a couple of my colleagues as at first I thought it was me just thinking about things in the wrong way but they agreed that there is certainly confusion as to which is the right term to describe certain solutions…and they’ve heard the NHS staff say it too!  And whilst ‘Supplier A’ may be clear in their own mind that what they have is an EPR, what if, it’s actually a PAS they have with a couple of clinical systems?  EPR rolls off the tongue better and sounds more modern, granted, but then when Supplier B says they sell a HIS, are they in fact not saying they deliver the same thing?  I guess it all comes out in the wash when suppliers respond to a tender…

[Now, stay with me…]

Surely, the NHS have enough confusion to deal with, plus they have their own dictionary to remain fluent in, both medical and colloquial. Nevertheless,  diagnosis and treatment would be disastrous, quite simply, if it wasn’t just one acronym clearly meaning one thing! Rx for BRDIS – ADDG=COPD (apologies to anyone medical reading this, if I’ve got that slightly wrong !).  And imagine how misleading it would be for a patient if they were told they had AIDS, when in actual fact it was HIV.  And so for prospective customers’ sake and for your own, I would appeal to all suppliers of EPR, EHR, PAS, HIS, clinical, departmental systems, please be clear and defined in your use (not abuse) of these terms!  Perhaps discuss this with a reputable, healthcare only marketing agency who could help make sure your messages are clear, simple and effective….hmm, now there’s a thought!

While I’m on the topic of confusing terms does everyone truly understand the difference between integration and interoperability and/or interfacing?

No, wait…I’ll save that one for another time!

OMG!  I need a G&T!

Laura Steward, Account Director

Government accused of risk register cover-up

The government has been accused of an ‘epic cover-up’ after defying a second court order to reveal the contents of the risk register, which analyses the dangers involved in the Health and Social Care Act reforms.

Pharma Times describes the decision by Health Secretary Andrew Lansley to defy the provisions of the Freedom of Information Act as ‘unusual’. It quotes shadow health secretary Andy Burnham as saying it was a ‘disgraceful decision’ and ‘a cover-up of epic proportions’.

But in a statement this week, the DH insisted that ministers and officials should be able to carry out sensitive policy formulation without the fear that it would later be published. It added that regular disclosure would skew the form and content of deliberations by preventing frank and open discussion.

A campaign for publication has been going on for 18 months, based on the argument that the public have the right to know what risks the reforms pose to the health services they pay for and rely on. Courts have twice found in favour of disclosure. A draft version of the document has already been leaked and widely publicised.

The Information Commissioner’s Office will now review Mr Lansley’s decision. The BBC reports a spokesman as saying: ‘We will need to study the secretary of state’s statement of reasons for imposing the ministerial veto in this case. These must, under the criteria established by the government, be ‘exceptional’. We will present the commissioner’s formal report on the matter to Parliament next week.’

Savings from IT – lessons from NZ and GPs

New Zealand reckons the NHS should follow its example in the use of healthcare IT – while a UK GP claims he knows how to save £20 a patient.

HSJ (subscription required) carries an interview with Chai Chuah, director of New Zealand’s national health board business unit, who discusses how IT has boosted efficiency and cut spending. Like the UK, the country faced major financial problems and demanded that its 20 district health boards took drastic action to cut their deficits. The country has a five-year national health IT plan with annual priorities.

Mr Chuah said key projects included a move to greater sharing of information between GPs and hospitals. These included ‘shared care plans’ in Auckland, the country’s largest city, with an IT system that allows GPs, patients, specialists and other healthcare professionals to access, update and share information.

New Zealand has also pioneered the involvement of patients at an early stage of IT programmes, helping to avoid concerns about privacy.

Meanwhile Pulse reveals that giving patients online access to their care records can be a serious money-saver. Dr Amir Hannan explains how his practice has saved £20 per patient by providing access to records and self-care advice on its website.

NHS Somerset is planning its own remote care project with a telehealth scheme to monitor the symptoms of 4,000 people with long-term conditions over the next three years, using technology from Safe Patient Systems.

EHI says it will be one of the largest roll-outs of telehealth monitoring outside the national whole system demonstrator project, and will focus on people with chronic obstructive pulmonary disease, congestive heart disease and diabetes.

The Safe Mobile Care System was developed by consultant surgeon David Morgan, and provides patients with a touch-screen mobile phone-style device, which is programmed with personalised care plans.

Health service failing on multimorbidity

The NHS is coping poorly with the rising number of under-65’s with chronic and complex conditions. New research, analysing 1.75m people in Scotland, showed that a quarter have two or more conditions. The BBC and GP online report that their care was poorly organised and co-ordinated.

The study, published in the Lancet, recommends radical change and a more personalised approach to care. Among its findings was that multimorbidity occurs 10-15 years earlier in people living in deprived areas. The result is that the poorest sections of society are more likely to have a combination of illnesses (physical and mental) ranging from COPD, diabetes and cancer to stroke and depression.

One problem is that current approaches tend to focus on a single issue, rather than the multimorbidity itself. Care is fragmented because patients see a variety of specialists whose efforts are not co-ordinated.

Graham Watt, professor of general practice at Glasgow University, said: ‘Any country with an ageing population is heading in this direction. The status quo isn’t an option because it leads in the wrong direction.’

In an opinion piece for Guardian Healthcare, Neelie Kroes, vice-president of the European Commission argues that the way ahead for all patients is through the greater use of telemonitoring, electronic prescriptions, and applications that help prevent people from needing acute care and allow them to live in their homes.

‘I would love to make healthcare less intrusive and more personalised, as well as more affordable. The way to do that is to design care around patients, and the means of achieving that is better integration of digital technology into the caring processes. That is worth fighting for, even if there are stumbles along the way.’

Child care record plans plus new moves on social care

The government has no plans for a single IT system to deliver its newly published proposals for child health information systems. The document instead concentrates on setting standards and describing requirements. This leaves the market open to different suppliers to compete for local contracts.

EHI reports that England currently has around 99 child health information systems with a range of suppliers and system types involving at least 17 external suppliers of which the top three suppliers have installed 55% of the systems in place.

The report, from the DH’s Child Health Information Systems Transition Steering Group, sets out functionality requirements for all elements of child health systems. It says the requirements are based on a consensus across professional bodies as well as national standards, statutory requirements and information sharing rules.

It envisages a shared record system able to exchange data with other systems, allowing access by multiple professionals. It would produce a summary report of individual children, meaning information would only have to be recorded once and allow parents, carers and young people to access their health records online.

Further change is on the way in social care, with the Queen’s Speech including a draft bill on overhauling care and support for elderly and disabled people in England.

The BBC says that the news received a lukewarm welcome from charities concerned about the unaffordability of proper care for many people. The director general of Age UK, Michelle Mitchell, said: ‘This means no legislation for at least a year to drive the reform of social care law and funding that we desperately need.’

Ministers say the bill will put people in control of their care and give them choice.

News in brief

• Citadel Events to join forces with HIMSS: British Journal of Healthcare Computing reports that Citadel Events has formalised its strategic alliance with HIMSS having worked closely together at HEALTH+IN4MATICS 2012. HIMSS has taken a financial share in the privately owned, event-organising company, strengthening the expansion plans of both organisations within the healthcare IT market.
• £30m Portuguese Record System: Brighton and Sussex hospitals are investing £30m for a full EPR from Portuguese firm Alert Life Sciences. EHI says it will cover everything from urgent care to care planning, decision support and integration.
• Welsh NHS needs radical change: The Welsh NHS Confederation has called for the centralisation of many services to avoid potential collapse. A complete change of focus is also recommended to catch illnesses earlier and avoid hospital admissions.
• 1,000 iPads for Bradford: Bradford Teaching Hospitals could give its clinicians up to 1,000 iPads for accessing electronic patient records. The Guardian says the contract with Kainos Evolve is expected to bring swifter data sharing and access.
• Trial favours cheaper eye drug: The NHS-funded IVAN clinical trials, involving 610 patients in 23 hospitals, found that savings of £84m can be made on the treatment of wet age-related macular degeneration – a leading cause of blindness. Avastin, costing £60 an injection was shown to be as effective as Lucentis, at £700.

Opinion

Dr Andrew Litt, Dell’s chief medical officer sets out his vision for the future of healthcare IT in Computing magazine. His call is to start local, and with clinical needs as the priority – adding that the technology is the ‘easy’ bit. In this way he believes that the world can save billions on health, sharing best-practice internationally.

‘We must connect disparate healthcare data sources to simplify information exchange and enable the kind of analytics that helps hospitals identify and replicate best care practices…

‘[We must] tap the digital data generated by electronic medical records, imaging and genomic research for intelligence that will lead to major innovations.

‘High-performance computing is making genomic information more accessible to physicians and researchers by collapsing the cost of gene sequencing — from millions of dollars per genome a decade ago to a few thousand dollars today. Once armed with integrated electronic medical record systems that include genomic information, physicians can develop more-targeted therapies and lifetime wellness plans for patients with genetic predispositions to specific diseases.

‘Now is the time to embrace the strategies and computing models that will help us turn an information deficit into an information dividend. Once individual countries have closed the gap, we can band together to bring every society to the health standard of the highest.’

Highland Marketing blog

Mark Venables compares the health IT events of the last two weeks and offers his predictions on what might happen next year.

This week saw the second of May’s major healthcare IT events take place in the UK, Health+In4matics.

The timing of the show meant that it went virtually head to head with HC2012, which was held last week in London and has been in existence for more than 28 years.

The first show (HC2012), which is backed by both the Guardian and British Computer Society (BCS), appeared to have a more unique conference programme, with several of the health IT big shots taking up speaking slots as well as keynotes including Earl Howe, Jim Easton, Mike Farrar and Katie Davis. This attracted hundreds of the 1,500 attendees to packed conference sessions but perhaps away from the exhibition floor, which was relatively small in size but managed to draw in virtually all of the big players including Harris, Cerner, CSC, Allscripts, BT and Epic.

New kid on the block In4matics, which was supported by HIMSS drew in speakers including Dame Fiona Caldicott and Stephen Dorrell MP, as well as those well known professionals that regularly run the health IT events circuit. However, despite nearly double the floor space being taken up by exhibitors, the show’s focus appeared to be much more around SME’s and it saw fewer of the giants whose stands towered the halls of HC2012. Final attendee numbers are still to be announced but were clearly considerably lower.

While chitchat at these events is usually centred around what the activity is like in the marketplace, many conversations were dominated by which event had worked better, which had more delegates and ultimately, which one would survive, with many suppliers hoping common sense would prevail to provide one springtime super conference.

An answer already appears to be emerging… No sooner was In4matics over than it had placed a large advert on its website announcing the show dates for next year. On top of that, HIMSS and In4matics formalised their strategic alliance announcing that HIMSS has taken a financial interest in Citadel (the organisers of the show) to “provide a strong, integrated platform for health information technology events in the United Kingdom.”

However, with In4matics virtually set in stone for next year, it has also been interesting to see the announcement by HIMSS last week that a memorandum of understanding has been signed that will see HIMSS collaborate with the BCS to introduce HIMSS Analytics Electronic Medical Records Adoption Model in the UK.

So with HIMSS appearing to have its finger in a number of pies, we wait to see whether all those pies can come together to provide the health IT industry with one huge feast of an exhibition in 2013. My prediction…there will only be two key health IT events over 2013 and both will be in Birmingham!

Mark Venables, CEO Highland Marketing

Innovations will help hospitals get the best from the latest computer technology

Future Labs Group, an exciting innovator in the healthcare technology market, has appointed Highland Marketing to help in its drive to transform the use of mobile technology. The company is currently developing new methods and ancillary devices to increase the ways in which iPads, and other tablet or slate computers, can be used by clinicians in hospital settings – where hygiene, ruggedness and instant access to patient data are essential.

Future Labs has a portfolio of products under development, which are designed by experts with many years of health service experience, to ensure that healthcare providers can make the best possible use of the revolution in mobile technology. Highland Marketing will develop the branding and provide the marketing and PR services that are needed to make customers aware of the benefits which Future Labs can offer.

What’s especially exciting is that Future Labs products will be invaluable in clinical settings across the world. They also have many potential uses beyond the health sector. Indeed, the London-based company is busily establishing a presence in the USA and Ireland.

Mike Casey, CEO, said: “Tablet computers have the potential to bring faster, better, safer patient services in the NHS and health services round the world. My aim is to provide the products and services that will unleash their revolutionary potential.

“Years of working in the NHS and in major technology corporations convinced me of how much could be achieved if clinicians could use tablet computers to access, record and share any information they needed at any time and in every setting. This is what exactly what Future Labs has been established to do.”

Future Labs is already known for its work in helping NHS hospitals to maximise their innovation and talent. This can involve anything from turnaround projects to stabilise a trust, to 3-5 year strategic planning.

Mike has wide experience, having been responsible for managing projects of up to £200m. He is also noted for his ability to help cut costs; his last NHS turnaround saved £14m. Mike was previously an IT manager at Hewlett-Packard Healthcare and then became IT director for HP Computer Group. He was also responsible for the entire IT spend across five NHS hospitals which was part of a £140m PFI new build. In addition to this, Mike was chairman of IT Acute Directors for the East of England, nominated ICT champion in the 2009 EHI awards and remains the only ‘Turnaround IT director’ to have won “Manager of the Year” in a NHS Hospital.

Mark Venables, Highland Marketing CEO, said: “Future Labs is clearly an up-and-coming business with the ideas, expertise, products and business skills to make a real difference in the world of healthcare. It’s great to have the opportunity to help raise awareness of everything it has to offer and to be part of what I believe, could be a big British success story.”

About Future Labs Group
• The group offers a range of solutions and services – find out more at www.futurelabsgroup.com
• Its services include turnaround consulting, site assessments, IT reviews and programme management, Apple infrastructure design and large scale NHS iPad Deployment.
• The company has a strong track record of helping the NHS achieve savings and get the best from its IT. Typically saving a NHS Trust £750K/year on its revenue spend.

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 http://www.highland-marketing.com/

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

Media Contacts
Laura Steward, Highland Marketing
Phone: +44 (0) 1877 339922
Mobile: +44 (0) 7899 061975
lauras@highland-marketing.com

Information strategy will put IT centre stage in NHS

IT will move from being the ‘back-room’ to become a critical front-room service’ when the much-delayed NHS Information Strategy is published this month. Better data sharing will also be a core concept, according to Guardian Government Computing.

The NHS Information Centre (NHS IC) will be at the forefront of new developments. CEO Tim Straughan, said: ‘People don’t just want to see raw information, they want to see information and data that’s linked together across a number of care settings that starts to link input data with output data. For example, what does somebody do to something in terms of an intervention, and what difference does it make?’

The NHS Commissioning Board will say what data should be used and set standards. NHS IC will get new powers around collecting, processing, linking and analysing data. It will be allowed to handle some patient identifiable data – one of many sticking points when the government was attempting to get the bill passed.

EHI says the strategy will acknowledge that working with data forms a ‘huge part of care’ in the NHS. It quotes Jim Easton, NHS national director for improvement and efficiency, as saying: ‘We are going to push really hard for integrated care, as that’s what patients ask for. The glue that will hold integrated care together is information, and that’s what needs to flow effectively between organisations’.

In a stark warning about the need to find more efficient ways to deliver care he added that the current NHS efficiency savings are a ‘dress rehearsal for the next 20 years’.

Technology could tackle prescribing errors

More effective use of IT could cut medical errors, with research showing that one in 20 prescriptions contain mistakes. A report from the General Medical Council declared that while 42% of the errors are minor, 54% are moderate and 4% severe.

Wider use of computer systems which flag potential mistakes, and closer working between GPs and pharmacists, were identified as potential solutions. This could make a significant difference to safety as 550 identified errors were life threatening.

According to BMJ the most serious errors included failure to adequately monitor warfarin, and the prescribing of drugs to patients with a documented allergy. EHI quoted GMC chair, Professor Sir Peter Rubin, as saying: ‘Using effective computer systems to ensure potential errors are flagged and patients are monitored correctly is a very important way to minimise errors.’

Computerisation is also seen as a key means of giving patients a greater involvement with their own care, with a government announcement that data will be collected on which practices are giving people online access to their records. The information will then be published.

The data gathering exercise will be used to highlight any blocks or problems in the rolling out of the government’s plan for all records to be available online by 2015.

Winning the war on hospital infections

A hand washing campaign directed at hospital nurses has successfully pushed down rates of potentially deadly healthcare associated infections (HAIs) such as MRSA and C. diff. The Telegraph reports that an evaluation of Cleanyourhands showed it had been ‘exceptionally effective’.

Evidence shows that as soap and gel orders went up, infection rates came down with those for MRSA halving from 1.88 to 0.81 cases per 10,000 bed days. The authors claim they have provided the first solid evidence that national campaigns of this kind have a clear and beneficial impact.

Further evidence of success in the battle against HAIs comes from Bath where the Chronicle says that MRSA cases at the Royal United Hospital have dropped from 17 in 2009-10 to one in the past year.

However recent newspaper reports have caused concern that a new flesh-eating superbug that spreads through coughs and sneezes may have hit the country. The NHS Behind the Headlines team have sought to calm fears, which are described as ‘alarmist’. The claims followed research into MRSA which was actually looking at why the illness rarely affects healthy individuals.

In a bizarre twist on the superbug issue a 76-year-old Scottish great grandmother, Elizabeth Miller, has ended her 11-year battle for compensation over an MRSA infection from Glasgow Royal Infirmary. The case came to an end when it was finally revealed that the medical notes had been wrong and she never had MRSA at all.

Private firms boycott NHS 111 while staff stage work-in

Private companies are failing to bid to provide NHS 111 urgent care call services amidst concerns about its ‘rushed’ and ‘shambolic’ procurement process. At the same time, nurses and health advisers at a Devon NHS Direct centre staged a work-in protest at plans to replace the service with the new 111 helpline, claiming it will create problems with patients simply being referred to other overstretched services.

HSJ (subscription required) reports that Serco has decided not to bid for any of the NHS 111 contracts which are being awarded on a primary care trust cluster or regional basis. Capita and Care UK, which formed a 111 partnership, are now undecided about whether to bid.

One prospective bidder said the process was rushed and warned it was impossible to predict demand before the pilots had been fully evaluated.

Meanwhile demands have been made for a new approach, involving a combined NHS 111 and out-of-hours service led by local GPs in England. GP online (registration required) highlighted a GP-led organisation that integrated out-of-hours care with the roll-out of the non-emergency number as offering a potential solution. It is suggested that GP input would improve the pathways system used to triage NHS 111 calls.

The Department of Health insists that the new helpline, due to launch next April, will ensure patients ‘get to the best service … first time’.

News in brief

• ICO issues first penalty to the NHS following serious data breach: A Welsh health board has become the first NHS organisation to be served a monetary penalty from The Information Commissioner’s Office (ICO) following a serious breach of the Data Protection Act. The BBC revealed that the Aneurin Bevan Health Board (ABHB), will have to pay a £70,000 penalty.
• NHS trust overspends on Cerner patient record system: The Guardian has reported on confirmation that North Bristol NHS Trust has overspent on its IT budget by almost 100% as a consequence of the roll out of its Cerner electronic patient record system. The trust has spent £4.5m implementing the Cerner system to date, the majority of which was spent during this January and February.
• Private profit fears: Private company Circle will keep the first £2m of any annual surplus following its takeover of the debt-ridden Hinchingbrooke Hospital in Cambridgeshire. The Telegraph reports Andy Burnham, the shadow health secretary, as accusing the government of putting profit before patients.
• Patients update own hospital records: The Queen Elizabeth Hospital in Birmingham has piloted a system from its own informatics team, which lets patients update their own records. Hospital Doctor says feedback shows that patients have responded well, taking more control over their conditions.
• Aspirin cancer trials: Evidence gathered from eight clinical trials has concluded that aspirin does cut cancer deaths. The researchers say that worries remain about striking the right balance between the benefits and the risk of internal bleeding.
• NI in healthcare IT push: Northern Ireland is establishing a forum to encourage industry, academics and health professionals to collaborate on using IT to deliver patient solutions. At the launch, health minister Edwin Poots said the province’s emphasis on connected health is already making a real difference to people’s lives.
• Welsh NHS bailed out: A cash injection of £12m prevented three Welsh health boards from ending the year in financial deficit. An external financial review has now been ordered to try and ensure boards operate within their means.

Blog

Is there a post-Health and Social Care Act malaise in the NHS – what will it take to bring about genuine and radical change? Dr Jennifer Dixon, writing on the Nuffield Trust website, argues that the time has come to start handing more power to thrusting young doctors.

‘This could be a post-Bill slump in the NHS, a response to the long grind of making cuts with no end in sight, and the sheer weight of detail to be worked through with what is now the Health and Social Care Act.

‘Far more important must be how much oomph there is in the service to make radical change, scrutinise the quality of care, and sort out the mess that is social care eligibility, funding and provision.

‘People have grown grey discussing what motivates individuals in large organisations. The economists, sociologists, organisational psychologists, management theorists all have their own constructs with language to match.

‘My vote is for youth: get a bunch of young docs and managers circa age 30 in the room and the freshness/energy/bravery would be almost palpable. In the 1940s the doers in the Ministry of War were mostly under 40. Let’s bypass some of the gerontocracy, because maybe the war is just starting.’

Highland Marketing blog

This week Ravi Kumar reflects on this week’s HC2012 and asks is it losing its inspiration?

On the back of a bad week for the British economy where real growth is looking like a distant prospect with the news of double dip recession, it was nice to see lots of familiar faces (both NHS as well as suppliers) with an optimistic outlook at HC2012. I had many interesting conversations, some around disruptive innovations and some focused on business models, some about recent procurement decisions, all looking forward to the opportunity to participate in the much talked about change in the NHS.

The conference agenda was certainly interesting with a good mix of speakers and topics covering the national policy through to clinical engagement.

Jim Easton’s keynote was informative, his call for ‘Informatics to be a frontline service driving the integration’ and ‘making the information flow and empowering the people’ is welcome news for the informatics community. Further endorsement of this will be the clarity and commitment of some money for frontline IT on the back of the upcoming and eagerly anticipated Information Strategy. What is worrying is, there were repeated messages in his speech about budget squeeze; ‘the current efficiency savings being implemented across the NHS are a dress rehearsal for the next 20 years’, ‘it is going to get harder as we go on, we know we did the easier things first and if you look at the Chancellor’s budget, deep structural change is going to be with us for the next decade’.

For those that missed it, Tim Straughan, chief executive of the NHS Information Centre’s keynote made some predictions on the role of NHSIC in connecting up the primary and secondary care data and its new powers from 2013. He made an interesting reference to being allowed to handle the patient identifiable data, which was one of the key sticking points when the NHS reform bill was being passed. It will be interesting to see how the much talked about Open Data will enable the supplier community to commercialise some of this data?

I noticed there was still a lot of speculation about life after the National Programme and the role of the central agencies is still less clear in practice, particularly amongst the suppliers and NHS community.

I also found the announcement around the coming together of HIMSS Analytics Europe and BCS to bring the EMR adoption model to UK hospitals in order to allow the UK to benchmark itself against the rest of the world an interesting one, although, I would have liked to have seen more debate and engagement on the model at the conference. Perhaps this is only the beginning and more will be coming?

The question I was looking to get answered was around how SME’s are doing. Do they feel more engaged? Are they seeing more business opportunities? Is the landscape getting better for them? Though they certainly see improved engagement, informal conversations indicate that it is still the game of big boys. We all know that SME sector is important to the British economic recovery, it is equally important to keep the innovation going in the NHS and to the recovery of the NHS IT market.

Someone at the conference said, ‘a medal should go to Mike Sinclair for organising HC2012, and engaging the SME sector.’ I will vote for that and hope that enough is being done to keep the brand alive for years to come! More engagement from all stakeholders and in particular SME suppliers and NHS decision makers will be the key to its continued success. HC used to be a conference that inspired; sadly I didn’t get inspired this year!

Ravi Kumar, Industry Advisor

Epic makes break into UK

EHI has exclusively revealed that Epic has won Cambridge University Hospitals NHS Foundation Trust and Papworth Hospital NHS Foundation Trust’s electronic patient record procurement, beating Cerner and Allscripts in the final stages of the tender. Hewlett Packard has won the hardware and infrastructure part of the tender.

Tablet roll out begins for health workers at Blackpool trust

Blackpool Teaching Hospitals NHS Foundation Trust has begun the roll out of tablet devices to hundreds of clinicians. The first tablets will be given to community services staff and then be rolled out to a further 400 workers including district nurses and then its remaining 500 clinicians.

Allscripts gets first UK EPR contract

Liverpool Heart and Chest Hospital NHS Foundation Trust has become the first trust in the UK to award a five-year contract to Allscripts Healthcare for the implementation of an electronic patient record. EHI reports that the trust will be deploying a number of modules from the US company, including e-referrals, a patient portal, clinical portal and various ward management tools.

Lansley: CCG allocations should be based on age, not poverty

Health secretary Mr Lansley has suggested CCG funding should take into account the age of a population rather than indices of deprivation, arguing age is the “principal determinant of health need” in an area. From next year CCG budgets will be decided by the NHS Commissioning Board with guidance from the Advisory Committee on Resource Allocation reports HSJ (subscription required).

NHS reforms could put children’s health at risk, warn managers

The Guardian has reported on the deep unease and confusion around structural reforms in respect of child health. The health of vulnerable children could be in jeopardy if service responsibility in the future is divided up among multiple organisations that are accountable for the care and safety of children with complex needs.

News from the CCG Leaders Conference

EHI reported the news that the chair of the NHS Commissioning Board links best use of information systems to CCG success, in particular to help tackle variations in primary care. Meanwhile, GP Online reports from the conference that Lansley has promised CCG leaders autonomy but asked for accountability for results and performance within budget in return.

Cerner in Bristol over budget, while System C delivers!

Campaign4Change has controversially reported on the £2m overspend at North Bristol NHS Trust for its Cerner implementation, while a local charity linked to the trust has raised £20,000 to buy 10 cardiac monitors. EHI however, reports on the success of the neighbouring University Hospitals Bristol NHS Foundation Trust and its successful go-live of System C’s PAS and EPR!

Drug company Novartis taking PCT cluster to court

Pharmaceutical company, Novartis is taking the Southampton, Hampshire, Isle of Wight and Portsmouth (SHIP) cluster to court over its decision to encourage the use of a cheaper, unlicensed drug known as Avastin for the treatment of eye disease AMD reports PharmaTimes.

New effort by Lane Fox to close the UK’s digital divide

Public Technology reports on the further attempt to bridge the digital divide and e-skill up the UK. As a result the official ‘UK Digital Champion’ Martha Lane Fox is to spearhead Go ON UK, a cross-sector partnership set up to bring the benefits of the internet “to every individual and every organisation in every community across the UK”.

Opinion

Whether you love it or hate it, information sharing is here to stay

“As technology has increasingly facilitated the treatment of patients and the provision of social care, concern has grown on the part of those who have entrusted their personal data to professionals, and also amongst those professionals, that the confidentiality of that data is insufficiently safeguarded. Does the data remain securely with those who the subject agreed could use it for their care, and only with them? To what extent do the public and our patients understand the uses to which their data are put that are not directly related to their treatment and support?”

In this article written for Pulse, Dame Fiona Caldicott, the chair of the National Information Governance Board for Health and Social Care, looks at these issues and explains her role in the review of Information Governance that the Secretary of State for Health has asked her to conduct.

She also urges everyone to participate actively in this review, so that care is improved, as well as patients’ experience. The plan is for the report to be produced later this year and you can contact Fiona.caldicott@dh.gsi.gov.uk with suggestions.

The King’s Fund releases its vision, mission and values

As part of its strategic review in 2011 – and taking the current reforms and productivity challenges facing the NHS into account – The King’s Fund has refocused its vision, mission and values.

To find out how it plans to continue with its contribution to improving health and social care in England read The King’s Fund strategic plan for 2012-14.

Highland Marketing blog

This week Jeremy Nettle explores the controversial subject of telehealth and the Department of Health’s failure to release information on ‘how it could save the NHS £1.2bn’.

Last month’s announcement by care services minister Paul Burstow that telehealthcare could save the NHS £1.2bn gave promise to the financially challenged NHS, however it appears to have stirred up a hornets’ nest!

Following a FOI request from publication GP, the Department of Health has blocked attempts to reveal documents detailing how the NHS will save this vast sum. The DH used the same defence as it did with the risk register, claiming that revealing the evidence could ‘inhibit future policy delivery’ and ‘undermine ministers’ and officials’ space for consideration and debate.’

The secrecy around this information does little to provide the NHS with the faith that it needs to consider telehealth as a real alternative to the systems that it currently has in place. Evidence for how telehealth can benefit the NHS is limited and the DH has yet to publish full results from its ‘whole system demonstrator’ (WSD) trial of the technology.

GPs and other experts have therefore backed calls to release the data fearing that telehealth – technology that tracks patients’ health – may not cut hospital admissions and could push more work on to GPs instead.

Despite the continuous pressure for more evidence to be released, ministers signed a ‘concordat’ with industry in January to provide three million patients with telehealth by 2017. This could cost the NHS more than £1bn.

General Practitioner Committee deputy chairman Dr Richard Vautrey said: “While investing in telehealth may superficially sound like a good idea, we’ve yet to see convincing evidence. The risk is that at great expense it gathers a lot of additional data from patients, creates increased workload for GPs, but doesn’t actually reduce admissions.”

Dr Deborah Colvin, City and Hackney Local Medical Committee chairwoman, added: “We need very robust evidence. The costs will be considerable and if we are chasing our tails coping with data that doesn’t benefit the patient it would be madness.”

David Barrett, telehealth lecturer at Hull University, said the £1.2bn figure may be a realistic estimate “if you deploy the right service for the right user in the right way’. But he said this was a ‘very big if’.”

It’s clear that without concrete evidence, provided by the Department of Health, it’s difficult to say how robust this figure might be. However, it’s likely to be based on numbers of consultations or potential hospital savings and some of the small-scale pilots that have been done. Can we really scale up these figures?

Telehealth is a disruptive technology and needs to be deployed on scale with call centre integration as well as combining other community services including a locally based triage centre. It appears that once we begin to realise these transformational changes (and cease to do the things we did before) only then will we realise the savings. What will not be acceptable, and this is supported by the GPs, is if implementation increases their workload for no additional gain.

Jeremy Nettle, Industry Advisor

Back to basics at Guy’s while GPs are warned over apps

The NHS needs to get the basics right before looking to the latest IT developments to solve its problems. Guy’s and St Thomas’ NHS Foundation Trust is reported in EHI as having agreed a ‘better basics’ policy in which it will focus on improving PC performance and internet access.

The Guy’s and St Thomas’ strategy signals an investment of £213m in IT following underspending in core infrastructure which has resulted in stability issues and service outages. The range of problems are significant. The laptop estate does not support offline working or applications such as Windows 7 and Office 2010. The telephony systems are ‘becoming unstable’ and the internet service cannot support the demands for remote access to information.

Group IT director, Scott Sommerville, said: ‘The need for the investment is really not so much about how infrastructure is impacting patients or clinicians today, but how we need to support them in the new world where 90% of data is held electronically and they are using systems live.’

Meanwhile the chair of the Primary Health Info 2012 conference has warned that apps are not a free silver bullet. Ewan Davis, chair of the Primary Health Info 2012, has warned that apps are not a free solution to healthcare or IT problems.

He said: ‘The government is always looking for white knights riding in firing silver bullets, but unfortunately, white knights and silver bullets don’t exist. The apps stuff is where the “zeitgeist” is. It’s very exciting, but they are naive thinking it can be done on the cheap.’

Mr Davis also warned that there are still big issues to deal with and that GPs are concerned about the end of the National Programme for IT and in particular, the end of the GP Systems of Choice contract in 2013.

Waiting times rise and savings cause worries

A 6% increase in waiting times for routine operations has been described by the Telegraph as a blow to David Cameron’s election pledge to drive down delays. At the same time a survey by the Guardian Healthcare Network suggests that delivering savings is currently causing more headaches than implementing the Lansley reforms.

The Patients’ Association’s research into hospital waits also found that fewer people have undergone planned operations such as hernia repairs and joint replacements as the NHS attempts to cut spending by £20 billion.

The average wait for a new knee rose from 88.9 days to 99.2, while the wait for hernia surgery increased from 70.4 days to 78.3. Waits for gallstone removal rose by 7.4 days, hip replacements 6.3 days, hysterectomy surgery and cataract removals by 3 and 2.2 days on average respectively. According to data from 93 of England’s 170 acute hospital trusts, the number of operations performed fell by 18,268 between 2010 and 2011.

The figures may partly explain why 64% of respondents to the Guardian survey said efficiency savings are among the main concerns facing the NHS, with the impact of the Health and Social Care Act coming in slightly below at 62%.

Respondents displayed a strong public sector commitment with 56% rejecting further private sector involvement in the NHS and just 27% thinking it is a good idea.

An exclusive report in Pulse claims that private out-of-hours GP services are more expensive and rated worse by patients than those delivered by not-for-profit alternatives such as GP co-operatives. Companies often matched the performance of not-for-profit and NHS providers but lagged significantly on patient satisfaction scores.

Single framework for PACS/RIS procurement

NHS Supply Chain has launched a procurement to create a single national framework for picture archiving and communication systems and radiology information systems.

According to EHI, NHS Supply Chain will develop and implement the new national framework, which will provide further choice to trusts as they near the end if their local service provider contracts for PACS and related services.

The tender notice in the Official Journal of European Union says that the four-year framework agreement will be worth between £171m and £363m.

Breast cancer is ten separate diseases

Landmark research has completely redefined our understanding of breast cancer, revealing that it is not one but ten completely separate diseases. The findings, reported in BMJ, follow a study of 2,000 women carried out by Cancer Research UK and Canada’s BC Cancer Agency.

The research, which involved the largest ever study of breast cancer tissue, revealed that the 10 categories of illness also correspond to patients’ chances of survival. It is hoped that the findings will eventually lead to tailored treatment.

The BBC quotes lead researcher Prof Carlos Caldas as saying: ‘Our results will pave the way for doctors in the future to diagnose the type of breast cancer a woman has, the types of drugs that will work and those that won’t, in a much more precise way than is currently possible.’

Rapid advances are now expected in techniques to identify which form of cancer patients have, and tests are expected to be available within five years.

Dr Harpal Kumar, chief executive of Cancer Research UK, said the study would have a transformative effect on its approach to clinical trials and will lead to entirely new ways of judging the effectiveness of new drugs.

Child heart surgery could end at national centre of excellence

One of the country’s top paediatric heart surgery centres may close following an appeal court ruling. The Royal Brompton in London had won a previous court battle in which it claimed that a national consultation of the reconfiguration of services had been unfair.

HSJ (subscription required) reports that the Royal Brompton and Harefield Foundation Trust has now been left with a £1.5m legal bill. The appeal judges overturned the earlier decision, which said that the Joint Committee of Primary Care Trusts that carried out the consultation, had failed to take proper account of the centre’s excellence in research and innovation.

The JCPCT believes that two of London’s three paediatric heart surgery centres should remain open, and its preferred option is to keep the ones at Great Ormond Street and the Evelina Hospital (part of Guy’s and St Thomas). A final decision will be announced in July.

The appeal judges specifically praised the quality of the Royal Brompton Centre and the trust itself has argued that closure could have a knock-on effect as children’s heart surgery is integral to its other services.

The trust, which has a £287m turnover, is a specialist in heart and lung treatment. Fears are now growing that the entire trust could become unviable.

News in brief

• 2e2 lands major IT and comms contract: SussexPartnership NHS Foundation Trust has handed all its IT and communications technology services to 2e2 (subscription required) in a contract that will run until 2019. The company will take over from the mental health organisation’s current provider, Sussex Health Informatics Service, this year.
• Language checks for doctors: New measures are beingdiscussed to ensure that overseas doctors can not only speak English but have the right skills to work in the NHS. The DH announced the proposals as part of its launch of the consultation on the role of Responsible Officers.
• Blind mice cured: Scientists at University CollegeLondon have transplanted photoreceptor cells to restore the sight of blind mice. The BBC says the findings, published in Nature, provide hope for curing degenerative eye diseases in humans.
• Long delay on Mid Staffs inquiry: The results of theinquiry into severe failings, including avoidable deaths at Mid Staffs, will be published in October rather than May as was expected. HSJ (subscription required) says those who face criticism will receive letters of warning in July, and will then have time to respond.

Blog

The King’s Fund’s Nick Goodwin has taken on a tough blogging task, responding to the far from glowing study of 16 integrated care pilots. The issue matters a great deal to the trust as integrated care is one of its great causes – a potential solution to many of the ills and challenges facing today’s NHS. His conclusion appears to be that the fault lies with the implementation rather than the concept.

‘What these findings imply is actually a common problem in integrated care – the process of “doing” the integration can often become the priority and the emphasis on the care experience gets lost in the process. This problem needs to be red flagged. ‘A key lesson from the integrated care pilots is that the experiences of patients and service users must be captured and acted on. This would help ensure that new approaches to care – which might involve shaking up the way patients interact with care professionals – focus on developing continuity of care with service users. It is for these reasons that The King’s Fund recently called for the use of patient experience measures to drive forward the integrated care agenda.’

Highland Marketing blog

Sarah Bruce asks if the time has come for telehealth to take to the High Street. As an added extra read how to spot those good PR professionals in Susan Venables’ blog Good PR is not easy but bad PR is!

Earlier this week I attended a telehealth event that brought together a small number of suppliers to discuss the 3 Million Lives Campaign. The campaign, which aims to provide telehealth and telecare to three million people over the next five years, is still in its early stages with relatively few users and some way to go to convince trusts and commissioners that the technology is cost effective and can improve outcomes.

Attendees at the roundtable discussed a number of challenges for telehealth including standardisation, interoperability, commoditisation, cost and evidence, which was of course followed by the question of how suppliers can convince CCGs and trusts to purchase and provide telehealth solutions to their local population.

What struck me was that despite the key concept of telehealth being about empowering patients, giving them greater choice and encouraging them to take ownership of their health and conditions, there was little mention of the involvement of the end user.

Outside of my profession, most people I talk to about telehealth have no idea what it is, the best response that I get is usually “the red button elderly people have on string around their neck” or an iPhone app that does X, Y and Z.

In my mind, there is a huge amount of work to be done in terms of educating the patient about telehealth and its benefits. So far this has really been limited to a couple of national headlines that really focus on how the technology can help to redesign services and save money to the benefit of the NHS.

But surely in order for the uptake of telehealth to be increased there needs to not only be demand from commissioners in the NHS, but more so from the patient. There needs to be greater awareness in the public domain about how telehealth can impact the individual, improve their health and lifestyle and save THEM money from, for example, fewer trips to the hospital or keeping them out of residential care for longer.

Perhaps it’s not only time for telehealth to be making the headlines at a regional or national level on a more regular basis, but for a more front-facing approach where small telehealth shops take to our high streets with technology from a multitude of suppliers and experts on hand to give advice and demonstrations.

Although there could be issues around supply and demand here, which would need to be addressed, this could be a necessary step to truly educate the public and drive the demand from the people that matter most.

Sarah Bruce, Communications and Digital Media Consultant

I like to think that I am pretty broad minded with a good sense of humour and the ability to laugh at myself. But whilst watching Twenty Twelve – the mockumentary about the team organising the London Olympics – although hilariously funny I actually found myself squirming as the character Siobhan Sharpe helps to draft a press release and delivers back her team’s thoughts on the message and branding options combining the Olympics and the Queen’s Diamond Jubilee.

Siobhan is an expert (apparently) in all aspects of communications theory with the single exception of how to actually apply any of it. She exudes everything that is bad about PR and communications, but sadly is a character that has probably been created on the perception that people have of individuals that work within this profession – unintelligent, dim-witted and all in all a bit of an idiot!

Rather ironic that the industry we PR professionals seek to influence, the media, is probably responsible for helping to create the reputation that now seems to exist. If only life really was like that of Edina Monsoon and Patsy Stone of Absolutely Fabulous notoriety, but you have to laugh!

Joking aside, PR is a powerful tool for building reputations and brand, portraying organisations as trustworthy and for selling products and services. So it needs to be taken seriously. But what deeply saddens me is when I hear of those PR practices that do nothing to help remove the stigma that the PR profession is bad. What I refer to is feedback I have heard from companies that have experienced poor service and advice from PR and communications professionals and no longer see the value – issues such as poor content and badly written copy, lack of knowledge of the market and lack of understanding of relevant media are just a few of the criticisms cited.

So whilst you might think that all PR people are idiots, this is clearly not the case. It is about finding those good practices that have in-depth knowledge and experience of the market your organisation operates within.  When choosing an agency you need to ensure they can demonstrate they have a team that includes people with many years of experience working in your sector so they have a full blooded understanding of the needs and challenges. Check they know and understand the target media and ask if they have existing or ex journalists as part of the team – that have worked for national newspapers and the specialist press. Plus establish who they know within the industry by checking their network and contacts, and get references. This is all an essential part of helping to ensure success.

Speaking personally, I believe successful PR and communications is about developing a good strategy, having good contacts, knowledge, experience and sheer hard work. It’s about working with clients to develop a coherent plan and helping to identify and develop compelling news stories and features. Also it is necessary to use all available media, not just the press, to get messages across, and remember; it is not just about building reputations it’s also about protecting them. Ensure you work with professionals that know how to develop messages and set clear objectives. Just pumping out press releases and developing inane tag lines is not enough.

Seven elements that make good PR

1. Good PR is telling the client what they need to hear instead of what they want to hear. It not about developing meaningless stories that nobody wants to read about.
2. Good PR is not just about the over-glorified launch. Good PR helps build and sustain a groundswell of brand support – incrementally changing customers’ behaviours via a steady stream of relevant and thoughtful communication to media and other targeted audiences.
3. Well written content is essential for good PR – success is when a good story has relevant detail and is told to the right people.
4. Good PR leverages pre-existing relationships with advocates – customers and influencers in an inclusive, non-exploitative way. And, good PR welcomes the input of ‘neutrals’ and ‘critics’ and adapts strategy accordingly. This helps to build trust and credibility.
5. Good PR is proactive in idea generation, ‘thought leadership’ and is responsive in a crisis – really it’s about finding the right balance.
6. Good PR is measurable. (And yet also hard to measure, since most clients want to measure different things.)
7. Good PR is built on having extensive knowledge, understanding, experience and contacts within the market the client is targeting.

These seven elements may seem simplistic and obvious, but they sum up over 20 years worth of hard lessons in this industry. PR is hard work, strategic work, under promoted but infinitely interesting. So to ensure you avoid a Siobhan an Edina or a Patsy, do some homework first!

Susan Venables, Client Services Director

Over £180m in grants and prizes for healthcare technology SMEs

Innovative eHealth and mHealth solutions from SMEs could win a share of a £180m government grant fund. The Biomedical Catalyst is a key element of the Strategy for Life Sciences launched last year. It will see the Medical Research Council (MRC) and the Technology Strategy Board working together to take the best British medical breakthroughs through to commercial success.

The programme, unveiled this week, will support opportunities with the highest scientific and commercial potential, irrespective of medical area. Three categories of awards will be available – feasibility, early stage and late stage. Individual grants to businesses will range from a maximum of £150,000 for feasibility awards to £3 million for early and late stage awards.

In addition EHI reports that the DH has announced two competitions, each worth up to £2m, to develop ideas to raise the number of patients taking their medicines, and to change behaviour and attitudes to cut obesity and alcohol related diseases.

Health minister Lord Howe said: ‘Technology and innovation have an important role to play in helping to address the healthcare challenges facing the NHS. That is why we are investing in new and creative ideas and projects which can make a difference to patients’ lives. Today’s competitions provide an opportunity to develop innovative solutions for some of the biggest health problems of our time.’

The DH created the prize fund in 2009, as part of a package of measures to encourage and spread innovation in the NHS, spearheaded by then-health minister Lord Darzi.

Home care tablets thrive while telehealth struggles

A project providing tablet computers to 800 NHS staff is giving community care teams extra freedom in North Devon. By contrast a £5m telehealth scheme in Gloucestershire has deployed less than a quarter of its 2,000 devices in 10 months.

EHI covers both stories, saying that access to Samsung Galaxy 7 tablets allows the Devon community care staff to save time and make more visits because they no longer have to return to base as often. This is valuable as they cover a large rural area, and have to record up to 150 pieces of information per patient.

North Devon’s approach to new community data requirements was to work with software companies NDL and Blue Diamond to create its own app. This does not require a mobile signal, as these can be patchy in some areas, and stores data until it can be sent.

However, only 454 NHS Gloucestershire patients with chronic obstructive pulmonary disease, chronic heart failure, chronic heart disease and diabetes have so far been equipped with self-management devices. The programme started last June and was supposed to be rolled out over 12 months.

Spire Health has been making advances on the mobile technology front, introducing Carestream Health’s Vue Motion viewer so clinicians can see patient images on iPads and Android devices. This will give clinicians at the 37-site private hospital network secure, on-demand access to its picture archiving and communications systems.

They will also be able to access images from home via a secure internet connection, and use iPad and Android devices to show images to patients at the bedside or on the way to theatre.

Private care and quality under scrutiny

The UK’s entire £5.5bn private health sector has been referred to the Competition Commission over concerns about cost and quality. The move follows a study by the Office of Fair Trading (OFT) which suggests that the market is not working.

The decision could have far-reaching implications as more private providers seek to enter the health market following the Lansley reforms. Health insurance experts We Know Money say the OFT is worried that advertised costs of treatment can be misleading. Likewise there were problems for GPs and patients in navigating the market.

OFT chief executive John Fingleton said: ‘The private healthcare sector is likely to be of growing importance so it is essential that the market works well. Yet private patients and their GPs face difficulties selecting private healthcare providers on the basis of quality or value for money, and this may ultimately result in patients paying higher prices, or receiving lower quality care.’

One worry is that competition could be restricted or distorted. The OFT believes it is difficult for new providers to enter the market and increase choice. It has looked at claims that some larger private healthcare providers can impose price rises, or set other conditions, if an insurer proposes to recognise a new entrant on its network.

According to the BBC David Mobbs, chief executive of Nuffield, said: ‘Patients need choice. This can only be achieved if the industry commits itself to providing transparent information about treatment options, quality and associated costs. This investigation offers a golden opportunity to get rid of some of the practices which have beleaguered the industry for years.’

Mr Mobbs added that the investigation should go further, and look at private medical insurers, of which he said two hold a 70% market share.

News in brief

• New academy launched for NHS leaders: National Health Executive reports on the launch of The NHS Leadership Academy which has been formed to improve patients’ experiences, health outcomes and wellbeing by promoting best practice in leadership.
• Night discharge row: The Telegraph says 8,000 patients a week are being discharged from hospital in ‘the middle of the night’ – sometimes to free up beds. The BBC says the figures are not clear cut as some are patients under observation who do not need admission, while certain hospitals register deaths as discharges.
• Patient Information Forum to build case for consumer information: The DH’s Innovation, Excellence and Strategic Development Fund have awarded the PiF £175,000 over three years to test and develop innovative approaches to health and wellbeing, reports EHI.
• Care homes cut hospital admissions: A study linking health and social care records shows that council care home residents have fewer hospital admissions than those having intensive support in their own houses. The Nuffield Trust says care budget cuts could be counterproductive as more people end up in hospital.
• iSOFT four in court: Former iSOFT directors plotted to create ‘huge discrepancies’ in the company accounts, deceived investors and got rich, a court has been told. EHI says Patrick Cryne, Stephen Graham, Timothy Whiston, and John Whelan each deny conspiracy to make misleading statements, promises or forecasts.
• CSC NHS agreement delayed until June: In a report in The Guardian CSC says that the planned deal has been pushed back due to NHS changes brought by Health and Social Care Act.
• Health Boards “could integrate care”: Public Service writes on a report from The King’s Fund which says that Health and wellbeing boards could be the catalyst for delivering integrated care.

Blog

As we move to an outcomes-based approach in healthcare, the quality of patient experience is being recognised as ever-more important as a measure of success. US blogger Dr Robert Rowley believes that technology is essential to making patients feel well-treated. Indeed, online access and smarter use of EHRs could be crucial.

‘There are several elements that influence a patient’s assessment of their experience. One is the ability to access personal health information on-line. Connected patient-facing web portals are a feature of many modern EHRs, which allows (at a minimum) the review of one’s problem lists, medications lists, allergies, immunisations, lab tests and upcoming appointments.

‘Two-way communications across these channels are also an emerging capability, so that patients can contact the practice in a secure way – these queries tend to be in lieu of phone calls (not of actual visits). Usually such communication is about refill requests, interpretation of lab results, and sometimes about health complaints.

‘Most directly, EHRs are now developing ways to send patient satisfaction surveys after each visit. If immediate feedback becomes a routine part of clinical care (after-visit surveys, generally by email), there is the opportunity to improve in real-time. This approach holds the most promise for affecting patient satisfaction than any other to date, and is something we will see built into EHRs in the near future.’

Opinion

In this week’s Guardian healthcare network, Dick Vinegar writes of his despair about the future of telecare following the launch of the whole system demonstrator (WSD).

‘You will remember that a trial, called the whole system demonstrator, covering 6000 long-term patients in Kent, Newham and Cornwall, has been chuntering along for about three years. In June last year, a Kings Fund conference announced relatively upbeat preliminary findings for the WSD. The full report was supposed to be imminent. But autumn and winter came and went, and still the report did not appear. We were told that it was just going through the necessary “peer review” process.’

To our valued clients and readers of Highland Marketing’s Healthcare Roundup – Happy Easter – Enjoy the break and indulge in some chocolate…

Yes, it is official! Chocolate IS healthy: (Well, the dark stuff anyway!) Go ahead and have a piece, guilt-free this Easter, knowing that chocolate has very high levels of flavonoids and antioxidants, and when enjoyed in moderation, has a positive effect on heart health.

News in brief – Easter Special

• Introducing ‘Barts Health’: One of the largest healthcare mergers in the country went live on Sunday, reports the Guardian. Barts Health is the new name for the joining together of three London-based NHS trusts: Barts and the London NHS Trust, Newham University Hospital Trust and Whipps Cross University Hospital NHS Trust. It is now one of the largest NHS trusts in England.
• Replacement PAS/EPR on the cards for Basildon and Thurrock: EHI reports that twenty-five suppliers have already shown an interest in the project and will be attending a briefing at the trust today! The tender is to be split into three parts with the priority being PAS deployment by October 2013, followed by Clinical 5 functionality and clinical modules within the next five years.
• Cutting £20bn from the NHS – and spending £5,000 a month on expenses: Sir David Nicholson is coming under fire in a recent report by The Independent for not leading by example in these austere times!
• NHS Reforms – What next for the Health Service: The passing of the Health and Social Care bill is just the beginning, the real test lies in implementing the changes, says Dr Anna Dixon director of policy for the King’s Fund. In this article for The Guardian she sets out briefly the three priorities that face the implementers of the reforms.
• Health Secretary explains new Health and Social Care Act: In a news release issued by the Department of Health, Health Secretary Andrew Lansley has set out what the Health and Social Care Act will mean for four key healthcare organisations and their staff – clinical commissioning groups, NHS foundation trusts, NHS trusts and local authorities.
• Care commissioning must meet people’s needs: In an article for The Guardian Lord Victor Adebowale chief executive of Turning Point explains why our social care system must adapt to meet the requirements of real people and communities. The key priority, he outlines is developing better integration between health and social care services.
• Market competition test proposed for trusts seeking extra funding: Monitor might refuse to allow local increases to the prices paid to NHS trusts unless commissioners haveproven they could not buy the services more cheaply elsewhere, an independent report (subscription required) for the regulator has suggested.
• Techsavvy patients drive demand for electronic health systems: Interesting new research out of consultancy KPMG has found evidence that a more technology-informed approach to healthcare provision can reap rewards – but that the biggest obstacles to progress on this front is probably more on the clinician than patient side, reports Public Technology. Highlights include: 61% claim eHealth will come about because of patient expectation, with 58% also suggesting demands for greater efficiency will lead to a technologically-driven health service.
• Building Better Healthcare Awards 2012 – Opens for entries: Celebrating the products, people, premises and processes that help to set a benchmark for the future delivery of healthcare services in the UK and overseas. 16 awards are up for grabs this year covering six categories including ‘technology, equipment and medical devices’: July 1st is your deadline to enter! Could this be the year your organisation or your customers get the recognition they deserve? For full details click here to visit the awards site.

Highland Marketing blog

This week Matthew Shelley asks the question, does the Information Revolution risk becoming a ‘Data Damp Squib’

Our political leaders are fond of telling each other to ‘get a grip’ when they fail to deliver on a promise. Well, perhaps it’s time that the healthcare IT sector told the DH to do precisely this on the repeatedly delayed NHS information strategy.

HSJ reports that the document – vital if we are to have coherence and purpose after the effective collapse of the National Programme – will not be out in April as promised. It is already a year overdue. Had it been on time then UK IT companies and healthcare providers would be much better placed to forge ahead with new, innovative and creative partnerships.

Most worryingly still it seems that the DH is having to do an 11^th hour redraft of the latest version. The proposed recommendations (circulated to selected stakeholders some weeks ago) were described as ‘basically a lot of motherhood and apple pie’. This follows last year’s binning, by DH chief information officer Christine Connelly, of Version One of the strategy. This first effort was described as ‘confused’. Ms Connelly then had a go at doing it herself. The timetable slipped. She has since resigned.

Yet more concerning is that last week’s leaking of the draft risk register, assessing the potential dangers from Andrew Lansley’s health reforms, identified informatics as one of the major areas of vulnerability.

Let’s just remind ourselves about what’s at stake. The Future Forum, set up by the government to provide advice, has said in no uncertain terms that the NHS needs a culture change to drag itself out of the ‘information dark ages’. This really matters. IT systems aren’t just nice things to have to save on a bit of paperwork. They are the bedrock of healthcare. They make the difference as to whether or not patients get the right treatments when it’s needed and how clinicians and patients engage.

Healthcare IT is about patients, services, NHS efficiency and about whether vast sums of taxpayers’ money are invested wisely. On a broader front, it’s also a matter of jobs and industry. The economy is in poor shape; healthcare IT is a potentially vibrant and high-value sector and should be encouraged not daunted.

This government quite rightly campaigned hard on the last administration’s failures and waste with aspects of NPfIT. That is all the more reason why it has to show that it can do a better job. There was genuine enthusiasm when we were promised an Information Revolution – but unless they get their act together their entire project faces dissolving into a ‘Data Damp Squib’.

With luck this latest delay will allow the document’s authors to come up with something that will sparkle and inspire. The next due date for publication is May. I truly hope that the final result, so long in gestation, will prove worth the wait.

Matthew Shelley, Writer and Communications Consultant

Government risk register warns that reform will raise costs

Internal government documents warn that the newly passed Health and Social Care Act could drive up costs and lead to poorer management of emergencies. The information comes from a leaked draft version of the ‘risk register’. The courts have ordered the government to publish the risk register, but it has failed to do so.

Set out as a colour coded chart, the document shows different levels of risk and likelihood on a scale of one to five. Those with a 4/5 score include:

• Point 3: Using the private sector could ‘add costs to the overall system.’
• Point 4: Implementation without adequate planning.
• Point 5: A disjointed system with the NHS moving faster than other areas.
• Point 7: Loss of financial control due to restructuring.
• Point 15: More failures such as bankruptcies and service cuts.
• Point 34: Low staff morale.

A 3/5 score was given for:

• Point 12: Emergencies being less well managed/mitigated.
• Point 13: The costs of the future system not being controlled.

IT is a specific danger area according to EHI. The register says the ‘future design of informatics’ is something that ‘comes too late to feed into the overall system definition/architecture’. Although the government has twice said it will dismantle the National Programme, it has yet to publish its IT strategy.

A Department of Health spokesperson said: ‘We have always been open about risk and have published all relevant information in the impact assessments alongside the bill. As the latest performance figures show we are dealing with those risks.’

Technology vital to a sustainable NHS

A major report by the King’s Fund highlights the role of technology in the financial and environmental sustainability of health and social care. The document was issued ahead of Wednesday’s NHS Day of Action on Sustainability. Both focus on the need to cut waste to reduce costs and to meet legal demands for an 80% cut in carbon emissions by 2050.

Sustainable Health and Social Care, the King’s Fund report, points out that the NHS is responsible for a quarter of public sector emissions. One of its top five recommendations (see audio slideshow) is to explore the opportunities presented by tele-care and tele-health. Another addresses the need to focus more on preventative care in order to avoid unnecessary interventions and hospital admissions.

Teleconferencing is encouraged and examples of savings include North Yorkshire Council’s £1m cut in spending through tele-care. Both are seen as ways of reducing ‘care miles’ travelled by staff and patients. The King’s Fund points to the findings of the 2006 Wanless Review which found that tele-care could play a critical role in providing better home-based care for older people.

Dr David Pencheon, director of the NHS Sustainability Unit, said the sustainability day – which involved over 100 trusts – is to emphasise that the benefits of healthcare are not outweighed by the environmental harm caused by their delivery. GPs were encouraged to take part by carrying out energy and waste audits.

Top tips provided by trusts include everything from cutting bills by investing in bio-enzymatic digesters to dispose of waste food to dealing with the menace of pigeons by getting a Harris Hawk! Pharmaceuticals have been identified as an area of key concern – responsible for 22% of the NHS carbon footprint – with huge quantities going to waste through poor storage or inappropriate prescribing.

Failing care commission gagged staff

The Care Quality Commission gagged its own staff to stop them talking about failures while shutting down an NHS whistleblower’s hotline. The Telegraph reports that the health and social care regulator has again been severely criticised by the House of Commons Public Accounts Committee.

The CQC has recently been condemned over a number of issues including failure to take action at care homes where staff were abusing residents. An unnamed board member said she tried to speak publicly about her concerns over the CQC but had been ‘ostracised and vilified’. Departing staff had also been made to sign gagging agreements, which committee chairman Margaret Hodge said was ‘unacceptable.’

Even though the head of the CQC, Cynthia Bower, has announced her resignation there are doubts about whether it is fit for purpose. The PAC says (subscription required) it is not up to its main task of registering 10,000 GP practices during the next year and should not take on responsibility for regulating IVF services. The DH has already extended the deadline for registering GP practices from April 2012 to April 2013 after the pressure of registering other healthcare providers led to a sharp decline in the number of inspections carried out.

The MPs concluded the CQC had failed its vital role of protecting people from poor quality and unsafe care. Looking ahead, they said that while things were improving, the CQC still had a ‘long way to go’ to become an effective regulator.

A CQC spokesman said: ‘We are disappointed that the report does not recognise the significant improvements of recent months.’

Slow progress on e-prescribing, but 111 presses on

Just 110 GP practices have gone live with the Electronic Prescription Service Release 2, nearly two years after first deployment. Meanwhile TPP is looking for NHS organisations to pilot its new call centre module for the troubled NHS 111 urgent care calls system.

The DH says EPS R2 take-up is expected to accelerate with two more of the main GP systems suppliers due to get full roll-out approval within weeks. EPS R2 should allow all practices in England to produce prescriptions electronically. These are digitally signed and sent to the pharmacy.

The SystmOne 111 module is a management system for organisations deploying the free urgent care number. It can send electronic referrals directly to other services, including messages to call out ambulances.

Pilots for 111 have had mixed results with claims that it increases, rather than reduces, hospital referrals and pressure on GPs. There has though, been great enthusiasm for the GP comparison site myhealthlondon, with more than a third of the capital’s practices now signed up.

In an industry where there are frequent reports of projects running late and over budget, HSJ (subscription required) reports that Kent and Medway NHS and Social Care Partnership Trust saved £500,000 by completing its roll-out of the RiO IT system three months ahead of schedule. Around 3,000 staff were trained in support of the roll-out in six months.

At the same time there has been huge interest in the £600m University Hospitals of Leicester NHS Trust’s 15-year plan for a comprehensive new IT system. Reports say that a shortlist of six potential suppliers has been drawn up after over 70 expressions of interest.

News in brief

• Monitor must dig deeper: David Bennett CEO of the Monitor NHS regulator has admitted that Morecambe Bay (subscription required) probably had ‘deep-seated problems’ when his organisation granted it foundation trust status. He says revelations about the trust’s maternity services and management show that his team must dig deeper to identify troubled organisations.
• Over £500m of non-acute services tendered: HSJ (subscription required) reports that services worth £555m over three years are being put out to tender by PCTs in Bristol and Gloucestershire. The tenders, for community, learning disability and secondary mental health services are attracting attention from the private and third sectors.
• Bring your iPad to work scheme trialled at Liverpool hospitals: Liverpool Women’s NHS Foundation Trust is letting some staff use their own tablet devices for work, and may help pay for them in future, reports The Guardian.
• Dementia research pledge: Prime Minister David Cameron has pledged that the dementia research budget will be doubled to £66m by 2015, saying it is an area in which Britain can lead the world.
• Doctors could vote to withdraw care: Pulse says the BMA has announced plans to ballot doctors on plans to withdraw all but urgent and emergency care for 24 hours in protest at proposed pension changes.

Blog

GP online blogger Neil Durham was born in Surrey’s Frimley Park Hospital – he never expected to end up there again, sitting at his dad’s bedside in the coronary care unit. With the NHS so often lambasted for its failings, he writes about the superb quality of service and the compassion and professionalism with which it has been delivered.

‘As [Dad] told me how he came to be there, I couldn’t help but think what a brilliant example he is of how exemplary NHS care can be; from the GP who realised immediately how ill he was and called an ambulance to take him to hospital, to the nurses who allowed my family to flout the two visitors only per bed rule (my sister and her husband-to-be had travelled 100s of miles to be there).

I remembered a conversation I’d had with former health secretary John Reid years earlier about his frustration with a media which concentrated on the one in a million problems with the NHS at the expense of the everyday stories of professionalism and expertise which, fingers crossed, will see my dad leaving Frimley Park today with a spring in his step and a newly fitted pacemaker: a story unremarkable in the big scheme of things but of huge importance to my family and me.’

Highland Marketing blog

Mark Venables takes a look at what the leaked risk register actually tells us.

Earlier this week, health writer Roy Lilley leaked the long awaited risk register, which the government had fought a six month campaign against being made public.

Not surprisingly the register listed a number of potential risks that could see the NHS reforms lead to a loss of financial control and reduced productivity across the board.

But perhaps what many are surprised to see alongside risks such as design and implementation, is that technology and informatics are listed as three out of the 43 total risks on the register. In addition to this they are noted for their importance in ensuring the effective redesign of services overall.

The top risk categorised as ‘system design’ identifies that the ‘policy design for some aspects of the future organisation is incomplete, for example the future design of informatics comes too late to feed into the overall definition/architecture of the health bill.’

In addition to technology’s role in system design being a risk, the other key points relate to transitioning contracts and failing to secure basic IT infrastructure and tools as well as questioning how IT will support the new system.

In this context, the register’s over-arching concern is that following the reforms there will be new organisations with IT systems to support them rather than the transactions between them needed to support a joined up and integrated healthcare system.

It says this means there is a risk that “the enormous potential of informatics (the knowledge, skills, processes and technology which enable information to be collected, managed, used and shared to support the delivery of health and care and to promote health and well-being) is not sufficiently taken into account in the system design.”

One of the other interesting areas that is deemed a risk (interesting because the register was collated in September 2010 before the formal announcement to dismantle the National Programme for IT) is the obvious fear that the health bill could result in another type of national contract such as an ‘ICT Managed Service Contract’ that would have to be ‘superimposed’ to aid the transition through 2012.

The fact that IT is considered a risk in itself could probably be viewed as a negative thing. However, while each of these risks are valid, the reality that technology and informatics are referenced consistently throughout the register highlights how much the importance and profile of technology has been raised within the health service over the past couple of  years.

Just a few years ago, IT and technology was considered a nice to have and now it is an integral part in aiding service redesign and transition during the reform as well as supporting healthcare professionals and patients moving forward.

Mark Venables, CEO Highland Marketing

Health bill to become law

The government’s health bill has passed its final hurdle in the Lords and the Commons and is now set to become law. Opposition, however, is likely to continue with HSJ (subscription required) reporting that a protest group of NHS doctors intends to field candidates against Coalition MPs at the 2015 election. Labour pledged to repeal the bill at the earliest opportunity.

A number of groups have now signalled their intention to do all they can to make the legislation work. Pulse quotes Dr Richard Vautrey of the BMA GP Committee as saying: ‘Our job now is to mitigate the worst elements of these reforms. We’ve got to make absolutely sure they work in favour of patients and not big business.’

Mike Farrar, chief executive of the generally pro-government reform NHS Confederation, told HSJ (subscription required) that post-bill guidance is needed to simplify implementation and aid service redesign, which he said could be hampered by the bill.

The Guardian quotes a call for unity by Mr Farrar who said: ‘We have to find our way through the considerable confusion and complexity that has been handed to us as we build and stress-test the new NHS system. We need to heal the rifts that have opened. We need to completely redesign NHS services against a backdrop of unprecedented financial pressure, bringing the public and staff with us. We have to do all this with significantly reduced management capacity.’

A DH source said: ‘Everybody is a bit bored with talking about the processes and structures. It was a very important debate, but we all want to get back to talking about people’s health and making people better.’

The Telegraph says that Royal Assent could come as early as next week, after the last of more than 1,000 amendments have been approved.

Another £20bn NHS savings to be demanded

NHS budgets are to be squeezed for the rest of the decade following a government decision that the Nicholson Challenge savings drive will continue beyond 2015. The FT says that the DH director-general of policy, strategy and finance Richard Douglas, told NHS directors earlier this month that they were ‘deceiving themselves’ if they thought that efficiency savings would not be ongoing.

The Nicholson Challenge saw NHS chief executive, Sir David Nicholson, demand year-on-year savings of 4% and was first set out in Chancellor George Osborne’s four-year spending review in 2010.

Reports suggest that another £20bn may be demanded. According to Pulse, Mr Douglas showed projections suggesting that further savings will be necessary because of increasing demand from an ageing population and more expensive medicines.

David Stout, NHS Confederation deputy chief executive, said: ‘The working assumption is that the NHS will be required to continue to produce significant savings beyond 2015. The initial £20bn is not the end game.’

The news comes as the latest figures show continuing falls in NHS nurse numbers, and staffing levels overall. Peter Carter, general secretary of the Royal College of Nursing, said the figures were ‘incredibly worrying’.

He added: ‘Despite the rhetoric, we know that frontline jobs are not being protected and NHS trusts must stop making cuts in a quick fix attempt to save money. Put bluntly, the idea that cutting hundreds of jobs from a hospital will not affect the care of patients is ludicrous.’

DH acts on patient safety and end of life care

The DH has made a series of announcements on investments to improve patient safety, end of life care and service integration. The research centres at Imperial College Healthcare NHS Trust and NHS Greater Manchester will share £13m to come up with practical ways to cut prescription errors, improve diagnosis of cancer and rare diseases and reduce accidents during surgery.

Initiatives will include surgical safety check lists, online symptom checkers for serious and rare illnesses and ‘medication passports’ so staff know what medication patients are on if they are admitted to hospital.

A further £1.8m is being invested to fund pilot sites, including one for terminally ill children, which will ensure the support is available for people to die in the setting of their choice. More than 50% of people in the UK say they would prefer to die at home but only 19% are currently able to do so. The DH wants to create a fairer system, which supports people to be cared for in the setting of their choice and enables end of life care to reach all in local communities who need it.

New online tools are being introduced to help the NHS join up the services provided, allied health professionals such as physiotherapists, dieticians, podiatrists, speech and language therapists. The DH says integration could save millions of pounds and have a dramatic impact on care for people with diabetes, cancer, musculoskeletal problems and for stroke survivors.

Healthcare IT projects forge ahead

The world’s first scalable, secure medical cloud network for pathology is to be delivered by a strategic alliance between Aperio and Dell. eHealth News says the deal will see Dell host the system – the company already manages five billion medical images and studies. Aperio’s ePathology Network aims to provide secure, compliant, worldwide access to pathology consultations.

This week brought good news for Agfa with Cardiff and Vale University Health Board upgrading its picture archiving and communications system as part of a four-year contract extension. The arrangement will include a complete refresh of all equipment. The board’s PACS and RIS serve nine hospitals, are used by 3,000 staff, and create 44 million images a year from 500,000 radiology examinations.

EHI reports that Ascribe has announced the successful go live and implementation of its Web Pharmacy solution at two East Lancashire Hospitals NHS Trust sites. The upgrade to Ascribe’s latest web-based pharmacy solution is said to provide a clinically rich platform for growth and improvements to patient safety.

Alder Hey Children’s and Liverpool Women’s NHS foundation trusts are to use Perceptive Software’s ImageNow system for a document management project. The announcement comes after the trusts, which share IT services, said they are looking to outsource their IT, in one of the biggest acute outsourcing deals to date.

Meanwhile Healthcare Software Systems has been bought by newly created holding company – Wellbeing Software Systems – and plans to significantly re-invest in its businesses. EHI reported last month that Radman House Group, the parent company of HSS, had been placed into administration.

News in brief

• Oxford NHS trust treats ills caused by electronic patient records roll out: According to The Guardian, Oxford University Hospitals NHS trust is dealing with issues around data quality and delays at its contact centre following the implementation of Cerner Millennium.
• Lothian manipulated waiting times: James Barbour, head of NHS Lothian, has apologised ‘unreservedly’ for unacceptable practices. The BBC reports that Scotland’s second largest health board marked patients as unavailable in order to artificially reduce the numbers in breach of waiting times guarantees.
• NHS trusts seek 111 non-emergency services supplier in £60m deal: The Guardian reports that primary care trusts in the north west of England are seeking a supplier of non-emergency telephone services to support NHS 111 in the region.
• Aspirin can prevent and cure cancer: Data from trials involving 77,000 patients suggest that low dose aspirin can prevent many cancers from occurring and also stop them spreading. However, leaders of an ongoing UK trial believe it has no preventative effect on cancers of the gastrointestinal tract.
• NHS £1.5bn surplus: The health service is on course for a £1.5bn surplus (subscription required) – £300m more than planned. However the trust sector surplus of £26m is £31m lower than intended.
• Cystic fibrosis trial starts: The BMJ says a UK trial involving 130 patients is about to start which aims to repair the genetic fault which causes the illness.

Blog

A contribution from the medical frontline this week, with Hospital Doctor featuring a blog by Manchester consultant anaesthetist Katherine Teale. After seeing a patient haemorrhaging several pints of blood when a cosmetic surgical procedure went wrong, she raises questions about patient choice – and the trend to make face lifts, breast implants, and fertility treatment as easy as clothes shopping.

‘This particular patient appeared to know nothing about the risks of the surgery she’d undergone … Small private clinics are commonplace these days – the message is that surgery is no big deal, you can just fit it in around your day. ‘Patients having to choose their healthcare provider is like me buying a new laptop – they don’t understand the language, don’t know what to ask, don’t know how to judge good from bad, and they’re suckers for dodgy stats. I chose my last laptop in the end because it had a nice blue case – patients choose their hospital largely according to how much it costs to park and how far it is too travel. None are great indicators of anything that matters.

‘This week a BMJ article confirmed what we always suspected – one third of adult patients have difficulty reading and understanding basic health-related written information. What chance have they got in a system where companies compete for their custom?’

Highland Marketing blog

After the passing of the health bill Ravi Kumar considers the road ahead for the ‘liberated’ NHS.

After 14 months of extensive debate and more than 1,000 amendments, The Health and Social Care Bill will soon become the law. This law is expected to ‘Liberate the NHS’ and will give rise to a new NHS structure.

Despite almost two years of uncertainty around the Health Bill, change always brings opportunities to make things better. In the new NHS:

• GPs along with NHS professionals such as hospital consultants and nurses will be given responsibility for spending £60-80bn of NHS budget.
• Clinical Commissioning Groups (CCGs) will replace Primary Care Trusts and will decide on patient care, treatments and payments.
• All hospitals will become foundation trusts and will compete for treatment contracts from CCGs.
• NHS providers will be expected to bring in more competition on the basis of quality and safety.
• Local councils will play a role in health and well being including taking responsibility for public health aspects such as obesity, smoking and alcohol abuse. This will be led by a new body – Public Health England.
• The NHS Commissioning Board will become responsible in the ‘big bang’ roll out of the bill from 1 April 2013.

Massive structural change like this is never easy. 2012 is a big year for the NHS and pretty much all the foundation work for the new structure has already been done. Both the CCGs and NHS Commissioning Board will require significant support in establishing themselves and discharging their responsibilities, and the role of clinical support services will be key. Even with this bill in the New NHS, going forward, there are a number of points to remember.

• The NHS is still free at the point of use (in as much as it ever was). Despite  speculation about the NHS becoming  privatised etc,  nothing seems to have changed on what will be charged.
• The Secretary of State is still responsible for provision of care in the NHS in England.
• Funding will still be an issue and that will continue to have impact on the quality and outcomes of care.

There is a lot of dissatisfaction and mistrust in the grass roots of the NHS and a huge amount of concern about the functioning of the NHS, which was clearly visible during the campaigns to stop the bill. Therefore there is a lot of work that needs to be done to rebuild the confidence that this reform will deliver what was promised.

Let’s not forget, underpinning all this reform is the QIPP agenda and the £20bn of savings to be made. In addition, the NHS IT Strategy is now handed over to the NHS Commissioning Board and we still await clarity on that.

That is the reality. Mandated change will bring plenty of new opportunity. Now the debate is pretty much over, time to get on with implementing the bill and make it work!

Ravi Kumar, Industry Advisor

Health bill battle swings in government’s favour – but doctors still opposed

The controversial Health and Social Care Bill has cleared a series of political and parliamentary hurdles and looks highly likely to become law. However, a new survey shows 69% of physicians want the bill dropped and just 6% are in favour.

This Tuesday saw the bill complete its House of Lords report stage, after further concessions. Former SDP leader Lord Owen will have a final attempt to stop the reforms by calling for a delay on any further debate until after the publication of a report on the risks they pose to services. The government has lost a series of legal battles to keep the document secret.

The Royal College of Physicians has revealed the results of a survey which shows opposition at close to 70%. RCP president Sir Richard Thompson said: ‘The areas of most concern are training, education and research; use of the private sector; commissioning by clinical commissioning groups; and choice and competition.’

The Liberal Democrat Spring Conference showed widespread grass roots opposition to the bill with a motion in its favour, sponsored by party matriarch Dame Shirley Williams, being severely mauled. The tide though, appears to be turning in the government’s favour. Only five Liberal Democrat MPs defied the party whips to vote with the opposition in a bad-tempered Commons debate which resulted from a GP’s e-petition calling for the bill to be ditched.

In a curiously timed move the Royal College of GPs sent a letter declaring its willingness to help the government implement the changes. The move was widely interpreted as a u-turn. But college head, Clare Gerada, insisted that the best option is still to scrap the bill. She claimed that her organisation was simply acknowledging that it may have to make the best of a bad job.

Private company set to take over Devon children’s NHS services

Core NHS children’s services, including care of the terminally ill, appear likely to go to a private company with no previous experience in the field. Serco, Virgin Care and Devon Partnership NHS Trust have all been shortlisted for the three year contract by NHS Devon and Devon County Council. A source close to the process told The Guardian that the NHS bid – in partnership with Barnado’s – is not likely to win.

If the £130m contract goes to a private company it will be seen by critics as evidence that the NHS will rapidly be broken up among private companies. The winner will run sensitive frontline services including child protection, treatment for mentally ill children and adolescents, therapy and respite care for those with disabilities, health visiting, and palliative nursing.

Final bids will be evaluated in May with the contract going to ‘the most economically advantageous’. Neither of the private companies has experience of specialist children’s health services for the NHS. Serco plans to run the services with Cornwall Partnership NHS Trust, but the extent of the trust’s role is unclear. Serco’s past NHS involvements have sometimes been controversial. Virgin Care has a major dispute with the NHS in Yorkshire.

John Ashton, director of public health for Cumbria, said: ‘What on earth are they doing taking risks with our children like this? Children’s services such as these are very complex and involve working with lots of agencies over long periods. How a private company can function in that area when it needs to identify ways of making money is really hard to see’.

A government spokesman said: ‘We support patient choices and whoever is best getting the contracts. We reject the idea that because a private company might get it, it is privatisation’. He added that services would remain free to use and publically funded.

London IT deal not a cert for Cerner

Cerner says it is not certain that its Millennium product will be chosen by all nine London trusts which have joined forces for a huge, collaborative tender. EHI reports that they could each choose different suppliers.

Matthew Swindells, managing director of Cerner Global Consulting, said he expected ‘most’ trusts to stick with Millennium. However, he added it was not a foregone conclusion and it was up to trusts to encourage other suppliers to bid for the work.

Suppliers can bid independently, or as a consortium. The estimated value of the tender is between £250m and £400m.

Meanwhile CCGs are showing increasing signs of wanting a powerful influence over the IT used in their areas. Three clinical commissioning groups in North Mersey have set up a joint board to provide strategic overview of IM&T programmes in the region. The group is writing to IT and medical directors at local trusts and providers to let them know about the role of the IM&T board.

In a further major development, Sussex Partnership NHS Foundation Trust (subscription required) has named a specialist provider 2e2 as its preferred bidder for a contract to provide information technology infrastructure and support. The work will include everything from computers to phones and support for all applications including the website, intranet and clinical information systems.

Tackling child healthcare variations

The DH has launched a drive to tackle variations in child healthcare. In a separate development the watchdog, Monitor, is to publish an annual blacklist of health services that must be reconfigured. Both moves are designed to ensure uniformly high standards across England.

GP online says the new NHS Atlas for the Variation in Healthcare for Children and Young People is aimed at spurring commissioners to review their care pathways and take firm action to end a postcode lottery in care. The document reveals that the number of emergency admissions for asthma among young children varies five-fold across PCTs. There were also wide variations in admissions for epilepsy and diabetic ketoacidosis.

Dr Sheila Shribman, national clinical director for children, young people and maternity services, said: ‘Tackling unwarranted variation can help the NHS to provide better care, reduce waste and make sure that all children and young people get the best possible results from their care’.

The Monitor blacklist, according to HSJ (subscription required), is intended to establish a ‘pre-failure regime’. This means that central authorities will be able to force healthcare providers to take action before they are deemed to have failed and are taken into administration. Providers that ask for subsidies above standard payment rates – as they are allowed to do under the bill – will automatically be considered for the list.

News in brief

• NHS trusts seek IT consultancy, project management for eHospital plan: Cambridge University Hospitals NHS Foundation Trust and Papworth Hospital NHS Foundation Trust are seeking suppliers to provide project management and IT consultancy services for the pair’s eHospital programme, reports The Guardian.
• Online GP booking through 111: Pulse claims that patients using an online version of the NHS 111 urgent care service will be able to directly book appointments with their own GP, or another practice within 10 miles. Some GPs are angry that their control over their appointments systems might be overruled.
• PCT managers get most top commissioning jobs: HSJ (subscription required) reports that 60% of CCGs have chosen primary care trust managers as their leaders. However, in most cases the role of chair will be taken by a GP.
• NHS Constitution update: The NHS Future Forum is to update the NHS Constitution – and a new section has just been included on whistleblowing. For details on this and all the latest DH news see the latest issue of The Week.
• Cancer and Alzheimer’s study: Research which followed nearly 1,300 older people has found that cancer survivors have a lower risk of Alzheimer’s, and that people who develop Alzheimer’s have a lower risk of cancer. BMJ reports that the risk of Alzheimer’s disease was lowest in survivors of smoking related cancers.

Opinion

Central versus local – it’s one of the biggest questions to haunt the NHS. Mike Farrar, chief executive of the NHS Confederation, has written an essay for the think tank Reform in which he argues that the pendulum has swung too far towards diktat from the centre and claims that it is a mistake that will come back to haunt us.

‘People in the UK fundamentally believe in the idea that access to healthcare is a universal right. But in recent years the use of choice and competition to move away from a universally available average system to a higher quality more personalised individually tailored system has begun to challenge these assumptions.

‘In light of this, the issue of centralist versus localist has often and misleadingly been equated with the view that centralism reflects the predominant desire for equity, whilst the non-centralist view has been equated to a less managed, deregulated world, in which a market philosophy sits more comfortably.

‘In this respect, it has led to the decentralisation policy question becoming a political question. Unhelpfully, this has turned what should have been an evidence-based debate about policy into a hotly-contested political debate.’

Highland Marketing blog

Jeremy Nettle calls for people to smile a little more to improve their health.

I noted this week that the Centre for Connected Health is interested in evaluating sensors that may be used to detect and monitor changes in emotional states.

The effects of emotional stress on overall health are well documented and the Centre for Connected Health says it is committed to innovative methods of providing quality care, effective wellness programs, and clinical research.

Sensor-enabled tools that can support self-management of physical and mental health could provide a great opportunity for anyone developing or considering developing mobile devices in healthcare and an even better opportunity for those looking for a potentially cheap and easy way to improve emotional well being.

In fact, when I reviewed the papers on ‘The effects of emotional stress on overall health’, I was very surprised to find this piece of research:

“Laughter is a powerful antidote to stress, pain, and conflict. Nothing works faster or more dependably to bring your mind and body back into balance than a good laugh. Humour lightens your burdens, inspires hopes, connects you to others, and keeps you grounded, focused, and alert.

“So with so much power to heal and renew, the ability to laugh easily and frequently is a tremendous resource for surmounting problems, enhancing your relationships, and supporting both physical and emotional health.”

Laughter is good for your health it seems:-

• Laughter relaxes the whole body. A good, hearty laugh relieves physical tension and stress, leaving your muscles relaxed for up to 45 minutes after.
• Laughter boosts the immune system. Laughter decreases stress hormones and increases immune cells and infection-fighting antibodies, thus improving your resistance to disease.
• Laughter triggers the release of endorphins. The body’s natural feel-good chemicals. Endorphins promote an overall sense of well-being and can even temporarily relieve pain.
• Laughter protects the heart. Laughter improves the function of blood vessels and increases blood flow, which can help protect you against a heart attack and other cardiovascular problems.

So while we are all looking a different treatments, personalised medicines and healthy lifestyles to help us feel better, or more importantly, keep us in good health and reduce the burden on the NHS, perhaps we need to look no further than finding someone or something to make us smile.

If you think I’m joking, I may have just cured you…

Jeremy Nettle, Industry Advisor

No confidence vote as thousands march against health bill

Senior doctors have defied their own leadership to pass a vote of no confidence (subscription required) in health secretary Andrew Lansley by a margin of four to one. BMA chair Dr Hamish Meldrum had advised the organisation’s consultants’ committee against the move saying we ‘do politics but cannot be doing personal politics’.

Backers of the motion argued that it was important to go ahead in order to ‘address the myth’ being put around by the government that it has the backing of medics. At the same time HSJ (subscription required) says more than 2,000 NHS staff took part in a march and rally demanding the scrapping of the health bill. Among the speakers was Lord Owen who claimed that the coalition government lacks any mandate for its reforms.

Last week’s decision that the Commons would not debate the scrapping of the bill, despite a GP’s e-petition which has gathered 170,000 supporters, has been overturned. An intervention by shadow health secretary Andy Burnham has resulted in a debate being agreed for next Tuesday – which Pulse says is a last-ditch attempt to derail the legislation.

In a letter to GP magazine health secretary Andrew Lansley has strongly denied that the proposed reforms would lead to inequalities in which patients can get what drugs. Lansley argues that it will have the opposite effect, enabling commissioners to be more responsive to patients’ needs.

Government hopes that the opposition to its reforms will disappear once legislation has been past appear to be evaporating, with the Guardian Healthcare Network predicting ongoing professional and political resistance.

NHS informatics shake-up

A major shake-up will see responsibility for the informatics strategy being shifted from NHS Connecting for Health to the NHS Commissioning Board by April 2013. Guardian Healthcare Network says the change was announced by Alan Perkins, the resources and transition director at NHS Connecting for Health, at London’s Public Sector Efficiency Expo.

He said that the board will provide a ‘whole range of things from policy through to strategy, to delivery and even ownership of some systems’. Perkins added that where there is a need for a single IT system across the NHS nationally, the DH will continue to provide it, but that the department intends to stimulate a ‘vibrant healthcare marketplace’ for technology locally.

The DH says the change will mean a leaner delivery organisation to manage existing national applications and services such as the Spine, Choose and Book, Digital X-rays, the Electronic Prescription Service, the Summary Care Record and a secure broadband network.

The emphasis will be on local healthcare providers being responsible for their own IT needs. Health secretary Andrew Lansley has also promised a greater role for SMEs in health service IT. He said: ‘Key to future success will be the NHS as a more intelligent customer and small and medium-sized suppliers no longer excluded from introducing their products. The local NHS is no longer being told what to do when it chooses its IT’.

Telemedicine drive in disarray

The government’s telemedicine drive has a less than 40% chance of being cost-effective according to researchers who the DH asked to appraise its proposals. Unpublished results from an assessment of the Whole Systems Demonstrator pilot project have been described as ‘very disappointing’. Research into its effectiveness involved the Nuffield Trust and the London School of Economics.

Pulse has revealed unpublished data in which researchers say the telemedicine pilot has shown little effect on quality of life, but costs £88,000 per QALY (quality adjusted year of life). Health minister Paul Burstow this week claimed that the government’s plans could save the NHS £1.2 billion a year. Early data had also looked promising with suggestions of a 45% fall in mortality and 20% drop in emergency admissions.

HSJ (subscription required) says that Nuffield Trust director Jennifer Dixon told its recent health summit that the evaluation showed ‘very disappointing results in emergency admissions’. Catherine Hendersen, a research officer at the London School of Economics, said analysis after 12-months showed QALY costs were ‘very high’ compared to the NICE threshold of £30,000.

Fraud could rocket due to personal care budgets

Fears have been raised that DH plans to introduce personal healthcare budgets could see fraud cases rocket. The concerns have emerged at the same time as a string of court cases revealed the breadth and depth of fraud in the NHS.

GP online reports that a personal care budget scheme in the Netherlands, similar to the one proposed for England, has been branded ‘unsustainable’ because of widespread suspected fraud and a 10-fold surge in costs. One of the biggest problems has come from the emergence of companies which specialise in brokering arrangements between clients and providers.

Researchers have warned that: ‘Unless the lessons of the Dutch experience are learnt, the unintended and negative consequences will outnumber the positive, empowering role of personal budgets’.

Meanwhile there have been a series of fraud convictions involving the theft of many hundreds of thousands of pounds of NHS money. These include:

• The use of forged documents by Romario Gordon to steal £250,000 from Heatherwood and Wexham Park Hospitals (HWP) NHS Foundation Trust. Some of the money was spent on a Porsche and a Caribbean holiday.
• False overtime payments for nearly £20,000 to Hitchin nurse Margaret Cowley who falsified work records.
• Illegal immigrant Herbert Sengati’s use of a forged passport and visas to fraudulently obtain over £116,000 in salary from Moorfields Eye Hospital where he was a porter.
• The theft of £100,000 by Brixton dentist Young Jun Suh for treating fictitious patients.

News in brief

• Clinical information leader network launched: The new EHI CCIO leaders network was launched this week by Andrew Lansley. The health secretary said it will help to bridge the gap between the IT that clinicians use in their daily lives and the IT they use at work. EHI is running a wider campaign to encourage all NHS providers to appoint a chief clinical information officer to lead on IT projects.
• £100m for clinical research: The DH has announced that over £100m will be invested in NHS clinical research. Some of the money will employ more nurses and technicians while there will also be investment in research on rare diseases.
• Alzheimer’s research shows drug benefits: Trials on nearly 300 UK patients shows that dementia drug Aricept slows the decline of patients even in the later stages of Alzheimer’s. This could double the number of patients benefiting – as its use is currently mostly restricted to those with moderate symptoms.
• Hospital consultants work weekends: The BMA wants consultants to help cut the 10% spike in mortality rates by working at weekends. The BBC says the organisation agrees with mounting evidence that the presence of more senior staff would be a vital step forward.

Blog

Welcome to the world of GP IT. Jobbing Doctor looks back to the days when computers were a novelty, and reflects of how current bureaucracy is holding practices back from achieving the best results for themselves and their patients.

‘When computerisation started in General Practice, in the early 1980s, I was keen but my senior partners thought that computers did not have a future. We started off with a commodore 64, and used it largely as a database.

‘Our practice went fully computerised nine years ago, and since then the hardware has not kept pace … Today we are getting a new server. The PCT decided on the size, speed and specification. I hope they have the future planned, as more and more will go onto the computer. We might need another new server soon. ‘In the meantime we will have two days without any computer as the new one is fitted, and the data is transferred. Today I shall sharpen my steely fountain pen, and plunge back into the 1980s, writing everything down.’

Awards

The awards season looms again and time is already running short to organise entries for some of them. The deadline for the Patient Safety Awards is 23, March – categories include Technology and IT to Improve Patient Safety and Data/Information Management. The Care Integration Awards have the same deadline – these emphasise advances in care for particular conditions such as dementia and diabetes. Entries are now being invited for the EHI Awards 2012. These have 11 categories including new ones for Outstanding Work in Imaging Informatics and Innovation in Healthcare Integration.

Highland Marketing blog

A nasty bout of norovirus prompts Sarah Bruce to reflect on the importance of cutting hospital acquired infections and the value of technology in reducing stays and readmissions.

Over the past week I have been lucky enough to be tucked up in bed, away from the once again sinking temperatures.

However, I have been unlucky enough to have contracted norovirus, a nasty bug-type virus which affects up to one million people per year and causes symptoms such as severe vomiting, stomach pains amongst others…

Having visited several hospitals over the past couple of weeks, I guess the risk of catching the bug is higher when you work in healthcare.

But catching the bug, from spending time on wards for less than an hour at a time and being laid up in bed for almost three days, has really driven home the importance of reducing readmissions and keeping people out of hospital for as long as possible in order to reduce such hospital acquired infections.

One trust recognised for stepping up its game in this area, following a prolonged outbreak of Norovirus across three months in 2007, is Royal Liverpool and Broadgreen University Hospitals NHS Trust.

The outbreak saw patients taking an extra 1,770 bed days and the trust lose about £708,000 over a three month period.

However, simply by the trust investing in cleaning standards and implementing a hydrogen peroxide mist technology, which sprays a low concentration of cleaning mist, they were able to save £650,000 within four months of implementation.

Yet another way trusts are increasingly looking to reduce the spread of hospital infection is by ensuring that patients spend as little time as possible in hospital.

Typically, patients are admitted to hospital seven days a week but only discharged during five of those days, often resulting in more patients than a trust can handle and prolonged length of stay. In addition hospitals are usually more able to predict the quantity and type of admissions but experience far more variation in patterns of patient discharge, which makes it difficult to predict how long a patient will be on the ward for. This can often be due to bottlenecks in the carepathway, for example, not knowing the exact location of a patient, their status or having the appropriate bed ready on the next ward or even the right social care service set up for when they leave hospital.

Technology seems to be providing a relatively simple solution to this in a whole range of areas.

Of course, the buzzword, tele-health – keeping patients with long-term conditions in a homecare setting rather than admitting them to hospital is key to addressing this. So it is important that the vast array of systems which can reduce length of stay, within the hospital setting, are not overlooked.

Bed management systems in particular which provide real-time decision support based on algorithms are able to aid discharge planning and patient flow. eWhiteboards systems ensure that patients are moved seamlessly across different areas of the trust quickly rather than waiting for beds (not to mention alerting staff and porters to areas that may need deep cleaning). Even clinical portals and electronic patient records, which can speed up a patient’s diagnosis and ultimately their discharge can help.

So next time I visit a hospital, I will not just be reaching for the hand sanitiser to make sure they are doing all that they can to prevent infection, but eagerly searching out those additional systems that can really make a difference.

Sarah Bruce, Communications and Digital Media Consultant

Health bill battle escalates

This week has seen clinical commissioning groups (CCG’s) take different sides as the battle over the Health and Social Care Bill escalates. Some 70 CCG leaders have backed Health Secretary Andrew Lansley and have written to The Times to say that dropping the bill would be a ‘disaster’.

The letter’s author Dr Paul Bowen, chair of Eastern Cheshire CCG, said he believed there was ‘a silent majority’ whose voices were not being heard. However, the views of CCG leaders appear at odds with those of many GPs. Tower Hamlets CCG and City and Hackney CCG have written to the PM, calling for the bill to be scrapped. They claim it has aroused deep anger among doctors. The GP committee of the BMA has expressed fears that CCGs will be dominated by profit-driven private firms which will undermine the traditional doctor-patient relationship.

An e-petition calling for a Commons debate on dropping the bill has been rejected by the House of Commons. This is despite the fact that the petition, set up by GP Dr Kailash Chand, was the largest ever on the government’s special website and attracted 162,000 supporters.

In further developments the The Royal College of Surgeons, the most notable college to back the bill, has announced that it is reconsidering its position. The Royal College of Obstetricians is also to hold an extraordinary meeting to consider its own stance.
Andrew Lansley himself has attempted to address concerns that the bill would turn the NHS into a ‘market free-for-all’. In an interview with the BBC he pulled back from his 2005 statement that ‘the first guiding principle is to maximise competition’. Mr Lansley now says he regards competition to be ‘a means to an end – not an end in itself’.

NHS must innovate – and government has to come clean on rationing

Speakers at the Nuffield Trust’s fourth health policy summit called on the NHS to look to the developing world for inspiration on doing more for less. This week’s event focuses on searching for the world’s best examples of innovation.

Among the speakers will be Dr Devy Shetty, chairman of Narayana Hrudayalaya Hospital in Bangalore, India, which Onmedica describes as ‘revolutionary’ for providing good-quality, low-cost, high-volume heart surgery to people without health insurance. The Nuffield Trust says that countries with some of the lowest GDPs are proving best at finding cheaper ways to deliver good care.

Writing for the think tank’s website Geoff Mulgan, chief executive of NESTA (National Endowment for Science Technology and the Arts), lists several areas where he thinks change is vital. These include:

• More use of ubiquitous, cheap technologies rather than costly and often over-engineered telecare and telemedicine.
• Raising productivity by learning from business making better use of the internet, call centres and intensive customer relationship management.
• Creating wider online support networks of healthcare professionals, family and friends to support older and isolated patients.
• Improve end of life care by moving away from costly hospital interventions to allow more people to have their wish to die at home.

The trust has also published a report (see podcast and summary) which calls for the government to be clear and open about what services are provided by the NHS and which must be paid for. It recommends:

• Establishing principles to shape how public money is spent in the NHS.
• A national list of the treatments that public money should not be spent on.
• Transparent decision-making by clinical commissioning groups.

Bleak outlook on hospital finances

NHS hospitals face rapidly escalating financial troubles according to a string of revelations. Among the most serious is HSJ’s (subscription required) report that Peterborough and Stamford Hospitals Foundation Trust, which has a £220m turnover, expects a loss this year of £56m. The trust has announced 300 job cuts and is having to rely on more than £47m of temporary assistance to pull it through.

Overall some two thirds of NHS hospital trusts have fallen behind (subscription required) on their savings plans in the first half of 2011-12. DH figures, released after a long Freedom of Information Act battle, show that 68% of the 72 non-foundation acute trusts missed savings targets for the first six months of its £20bn efficiency drive. Tory Commons health committee chair Stephen Dorrell fears that money intended for community services will be hijacked to plug gaps.

On a more positive note, the new £650m Royal London Hospital, Whitechapel, has opened its doors to patients. The 17-storey building replaces a series of older facilities, some dating back to the 18th century. The hospital will house more than 3,000 staff and patients and has 110 wards plus 26 operating theatres.

Older patients face daily humiliation

A major report has concluded that older patients face humiliation and degrading treatment on a daily basis. The Telegraph reports that a commission of senior NHS managers, charities and council leaders is demanding a drive for care with dignity.

More than 40 organisations were involved in the report, which says a fundamental shift is needed in the training of medical and care staff. It also says that disciplinary action should be taken against staff who patronise older people. A key recommendation is that compassion should be at the heart of care, with universities and colleges rejecting applicants who lack ‘basic warmth’.

Royal College of Nursing Chief Executive & General Secretary Dr Peter Carter said the Commission on Dignity in Care for Older People was right to focus on the leadership role of the ward sister or charge nurse, and the need to empower them to ensure the highest possible standards of patient care.

Royal College of Physicians clinical vice-president, Dr Linda Patterson, welcomed the publication of Delivering Dignity, and said: ‘In addition, the RCP recommends that hospitals provide adequate staffing with sufficient time to care for patients, including those with complex needs like dementia, and better continuity of care in acute settings and across providers, with clear accountability’.

News in brief

• Serious incident report failings condemned: Scottish Information Commissioner Kevin Dunion has criticised NHS Ayrshire and Arran for the worst failings in records, management he has ever seen. The Scottish Government has launched an investigation after accusations that the health board withheld reports on 50 serious incidents including 20 deaths.
• Child mental health cash: The NHS will invest £22m in England’s child mental health services to deliver more counselling and talking therapies. Some 10% of 5-16 year olds experience a mental health problem and it is hoped that early intervention will reduce problems in later life.
• Breast cancer trials: Small scale trials have shown promising results for the use of trastuzumab (Herceptin) and bevacizumab (Avastin) in primary non-metastatic HER2-positive inflammatory breast cancer, an aggressive form of breast cancer with a poorer prognosis. Follow up work is planned.
• Blood test: With donor supplies a major issue, EHI says NHS Blood and Transplant is trialling US software to give hospitals in England and Wales more information about their clinical use of blood.

Blog

The DH has published a new patient experience framework. Jocelyn Cornwell of the King’s Fund welcomes the development and says it draws on 20 years of the fund’s research into what matters to patients. It will, she hopes, bring a clearer understanding of the way ahead. But success takes more than a document.

‘The key to making improvements in service quality though, is to win over clinical staff, especially doctors, and encourage clinical leadership on patient experience. We believe that measures of patient experience must be aligned with clinical level data on process and outcomes; must be rigorously based on evidence (a no brainer), must be simple and must be embedded in the new quality standards from NICE.’

Latest podcasts

Where next for human to human transplants and are today’s ethical regulations getting in the way of further advances – have a listen to The Guardian Science Weekly Podcast.

Highland Marketing blog

This week Matthew Shelly looks at Science superstition and the future of health and how science has transformed healthcare, meaning a man of his age can expect an extra 30 years of life.

It was my 47^th birthday last week and the thought of being so close to the half century made me grumpy. But this Tuesday’s Richard Dimbleby Lecture, by president of the Royal Society Sir Paul Nurse, persuaded me to stop lamenting my lost youth and to be grateful. His subject was science and the contribution it makes to our lives – with much reference to medicine and health. One of his key points was that life expectancy back in 1912 was around 50 but now, thanks to many phenomenal advances, it’s around 80.

Sir Paul said it was only thanks to the NHS team which performed a quadruple bypass in January that he was still alive and able to deliver his talk. Science made this possible. It is also the only hope we have to tackle the great challenges of climate change, fossil fuel depletion, food shortages, and a rapidly growing population. In global terms there is a particular need for science to help provide for the growing numbers of people with long-term and chronic conditions, and to ensure that older people get support to lead fuller and healthier lives.

Something that particularly worries me is that it has become acceptable in some quarters to attack science and scientific endeavour – this is astonishingly dangerous. During my PhD research, which was in underwater archaeology, I helped with the excavation of sites from the largely pre-scientific past. To be several metres below the surface of a Scottish loch and handle an artefact which last felt the warmth of a human hand 500 years ago was thrilling. It was also alarming as I was also able to read contemporary accounts of the lives, and deaths, of people from these communities. The rich fared better than the poor, but there was little to envy. Many children died before their first birthday and adults were carried off in their prime by illnesses and injuries which now cause little concern. Indeed, their fates were sometimes sealed by treatments based on tradition and superstition.

It is science and effective research which allowed us to escape the miserable lot of our ancestors and the NHS which ensures (on the whole) that care is distributed to everyone  regardless of wealth or status. But one of the big questions we face is how to ensure that science and healthcare can deliver for the future.

Sir Paul addressed this very issue, pointing to the potential of life sciences and of stem cell research. He stressed that it is essential to understand genetics and their influence on illness, and their interaction with lifestyle and diet. Progress, he believes, can be achieved through an effective partnership between publicly funded science, the NHS and industry. The benefits would not just be for our health, but also to the economy. His ultimate vision is for an NHS which takes full advantage of being a genuinely national service, to become a ‘healthcare producer’ as well as a provider.

Properly resourced and organised, this could provide the NHS with an exciting future and encourage closer, stronger links between scientists and the rest of society. In the meantime I’ll try to be properly grateful for everything that science and the NHS has given me, and the many extra years of life they gave my father. Oh, and even though I’m scared of needles, I’m really, really grateful that GPs have stopped using leeches.

Matthew Shelley, Writer and Communications Consultant

Care quality chief quits

Cynthia Bower, head of the Care Quality Commission (CQC), which checks hospital standards in England, will quit after a highly critical government review. The CQC and Ms Bower have been under intense fire during the public inquiry into failings at the Mid Staffordshire Foundation Trust – where patients were allegedly neglected (subscription required) in the rush to cut costs and meet targets.

The report makes 23 recommendations for change. HSJ (subscription required) says the DH acknowledges considerable achievements by the CQC but says it ‘underestimated’ the challenge of registering 21,000 care providers and has failed to be clear about its role.

Pulse claims that the CQC was running over budget and that its approach to regulation may have forced care providers, including dental practices, to close. The CQC was also accused of failing to act when the BBC’s Panorama programme raised concerns about the Winterbourne View care home. Three people who worked at the home admitted ill-treatment of residents but eight cases are still to be heard.

Ms Bower, who will leave in the autumn, said: “I am pleased that the review recognises the scale of what has been achieved … I’m confident that CQC will continue to build on the progress already made, delivering increasing benefits to people who use services by shining a light on poor care.”

Government attempts health bill fight back

The government has attempted to regain the political initiative in the long battle to get the Health and Social Care Bill through parliament. The DH is promoting a series of fact sheets, which attempt to explain its benefits. The prime minister tried to change the mood by hosting a summit at Number 10 of organisations which were either neutral or broadly supportive of the bill.

Shortly after the meeting, intended to discuss implementation of the bill, one of the groups attending, the Royal College of Paediatrics and Child Health (RCPCH), called for it to be abandoned. The Royal College of Physicians, also in attendance, expressed far-reaching concerns of its own – with some members angry that their leaders had even been there. Members of the Royal College of Radiologists added their voice by voting for the withdrawal of the bill at an extraordinary general meeting.

Further troubles loom as Lib Dem opponents of the bill have tabled an emergency motion for it to be debated at the party’s spring conference. It was a backlash against the bill at last year’s event which led to the long ‘pause’ during which hundreds of minor amendments were made.

Dame Fiona Caldicott to lead patient confidentiality review

Dame Fiona Caldicott has agreed to lead an independent review of the balance between protecting patient information and its sharing, to improve patient care the Department of Health has announced.

Dame Caldicott will be calling on an expert panel made up of clinical, social care, research and other professionals, as well as patients and service users to determine the scope and priorities for the review. The review is expected to be published in 2012 and the government expects to respond following its publication.

Emergency 111 worries and ghost patient payments

NHS Direct and the BMA have severe misgivings over the new 111 phone service for patients with serious but not life-threatening illnesses. The BMA supports the principle behind NHS 111 but is concerned that its roll out is being rushed and may put existing services under strain. It has asked that the delivery deadline be relaxed. According to the BBC the government will consider BMA concerns.

Nick Chapman, chief executive of NHS Direct, which is leading work in four of the seven 111 pilot sites, said the new service has potential but expressed worries. These are largely because more patients tend to be referred for face-to-face care than under previous arrangements – potentially putting GP and A&E under pressure.

Meanwhile, GP funding has come under the spotlight with claims that England’s doctors are earning £162m from 2.5 million ‘ghost patients’. The Daily Mail claims that an audit showed that dead patients, including some who passed on 30 years ago, remained on lists – attracting annual practice payments of £64.49 each. Many patients who had moved, or left the country, were still on lists. GP online says doctors have questioned the Audit Commission figures.

Apps on prescription

Healthcare apps could soon be prescribed by GPs to help patients manage their conditions. The greater use of smartphones is being seen by the DH as the ‘next step’ in giving patients more control over their own health.

Further details of how this will work will be in the government’s Information Strategy expected this spring. One advantage of apps on prescription is that it could potentially reduce the costs for many people.

The apps by prescription announcement was made as part of the ‘maps and apps’ competition, to seek out new ideas in smartphone healthcare. The competition attracted 500 entries. Some 12,600 votes were cast on which ideas were best. The most popular were apps to:

• help manage long-term conditions such as diabetes
• help deal with post-traumatic stress
• track and monitor conditions such as high blood pressure
• help people find NHS services on a map
  get practical information about keeping fit and eating healthily.

The government has also launched the Cloudstore app store to help SMEs offer IT services to the public sector. It will feature 1,700 apps from over 250 suppliers, many of them smaller companies, and is hoped to be a source of substantial savings.

NHS staffing – the ups and downs

Nurse numbers have fallen by 1.3% in the past year while the figure for senior managers is down 8.7%. HSJ reports on data from the NHS Information Centre which shows that in the year to November 2011 there was a decline in qualified nurses from 281,836 to 278,140.

There are now around 10,786 senior managers, down from 11,816. At the same time there has been a 2.9% rise in the number of midwives working full-time equivalent, from 20,428 to 21,028 in November 2011. Health visitors, though, are down 1%.

The number of doctors, including locums, has gone up from 100,204 to 101,668 – a rise of 1.5% across England. Overall, there were 1,193,344 NHS staff working full or part-time in November 2011, down 24,370 (2%) on November 2010 (1,217,714).

News in brief

• Microsoft announces joint company details: Microsoft and GE Healthcare have announced details of their new joint company, Caradigm. According to EHI Caradigm will develop and market an open, interoperable technology platform and collaborative clinical applications focused on enabling better population health management.
• New Millennium: Cerner used the HIMMS12 event in Las Vegas to launch Millennium+ which EHI says will integrate cloud-based services and mobile applications.
• Welsh health record goes live: The Welsh Individual Health Record (IHR) is now up and running, with 300 GP practices making summary care records for two million patients available to emergency care providers.
• Gene therapy progress: The newly published Gene Therapy Advisory Committee (GTAC) annual report shows that in 2010 it considered seven applications for clinical trials (four for cancer) and looks at what it has done to adapt to reduce bureaucracy and create a more streamlined research sector.
• Twitter founder gives keynote on healthcare: Twitter Founder, Biz Stone gave the keynote address at HIMSS this week and claiming that the world needs social tools to make sense of ‘infinite information’ and to transform information into understanding and action.
• GP software incentive scheme pulled: TPP has pulled its offer to give GPs M&S vouchers and tea at the Ritz for hosting SystmOne software demonstrations. Pulse says the new assurances follow a revelation that the practice had been resumed, even though the DH had been told it had stopped.

Blogs and opinion

Chris Ham head of the King’s Fund argues that inertia rather than privatisation is the greatest threat to the NHS. He outlines three areas which he regards as essential for progress.

‘First, NHS leaders must be ruthless in identifying and copying best practice wherever it exists. After all, much innovation is really adaptation of ideas initiated elsewhere, and shameless plagiarism is an underrated virtue.

‘Second, leaders must create time to look outside their organisations, while also attending to operational imperatives.

‘Third, there is a need to invest in the training and development of staff to enable continuous improvements in patient care. High-performing health care organisations do this systematically and are rightly admired for the results they achieve.

‘The most effective response to concerns that the core values of the NHS are under threat is to show it can adapt rapidly. If NHS organisations demonstrate that they can deliver high-quality and responsive care, they have nothing to fear from choice and competition.’

Alan Milburn, the former Labour minister recently tipped as a possible recruit to the Cameron government to replace Andrew Lansley as health secretary, has written a detailed article for the New Statesman giving his views of the future of the NHS.

‘In the next decade and beyond, governments will need to think of themselves less as big spenders when it comes to health care and more as switch spenders, where resources are switched from less optimum services to others that produce better outcomes for lower costs. That will entail resources being switched from hospitals to community services and from treatment to prevention. And it will demand driving forward reforms that empower patients, financially incentivise outcomes, increase competition, improve transparency and devolve accountability to local care organisations.’

Highland Marketing blog

This week Mark Venables reports back from the HIMSS12 event in Las Vegas.

It’s my third year attending HIMSS and each year the conference, aimed specifically at the healthcare IT and technology industry, appears more vast. This year, numbers were up again, with more than 39,000 delegates descending on the Venetian Sands Expo Centre, approximately 35 times more attendees than even the biggest health IT conferences in the UK.

Perhaps the slightly more exciting location of Las Vegas drew the crowds in this year, although more likely, it is the continued hype around ‘Meaningful Use’, the US government’s initiative that sees billions of dollars promised to doctors and hospitals to buy and start using electronic medical records (EMR).

Although only around $1 billion was paid out under Meaningful Use in its first year, one of the key themes dominating the conference was the details of the stage two criteria – the criteria the government says must be met to achieve incentive payments.

Perhaps the incentives are something that the UK should consider in order to encourage clinicians to more actively use EMRs. In the US the number of hospitals using EMRs has more than doubled in the last two years, from 16% in 2009 to 35% in 2011.

The talk of Meaningful Use and the Health Information Technology for Economic and Clinical Health Act (HITECH) certainly ensured that there was a sense of the market being alive and business being done at the conference.

But equally as prominent was the theme of innovating to provide healthcare in new, cheaper and more efficient ways.

In tandem with the headlines that have hit the UK this week around the potential for doctors to prescribe medical apps to patients, the buzz around applications and the mobile revolution resounded throughout the conference, with an iPad or a smartphone on virtually every stand.

Yet few had answers to some of the challenges that such devices raise in the healthcare environment such as infection control, privacy and security requirements as well as how to ensure apps were not just a fad.

Dr Wasden, managing director of Pricewaterhouse Coopers said in his session that 26% of apps are only used once and 42% are used only to find health information.

Of course the challenge of mobile working and applications extended onto the theme of the use of the cloud in the healthcare environment. Over the years people have been sceptical of the clouds use in healthcare but it appears that organisations are beginning to adapt to the cloud in order to speed up efficiencies and help manage a growing wealth of information.

One particular area that seemed to have its head firmly in the cloud was that of medical imaging and its ability to help deliver improved real-time access to medical images anywhere and on any device.

With several more healthcare IT conferences in the UK than ever before this year, it will be interesting to see whether the themes in the UK resonate with those in the US, or whether they are just one step ahead.

Mark Venables, CEO Highland Marketing

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.