Mark DaviesGuest blog

As the NHS gets serious about shifting attention from illness to wellness, Dr Mark Davies, medical director at MedeAnalytics, details why new plans must focus on individuals rather than organisations.

News in brief

NHS trusts ranked on learning from mistakes: Health trusts in England have been ranked by their ability to learn from mistakes, as part of several changes designed to improve patient safety, reported the BBC. The “learning from mistakes league” rates 120 trusts outstanding or good, 78 with “significant concerns” and 32 with a “poor reporting culture”. The first annual “learning from mistakes league” uses feedback from staff on their freedom to speak when things go wrong. Health secretary Jeremy Hunt, who hosted a “global patient safety summit” in London said the changes were a step towards a “new era of openness”. He said health services must “unshackle ourselves from a quick-fix blame culture and acknowledge that sometimes bad mistakes can be made by good people”. Peter Walsh, chief executive of patient safety charity Action Against Medical Accidents, welcomed the initiatives but said he remained concerned about the “woeful inconsistency and often inadequate quality of NHS investigations into serious incidents”. He said there was “nothing” in Hunt’s announcement to reassure his organisation that urgent action would be taken to address the quality of local investigations. James Titcombe, whose son Joshua died after failings in care, said the measures were “major steps that will help move the NHS towards the kind of true learning culture that other high-risk industries take for granted”.

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NHS England has pledged to spend £55m on making all GP referrals electronic by 2018: Currently just 50% of GP referrals are electronic, however NHS England has launched a drive to push this up to 60% by September this year, 80% by 2017 and 100% by 2018, reported GPOnline. However GP leaders warned that plans for patients to leave consultations with a booked appointment in their diary could be undeliverable within a 10-minute consultation. The £55m cash set aside to incentivise the switch to electronic referrals will come from “quality premium” cash that clinical commissioning groups (CCGs) can earn for hitting NHS quality targets. Details of how practices can earn the cash have yet to be revealed, but huge sums in quality premium funding have been unclaimed by CCGs across England in recent years. NHS officials said the electronic referral scheme aims to “end hospital referrals by second class post”, and set out plans to “consult on a proposal that by 2018 NHS commissioners and providers will no longer be paid for referrals made by paper”. NHS England director of digital technology Beverley Bryant said: “For a long time our first class healthcare system has been let down by outmoded systems, where patients are referred to hospital by second class post. We have a duty of care that extends beyond providing effective treatments. We must also provide an effective patient experience that ensures patients feel reassured at a time when they are most vulnerable.”

Scottish Government’s leadership of their own NHS reforms questioned by damning report: The lack of leadership provided by the Scottish Government to realise its own vision for the future of the NHS has been exposed in a stinging report. Audit Scotland, the nation’s official public spending watchdog, said the government had not explained how it expected its grand plan to be delivered and its cost implications remained “unknown”, reported the Herald Scotland. The watchdog warned the overarching aim of caring for the frail better in the community to help keep them out of hospital “is not happening fast enough to meet the growing need”. Real terms decreases in NHS spending over the last five years and on-going cuts to council budgets “pose risks” to making progress with this aim, according to the report which noted the number of over 75s in Scotland will soon be growing by 16,000 every year. Even the Scottish Government’s much trumpeted policy of merging NHS and council social care budgets under new care partnerships appears to be off to a shaky start. With just weeks to go before the new authorities take control of millions of pounds the report said they are struggling to agree how much money they have to spend. Caroline Gardner, Auditor General, said: “An ambitious vision can be a catalyst for change but, without a clear and detailed plan of action, there’s a risk that ambition is overtaken by circumstances. The Scottish Government must produce comprehensive long-term plans for realising its 2020 Vision.”

A&E suffers “worst ever month”: A&E delays in England have reached record levels, official figures show, reported the BBC. The data for January from NHS England showed 88.7% of patients were dealt with in four hours against a target of 95%, the worst monthly performance since the target came into force in 2004. NHS England blamed rising demand, with overall attendances up by more than 10% compared with the same time last year. There was also a sharp rise in emergency admissions and calls to NHS 111. Other parts of the UK were also struggling with Scotland, Wales and Northern Ireland missing the A&E target. The monthly performance publication showed the NHS was struggling in other areas including NHS 111 failing to hit its target to answer calls within 60 seconds and the key cancer target for patients to start their treatment within 62 days of an urgent referral from GP was missed for the 20th time in 21 months. Delays in discharging patients continued to be a problem with 160,000 days of delays being reported in January – the second highest on record. The result is a backlog of patients which has a knock-on effect in A&E. Richard Barker, from NHS England, said: “Against this backdrop it’s not surprising hospitals saw a dip in their performance and it is credit to all those working in emergency care that we are still admitting, treating and discharging almost nine in 10 patients within four hours. Winter pressures have come late this year with a sustained cold period and an increase in seasonal infections.”

Health Secretary unveils plans for safer 7-day dementia service: Health secretary Jeremy Hunt has published the dementia implementation plan which will empower people with dementia through improved care and transparency, reported For the first time the dementia implementation plan will make sure that dementia sufferers and their families will benefit from greater transparency and will be able to compare the quality of dementia care in their local area. The Care Quality Commission will include standards of dementia care in their inspections to make sure services are safer for people with dementia seven days a week and every person with dementia will receive a personalised care plan. NHS Health Checks will include awareness raising, education and discussion of risk reduction for dementia for people aged 40 or older. This is currently only available for over 65s. Under new plans all patients in high dependency care will be seen and reviewed by a consultant twice a day, every day of the week by 2020 and if clinically appropriate, all patients, including those with dementia, will be reviewed by a consultant ward round once a day, every day of the week by 2020. Health secretary Jeremy Hunt, said: “A dementia diagnosis can bring fear and heartache, but I want Britain to be the best place in the world to live well with dementia. Last Parliament we made massive strides on diagnosis rates and research – the global race is now on to find a cure for dementia and I want the UK to win it.”

DH and NHS given until end of year to set out strategy for tackling GP crisis: The government must set out plans to tackle the GP crisis by the end of the year, the Public Accounts Committee (PAC) has said in a new report which found that the staffing gap is creating increasing difficulties for patients accessing care. In its new report, the PAC reiterated that more GPs are leaving the profession and not enough are being recruited, and that access to GP appointments is uneven, with patients who are young, from a minority ethnic group or living in a less affluent area less likely to be able to make an appointment, reported National Health Executive. It said the Department of Health and the NHS must set out plans to reduce the number of GPs leaving the profession, how they aim to attract more GPs to return to practice, and establish the best incentives for attracting new recruits to general practice. The influential group of MPs want the organisations to report back on their progress meeting these targets and fulfilling their goal of 5,000 more GPs by 2020 in December 2016. Meg Hillier MP, chair of the PAC, said: “There is a looming crisis in general practice. For too long staffing levels have failed to keep pace with the growth in demand and too little has been done to close the gap. Experienced GPs are quitting while training places go unfilled; there are alarming variations in the experience of different groups of patients, and in some cases even basic information is hard to find – piling additional pressure on other parts of the health service. These are serious problems requiring serious solutions.”

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System C and IMMJ Systems team up to provide an integrated electronic document management solution to Medway: System C and IMMJ Systems have teamed up to provide full integration of the MediViewer EDM with Medway EPR reported The MediViewer EDM solution is built by IMMJ Systems specifically for UK healthcare and aims to deliver a paperless NHS. Its primary goal is to enable hospitals to scan, index, retrieve and archive paper medical records and access them quickly through an intuitive user interface. Under the new partnership agreement, the two systems are being very tightly integrated, using intelligent software to achieve the most secure and efficient level of inter-operation possible. The integration will enable Medway users to launch the EDM solution from within Medway and access any patient-related documentation from multiple sources. This means that a clinician can view documents for any patient on an outpatient list, for example, without having to log onto a separate system or select the patient manually. Any notes or letters generated within Medway are posted to the EDM solution automatically. “We are working with our clients on a massive drive to remove paper and for hospitals EDMS provides a huge and proven opportunity to increase efficiency and save money,” said Markus Bolton, joint CEO of System C. “One of our trusts achieved savings of £1m a year on moving and storing paper notes and we want to help all of our sites go paperless in this way,” he added.

IMS MAXIMS creates new board position: Experienced communications expert, Natalie Bateman, has joined IMS MAXIMS as its policy and communications director in a newly created board position, reported Building Better Healthcare. Strengthening the company’s senior management team, Bateman will be responsible for raising the profile of IMS MAXIMS and its products among stakeholders, including strengthening its proposition for influencing policy development. She joins from technology membership body, techUK, where she spearheaded two of its public sector programmes – Health and Social Care and Local Government – for over two years. During her time there she championed the use of technology and data in the NHS to various stakeholders and helped launch the interoperability charter, which called for international standards to help integrate health and social care ICT systems. “I am excited about being part of the IMS MAXIMS journey to continue to push the boundaries of digital healthcare for the benefit of patients, service providers and the nation as a whole,” she said. Shane Tickell, chief executive of IMS MAXIMS, said: “Natalie has a well-respected profile within the industry, a significant network of contacts and in-depth experience in healthcare communications. I have been impressed with her achievements at techUK and look forward to seeing her strengthen our communications drive.”

Norfolk looks to procure “joined-up” social care system: Norfolk County Council is looking to procure and implement a joined-up social care information system to enable a more integrated approach comprising of a wider picture of families, the transition from children to adults, more complete contract details and forecasting, reported Government Computing. The introduction of the new system will form the platform on which, the county council hopes, savings and integration can be developed with Norfolk’s partner agencies, and on which service improvements can be delivered for more than 3,000 system users. The council’s stated priorities for the project indicate that “integration with health and other partners is key, reflecting our integrated commissioning and delivery in adults, including direct working together under section 75, and the new locality-based multi-agency hub approach in children’s.” Norfolk said its strategic ICT information management architecture requires integration of the social care system with identity management, the local “information hub”, records management, customer relationship management, portals, and a “granular access control model” to support the council’s corporate programme and exploit wider benefits. The pre-tender note said, “We are therefore looking to work with a supplier who has the capability to deliver to this agenda, respond to government and legislative changes and develop the product innovatively. Suppliers are invited to contact for a discussion.”

Wellcome Trust issues new data sharing report: The Wellcome Trust has returned to the debate about the use of health data with a report that finds hostility to sharing information with insurers and marketers and a need for companies and researchers to show ‘public benefit’ for this to be acceptable, reported The latest, lengthy, report from the Wellcome Trust acknowledged that around 20% of the population will not want their health data shared in any circumstances, and that they should be opt-outs in place that respect this. Otherwise, the report, which is based on an Ipsos Mori poll of 2,000 people and six workshops that explored different data sharing scenarios with 200 participants, said attitudes to data sharing vary according to the amount of public benefit that people think will arise. It recommended that there is a need for public education, so people are “in a better position to understand the real risks or benefits of data sharing”. Nicola Perrin, the head of policy at the Wellcome Trust, admitted that had left a “toxic legacy”. She said: “The research showed that in order for people to support this system they need – and want – to know much more about it, and that there must be an opportunity for them to opt-out. We must make sure there are no surprises for people about how their data could be used, especially by commercial organisations, and to do this it is critical that the government, the NHS and researchers work together to communicate and engage the public.”

HSCIC develops Raspberry Pi telehealth kit: The Health and Social Care Information Centre (HSCIC) has created a telehealth prototype on a Raspberry Pi, called MediPi. The aim is to pilot the kit next financial year. Both software and hardware are open source, reported Computer Weekly. The MediPi project aims to address one of the reasons why telehealth uptake in the NHS remains relatively slow: Affordability. The Whole Systems Demonstrator (WSD) programme – which the Department of Health set up to find evidence supporting the use of telehealth – released its report in 2013, saying that telehealth was not cost-effective. The research found that adding conventional telehealth measures to usual care would cost £92,000 per quality-adjusted life year and was unlikely to ever be cost-effective. However, the HSCIC may have come up with an answer to that. The MediPi system uses a Raspberry Pi, a 7in touchscreen tablet and a set of equipment such as a blood pressure cuff, a finger oximeter and some diagnostic scales, all off-the shelf products coming in at a total of £250. Richard Robinson, a technical integration specialist at the HSCIC said: “The cost for telehealth is crazy when you think about it. Devices like Raspberry Pis are being churned out at £32, so I thought I could definitely do it cheaper.” Robinson developed the prototype, which has a simple interface using a tile dashboard for easy interaction. Each tile represents a device, such as the blood pressure cuff, and also has a quick “yes” or “no” questionnaire for patients to fill out.

Ipswich battles winter pressures with BI tool: A winter pressures business intelligence tool developed at Ipswich Hospital with MedeAnalytics is providing an early warning system for capacity shortfalls and enabling the trust to develop alternative provision. The Ipswich Hospital NHS Trust has used the solution to analyse previous winters’ demand and then forecast its bed use this winter – highlighting a potential shortfall of 45 beds this February and March. Nick Hulme, chief executive of Ipswich Hospital, said the ability to analyse previous winters’ data and to pinpoint patient cohorts at risk of emergency admission had helped the trust plan for this winter. A hard evidence base had mobilised clinicians around a “Gearing up for Winter” campaign across the hospital. He told “Everybody says it is the frail elderly, but when we started to break the data down and look in detail at the admissions and length of stay, we found it was respiratory admissions that peaked in winter.” By developing a bed-modelling tool within MedeAnalytics, the trust was able to predict the shortfall of 45 beds at times of peak demand this winter and to develop alternative provision for at risk patients, including a frail elderly assessment unit and a community-based crisis action team. Hulme said: “The main advantage is that we now have real time information. Everybody in the organisation can go to a desktop computer and analyse what is going on. We can look back and learn for the future as well as know on a day-to-day basis how many patients are likely to be coming in so that we can match resource to demand. It has given us confidence to know that the decisions we are making are based on fact, not anecdote.”

Separating mental and physical health care ‘no longer affordable’ – King’s Fund: Treating mental and physical health problems separately costs the NHS £11bn a year and is “no longer affordable”, The King’s Fund has warned. In a new report, the think tank said integrating physical and mental health is necessary because of the high rate of mental illness amongst people with long-term health conditions, poor management of medically unexplained symptoms and reduced life expectancy among people with severe forms of mental illness. It also stated that there is limited support for wider psychological aspects of physical health and illness, reported National Health Executive. This lack of co-ordination is associated with problems such as increased service costs, health outcome inequalities and ineffective care, costing NHS England more than £11bn annually, The King’s Fund stated. Chris Naylor, senior fellow at The King’s Fund, said: “Traditionally physical and mental health have operated as distinct, separate systems in terms of both treatment and funding. That is no longer affordable financially or acceptable clinically. The government has set the goal of parity of esteem, meaning that mental health care should be “as good as” physical health care. We argue that there is an even greater prize at stake – that mental health care should be delivered “as part of” an integrated approach to health.”

Sheffield Hospitals links £12m shortfall to CSC Lorenzo EPR: Challenges with booking and reporting patient activity following the implementation of Lorenzo at Sheffield Teaching Hospitals NHS Foundation Trust are contributing to major activity under-performance, which has cost the organisation £12m to date, reported Sheffield Teaching Hospitals went live with CSC’s electronic patient record (EPR) in September last year. An integrated performance report, dated February 2016, said the trust’s major activity under-performance has continued to grow over recent months and now stands at £11.9m. This is largely due to elective activity, out-patients, critical care and a larger than expected deduction for emergency readmissions within 30 days; and the report indicated that at least some of this is because of problems with technology. “There are still data issues following the implementation of the new Lorenzo (patient administration system) towards the end of September which are creating challenges in reporting complete and accurate income figures,” the report said. “However, it is clear that the bigger issue is the operational impact of the new system on booking and scheduling processes, particularly in outpatient services.” The report said that some administrative tasks around outpatient booking have been more time consuming on the new EPR and that Lorenzo experts are visiting outpatient areas to “assess the issues and recommend changes to processes where appropriate”.

Ray takes up HSCIC director of data science role: Informatics specialist Daniel Ray will be the new director of data science at the Health and Social Care Information Centre (HSCIC), reported He will join the HSCIC on 14 March and head up a new Centre of Excellence for Big Data and Data Science. The idea for the Centre of Excellence was proposed under the government’s Data Science Programme, designed to catalyse the use of data science in government policy-making and service delivery. In early 2015, government departments were asked to produce action plans and the HSCIC, together with the Department of Health and the Cabinet Office, proposed the new centre as part of this work. Ray recently left his position as director of informatics at University Hospitals Birmingham NHS Foundation Trust, where he co-founded the university’s Quality and Outcomes Research Unit. He was in the role for nine years and has worked in the NHS for 17. He is also an honorary professor at the FARR Institute of Health Informatics Research, and was chair of the Health CIO Network from 2014-15. Ray said the new role will involve “further unlocking national health datasets to help underpin evidence based policy making, along with being able to create an enabling secure environment to catapult world class research on the unique data holding the NHS generates.”



Another view: of IT check-ups
GP Neil Paul has been carrying out IT health-checks for local practices; and has discovered that many are struggling with the basics. He argues that GP federations should employ their own IT staff to help staff find the tools they need, and to train them to use them effectively.

“I’m going to be brutal here: in my experience, most staff in a GP practice aren’t the most computer literate. They are ok as users; but they don’t see possibilities or show much willingness to experiment with what systems can do.

“I don’t think that many of the more senior managers in practice are any better. Indeed, while many of my younger partners are found on Facebook and internet forums, they still don’t really get IT. This means that, while primary care IT might be miles ahead of hospital IT, it is stagnating because of a lack of investment in training and in managers who know what is possible and how to deliver it.

“To prove or disprove this theory, we have been doing some in-depth IT health-checks for the practices within the two local GP federations that we have been setting up locally.

“As far as we know, we have done these at a much greater level than anyone else has done previously. We have tried to understand the use of IT, the level of knowledge, the things that go well and the things that could be done better – with a view to finding solutions and sharing best practice.

“We are learning from each practice that we do and we will need to go round again, possibly a few times, because it is amazing how different two practices can be when it comes to doing the same thing.

“The whole health-check process has been very worthwhile. We have come up with three or four amazing ideas from listening to our practices that could change the face of primary care IT; if we can get them implemented.

“There is clearly a huge training challenge if practices are going to get the best out of their software. Lots of the big companies charge a fortune for daily training. Employing in-house trainers has got to be the way to go.”

Health and care integration will not happen unless budgets are pooled
In England, successful integration is only found in local initiatives that focus on specific areas of care or patient groups, writes David Roots, executive director of health and social care at Civica.

“The desire to see integrated heathcare and social care services is broadly shared by care professionals, government bodies and special interest groups. But in England, successful integration is only found in local initiatives that focus on specific areas of care or patient groups. These successes are driven by joint working between local authorities and health trusts, plus third-sector organisations, and are to be commended; not least because they have generally been achieved despite national funding mechanisms working against them.

“There are a number of major obstacles to full integration: differences in pay scales between the NHS and local authorities would force costs upwards and healthcare budget deficits would create further pressures on, and likely damage, local authority services.

“Frontline clinical information leaders across the NHS made the Newcastle declaration, calling for a change in information sharing between different electronic systems. Lack of access to service user and staff records, and incompatibility of systems across different services, is a barrier to joint working, so better information sharing is key in integrating health and social care.

“Different funding streams are a hindrance to integrating health and care services – and recognition of this fact must lead to actions that bring the different streams together.”

Hospitals and airlines – on the same safety journey
In the august London-clubland surroundings of the Royal Society and Lancaster House, a high-level conference has taken place this week, writes BBC Health Editor, Hugh Pym.

“The patient safety conference was the first such global meeting of its kind led by ministers. At the centre of the discussions was a striking figure – there are apparently one million deaths every year around the world caused by medical mistakes. Health Secretary Jeremy Hunt, who co-hosted the conference with his German counterpart, said the figure for such avoidable deaths in England was about 750 a week. “We need,” he told the conference, “to ask what is blocking the development of the supportive, learning culture we need to make our hospitals as safe as they should be”.

“New measures were unveiled by the secretary of state to try to achieve this shift, including tougher legal protection for NHS whistleblowers, and staff participating in internal trust investigations and enquiries on safety incidents mounted by external agencies. The airline industry is widely quoted in this context. A crash in the 1970s which left 10 dead was blamed on the pilot failing to notice that his plane was dangerously low on fuel. But at the time, he was dealing with another potentially lethal problem with the landing gear. Colleagues either had not noticed or for whatever reason did not tell him about the fuel issue. The lesson was that there had to be much more open discussion, with the most junior team members encouraged to speak up.

“Airlines have transformed safety training and reduced accidents. Now there is a push to take health in the same direction. The newly-announced policies include a health-safety investigation agency following the precedent of the Air Accident Investigation Branch. A crucial part of its brief will be to hold “no-blame” investigations. That is where the legal protection aspect is so important. Staff will know they can speak frankly about hospital incidents without fear of their evidence being used against them. Openness about safety and rectifying mistakes must be embedded in everyday working.

“Mr Hunt has made transparency and honesty over safety in the NHS one of his mantras.

“It is his chosen agenda rather than the growing pressures on A&E and other declining performance issues also highlighted this week. The patient safety conference and pronouncements will ultimately have to be judged against outcomes.”

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