News in brief 

Companies supplying NHS could cost £1bn a year in fraud: The former head of fraud detection in the NHS has said the healthcare system could be losing as much as £1bn a year from fraud while procuring services, often from private companies, reported The Independent. Jim Gee, the former director of counter-fraud services for the Department of Health and chief executive of the NHS Counter-Fraud Service, said the health service was missing out on huge potential savings by cutting the budget for research and investigations into the problem. His report highlights how NHS Protect, the national fraud prevention and investigation body, has had its budget cut by about 30% since 2006 and now employs only 27 expert investigators. He also accused the government of cutting back on fraud measurement exercises, meaning it now had little idea of how much it was actually losing. The most common scams in NHS procurement fraud are where a company fails to deliver the goods and services it has been paid for, or overcharges for them. The most common involve “high-volume, low-value” transactions which can go undetected for long periods, but bigger attacks are not unknown. Gee, who is now a healthcare investigator at PKF, said: “Fraud is one of the last great unreduced healthcare costs. Putting money into it makes absolute sense. It is one of the least painful ways of cutting costs, before you cut the quality, or extent, of patient services.” 

Vanguard NHS trusts face Monitor probe over financial or governance problems: A directory of organisations published by financial watchdog Monitor has revealed that 17 foundation trusts involved in vanguard schemes are rated at “high risk” of becoming financially unviable or are being investigated for governance problems, reported GP Online. The directory has given 12 trusts a “red” governance rating – indicating that Monitor has concerns about how the organisation is being run, and is taking enforcement action. Two of these organisations also have the highest possible risk rating for continuity of care – meaning Monitor is concerned the trust could ‘fail to carry on as a going concern’ because of its financial situation. A further three foundation trusts in vanguard schemes are “under review”, and two others have no governance concerns but are in the highest risk category for their financial situation and threat to continuity of care. NHS England new care models programme director, Samantha Jones said: “We are working closely with all of the organisations involved in the vanguard programme and providing them with support to make the ambitious changes they have each outlined.”

Healthcare industry 200% more likely to encounter data theft than other sectors: An analysis of security in the healthcare industry by Raytheon and Websense has revealed the sector is at serious risk of attack by data thieves keen to exploit how modern medical care is delivered through a complex network of IT systems, reported Government Computing. The systems, which link patients, doctors, nurses, pharmacists, technicians, administrators and accountants with electronic health records (EHR), connected medical devices and insurance companies risks creating a landscape that is ripe for security attacks. Driven by the desire to improve patient outcomes and lower costs, the rush to embrace digital technology has created a complex network of connected devices, systems and entities where security may be an “underfunded afterthought”. The analysis suggests that valuable data is being targeted for theft by advanced malware because healthcare records contain information which is up to ten times more valuable on the black market. The report found that the healthcare industry suffers 340% more security incidents and attacks than the average industry, and is more than 200% more likely to encounter data theft.

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Celts agree IT alliance: NHS Wales and NHS Scotland have agreed an alliance to share technology developments and expertise, reported NHS Wales already uses an electronic messaging system developed in Scotland called SCI Gateway. This manages electronic referrals and discharges and cross-border exchange of patient information. Northern Ireland also uses the Scottish system for referrals and is expected to join the Wales/Scotland collaborative shortly. The agreement has created a service management board with representatives from Wales and Scotland, which will agree shared objectives. NHS Wales informatics service director, Andrew Griffiths, said: “This collaboration will ensure that we can work together to deliver services effectively to benefit the member countries, with new opportunities to be gained from shared innovation.”

Cambridge put in special measures: Cambridge University Hospitals NHS Foundation Trust has been put into special measures by Monitor, which says the trust’s e-hospital programme has caused “significant cost increases” reported The Care Quality Commissioner’s chief inspector of hospitals, Professor Sir Mike Richards, recommended the intervention following the publication of an inspection report, which highlights serious safety and quality issues at the trust, including several related to the introduction of its ten year, £200m eHospital programme. Monitor announced this week that it has responded by deciding to put the trust in special measures. The regulatory body for foundation trusts in England said Cambridge is predicting at least a £64m deficit this year, due to an average overspend of £1.2m a week. Monitor’s own investigation into the trust’s finances has concluded that the trust lacks the adequate financial control it requires. “The trust also underestimated the scale and challenges of implementing its new electronic patient record system, eHospital, and the impact this would have on its provision of healthcare for its patients,” a statement from the regulatory body says. The news comes a week after the Cambridge University Hospitals’ chief executive Dr Keith McNeil resigned his post, referencing the trust’s “growing financial deficit”, which stood at £20.6m at the end of July.

NHS-approved apps found ‘leaking’ ID data: Many NHS-accredited smartphone health apps leak data that could be used for ID theft and fraud, a study has found. The apps are included in NHS England’s Health Apps Library, which tests programs to ensure they meet standards of clinical and data safety, reported the BBC. However, the study by researchers in London discovered that, despite the vetting, some apps flouted privacy standards and sent data without encrypting it. The apps that leaked the most data have now been removed from the library. “If we were talking about health apps generally in the wider world, then what we found would not be surprising,” said Kit Huckvale, a PhD student at Imperial College London, who co-wrote the study. But given that the apps the study looked at were supposed to have been vetted and approved, finding that most of them did a poor job of protecting data was a surprise, he added. delayed by two years: Final approval for the ‘pathfinder’ stage of the controversial programme to go ahead will not be given until early next year, reported This means the patient data collection scheme will be delayed by at least two years after the patient information campaign was first launched in early 2014. A number of issues need to be addressed by NHS England and final authorisation for patient data to be collected now sits with national data guardian for health and care, Dame Fiona Caldicott. The Health and Social Care Information Centre (HSCIC) first approved a ‘direction’ from NHS England to deliver in December 2013. This covered a national project to extract data sets from different NHS organisations and link this information to an expanded set of Hospital Episode Statistics. However, that will be revoked once a new direction is in place, as the scheme has been scaled back to four pathfinder areas following outcry from privacy groups about the ability of patients to opt-out of the scheme. A draft direction for the revised ‘pathfinder’ project was considered at the HSCIC’s July board meeting and feedback provided to NHS England to update it before it can be issued. As outlined by health secretary Jeremy Hunt at a speech in Manchester this month, final approval must also be given by Dame Fiona before it can proceed. Hunt said she was due to report back in January next year.

5,000 GP practices offer e-prescriptions: More than 5,000 GP practices in England offer electronic prescriptions and 15 million patients have signed up for the service, reported The NHS Electronic Prescription Service (EPS) has gained significant ground among GP practices over the past year, jumping from around 33% to 65% take-up. The service was originally due to be rolled out in 2007, but the first deployment at a practice and pharmacy did not happen until July 2009. Delays to the development of Release 2 of EPS meant that by mid-2012, only 198 practices were live with the system, which allows patients to nominate a pharmacy and have their prescription sent to it electronically. More than 5,000 practices are now live, nearly a quarter of the population have nominated their preferred dispenser, and 97% of pharmacies are set up to process digital prescriptions. Richard Jefferson, NHS England’s head of business systems, said: “[EPS] has reached critical mass now and needs to move to adoption for it to become absolute business-as-usual for GPs and pharmacies.”

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Care of vulnerable people ‘put in danger’: The dignity, heath and wellbeing of older people and those with disabilities in England are in danger, health and care groups have warned. In a joint submission to the Treasury ahead of November’s Spending Review, 20 organisations said the care sector was facing a “deepening crisis”, reported the BBC. They have called for funding to councils to be protected, as is happening with the NHS. While the government has pledged an extra £8bn a year for the NHS by 2020, social care has received no such assurances. Ray James, president of the Association of Directors of Adult Social Services, said: “It is vitally important that this year’s Spending Review understands the importance of our services to vulnerable people. The near-certainty is that without adequate and sustained finances our ability to carry out our work will be in jeopardy.” A Department of Health spokesman said the care sector would be benefitting from the extra investment in the NHS, adding “we are already getting NHS and councils working together to keep people well and living independently”. New guidance said carers should spend at least 30 minutes on home visits to older people in England as part of a new gold standard for services, reported the BBC. NICE has recommended a package of measures, which also includes ensuring people’s carers are not changed too frequently. However, it acknowledged extra money would be needed to fund the measures.

Scottish health board to share health data with partner organisations: NHS Dumfries and Galloway has deployed NextGate’s Enterprise Master Patient Index (EMPI) system, enabling users across the area to identify and match patient records across various organisations, reported Digital by Default. The initiative will ensure a further step towards the integration of children’s records across health and social care. According to general manager ICT at NHS Dumfries and Galloway, Graham Gault, linking records on such a large scale was a “pioneering achievement”. Andy Aroditis, CEO, NextGate, said: “As an organisation, we understand that patient outcomes depend upon the accuracy of the identity verification and the quality of data provided by our technology. This project is a very positive step for the area of Dumfries and Galloway, as their local teams recognise how data management is essential to the delivery of integrated and coordinated care.” Gault said: “We now have a powerful and sophisticated tool to link children from records and datasets that use NHS numbers, social care numbers, police references, education references and any other type of identifier.”

Pioneering NHS early warning technology to showcase at London conference: Technology that is alerting doctors and nurses to acutely ill patients in hospitals so that clinical staff can intervene early and prevent people in their care from coming to harm, is to be demonstrated live at London’s Healthcare Efficiency Through Technology (HETT) Expo in September, reported eHealth Delegates from across the UK’s different health and care settings will attend the event, where they will hear how forward-thinking NHS hospitals are improving care as a result of clinicians making innovative use of Patientrack, a technology that is being used to help tackle life threatening conditions such as sepsis, acute kidney injury (AKI) and other serious illnesses. Donald Kennedy, managing director at Patientrack, said: “Clinicians and technology providers really can prevent avoidable harm through collaboration. It is fantastic that we are getting the chance to help hospitals do more and more of this, so that the NHS can deliver safer care environments, where nurses and doctors have the tools they need to identify patients at risk of deterioration and intervene early.” HETT Expo 2015 will take place on 30th September at Olympia, London.

Camden and Islington NHS Trust leads digital revolution for mental health services: Camden and Islington NHS Foundation Trust has begun a digital revolution to improve its mental health services, reported Building Better Healthcare. The organisation has successfully gone live with Carenotes, an Electronic Patient Record system (EPR) from Advanced Health & Care. This next-generation EPR solution went live on 8 September, meeting ambitious delivery targets following completion of a focused two-year project. The system will enable staff to view patient records and make quicker, more-informed and accurate clinical decisions due to improved data accessibility. Wendy Wallace, chief executive of the trust, said: “Our ambition is to lead a digital revolution to provide better overall patient care to thousands of people with mental health conditions. By working in partnership with Advanced to meet tight project timescales, we now move this vision closer to reality. Our successful ‘go live’ is not only a great achievement for the technical teams, but also for all our staff who have committed to training in the new Carenotes system. I’ve been particularly impressed by the network of highly-enthusiastic champions that have stepped forward to support their colleagues and the trust. User confidence is one of the keys to a successful transition and we are clearly demonstrating this now.”

NHS England accredits IMS MAXIMS as Code4Health supporter: NHS England has accredited healthcare open source pioneer IMS MAXIMS as a supporter to its Code4Health initiative, marking another key milestone in the drive to open source technology in the NHS, reported Code4Health aims to bring like-minded individuals and organisations together to exploit the opportunities for digital health in the NHS. IMS MAXIMS has become the first open source electronic patient record (EPR) provider to win an accreditation. As a result it will see its open source code, openMAXIMS, utilised by groups of clinicians and developers to build applications via the Code4Health Platform. Paul Cooper, head of research at IMS MAXIMS, said: “This latest phase signals a real step change for Code4Health. The initial concept was to encourage clinicians to develop apps themselves, but it makes infinitely more sense to instead create local communities that are able to pool the right people and the right skills and adopt a collaborative development approach. From our perspective, we are offering tried and tested EPR technology as open source that will allow these local communities to build apps. Why? We feel our technology is well-placed to act as a key enabler for developers to help improve the way healthcare is delivered.”

FT secures £30m to upgrade IT system and A&E: A North West trust has secured capital funding of £30m to upgrade its IT system and estate, reported Health Service Journal (subscription required). Bolton Foundation Trust said in a statement that three-quarters of the cash would be issued as a loan from the Department of Health, while the rest will not have to be repaid. It plans to spend £8m on replacing its IT system, which is not fit for purpose. The other £22m will be spent on the estate, including refurbishment of the accident and emergency department and converting the boiler house into an “energy centre”. The trust had previously warned of the “clinical and information governance risk” posed by its paper document management system and ageing patient administration system.

System C buys The Learning Clinic: System C has bought mobile clinical specialist The Learning Clinic, best known for the VitalPAC vital signs recording software, reported The acquisition fills a gap in System C’s product portfolio and gives the company instant access to a widely used mobile platform, which it can potentially leverage for its existing clinical software and extend into social care. System C, previously McKesson UK, said it will tightly integrate VitalPAC and The Learning Clinic’s newer VitalFLO patient flow products into its Medway patient administration system and electronic patient record software. The company also says it will give existing clients access to the mobile clinical applications. No details were released on the value of the deal. VitalPAC enables clinicians to capture, assess and act on clinical data at the patient, ward and hospital level. The system is in use at more than 50 hospitals across England and has been used to record 100 million patient observations to date. System C said it will add additional clinical functionality into VitalPAC, including workflow, results and ordering, as well as access to care community shared records.

Scores of GP practices risk contract breach over friends and family tests: Since April 2015, GP practices have been required to collect friends and family test (FFT) responses from patients and submit data to NHS England monthly, reported GP Online. However, 118 practices have “made no attempt at all to meet their contractual requirements since the implementation of the programme”, a spokesman said. GP leaders in London have warned practices that FFT participation is not optional. Guidance on the London-wide LMCs website said: “Please remember that if you do not submit FFT data monthly for three consecutive months you will be in breach of your contract and risk having a breach notice issued to you.” NHS England has been unable to confirm how many practices have been issued with breach notices over failure to fulfil FFT duties. A spokesman said: “While our emphasis is on supporting practices, we have already provided advice to GP service commissioners on the NHS England website, which says that, taking into account the local situation or any mitigating circumstances, they should consider a breach notice for practices that fail to submit data for three months.”



For the second year running, Highland Marketing is sponsoring the EHI Awards social media category, which will recognise the winner for its “best use of social media to deliver a health campaign”. Good luck to all the finalists, we look forward to presenting the winner with their award.



Better data is vital to solve A&E problems
A&E attendance has reached record levels – but commissioners and providers don’t know enough about this surge in demand to properly plan and fund services, says Tim Fuller, propositions manager, Dr Foster.

“Digitisation of healthcare is moving apace but when our hospitals capture information about emergency care, they rely on a dataset developed in the early 1980s. It seems odd in an age which aspires to delivering integrated care and digital interoperability that we’re making do with a functional but pretty basic dataset.

“The accident and emergency commissioning data set does a good job of providing us with the key information required to benchmark A&E performance, such as the four-hour waiting time standard. Trusts’ efforts to meet the 95% goal were front page news for the first few months of this year, when A&E departments across the country came close to breaking point. But richer data could give us the opportunity to better design and deliver more joined-up care.

“The need for change in emergency care data practices has become increasingly apparent as demand at A&E has surged. According to the King’s Fund, A&E attendances rose 30% over the decade to 2013-14, reaching 21.7m. 

“The integrated care models of the Five Year Forward View – including eight vanguard sites that will launch the transformation of urgent and emergency care for more than nine million people – are a crucial step towards achieving that. But the transformation envisaged over the next few years needs to be predicated on accurate information. It is data that will provide the impetus for evidence-based change. 

“A&E must be a central component of this. We need to address the problem of acute care demand at one of its main points of entry to stop the whole system being placed under extreme strain and seizing up. Better data can help us tackle this key issue and start to unblock some of the wider issues affecting the health service.”

Another view: of point of care testing
Dr Neil Paul, full time partner at Sandbach GPs, believes he could offer a cheaper, better testing service to patients. If only NHS funding flows didn’t get in the way.

“We have been using online order communications for years. Locally we use Anglia ICE. Every GP request for the past ten years must be in the system. Do we ever get a report? No. I’d love to get a really hot data person to look at it with me. Let’s throw the whole lot into some “big data” engine and see what it comes up with.

“As well as looking at doctors, we could also look at the patients. Why do some diabetics get 15 tests a year, while others get just two? Do those getting 15 tests need all of them? Do we concentrate on the “wanty” not the “needy”? Should we look at outliers in terms of investigations, just as we look at high users of salbutamol (an asthma medication, for my non-clinical readers)?

“I’m convinced that if we really looked at ordering – whether of back x-rays or bloods – we could save money. That money I’d invest in point of care testing.

“At the moment, most chronic disease clinics make you come in a few days before an appointment to have your bloods done. This is so they have the results to go through with you. Much better this than: “I’ll give you a ring in a few days…” because you can actually discuss treatment changes. 

“However, it is inefficient. It means at least two visits to the surgery – two appointments made with reception, queuing twice, two days off work. Why not have the bloods done on arrival and have the results available immediately? Let’s face it, table top analysers exist; we just need to be confident they are accurate and work out how we pay for them.

“Personally, I think the CCG should give us the budget after doing a deal with us on risk sharing any saving or overspend. If I thought I could save £30,000, then I would consider hiring a new nurse. If I thought that I could be more efficient by ordering fewer bloods, I might concentrate on doing that. So, in summary, give me the tools to spend money in different ways, cut costs, and improve the service for patients.” 

On trend: Check your vital signs with wearable technology
Printing circuits directly onto fibres could open more reliable ways to provide real time healthcare in everyday lives. Electronics integrated into clothing could open up new opportunities for the NHS and patients, writes Dr Kathryn Wills, KTP associate in smart textiles at National Physical Laboratory and Coventry University.

“Keeping track of patients’ vital signs in and out of the hospital can be hugely beneficial to healthcare professionals. Devices from watches to sports sensors are offering promise for remote healthcare, but as yet haven’t been able to reliably capture and communicate the really valuable information. But progress is coming in this area from research into integrating electronics directly into the fabric of clothing.

“Patients can be continuously monitored away from the hospital. If there is a warning sign – high blood pressure, swelling, and so on – medical professionals can be alerted. The data collected can also reveal insights into the effectiveness of treatments.

“This can be used to develop personalised recovery plans – even adapting during the process – without the need for check-ups. This could revolutionise remote healthcare, allowing more patients to live normal lives, reducing hospital admin and freeing up beds.

“Simple sensors are already widely used for healthcare, but we are yet to see sensors that can pick out minor physiological fluctuations, whilst integrating unnoticed into everyday living.

“Clip-on sensors have been used in sport, but they must be visibly attached, so are unsuitable for monitoring conditions patients may not want to draw attention to. So the drivers of wearables in healthcare are accuracy and reliability, as well as needing to discreetly integrate into daily routines. This is why smart fabrics are so exciting; they can provide additional functionality to clothing that would be worn anyway.”



In this week’s blog Gregor MacKenzie looks at the secret techniques used to enhance collateral, websites and content.

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