News in brief
NHS needs ‘single quality strategy and national centre of expertise’: The NHS must become a “learning and high-performing organisation” by establishing a single, coherent strategy to improve quality of care, helped by a “modestly sized” national centre of expertise, the King’s Fund and Institute for Healthcare Improvement CEO Dr Don Berwick said. In a report arguing that the NHS cannot meet healthcare demand without sustained commitment to quality improvement, the think tank made the case for a “single quality improvement strategy” developed and supported by leaders of all relevant national bodies, reported National Health Executive. While the report welcomed NHS Improvement chief exec Jim Mackey’s case for more support and interventions for challenged trusts, it said the real experience of struggling providers “remains one of closer scrutiny of their performance and an ever-present risk that their leaders may be replaced”. “That looming threat and the fear it induces are severe impediments to the proper pursuit of quality improvement, illustrated by the health secretary’s recent warning that provider boards will be sacked if they fail to bring budgets back into balance,” the think tank said. “National bodies should share, and co-operate, in striving for robust, system-wide improvement activities. They should commit to major investments in innovation, such as the new care models programme, and to an evolving, jointly embraced vision of the new NHS care system as a whole.” It argued there is already precedent for a single strategy in the Five Year Forward View, but it is now more important than ever to ensure the work of the CQC is fully aligned with that of NHS Improvement.
One in four trusts plunge deeper into the red: More than a quarter of acute trusts reported a financial position which was more than £5m worse than planned for the first nine months of 2015-16, reported Health Service Journal (HSJ, subscription required). The majority of these trusts had already planned for large deficits at the start of the year, but are now even deeper in the red than expected. Last week, regulators said the NHS provider sector had reported a combined deficit of £2.3bn for the nine months to December, which was £622m worse than planned. The deterioration came almost entirely from the acute sector. About half the acute sector reported their performance against revised plans or “stretch targets” issued by Monitor or the TDA last summer, while the rest reported against their original plans. Of those reporting against original plans, Heart of England Foundation Trust was furthest from target with a year to date deficit of £46m. This was £38.5m worse than planned, and left the trust forecasting a year-end deficit of £59m. A further 22 trusts were at least £5m behind their original plan. One finance director said: “Some boards probably underplayed the downside risks in their 2015-16 plans and have never been able to make up the lost ground. We have always been put under pressure to pull something out of the back pocket, and an unsupported finance director might just get overly creative, but the truth will emerge in the end.” Out of 136 acute trusts, 101 reported positions that were worse than planned in their latest finance report.
Hunt “misrepresented” data on 7-day NHS: According to Jeremy Corbyn, the health secretary “misrepresented” data to put his case for a seven-day NHS in England, reported the BBC. The Labour leader attacked Jeremy Hunt after the BBC revealed the health secretary used academically unverified and unpublished data to back his plans. Last July, in the pay row with junior doctors, Hunt said there were about 6,000 deaths a year because of the lack of “a proper seven-day service”. But this assertion was later questioned by academics. Emails showed one of the authors of the unpublished paper, which Hunt was using to justify the 6,000 figure, was unhappy with how his study was being used. A spokesman said the information had been shared with the department by the NHS’s medical director for England, Sir Bruce Keogh. Labour is calling for an investigation into whether the health secretary leaned on his department in order to cover up his advance sight of the study. Labour leader Jeremy Corbyn said the prime minister and health secretary owed the profession an apology. “This dispute with junior doctors has been on the basis of misrepresented research.” But David Cameron defended Hunt, saying the contract was needed to introduce more seven-day services. When the BBC asked NHS England and the Department of Health for the source of the 6,000 figure, neither was able to answer. The UK Statistics Authority then wrote to NHS England, reminding the department that “data mentioned publicly by ministers should be available equally to all users”.
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Junior doctors offer ‘a good deal’, claims Cameron: David Cameron has sent a strong message to junior doctors that a new contract being imposed on them by the health secretary Jeremy Hunt will not be renegotiated, arguing that the contract is a “good deal”. The prime minister’s remarks in Parliament come after the British Medical Association announced three more strikes and doctors’ leaders said they would seek a judicial review of the plans to enforce a new contract, reported the Financial Times (subscription required). At his weekly Prime Minister’s Questions, Cameron insisted the contested contract will “not impose longer hours” and it includes “tougher safeguards to reduce the hours worked”. The prime minister added that the dispute had been “plagued by scaremongering and inaccurate statistics”. Fresh 48-hour strikes have been ordered for March 9, April 6 and April 26.
EPR implementation led to “catastrophic loss of confidence”: Problems with the introduction of the Epic electronic patient record (EPR) at Cambridge University Hospitals NHS Foundation Trust led to a catastrophic loss of confidence in the system that took months and a “huge amount of effort to rebuild”, the president of the Royal College of Surgeons has said. Clare Marx, was speaking about a visit to Cambridge at a Westminster Forum on electronic patient records this month, reported DigitalHealth.net. Cambridge went live with Epic in October 2014 as part of a £200m eHospital programme. It is the first and only trust in the country to have deployed the EPR, which is widely used in the US. Marx said the trust had made a real effort to improve its services with its eHospital programme, but: “When they went live problems arose and staff, patients and management rapidly and catastrophically lost confidence in the system. That took months and a huge amount of effort to rebuild.” She told the forum that clinicians suffered phenomenally because of the time taken to access and input information into Epic, which was sometimes longer than the time allocated for the appointment or patient interaction itself. This ultimately interfered with the clinician patient relationship. Marx also said the trust had invested a lot in clinical champions for the IT implementation, but that not all users had the same experience of the system. “It’s really important that the clinicians required to use these systems have really robust training beforehand and that carries on after the system goes live,” she said.
Women to be offered their own £3,000 ‘birth budgets’: The NHS in England is to offer pregnant women their own “personal budgets”, worth at least £3,000, so they can pick and choose the care they receive. Women will be able to use it to pay for anything from one-to-one midwifery care to home births in pilots due to start later this year, reported the BBC. The move is part of a shake-up in maternity care unveiled by NHS England to increase the choices women have. The overhaul is also aimed at improving safety in maternity services. It has been agreed to on the basis of recommendations from an independent review of services. This was set up by NHS England in the aftermath of the inquiry published last year into the failures that led to the deaths of babies at the University Hospitals of Morecambe Bay NHS Trust. The review – chaired by Conservative peer Baroness Julia Cumberlege – said it had never been safer to give birth in England, but improvements still needed to be made to ensure care was “world class”.
Great Ormond Street NHS hunts for EPR and research platform worth up to £50m: Great Ormond Street Hospital for Children NHS Foundation Trust (Gosh) has gone out to tender for an electronic patient record system (EPR) and a business intelligence and clinical research platform. The children’s hospital is procuring in two lots, reported ComputerWeekly. Lot 1 is for the EPR and Lot 2 for the research platform, with the entire contract worth up to £50m over 20 years, according to a tender document. According to a briefing document attached to the tender, the technology will help deliver its vision of a “digital hospital”. This includes clinical decision support, mobile and wireless technology such as tablets, iPads and voice recognition software. “We intend to provide our staff with a multiplicity of access points and devices to a single patient record,” the briefing document said. Gosh is looking for an EPR that includes a patient administration system, but also has wider clinical functionality, such as order communications, e-prescribing, theatre scheduling and decision support tools. The hospital hopes to award a contract by the end of 2016 and aims to go live with a new system by the middle of 2018.
HSCIC plans big data centre of excellence: The Health and Social Care Information Centre (HSCIC) is to set up a Centre of Excellence for Big Data and Data Science with the Department of Health (DH) and the Cabinet Office, reported DigitalHealth.net. The idea for the centre was proposed under the government’s Data Science Programme. In early 2015, government departments were asked to build on this work and produce their own action plans themed around demonstrator projects, building capability, technology and other practical barriers, and communications and transparency. The HSCIC, together with the DH and Cabinet Office, proposed the new centre as part of this work. It is not clear yet what the remit of the new centre will be or how it will fit with the HSCIC’s existing work on Big Data. “The centre will become operational once a director has been officially appointed,” a statement said. The move comes as interest in big data is mounting. A new Big Data Institute is due to open in Oxford shortly, with more than 500 scientists set to analyse data from the UK Biobank. Dr Mark Davies, medical director for MedeAnalytics, welcomed news of a new centre of excellence for big data and data science but warned that it must not stifle supplier innovation. “I would hope that this will create an environment of innovation where we can harness the best data science in the world for health and drive forward approaches to predictive analysis and population segmentation that the NHS needs so badly,” he said.
Peterborough and Stamford Hospitals to tackle A&E targets with new analytics tool: For the first time, Connexica’s CXAIR will provide senior doctors, nurses and managerial staff across the trust with the ability to generate instant reports and dig into unprecedented detail on clinical activity, patient discharge times, A&E performance and a whole range of other clinical and business areas, so that they can immediately respond to pressures and target resources at priority patients, reported Hospital Healthcare Europe. A&E has been an immediate focus and developers have already used CXAIR to create a daily A&E dashboard. This will allow clinicians and managers to see data from a variety of systems at a glance and interrogate that information in the detail required, so they can monitor and respond to the effectiveness and timeliness of care within the department, all without the need for technical data skills. Alec Dearden, head of information services at Peterborough and Stamford Hospitals NHS Foundation Trust, said: “This represents a step change in the way clinical staff and executives across the trust will be able to use data to understand pressure points, improve our services to patients and to measure how well we are delivering against our goals.” Richard Lewis, Connexica’s managing director, said: “Identifying insights and seeing information at a glance is essential for ensuring the best possible services are delivered to patients. CXAIR has allowed staff to interrogate the trust’s data within days of the trust using the system. As the tool helps to generate growing numbers of reports and dashboards, staff across the trust will be able to understand demands and manage services even more effectively.”
GPs will have to submit evening and weekend access data under new contract: GP practices will be required to record the availability of evening and weekend opening for routine appointments under the 2016/17 GP contract deal. The new requirement, to which the General Practitioners Committee (GPC) has agreed, will see all GP practices having to submit “access surveys” every six months until 2020/21. The move comes as the Government is working to a manifesto commitment to ensure all patients have access to routine evening and weekend appointments by 2020, which the GPC has previously branded “a pipe dream”. Commenting on the deal earlier this week, health secretary, Jeremy Hunt said the contract agreement was “just the start of significant new investment for general practice, which will help GPs to provide a truly modern, efficient service every day of the week”. However GPC deputy chair Dr Richard Vautrey told Pulse that although the GPC had agreed to the data collections, it represented no change to the terms of the extended hours enhanced service or introduced any contractual requirement on practices themselves to offer routine evening and weekend appointments.
RT Hon Paul Burstow appointed senior advisor of TSA: The former minister of state for care services, chief whip of the Liberal Democrats and MP for Sutton and Cheam, Rt Hon Paul Burstow has been appointed as senior advisor for the TSA to help drive forward strategy across the Technology Enabled Care industry and shape the organisation’s future work programmes. The health and care thought leader said: “My role with the TSA is to bring my knowledge of the wider health and social care sector, the key players in the National Health Service and use that information to help connect the Association into conversations. The TSA don’t operate in a vacuum, they have to be put into a context of people’s everyday lives, and also in the context of what other commissioners and service providers in the NHS and in social care and in housing need. What I bring is expertise and knowledge of that landscape and I can help the TSA navigate it. Commenting on his ambitions and desired achievements for the TSA, Paul said: “What I want to achieve by working for the TSA is to try and move the debate on about the contribution that Technology Enabled Care can make to actually enabling people to have a better quality of life. Framing the whole debate – not around the kit but actually around the lives that people want to lead. People want to maintain their independence, they want to stay in their own home and they want to maintain a connection with their families and their communities. Technology can enable that and we need to really have the conversations with those that are our allies and partners in social care, housing and so on about how we work together to offer the bundle of services that enable people to do that.”
NHS dementia patients to trial wearable technology: People with dementia are set to trial wearable technology to enable them to live independently for longer, reported Building Better Healthcare. Manchester-based eLucid mHealth has teamed up with the Business Growth Hub, part of Manchester Growth Company (MGC), to secure a contract with the NHS as part of the first wave of innovation technology test beds. The test beds project is part of the Technology Integrated Health Management (TIHM) scheme, which will initially be rolled out as a collaboration between Surrey and Borders Partnership NHS Foundation Trust and health technology providers. It will provide dementia patients and carers with sensors, wearables, monitors and other devices with the aim to give individuals more independence. All devices interconnect and continuously monitor medication levels and timings through a facial recognition app. This information is relayed back to carers and clinical health professionals to allow them to monitor a patients’ medication and flag possible issues, enabling them to deliver tailored and responsive care. Remote dispensing devices will address the £350m problem of patients not taking their medication, which can lead to further health issues. The project will allow people with dementia to live in their own homes for longer and give them the ability to take control of their own health, while keeping in touch with effective services, GPs and carers on a regular basis.
Nurses will be key to the success of NHS seven-day healthcare
The health service is facing huge challenges. Nurses provide the solution to many of them, says Janet Davies, chief executive and general secretary of the Royal College of Nursing.
“It’s exactly a 100 years since the Royal College of Nursing (RCN) was founded; what a long way the profession has come in the past century. Nursing has evolved into a highly complex, demanding and skilled job, requiring difficult clinical decisions on a daily basis. But it’s also evolved into a job with significant challenges.
“It’s a wonderful profession, and the RCN is proud of the sterling work that its members provide 24 hours a day, seven days a week, looking after their patients and advancing their own skills. But behind all that great work is the knowledge that the health service is facing challenges as never before. We are treating more patients with complex needs and budgets are tighter than ever. We believe nurses provide the solution to many of those challenges.
“We will be key to the success of NHS seven-day healthcare; nurses working in senior, decision-making roles deliver complex care, help patients live with long-term conditions, arrange prompt discharge from hospital, treat minor injuries, prescribe medication, and refer patients for other treatments.
“There’s no doubt those pressures are affecting all nursing staff. We worry about the numbers who say they have had enough and are leaving the profession. But nursing has adapted and developed before – it’s done so throughout the RCN’s first hundred years – and it will continue to do so in the best interests of those at the centre of our work: our patients.”
Why the NHS is putting a plaster on its gaping wound
Implementing a single collaborative platform accessible to all healthcare professionals is key to successful digital transformation in healthcare, says EMC’s James Norman.
“The healthcare industry must take radical action sooner rather than later. The current re-injection of funding is not going to deliver transformation change, improve efficiencies and make cost savings. So what can be done to not only sustain the future of NHS, but help the current financial crisis and reduce growing pressures? These are the four things I believe will help drive digital transformation and minimise costs in healthcare.
“1. Look beyond small-scale, frontline investments: Digital transformation within the NHS can only be realised and achieved through looking beyond the small-scale, local investments currently being made such as building a new NHS website, developing relevant apps and providing free wi-fi in hospitals.
“2. Implement collaborative infrastructure: Whilst there have already been investments in wi-fi in hospitals and EPRs, these advances are not going to transform the way healthcare services are provided. Using technology, manual processes need to turn into automated functions freeing up time and resource to be invested in elsewhere. Investment into collaborative platforms that work across government departments – including healthcare – will be key to easing financial pressures.
“3. Overcome concerns of data governance: Data security and governance is still a challenge in health organisations when gaining access to patient data. Slow and steady steps need to be made to provide interactive feedback to the patient, for them to realise the value of sharing their data.
“4. Appoint a leader to support cultural change: At this moment in time, there is no department or champion in government taking the lead on this transformation. There needs to be a direct steer given to trusts that this must happen.
Leveraging innovation to realise the human and financial benefits of digital care
Out-dated infrastructure and an increasingly fragmented market threaten the future of technology-enabled integrated care, says Tom Morton, CEO of Communicare247.
“Growing elderly populations and stretched resources means great hope is being placed in technology-enabled care to help citizens to maintain independence and provide support for their carers.
“Yet the personal alarms and health monitoring devices that for many are a critical lifeline often rely on out-dated technology – the telephone landline. These can be at risk when people forget to check equipment and other devices fail, and are often only effective within close proximity to the home. Current technology that aspires to support more independent living can be restrictive and is starting to look out of place in the UK’s ‘smartphone’ society.
“Councils have invested heavily in such analogue telecare solutions. But these investments need urgent review if the UK is to deliver care that helps keep people independent for longer in their own homes, and connected to the support networks they need. Digital technology can make this happen, and provide a better, more efficient service that benefits all.
“Health and social care providers can benefit from monitoring and caring for people in their own homes in the most efficient way possible. Carers, next of kin, emergency services and housing providers can also use the information that digital platforms can provide, through alarms, location-finding or video conferencing.
“Such approaches are shown to improve rates of self-care, and reduce hospital admissions. Social benefits include reducing isolation and relieving carer and relative anxiety. Financially, savings could be considerable. In Scotland for example, we have estimated that digitally-enabled remote monitoring could save £15m a year by redirecting resources to those that need it most.
“Digital solutions can enable the delivery of multi-agency, person-centred care. The UK is well-placed to lead this drive, but the country needs to work together to make it a reality.”
What steps can be taken towards quality improvement in the NHS?
The NHS needs to acquire internal capabilities in quality improvement, to manage the immense challenges of improving patient care at a time of growing financial and workload pressures, writes Chris Ham, The King’s Fund chief executive.
In a blog on the think tank’s website, he says: “All NHS organisations need to build in-house capacity for quality improvement and to commit time and resources to acquiring the necessary capabilities. They should do so by learning from the experience in trusts such as Salford, Sheffield and Wigan where quality improvement is well established.
“Organisations need to work together through improvement collaboratives and other means to share learning and provide mutual support. This is happening already in the north west of England through the Advancing Quality Alliance and in London and the south east through UCLPartners. The newly established UK Improvement Alliance is also beginning to play a part.
“By learning from these examples the NHS could reduce reliance on expensive management consultants and make better use of its in-house talent.”