News in brief:
Extra NHS funds will prioritise Forward View reforms, says Stevens: Allocations from an additional £2bn of government funding to be provided to the health service next year will be set out later this month, NHS England chief executive Simon Stevens has announced, according to Public Finance. Speaking at the Healthcare Financial Management Association’s annual conference, he revealed that at least £450m of the money provided in the Autumn Statement would be prioritised to implement reforms set out in NHS England’s Five Year Forward View. Stevens said the report, which set out the case for additional funding for the NHS in the next parliament as well as for reforms to integrate care, had unlocked “a hidden consensus about what the future will look like”. Demarcations between different NHS services that have been hard wired into the system need to be tackled as part of implementing the forward view to 2020/21, Stevens told delegates. These include the split between primary and specialist care, the divide between physical and mental health services, and the different systems for health and social care. This last area represented the key area in the next five years, and the NHS must recognise that for service users, this is increasingly a distinction without a difference.
Controversial NHS patient data sharing pilot scheme may be delayed until 2015: Pilot schemes for the delayed and controversial NHS programme to share data from patients’ medical records might not start until well into the new year, reports The Guardian. The launch of the care.data programme was postponed for at least six months in February this year – well past its planned date of April 2014 – and the NHS has now said it will not even have completed signing up GP practices for experiments in how it might work until the new year. Doctors in four parts of the country will be involved, and there will be trials in how to inform the public and patients about how the system will work, its perceived benefits and on how they can opt out of having confidential information shared. The continuing lack of a firm date to start or even a new public awareness campaign came as the All Party Parliamentary Group for Patient and Public involvement in Health and Social Care and the Patients’ Association, which acts as its secretariat, published a report raising continuing concerns. Katherine Murphy, chief executive of the Patients’ Association, said of its report: “Evidence taken from a cross-section of healthcare charities, royal colleges, the research community and NHS England, all points towards strong support for medical data sharing in theory. Patients and the public are broadly supportive of the principle of using health data that is in the public interest.”
HSCIC reviews data releases to police: The Health and Social Care Information Centre (HSCIC) is reviewing how it provides non-clinical information about NHS patients to law enforcement organisations, after concerns were raised by a privacy watchdog. News of the review comes after eHealth Insider (EHI) reported in July that more than 2,700 releases of non-clinical information about NHS patients were made to law enforcement organisations in the year to March 2014. The information was included in the HSCIC’s quarterly register of approved data releases, which was established in connection with a review by HSCIC board member Sir Nick Partridge into how its predecessor the NHS Information Centre shared patient data. The details about releases to law enforcement over the longer 12-month period were included after privacy campaign group medConfidential drew attention to their absence from the HSCIC’s data audits. Phil Booth, the co-founder of medConfidential, told EHI at the time that the figures showed the scale of data being shared with law enforcement. “We knew police were going and asking and getting data from the NHS… but we weren’t aware of the scale of it. It’s quite shocking. You’re talking of thousands of requests a year – it’s routine.”
Schism emerges over Stevens’ integrated care organisation models: Plans to introduce a range of new care models into the NHS over the next parliament has split the opinion of provider chiefs and clinical commissioning group (CCG) leaders, an exclusive Health Service Journal (HSJ, subscription required) poll, in conjunction with advisory firm FTI Consulting, has found. While CCG leads and GPs favour the “multi-speciality community provider” (MCP) model suggested by NHS Five Year Forward View, trust chiefs have thrown their weight behind the “primary and acute care system” idea (PACS). Both forms were named in October’s forward view paper as the kinds of care models that could help modernise the NHS and prevent it from falling into the red. Under the MCP model, GP practices would merge or form partnerships to supply a broader range of services, including running community hospitals. While in a PACS, hospital trusts would become “vertically integrated care organisations”, providing a wider range of services from primary to acute care. Support levels for MCPs were also relatively high among trust chief executives with 74% saying that the model was a good idea. Trust chief executives’ support was however less warm than that of CCG leaders, with only 28% of providers saying they were “very supportive” compared with 69% of CCG leaders.
A third of NHS contracts awarded to private firms: A third of NHS contracts in England have been awarded to private sector providers since the service was reorganised in 2013, figures suggest. The information reported by the BBC comes from a freedom of information request made by the British Medical Journal. Of 3,494 contracts awarded by 182 clinical commissioning groups (CCGs) in England between April 2013 and August 2014, 33% went to the private sector. The government says the data is misleading. It is unclear how much the contracts were worth because the CCGs would not disclose this information citing commercial sensitivities. A Department of Health spokesperson said: “Official NHS accounts show that use of the private sector amounts to only six pence in every pound the NHS spends, slowing the rate of increase to just one penny since May 2010. Charities, social enterprises and other providers of healthcare play an important role in the NHS, as they have done for many years.” The investigation looked at different types of contract to provide NHS clinical services, including those awarded to a single provider without an open tender, those awarded via a competitive tendering process, and those awarded to multiple providers under Any Qualified Provider – a government policy that opened up a wide range of community-based NHS services to different providers from outside the NHS. Private sector providers were most successful at winning contracts awarded via competitive tender – 80 compared with 59 won by NHS providers.
Barts suspends RTT data reporting: Barts Health NHS Trust has suspended reporting of its referral to treatment (RTT) waiting time data to address “significant” IT problems, reported eHealth Insider. The issues are in part due to the implementation of a new electronic patient record system at Whipps Cross Hospital, which has had a “significant adverse impact” on data quality in outpatients, as well as the failure of a RTT validation database. Barts’ December board papers state that data quality has been a major area of concern for the trust, which has been operating with three legacy data warehouse systems and three patient tracking lists. The implementation of the Cerner Millennium system at Whipps Cross had led to data quality problems and was “compounded” by the failure of an RTT validation database on September 22. A review of the trust’s IT and reporting systems had revealed “some fundamental issues” in the way that patients were being placed on lists and prioritised for treatment. In his report for the board meeting, chief executive Peter Morris said that the trust was falling “significantly short” of the 18-week RTT standard, leading to the decision to suspend mandatory data reporting.
CQC under fire over monitoring data: The Care Quality Commission (CQC) has been criticised after incorrectly placing 60 GP practices in high-risk categories due to “severely flawed” data in a monitoring tool, claims eHealth Insider. The news comes less than a month after the CQC published the ratings for every GP practice in England for the first time. The CQC said the “intelligent monitoring”, based on a range of different data sources including the Quality and Outcomes Framework and the GP Patient Survey, would help it decide how to prioritise inspections under a new regime. The monitoring tool included 38 indicators on whether patients at the surgery could be at ‘risk’ or ‘elevated risk’ beyond what would be expected normally, with practices placed into one of six bandings depending on the level of potential concern. Practices in the highest two risk bands would be prioritised for CQC inspections. However, the organisation announced that it has reclassified a number of trusts after reviewing the data and making changes to indicators. In a letter on the CQC’s website, senior national GP advisor Professor Nigel Sparrow said the organisation has made changes to the data and indicators after completing a “comprehensive review” which included discussions with stakeholders and NHS England.
Royal Brompton takes Lorenzo: Royal Brompton and Harefield NHS Foundation Trust has agreed a deal with CSC to deploy its Lorenzo electronic patient record system and Medchart electronic medicines management system, reports eHealth Insider (EHI). The trust will become only the second to take Lorenzo outside of the terms of a central agreement between CSC and the Department of Health for trusts in the North, Midlands and East. Joanna Smith, the trust’s chief information officer, said the trust’s IT transformation programme is based on a ‘best of breed’ approach, with CSC standing out as the best supplier. “Through a rigorous competitive process, we concluded that CSC’s Lorenzo and MedChart will allow us to accelerate our transformation plan, and enable us to provide better care for patients.” The web-based MedChart solution includes electronic prescribing, pharmacy review, drug administration and clinical decision support, and is designed reduce risk, error and inefficiency and improve coordination between clinical teams. The trust made a successful bid for an e-prescribing and medicines administration system in the first round of NHS England’s technology fund, along with another successful bid for electronic document management. It should receive a total of £2.9m from the ‘Safer Hospitals, Safer Wards: Technology Fund’ for the two projects.
GPs to be offered ‘perverse’ incentive for reducing emergency admissions by 10%: GPs in one area are being incentivised to achieve a 10% reduction in emergency admissions this winter, which the General Practitioners’ Committee warned was a “potentially dangerous” scheme that could “undermine the patient-doctor relationship”, Pulse revealed. The ambitious scheme has been rolled out by NHS Doncaster Clinical Commissioning Group (CCG) in response to pressure to reduce hospital admissions, and will give practices the chance to earn up to £2 per patient. The local medical committee said it recognised it as a ‘perverse incentive’ for GPs but was ‘trying to be positive’ about the potential to access the extra funding. This is the latest CCG scheme to link payments to emergency admissions, after a Pulse investigation found that NHS West Suffolk CCG and NHS Ipswich and East Suffolk CCG are linking funding worth £5 per patient to outcomes. NHS England’s ‘cash for diagnoses’ dementia scheme has similarly been criticised for putting GPs in a difficult position as their clinical decisions are viewed by patients as being influenced by financial interests. Under the NHS Doncaster CCG scheme, local GP practices managing to achieve a 2% reduction in unplanned admissions in January to March 2015 compared with the same period in 2014 will receive 40p-per-patient. They will receive a 40p-per-patient incremental increase for every 2% further reduction up to £2 per patient for those reducing admissions by 10%.
Texting patients to remind them to take pills could save thousands of lives a year: Texting patients to remind them to take drugs could prevent the deaths of thousands of people from stroke or heart attack and save the NHS millions of pounds each year, a new study suggests. The Telegraph reported that £500m is currently wasted each year because patients do not continue their prescribed medication. However a new study by Queen Mary University of London showed that sending a text reminder improved the uptake of pills by 64%. Not only would it stop the NHS wasting millions on drugs, it would also stop thousands of people dying needlessly because they fail to take medication which lowers their cholesterol or blood pressure. Professor David Wald, consultant cardiologist and lead author, Queen Mary University of London, said: “An important and overlooked problem in medicine is the failure to take prescribed medication. Around a third of people do not take their treatment as prescribed. Some patients forget to take their tablets and others stop because of uncertainty over the benefits or harms of treatment.”
BlackBerry, NantHealth launch cancer genome browser: BlackBerry and NantHealth, a healthcare-focused data provider, have launched a secure cancer genome browser, giving doctors the ability to access patients’ genetic data on the BlackBerry Passport smartphone, reported Reuters UK. Earlier this year, BlackBerry bought a minority stake in privately held NantHealth. The mobile technology company sees healthcare as one of the niche sectors in which it has an advantage, due to the heightened focus on patient privacy and BlackBerry’s vast networks that can manage and secure data on mobile devices. The company said the cancer genome browser on the BlackBerry Passport enables deep, interactive reporting on genomics data for physicians. It gives oncologists a tool to view individual genetic alternations in a disease and allows them to highlight relevant treatment options. BlackBerry launched the square-screened Passport device in September, and was designed to tailor to the needs of the physicians, with a wider screen that allows for better viewing of x-rays, scans and documents. “Our partnership with BlackBerry has really been able to create a scalable super-computer in the palm of the hands of the doctor,” said Patrick Soon-Shiong, chief executive of NantHealth. The genome browser is fully encrypted to allow deployment to enable clinicians to securely access patient data as soon as it is available, wherever they are.
Outcomes Based Healthcare secures £1m to find big data diabetes solution: Medtech startup Outcomes Based Healthcare (OBH) has teamed up with the Big Data Partnership on a £1m project that hopes to save the lives of diabetes sufferers, Tech City News has reported. A match-funded grant has been secured from Innovate UK to fund the possibly revolutionary project, which will be bring a much more data-driven approach to traditional medical research. The London-based start-up will use medical data about type-2 diabetics combined with non-health data about the same individuals such as income to predict the outcomes of a patients illness well in advance of what is currently possible. Dr Rupert Dunbar-Rees, former GP and founder and CEO at OBH, said: “Healthcare systems are cracking under the pressure of ever-growing global health budgets, partly because we’re treating people with drugs and interventions, without being sure exactly who will benefit from any given treatment.”
21% of patients in England can now access their medical record online: As the health service continues to move online, 21% of patients in England have been able to access their medical records online as of September 2014, a significant increase on 2% this time last year, reported Integrated Care Today. The number of patients able to book their appointments and request repeat prescriptions has also jumped to 91% and 88% respectively. NHS England’s Patient Online programme team has been working closely with practices across England to ensure they have the support they need to confidently offer these online services. As well as a national network of implementation and clinical support services, practices continue to use the recently published Patient Online Support and Resources Guide. This guide includes guidance and practice tools developed by the Royal College of GPs, as well as materials for patients, frequently asked questions, regional and local support arrangements and much more.
Prestigious awards recognise Northern Ireland Electronic Care Record for outstanding informatics: The Northern Ireland Electronic Care Record (NIECR) powered by Orion Health technologies has won both the Health Service Journal (HSJ) Award for “Enhancing care by sharing data and information” and eHealth Insider (EHI) Award for “Best use of IT to support integrated health services” in recognition of its outstanding contribution to informatics. HSJ judges praised the way clinicians in all care settings were able to access a range of information about patient care from different providers. The country’s pragmatic approach to solving the problem of information sharing also won acclaim. Speaking of the EHI award, Des O’Loan, ICT strategy manager, Health and Social Care Board, Northern Ireland stated that “the EHI award was reward for the determined and collaborative efforts of Health and Social Care Northern Ireland to implement a world class electronic care record for all the citizens of Northern Ireland “. Since going live on July 4th 2013 the NIECR is now being used by over 18,000 health and social care professionals to care for over 472,000 patients, or nearly 27% of the total Northern Irish population, reported eHealthNewsEU. The system integrates more than 70 million messages from sources spread through acute, community, pharmacy and social care sources.
Initiative to improve patient safety and quality across the UK: The Health Foundation has launched plans to work with NHS England to boost the expertise available in the NHS to improve the quality of patient care throughout the UK, reported Integrated Care Today. Launching in early 2015, the initiative will recruit and connect people from across health care with safety and quality improvement expertise to help overcome a key challenge: how to spread improvement throughout the healthcare system, with the longer-term goal of encouraging safer care for patients. The initiative reflects one of the recommendations made in the Berwick review and taken forward in Hard Truths. Together the Health Foundation and NHS England have committed nearly £2m of initial seed funding to launch the initiative. It is anticipated that they will recruit 5000 participants by 2020. Dr Jennifer Dixon, chief executive of the Health Foundation, said: “The initiative will allow us to identify a critical mass of people leading improvement from across the UK and to help accelerate the pace of change within the NHS. There’s a lot of talent and drive in the NHS, but this initiative will help boost skills specifically in quality improvement across the country as is needed to help transform health care.”
Be sure to look out for the 2014 last edition of the Healthcare Roundup. This is due to arrive in your inbox on Tuesday 22nd December.
Opinion
Computer says no: NHS IT was not designed to operate at this level
Ellie May, a consultant anaesthetist and author of Adventures in Anaesthesia and How To Pass Exams writes in The Guardian whether we are expecting too much of today’s healthcare technology.
“It’s not just the doctors who struggle; the ageing bones of the crumbling hardware system creak ever louder as it cranks up to process another new data load. Shiny software systems have been introduced for lab results, for requesting, reporting and reviewing x-rays, to dictate and verify letters and our latest coup, e-prescribing. These developments, designed to help us to manage patient care more safely and efficiently now have the opposite effect due to a lack of parallel investment in the supporting hardware and operating systems. It is common to find only two of these slow, outdated species in clinical areas where half a dozen health professionals need to access them.
“You know how infuriating it is when a customer service centre explains, “The system is slow today”? I now know they really are not joking.
“In the labour ward things are no better. Documenting the epidural you cited takes longer than the procedure itself and will be postponed indefinitely while the midwife has the patient’s profile open to document – well – everything, really. Whoever named the system e-clipse obviously foresaw our problems.
“Restrictions to other types of computer use have been imposed. As always, the theory is great but does not translate into everyday practice quite so well. Any site derived from Facebook, YouTube, or eBay is “deemed inappropriate by your line manager” and cannot be accessed, not even to revise a practical procedure with a YouTube demonstration. Not even to find a forum for advice or to search for those rare syndromes that only present in the middle of the night. My Google search for pain relief for a complex patient was thwarted at the a-n-a-l of analgesia (and a secret alarm was set off too I’m sure).
“A huge investment in information technology is required if our move to e-health is to continue. At what cost? The numbers are not important, rather the fact that this amount is visible, measurable and accountable, unlike the time and resource we all waste waiting for the egg timer to stop spinning.”
Digital future signals more active role for the patient:
Andrew Ward, the pharmaceutical correspondent for the Financial Times, evaluates the digital future of healthcare.
He says that healthcare is a slow moving industry, from the 10-15-year development cycles in pharmaceuticals to the difficulty of pushing reform through politically sensitive health systems and the conservative medical profession. In the long term, however, change seems inevitable as an ageing global population puts health budgets under pressure.
The contours of a more efficient health landscape are slowly coming into view. Digital technology is at its heart. Breakthroughs — from wearable sensors providing real-time data on an individual’s wellbeing to the ability to sequence a person’s genome for $1,000 within 24 hours — promise greater visibility over personal health and offer the possibility of earlier, more targeted treatment when people fall ill.
In fact, these devices herald the beginning of an important shift towards more informed patients taking greater control over their own health, according to Daniel Mahony, healthcare fund manager at Polar Capital. “We’re going through a Copernican revolution of healthcare, where the patient is going to be at the centre. The gateway to healthcare is not going to be the physician. It’s going to be the smartphone.”
Christofer Toumazou, chief scientist at the Institute of Biomedical Engineering at Imperial College London, says there are “megabucks” to be saved by using technology and data to shift the focus of healthcare towards prevention. But he warns of big obstacles from health infrastructure and business models that are geared towards reactive care.
Bill Hait, global head of research and development for Janssen, the pharmaceuticals arm of Johnson & Johnson, says the combination of big data and advances in genomic science is greatly increasing the potential to spot risk factors behind disease.
Severin Schwan, chief executive of Roche, says that, for all the challenges, the combination of rising demand and advances in science and technology will be good for the healthcare industry. “We see science at a turning point where our understanding of the molecular pathways of the human genome is finally reaching the stage where we can translate it into medicines. I really cannot imagine a more exciting time than today from a medical and scientific point of view.”
Power to the people on: the great confidentiality face-off
It’s tempting to think that confidentiality is something that can just be toggled on and off in electronic systems. Paul Hodgkin, founder and chair of Patient Opinion, argues on eHealth Insider that it can’t, because it goes to the heart of the doctor/patient relationship; and new IT systems need to respect that.
“Both confidentiality and information sharing are ‘good’. Hippocrates and Tim Kelsey, the director of patients and information at NHS England, and the most vigorous and articulate proponent of seamless clinical data around at the moment, are both speaking to big, important, principles. But today’s excitement over integrating care and the promise of big data means that confidentiality is less honoured. This carelessness is less than ten years old.
“Confidentiality – “holding this painfully revealed information sacred in my heart” – is the homage that the professional pays to the patient’s struggle and to their courage. Treating confidentiality simply as a transactional issue that can be toggled on or off (“can I just access your Summary Care Record?”) not only does violence to the patient’s courage, it diminishes the professional’s sense of themselves.
“All this is even more important because we live in a culture where sharing personal information via social media is the norm, and where celebrities are eager to let slip salacious titbits to feed their online personas.
“This low friction world can make confidentiality seem passé. It would be understandable if those building the SCR thought that confidentiality was pretty much synonymous with tweaking your privacy settings on Facebook. It isn’t. Confidentiality and the truths that can be disclosed within it lie at the heart of medicine and of healing. Behaviours do not endure for 2,500 years without good reason. The information held on our electronic health records is indeed “secret and sacred”.
“Writing the code that allows us to share it appropriately requires a deep respect that goes way beyond the binary toggle of ‘consent on’/’consent off’. Software, well executed, has a tremendous ability to deliver that Holy Grail of ‘changing the culture’ – just look at how we all now interact with Facebook or use online banking. It would be a tragedy if we inadvertently threw out the 2,500 year old Hippocratic baby with the ‘seamless’ bath water of the SCR.”
Blog:
In this week’s blog Sarah Bruce looks at the first comprehensive report into the use of social media in the NHS and how the results can be applied by B2B marketers.
