News in brief
Flory: “Loss of experience is greater than I’ve ever seen”: David Flory has said the current NHS reforms have prompted the greatest loss of management experience of any health service reorganisation he has seen in his career. In an exclusive interview with HSJ (subscription required), the NHS Trust Development Authority chief executive and former deputy chief executive of the NHS said the service was now struggling to find enough people with the “requisite capability” to run its most challenged hospitals. The old system of primary care trusts and strategic health authorities was abolished on 1 April prompting many senior leaders to leave the NHS. The hospital sector has also seen a significant number of experienced chief executives and senior directors retire. Flory also revealed to HSJ that the NHS trust sector is looking to cut £1.5bn from its cost base this year in a squeeze that could prompt questions about the viability of some organisations. The trusts he was responsible for had set an average cost improvement programme target of 5.1 per cent − roughly £1.5bn of the £30bn they are due to spend in 2013-14. Asked to estimate how many of the 81 trusts planning on a standalone foundation trust application would struggle to deliver the savings year-on-year, Flory said it was “somewhere in the order of 10-12” this year. The former NHS deputy chief executive said finding the savings would be harder than in the past and would force the authority to think about the viability of trusts.
Standards Board splits in two: The Information Standards Board for Health and Social Care (ISB) is being replaced by two new organisations, reported eHealth Insider. Speaking at a Westminster Health Forum, ISB chair Professor Martin Severs said: “The ISB will be replaced by two bodies, the informatics partnership group and the informatics collection group. “They will advise the informatics services commissioning group (ISCG) on what standards to use and what [data] collections [to make]. They [the ISCG] will make the final decision on what’s going to happen.” The ISCG is made up of representatives from the Department of Health, the National Institute for Health and Care Excellence, the Care Quality Commission and NHS England, among others. It will be chaired by Tim Kelsey, the national director of patients and information at the NHS England, and will decide what infrastructure, standards, and data sets will need to be commissioned and promoted.
Caldicott recommends ‘duty to share’: The Caldicott2 review of information governance in the NHS recommends a new duty to share information when it is in the interest of the patient. ‘Information: to share or not to share’ is expected to be launched on 17 April, reported eHealth Insider. It details how the NHS should share patient information while also protecting patient confidentiality as it moves towards a paperless future. Speaking at a Westminster Health Forum this week, Dame Fiona Caldicott – who led the review – said that education and information sharing were key to providing safe care for patients. “We’ve come as far as to suggest a new Caldicott principle, which is that information should be shared when it is in the patients interest,” she said. “Some professionals have become over occupied with concerns about the security of information to the point where they are not confident about how to share it”.
Risk patients will be identified by anonymised GP record data, NHS England admits: Patients with rare diseases may be able to be identified despite data extracted from GP records being anonymised before it is shared in the health service, NHS England has admitted. The ‘small risk’ of identification means that certain patient data obtained by NHS England through the GPES system will only be disclosed in a ‘controlled environment’ where ‘robust safeguards’ are in place, Pulse has learnt. GPs say the admission – contained in a document sent to the GPES Information Advisory Group – undermines previous assurances from NHS England that all data would be completely anonymous before it was sent to other ‘accredited’ organisations, such as CCGs and commissioning support units. Patient-identifiable data will be extracted from GP practices by the Health and Social Care Information Centre (HSCIC) using the GPES system, but will be anonymised before being passed to NHS England.
Cambridge University Hospitals signs £137m deal with HP: Cambridge University Hospitals (CUH) has signed a £137m deal with HP for its eHospital Program, reported ComputerWeekly. Under the 10-year deal, HP Enterprise Services will provide Cambridge University Hospitals with enterprise applications hosting, network management and HP WorkPlace 360 services. This could also include the delivery of new technology, such as an electronic patient record (EPR) system. “This is the most significant decision the hospital has made in recent times, and one which is incredibly exciting and will help transform the way we deliver care to our patients,” said Keith McNeil, chief executive of Cambridge University Hospitals. “We cannot continue to deliver the highest quality of compassionate care to our patients unless we invest in IT systems to transform our services. Our patients will see significant benefits as we will be able to care for them in a safer and more effective way, spend more time with them and, very importantly, they will be much more involved in their own care.
Data Protection Act is not a barrier for information sharing in NHS, says ICO: The Data Protection Act 1998 is not a barrier for information sharing but an enabler, according to Dawn Monaghan, group manager of strategic liaison at the Information Commissioner’s Office, reported Computing.co.uk. Speaking this week at a Westminster Health Forum focusing on the “technology revolution” in the NHS, Monaghan said there were many myths within the industry on information sharing, and one of them was that the Data Protection Act (DPA) is a barrier. “The DPA is not a barrier, it is an enabler,” she said. “The drive behind it was to free up the market and to be able to use data which is personal in a protected way to enable that data to be shared. Not sharing information can often mean people are unprotected. The DPA is all about mitigating risk, but in the health sector the DPA is becoming like the health and safety legislation – an excuse not to do things, not to change.”
Torbay patients’ medical records found on Dawlish road: A woman who found two courier bags containing patients’ medical records on a busy road in Devon has said she was “absolutely horrified”, reported the BBC. Jo Bell, from Dawlish, spotted the bags on the A379 near Powderham Castle, near Exeter, on Wednesday afternoon. She said they appeared to have been in transit from Torbay Hospital to the Royal Devon and Exeter (RD&E) Hospital. The RD&E NHS Foundation Trust said it was “deeply concerned” the records had been mislaid. It said it was carrying out an “urgent investigation” into the matter. The bags which were partially opened contained eight patients’ confidential medical records. One patient from Paignton, whose medical records were among those found, said: “I find it hard to believe. I’m shocked. “How the hell have they done that? I’d like an explanation. I am extremely annoyed.”
Princess Alexandra picks Cambio: The Princess Alexandra Hospital NHS Foundation Trust has signed a ten-year contract with Swedish company Cambio to deploy its electronic patient record system, reported eHealth Insider. The Essex trust aims to have the new system in place next year as its McKesson Totalcare contract expires in March 2014. The trust went out to tender for an EPR last year and the contract will be for a minimum of ten years. The Official Journal of European Union (OJEU) notice said the system should include a patient administration system, A&E system, maternity information system, order communications and results reporting, e-prescribing, and a clinical portal including patient and community access. The trust has chosen to add electronic whiteboard technology and mobile applications to the initial implementation. It may also expand the scope of its work to include the management of community care in partnership with local GPs.
GPs fear legal threat and rising workload as records go online: Dr John Lockley, a GP in Bedfordshire and a medical informatician, told a seminar of health IT policy experts and business leaders that uncertainty over patient records in primary care was an ‘elephant in the room’, reported GPOnline. The government’s Information Strategy, published in 2012, set a target for GP surgeries to make electronic access to medical records available to all patients by 2015. Dr Lockley told panelists discussing implementation of the strategy that records should belong to the GP, for the GP’s own information and that handing open access to patients could prevent doctors recording uncertainties. Lockley said: “When patients come to see me for the first time I probably know what’s going on in about 50% of cases. It’s my record about the patient, not the patient’s record. It’s my notes about what is going on.” Professor John Williams, director of health informatics at the Royal College of Physicians, told Dr Lockley it would be ‘very unfortunate if that elephant was used to stop progress’, and there would need to be a ‘patient friendly and appropriate view’ available for electronic access.
IMS MAXIMS enables Royal Cornwall Hospitals NHS Trust to meet CQUIN targets for dementia care: Royal Cornwall Hospitals NHS Trust is to become one of the first in the UK to exceed all its Commissioning Quality for Innovation (CQUIN) targets for dementia care after implementing software designed by IMS MAXIMS to support NHS trusts with early diagnosis and improved care of patients with dementia, reported ProHealth Service Zone. The Department of Health’s CQUIN requirements aim to help identify patients with dementia and other causes of cognitive impairment to enable a better referral process, reduced length of stays in hospital and effective follow-up care. Frazer Underwood, associate director of nursing and consultant nurse for older people at Royal Cornwall Hospitals NHS Trust said: “This system means we are able to ensure that all patients over 75 years old are identified, assessed and referred as appropriate. It enables us to increase the early identification of people with dementia. In Cornwall, we have 10 percent more older people than the national average and the prevalence of dementia correlates with that higher figure.”
Healthcare assistants ‘want professional register’: Most healthcare assistants in the UK want to see tougher regulation of the profession, a survey suggests. A British Journal of Healthcare Assistants poll of 385 staff found 93% backed compulsory registration – with many prepared to pay for it, reported the BBC. It would mean healthcare assistants would have to be on a formal register to work, just as nurses have to be. The move was recommended in England by the Stafford Hospital inquiry, but rejected by ministers last month. They argued that registering the thousands of healthcare assistants working in the NHS and private sector to do basic tasks such as feeding and washing patients would be too burdensome bureaucratically to introduce for the 1m staff working across the public and private sectors. Ministers also said it would be unfair to ask lowly paid staff to pay annual fees to support the system. Instead they proposed a code of conduct and minimum training standards, similar to the scheme that has already been introduced in Scotland.
Orion Health and Caradigm Expand Partnership to Deliver Integrated Electronic Health Records, Intelligence Platform and Applications: Caradigm, a Microsoft and GE Healthcare company, and Orion Health, a global leader in eHealth technology and interoperability, have announced they have expanded their alliance agreement to integrate Orion Health’s market-leading Electronic Health Records (EHR) solution with the Caradigm Intelligence Platform (CIP) and ecosystem of applications, which will allow healthcare communities to more rapidly address today’s most complex challenges – including new models of care delivery and payment, population health management and patient engagement – while also helping to reduce costs and increase revenue, reported eHealthNews. The companies’ integrated, end-to-end solution will offer healthcare organisations the ability to move beyond simple data exchange by using near real-time data aggregated from disparate systems across the healthcare community to rapidly gain insight about patients, populations, performance and outcomes. We’re excited to partner with Orion Health to address the escalating needs of healthcare organisations worldwide with a new generation of interoperability solutions,” said Caradigm CEO Michael Simpson.
Funding fragmentation threatens integration of NHS care: An increasingly fragmented funding allocation system risks undermining the government’s emphasis on integrated care, revealed a report by the Kings Fund. The report on health resource allocation found recent reforms such as splitting public health and NHS funding and the new role for NHS England in resource allocation, created a ‘strikingly more fragmented’ system, reported GPOnline. It also warned that the system would become increasingly fragmented as the number of commissioners increased, posing ‘substantial risks to a system that needs to integrate around whole care pathways and populations’. ‘There is as yet no sign that the Department of Health is addressing these risks,’ the authors warn. The report calls for the review to assess whether allocation should be increasingly based on outcomes or more explicitly linked to clinical standards.
£40m Health Care Centres announced for NI: Two new £40m health care centres for Northern Ireland have been given the go-ahead. The new Lisburn and Newry facilities will accommodate GPs as well as a number of community services provided by the trusts, reported 4NI.co.uk. Health Minister Edwin Poots said the new centres, which will serve as hubs for the provision of health care in both communities, are a pivotal part of the reform of health and social care, as set out in Transforming Your Care (TYC). Speaking to representatives from the Local Commissioning Groups, Mr Poots said: “A key element of ongoing health care reform is the need to move services away from hospitals except where it is absolutely necessary and to develop service provision in the community so that people can access treatment closer to their own homes or, where possible, at home. The provision of these new facilities will assist that process.” The proposals are based on an analysis of the health needs of the local populations.
Opinion
The NHS must gear up to meet the challenge of workforce planning
This week, Stephen Eames, chief executive at Mid Yorkshire Hospitals Trust, describes how the NHS should learn from the pioneering workforce deal in the car manufacturing industry to help manage the demand in healthcare to workforce supply.
Eames commented: “It is a basic truth that workforce planning in the NHS has lacked rigour in matching clinical and general workforce supply to the ever-changing demand for a variety of healthcare and service needs.
Workforce planning in the NHS has traditionally been difficult. Part of the reason for this is the oil tanker nature of professional education and training, which never moves as quickly as the market does. NHS trusts have largely struggled to effectively match the ebb and flow of service demand to workforce supply.”
Looking ahead, Eames predicts: “In the future it is likely that the demand for specialist services will be concentrated in fewer, larger centres of excellence and routine hospital services will increasingly be localised. It is not rocket science to assume therefore that both legally and professionally the scope of practice for non-medical professionals will expand even more rapidly.
“An ability to combine strategy and agility in delivering workforce change is likely to be the single most important factor between success and failure in the years ahead. Any trust that does not take steps to tackle this challenge now is likely to find that it is unable to manage almost two-thirds of its spending effectively.”
The new NHS: Only the fittest will survive and flourish
This week on Public Service.co.uk, Kurt Long, CEO of FairWarning, explains that reputation means everything as healthcare providers start to compete. Long argues that within the reformed NHS landscape only the strongest will survive.
“The NHS is currently undergoing a transformation, which once completed will give place to a new, leaner and more efficient healthcare landscape. With limited financial resources and having to meet the growing needs of an ageing population, many NHS trusts are struggling, some have gone into administration, such as South London Healthcare NHS Trust, with more to follow suit.
“Whilst many refuse to accept this and fight to keep the current status quo, the fact is that these irrevocable changes will happen. The government, having to reduce its own deficit and cutting back in all areas, no longer has the financial means to bail those trusts out nor to prop up a healthcare system that is no longer viable.
Long continues by explaining how current reforms mean that NHS trusts are now operating in a more competitive environment.
“I would go as far as arguing that the healthcare environment is becoming a commercial marketplace with various providers competing against each other.
“This is a tectonic shift in the history of the NHS: the rules of engagement are changing and as a consequence only the strongest, most agile and financially viable organisations will survive.”
He concludes by saying that forward thinking healthcare providers such as NHS Scotland, are already moving ahead at some pace to deploy privacy enhancing technology and procedures.
“Those providers that see implementing best-in-class privacy measures as crucial will be able to deliver effective and efficient care, attract patients and secure contracts. Those who do not will be dangerously exposed in a healthcare market where reputation means everything and where only the strongest will prosper.”
Time for the NHS to import innovation
In this week’s HSJ (subscription required) Nick Seddon, deputy director of the independent think-tank Reform, explains why the NHS needs to break its habits of the past in order to boost the service’s ability to take up and spread innovation.
“When Robert Francis said the NHS needs to change “fundamentally” he rubbed up against the old paradox: plus ça change, plus c’est la même chose (the more it changes, the more it is the same thing). For structures have been repeatedly reorganised, it is just that the culture has been unreformed.
Unquestionably, real advances have taken place here and there (publishing outcomes for cardiac surgery, the London stroke care reconfigurations), but progress has been patchy, at best.”
Nick continues by saying that the reason for this is that governments typically try to will the end, but not the means. He explains that if the NHS is to become much safer and more caring while saving money, we need to break that cycle and boost the service’s ability to take up and spread innovation.
“The gap between global innovators and the NHS is arresting: top organisations give professionals more power to improve the quality of care for patients and hold them properly to account when they don’t. Mexico’s SalaUno has copied India’s Aravind in its use of data, process redesign, and efficient use of staff, so that doctors and nurses only do what only doctors and nurses can do, and a range of other people are up-skilled.
“The government can create the space for transformation by giving leaders more freedoms. But while the South West consortium calls for more flexible terms and conditions, the Department of Health is leaving them isolated. As Chris Hopson, chief executive of the Foundation Trust Network, argues, Jeremy Hunt needs to show the “strong political leadership of the type that Michael Gove and Theresa May are providing”.
The dialectic of foundation trust finances
In today’s HSJ (subscription required) Sally Gainsbury compares the challenge being faced by foundation trust finance directors as a Marxist battle – “when two opposing interests clash in bloody conflict, something kind of beautiful happens in the dialectical birth of a new, more advanced mode of being: communism, in the case of the capitalist and the proletariat.”
What Gainsbury is suggesting is that despite the pressures finance directors are under, something positive will eventually happen.
“These past few months they have been sweating blood in a desperate struggle to sign off workable contracts with cash-struck commissioners.”
“Marching against this interest is Monitor’s proposed new risk assessment framework.”
“These competing forces create dilemmas for FTs. On the one hand, commissioners like to moan about the size of the FT’s surplus, citing it as evidence the hospital is surely ripping them off when it expects to be paid for every damn patient it treats, or to get extra cash for doing more work.”
“The dialectical moment in all of this is the flourishing of an ever-more advanced set of skills and creativity in the FT finance directorate, which will make forthcoming sets of FT accounts true works of beauty to behold.”
Joe’s view of the end of CfH
NHS Connecting for Health did not get a public send off as it finally ceased to exist on 1 April. Which is a shame, as Joe McDonald had his funeral oration all ready…
“The start of the month saw the end of the arm’s length body that was NHS Connecting for Health. Latterly, CfH became something of a barge-pole’s length body, as successive governments attempted to distance themselves from the blame attached to its failure to deliver supposedly ‘strategic’ IT systems to acute trusts (although it was supposed to do other things as well).
“At the time I joined, a colleague pointed out that “the programme has fallen over in the street and the general public are pointing and laughing at it.”
Joe goes on to say that he feels the passing of CfH should have been marked by some sort of social event like a party or a wake and some kind of closing ceremony. In that unlikely event, he would love to have the opportunity to speak to his 1,500 fellow CfH veterans. He even prepared his speech…
Highland Marketing Blog
This week has seen the launch of eHealth Insider’s latest campaign, this time titled ‘The big EPR debate.’ In this week’s blog Sarah Bruce asks what is EPR anyway?
