News in brief
NIB strategy due ‘later this year’: The National Information Board (NIB) is set to release its long awaited informatics strategy later this year, outlining a ten-year plan for how to make the most of data and technology in healthcare, reports eHealth Insider. An update on the NIB’s informatics strategy in the board’s latest working group papers says the document is due to be released soon. When NHS England published its guidance on bidding for the first round of the tech fund last July, it said a technology strategy would be published in December. This became June, before being pushed back to the third quarter of 2014 in the Department of Health’s (DH) 2014-15 corporate plan. The update says the strategy is focussed on the NIB’s endorsement of six strategic outcomes, which are service user experience; generating user demand; transforming professionals and services through training and education; providing an “open” framework of infrastructure and standards; enhancing staff skills and productivity; and providing “consistent, ubiquitous, reliable information” for decision-making. A spokesperson for the DH said the informatics strategy will build on the DH’s 2012 information strategy, The Power of Information, and will “cut across” both the DH’s and NHS England’s informatics strategies. They said: “The purpose of the strategy is to combine all part of the health, public health and care system to ensure a joined up approach to data. It will address all aspects of informatics across the system”.
Islington CCG plans £11m patient record scheme: Doctors and nurses will be able to access patient health records through a new Facebook-style page or app being developed by Islington clinical commissioning group (CCG) says The Commissioning Review. The pages could be updated automatically with data sent from blood pressure machines or weighing scales. New medications and hospital discharges will also be included on the site, which will allow patient records to be accessed from any computer in England. Patients would be able to control their own details. The CCG believes confidentiality issues could be solved through patients allowing others access to the record. Islington CCG will spend an estimated £10.8m on the software. Islington Council will contribute £600,000, and if the business case is approved NHS England will donate £1.7m. Creating the software will cost around £3.5m, and it is expected to cost £1m per year to run. However, the CCG believes it will save £14m over the life of the project. Katie Coleman, vice-chair of Islington CCG said: “Clinicians tell us that the biggest problem they come up with is the lack of joined-up technology and this problem of consent when sharing information. We need to make it easy for information to be shared so that residents feel in control of their information. People will be able to take their data with them wherever they go. You could use it in Islington, in Cornwall or in Scotland.”
Care.data pilots to be chosen ‘shortly’: Between two and four clinical commissioning groups (CCGs) will be selected “in the coming weeks” to begin the pathfinder stage of the care.data programme, reported eHealth Insider (EHI). The pathfinders will test different communication strategies before moving forward with the data extraction part of the project. The care.data programme will extract data sets from different organisations, starting with GP practices, and link them to an expanded set of Hospital Episode Statistics within the ‘safe haven’ of the Health and Social Care Information Centre (HSCIC). The project was due to start earlier this year, but was “paused” by NHS England after medical and privacy groups objected to a public leaflet campaign that failed to include a clear account of the programme, who would receive the data, or an opt-out form for patients. Up to 500 GP practices will now trial care.data in a phased roll-out starting this autumn. EHI reported last month that CCGs were due to receive letters inviting them to take part in the pathfinder stage, but that the letters had not been sent. Speaking at a care.data advisory group workshop last weekend, David Corbett, head of the care.data programme at the HSCIC, said this was because it had decided not to send letters, but to contact CCGs who had “expressed an informal interest” in being a pathfinder. “Initially we were going to write to all CCGs inviting them to take part, but had some advice that people would find that to be a little bit cumbersome. Also, if we got 50 CCGs wanting to take part and can only select two, that might not work,” he said. A selection panel that includes representatives from the royal medical colleges, Healthwatch England, and patient groups is currently considering expressions of interests from the CCGs and is hoping to make a selection in the next couple of weeks.
NHS Spine ‘successfully’ rebuilt, says HSCIC: The NHS Spine 2 has been “successfully” rebuilt and launched, according to the Health and Social Care Information Centre (HSCIC), reports Computing. The Spine is a part of the national infrastructure that stores patient information and enables electronic messaging; it was one of the only parts of the ill-fated NHS National Programme for IT (NPfIT) that emerged with some credibility. The Spine handles about 400 million electronic messages a month and more than 2.6 billion information requests and amendments each year. HSCIC claims that health professionals view 2,700 Summary Care Records a day – or one every 30 seconds. As the NHS’s contracts for the Spine had come to an end, the organisation decided to move the Spine onto a new infrastructure, in an IT operation that was completed at the end of August. The NHS has now officially stated that Spine 2 has been launched, with more than a dozen national IT systems and services being migrated to the new Spine in the space of a weekend. The new infrastructure has been built in-house by HSCIC in collaboration with agile software provider BJSS, and with other companies such as open source firm Basho also involved. “We have harnessed the latest technology to rebuild the most important NHS electronic system, built over 10 years ago and today relied upon by hundreds of thousands of health staff and patients every single day,” said HSCIC’s chief executive, Andy Williams.
NAO worries if town halls and the NHS understand risk of cyber threats: A National Audit Office (NAO) report on the work of the National Cyber Security Programme has raised concerns over local government and the NHS’s ability to deal with cyber threats. It suggests that although there is a good understanding of the threat by central government, the understanding diminishes the further away organisations are from the centre. There is a concern that central government departments unused to dealing with national security or fraud-related threats and the NHS and local government organisations “may have a more varied, but limited understanding of the cyber threat and they may not yet understand what would represent an appropriate level of threat protection.” The findings match those from research that Government Computing and CSC will release later this month around cyber security in the public sector. NAO believes that overall, the government continues to make good progress in implementing its National Cyber Security Programme, which is helping to build capability, mitigate risk and change attitudes, as well as taking advantage of opportunities for economic growth. But, it says, cyber threats continue to evolve and the government must increase the pace of change in some areas to meet its objectives. The government also needs to decide which initiatives should be mainstream activity across public sector organisations and which require the impetus and coordination that a successor programme might provide.
IT strategy to save Morecambe Bay £35m: University Hospitals of Morecambe Bay NHS Foundation Trust could save £35m over the next five years thanks to its IT strategy and implementation of the Lorenzo electronic patient record system (EPR). eHealth Insider reports that the trust is now developing a roll-out plan for electronic prescribing and order communications systems as a result of “significant progress” improving the functionality of Lorenzo, following a troubled beginning. A review of the trust’s six-year informatics, innovation and information technology strategy in its August board papers says the trust’s EPR programme is “still very ambitious and is still ahead of most other [trusts].” Morecambe Bay went live with Lorenzo’s patient administration system in 2010, becoming the first acute trust in the UK to start implementing the system, which was slated for use across the North, Midlands and East of England as part of the National Programme for IT. The trust subsequently encountered severe problems in the year after the go-live, and had to put a stabilisation plan in place to address issues with data input, clinic booking, and letters. The report says the trust has since made progress with the system developed by iSoft, a company since bought by CSC; implementing the maternity module in July 2013 and launching a project to make its outpatients department paper-light. The report says the trust will develop a business case for implementation of the clinical charting functionality, as well as for a mobile Lorenzo solution for tablets.
Most NHS staff think care has worsened over the past year: The number of staff who think the quality of healthcare has fallen has doubled compared to a year ago, while morale has fallen to below mid-point level, a survey has shown. In its second annual survey of primary care staff engagement, Cogora, a health research and publishing company, found that around 65% of respondents, in particular GPs, felt that healthcare had worsened in the last 18 months, reported The Commissioning Review. This compares to 35% of respondents last year. British Medical Association (BMA) GP Committee’s deputy chair Richard Vautrey said: “There’s a sense that as the NHS is under financial pressure, there is increased focus on cost cutting and trying to reduce costs by reducing services, and that would inevitably mean that patients get a poorer deal as a result of that and the GPs can see that.” The level of morale and hopefulness about the future of the NHS had fallen to an all-time low of two out of five, a further deterioration from last year’s survey results. Overwork and bureaucracy affected GP and practice managers’ morale the most, with GPs and practice managers providing an average rating of five out of five for both factors. Dr Vautrey said: “Every practice is aware of the pressure on appointments, they are struggling to meet the demands of patients and are not able to offer appointments in a timely manner in a way they would want to because of huge work demands, and they don’t feel NHS England or clinical commissioning groups are supporting them in that regard.”
GP crisis as soaring numbers refusing to take patients: Soaring numbers of GP practices are demanding to close their doors to new patients and force current patients to go elsewhere as doctors warn that services are “teetering on the brink of collapse”, according to The Telegraph. New figures show that last year 104 GP practices applied to NHS authorities for permission to stop accepting patients – more than twice as many as two years before. A further 45 surgeries asked to “shrink” their practice boundaries, throwing existing patients off their lists, while 100 more practices are threatened with closure, an investigation by Pulse magazine found. Doctors said they were unable to cope with “vast numbers of people” moving into some parts of the country, forcing them to close their lists to newcomers, or divert existing patients to new surgeries. Dr Maureen Baker, chairman of the Royal College of General Practice, said the situation was “extremely distressing” and having a “severe impact” on patient care. She said: “Family doctors are heaving under the strain of increasing patient demand, due to a growing and ageing population, and plummeting investment. Unfortunately, what we are seeing now is a sad consequence of the desperate shortage of GPs in many parts of the country, with many practices finding it difficult to find replacements for those doctors that have retired. This is leaving general practice teetering on the brink of collapse and having a severe impact on the care we can provide for patients.”
PKB will add genomics to records: Patients Know Best has formed a partnership with Tute Genomics to create genomic profiles for patients as part of their health record, reports eHealth Insider. The patient records access portal has teamed up with the genomics analysis company, which operates on a cloud-based software platform to create a full genetic profile for patients, stored in their medical record. Patients Know Best gives patients online access to their medical records and care plans, and allows clinicians and patients to message securely through the site and hold online consultations. Dr Mohammad Al-Ubaydli, founder and chief executive of the company, said that when doctors know a patient’s genomic profile, they can design specialised care plans tailored to the condition. “For example, gene tests can predict whether or not a patient with breast cancer will benefit from a certain type of chemotherapy, or a patient with an infection can safely receive powerful antibiotics,” said Al-Ubaydli. “We believe that before long, everyone will get his or her genome sequenced.” Tute Genomics specialises in creating genomics profiles that “even the most specialist doctors” can use and the companies hope that the partnership means that a patient will ultimately receive better healthcare services. The move comes as NHS England has set out its plans to have 100,000 genome sequences done by the end of 2017 and expects to select five genomics centres in the first wave of the project by January this year. Prime Minister David Cameron also recently announced a £300m investment into the national genome project.
Dementia now costs the UK £26bn a year, research reveals: The cost of dementia in the UK has hit £26bn a year, with sufferers, their carers and families shouldering two-thirds of the cost themselves, new research published by the Alzheimer’s Society has revealed. The report – Dementia UK: The Second Edition – prepared by the London School of Economics and King’s College London, reveals how people with dementia and their carers are left footing a £5.8bn social care bill for help with everyday tasks such as washing and dressing, reports National Health Executive. It added that 1.3 billion hours of unpaid care that carers, usually spouses or adult children, provide would cost the state £11.6bn if they did not provide it for free. Meanwhile the current cost of dementia diagnosis and treatment to the NHS comes in at £4.3bn and local authorities pick up a further £4.5bn. Alzheimer’s Society is now calling on the government to end what it calls the “artificial divide” between health and social care, which it says unfairly disadvantages people with dementia. Jeremy Hughes, chief executive of Alzheimer’s Society, said: “This new research exposes the staggering financial and human impact of dementia. It is plain to see that our social care system is on its knees, leaving an army of tens of thousands of unpaid carers bearing the brunt. If you have cancer or heart disease you can quite rightly expect that the care you need will be free. That is just not the case for people with dementia. Families are forced to break the bank to pay for basic care for a loved one.” The report, which draws together evidence from a survey of over 1,000 people with dementia, also estimates that by the next general election in 2015, there will be 850,000 people living with dementia. If current trends stay the same and no action is taken, this number is expected to bypass two million by 2051.
CSU independence plan put on hold: NHS England has paused a project that would enable its commissioning support units to become independent in just over two years. CSUs are hosted by NHS England and made £808m in 2013-14 by selling support services to clinical commissioning groups, local authorities and NHS England itself. Guidance on how they could become autonomous was expected to be released last month, with a further, more detailed installment due in November, says Health Service Journal (HSJ, subscription required). These documents were expected to chart a clear path on how the support units could become independent entities by the end of 2016. But NHS England’s director of commissioning support services and market development, Bob Ricketts confirmed to HSJ that nothing will now be released until after the beginning of 2015. Other well connected sources said they expect no further word on autonomy until after next year’s general election. CSUs were expected to become independent of NHS England by the end of 2016. CSUs are currently bidding for accreditation to NHS England’s procurement framework for commissioning support services, which reached the invitation to tender stage last month. This, rather than the organisational form, is CSUs’ most urgent area of focus, as NHS England has made it clear that CSUs will have no future unless their bid is successful. Although the decision to pause the autonomy project was widely welcomed by CSU leaders, some also expressed disappointment at the ongoing uncertainty for the sector.
NHS England mulls senior staff cuts in efficiency drive: NHS England is considering cutting at least 75 senior staff posts across its operations by March 2015 in a move to streamline its procurement as part of a wider review of its operations and how it manages major healthcare projects, reports Government Computing. The non-departmental body, which since 2013 has been responsible for commissioning primary health care services across England, including the proposed care.data patient records sharing project, has been undertaking an organisational review on operational efficiency since spring. In an e-mail sent to staff last week to update staff over the organisation’s review process, NHS England chief executive Simon Stevens said that potential reductions to levels of senior staff were among possible options to try and overcome funding pressures on delivering frontline health services. With an estimated 300 people working in senior clerical or managerial posts for NHS England, a collective consultation period began on September 8th regarding reducing the number of these positions. A final decision on staff numbers is expected to be made around November time, according to Stevens. By April of next year, NHS England said its national and regional directors expected to have implemented a number of operational changes such as bringing together all existing national specialised commissioning activities and resources.
Opinion
Why open source is positive for healthcare:
Andy Clegg, clinical consultant at Orion Health talks in The Information Daily about how open source is receiving positive attention and how it has the potential to drive a new level of innovation throughout the industry.
“As a clinical consultant representing a proprietary software supplier in healthcare, you may be surprised to hear that I believe the attention that open source software is receiving is positive. This is not because open source can solve all of the current IT challenges within the healthcare service, but because it has the potential to drive a new level of innovation throughout the industry.
“Whilst trusts start to consider the benefits that open source can deliver, any chosen IT strategy which includes this software should be approached with degree of caution. Both trusts and vendors are having public discussions around the unknown entities of how open source will work – support, development, liabilities, management, governance, pricing, interfacing between systems – and this is because the software, and its approach, is relatively new to healthcare.
“For open source to work you need a very active community of developers to input into the software. If you also consider the complexities with digitising healthcare compared to other industries where open source is more advanced in its application, then challenges can occur in finding professionals with both the IT skills and healthcare market knowledge required. This gap needs to be filled in order to ensure that clinical and efficiency gains are met.
“In eHealth, similarly to other areas of IT, open source seems to suit tactical applications rather than the larger strategic solutions. Of course, strategic open source products can be a viable option when the risks in doing so are reduced across a global user base; Linux is a great example of this. With the increasing reliance on IT to enable efficiencies and improve outcomes, can strategic open source products and contracts offer a level of risk mitigation that is acceptable to trusts?”
Scotland’s health – at the heart of the debate
With healthcare taking the central stage at the run-up to the Scottish referendum, Hugh Pym, the health editor at BBC, is reviewing the two sides’ arguments for and against an Independent Scotland in relation to the NHS.
“The Yes campaign has alleged that a trend towards privatisation in the NHS in England will inevitably drag Scotland down the same route. Contracting out some health provision, the argument goes, will result in lower public spending which in turn will affect Scotland’s allocation.
“Better Together has accused the Yes campaign of scaremongering over privatisation, pointing out that the Edinburgh government has control of health spending and the structure of the NHS in Scotland. The Scottish health system, it’s argued, has been run in a different way from England’s for many years. There is for example no split between commissioners and providers of health care.
“Central to this debate is what will happen to health funding. Under the so-called Barnett formula (named after a Labour minister in the 1970s), Scotland and Wales receive block grants from Westminster calculated as a proportion of what the Government at Westminster has decided to spend in England. Its then up to the administrations in Edinburgh and Cardiff to distribute funds as they see fit.
“Health spending in England has been “protected” by the Government from cuts. This helps underpin the overall budget calculated for Scotland via the Barnett formula. But the Yes campaign says because the “protection” of England’s health finances is not guaranteed in the next parliament there can be no certainty over future funding for Scotland.
“And what of the privatisation argument? Around 1% of Scotland’s health budget is spent on private provision, for example operations in private hospitals. This proportion has been growing as health chiefs strive to bring down waiting lists. The equivalent figure for England is just under 6%.”
Apple bites into wearables
Apple has launched its first wearable device. Sam Sachdeva asks what this could mean for the wearable tech market and for healthcare.
“When Apple enters a market, competitors – and the world – take notice. So it’s no surprise that the company’s anticipated arrival in the wearable technology sector has generated a huge amount of speculation about what it might entail.
“While there are a number of smartwatches and other wearable devices on the market, analysts are hoping that Apple will break new ground by creating something more complex than a fairly rudimentary health tracker.
“The potential of a wearable device that can successfully make a leap into healthcare is huge: in a column for EHI, GP Dr Neil Paul speculated that an iWatch could be used to detect falls, measure heartbeat abnormalities and even provide an early warning of hyperglycaemia.
“At a wearable technology conference in London earlier this year, US analyst Shane Walker predicted that monitoring your activity using a tracker could become a prescribed treatment within the next year. “You will be handed an activity monitor tied into your doctors’ electronic medical record, programmed when you leave the doctor’s office,” he said.
“In the end, what is more important than the hoopla surrounding the launch will be whether the iWatch has broken into the medical sector a year from now, or whether it joins the other fitness trackers gathering dust in their owners’ homes.”
Post diagnostic support in dementia
As NHS England launch a new Dementia Toolkit, Alistair Burns, the national clinical director for dementia, gives his views on support for people with dementia and their carers.
“Being diagnosed with dementia is the start of a life changing journey, and that’s why it’s so important that we reach our ambition of increasing correctly diagnosing dementia in more people, and putting in place the support they need. Of course, the word “support” potentially covers a lot of things and can be directed primarily toward the person who has the diagnosis or their carer – paid or unpaid, formal or informal.
“The emphasis on support for carers is rooted in the fact that caring for a person is recognised to be one of the most stressful things around and underscores that a diagnosis in and of itself, must be backed up with something. It is essential that the support be provided bespoke to the individual and tailored to their needs.”
Speaking about the importance of making information about dementia available, including the implications of the diagnosis and a list of available support and facilities, Burns said: “A great initiative I saw recently in Derbyshire was that the local library produced a booklet – in collaboration with the Sherwood Forest Hospitals Trust – detailing books available for people with dementia, ranging from the classics such as Dancing with Dementia by Christine Bryden, John Suchet’s “My Bonnie” to the delightfully named “Knickers in the Fridge” by Jane Grierson.
“That type of readily identifiable and accessible information is so important and in my view underscores the reach that dementia has and is now achieving. I think it is fair to reflect that, just a few years ago, it would have been far less likely that such an initiative would have been created – a real indicator of the profile of dementia and the recognition of the need for support.”
Highland Marketing blog
In this week’s blog, Danielle Gibson looks at Apple’s new HealthKit feature.
