News in brief
£75m spent on IT for NHS reforms: A House of Commons statement by health secretary Jeremy Hunt into the costs and benefits of NHS modernisation has revealed that £75m has so far been spent on IT to create new organisations, reported Government Computing. The health and care reforms came into operation on April 1 2013 with the intention of reshaping the NHS to give patients a stronger voice and give doctors, nurses and elected councillors more power to decide how best to use local resources to significantly improve services and patients’ health. According to Hunt, although the Department of Health originally forecast the total cost of transition to be £1.5bn, the publication of the department’s Annual Report and Accounts for 2014-15 revealed that the actual costs to March 31 2015 were £1.38bn, with total expenditure forecast to be under £1.43bn. Hunt said, “By removing excessive layers of bureaucracy, the NHS has significantly reduced the number of managers it employs. For example, the reduction of central administrative staff by 18,000 since 2010 has helped the NHS to increase the number of professionally qualified clinical staff by over 23,500, including over 8,500 more nurses and over 9,000 more doctors. These extra clinicians are treating record numbers of patients. For example, compared to 2012-2013, in 2014-2015 the NHS admitted 600,000 more patients to hospital, saw 3.4m more outpatients, and did 2.2m more diagnostic tests.”
New wave of NHS vanguard urgent care sites announced: The NHS in England has announced eight new further vanguard projects aimed at driving forward more integration between health and social care, reported Care Appointments. The move will see the transformation of urgent and emergency care for more than nine million people by changing the way organisations work together to provide care in a more joined up way. NHS England chief executive Simon Stevens said it would link up the “often confusing array of A&E, GP out of hours, minor injuries clinics, ambulance services and 111 so that patients know where they can get urgent help easily and effortlessly, seven days a week”. Another aim is to break down boundaries between physical and mental health. Six vanguards will cover smaller local systems, which may include hospitals and surrounding GP practices and social care, while two network vanguards will be working with much larger populations to integrate care on a greater scale. Professor Keith Willett, NHS England’s director of acute care, who is leading the urgent and emergency care transformation, said: “This proves a modern NHS needs a very different approach and shows we can transform patient care. These networks and new vanguards will support and improve all our local urgent and emergency care services, such as A&E departments, urgent care centres, GPs, NHS 111 and community, social care and ambulance services, so no-one is working isolated from expert advice 24 hours a day.”
NHS chief: Cancer reforms will save 30,000 lives yearly: Major reforms will lead to an 80% increase in the number of cancer tests, with all patients given a definitive diagnosis within a month to enable treatment to be started more quickly, reported The Telegraph. Simon Stevens, the chief executive of NHS England, said the £2bn initiative would also replace a range of outdated equipment and mean that the UK has a “world class” cancer service within five years. Figures show that the UK has one of the lowest cancer survival rates in Europe, with around 10,000 more cancer deaths a year compared with similar countries. “One in two of us will get cancer at some point in our lives, and the good news is that survival rates are at their highest ever,” said Stevens. “But two fifths of cancers are preventable, and half of patients are currently diagnosed when their cancers are advanced.” The plan to overhaul treatment of the disease has been devised by the Independent Cancer Taskforce, made up of expert groups including NHS England, the Royal College of Surgeons, the Royal College of GPs and cancer charities.
Vanguards in digital drive: NHS England will provide information on how the NHS vanguard sites can make use of digital technology as part of a support package published by the end of this month, reported DigitalHealth.net. The package gives details on what organisations need to do to drive the vanguard programme, which was launched in March this year as a way to trial new models of care at 29 different sites across England. As reported in board papers ahead of its meeting on Thursday, NHS England has visited all the sites over the past few months to identify several “enabling areas for support”, which form the basis of the work programme over the next year. From October 2015, sites will have support to map, understand and use existing digital capabilities in the local health system, while there will also be a guide to identify gaps in their technology and define digital priorities. NHS England’s chief executive Simon Stevens discussed the progress of the vanguards during a meeting of the House of Commons’ health committee, where he said that the sites must bring about change in their local area and produce “generalisable insights that other parts of the health service can then beg, borrow and steal”.
Think tanks seek more investment for NHS: A report from the Health Foundation and The King’s Fund sets out a “transformation fund” that will need at least £1.5bn a year on top of £8bn the government has promised by 2020 reported the BBC. The fund would allow for investment in new types of care, the report says. The Department of Health said the government was investing the additional money the NHS had asked for. It said efficiency savings and cost control measures had to be delivered by the service. Anita Charlesworth, chief economist at the Health Foundation, said: “While we recognise that it is challenging to provide additional funding for the NHS in the context of other services receiving cuts, the alternative is to risk a decline in quality and safety in NHS-funded care and a reduction to the services currently available.” She added: “The transformation fund should become a fundamental part of the DNA of the health service from here onwards.” Chancellor George Osborne told unprotected government departments they must find savings. His spending review is calling for £20bn cuts to Whitehall budgets, although the NHS budget will be protected.
Petition for Hunt’s removal as health secretary surpasses 100,000 signatures: Over 100,000 people have signed a petition calling for a vote of no confidence in health secretary Jeremy Hunt in just 24 hours, reported Pulse. The petition launched via Parliament.uk, started this week and quickly surpassed the 10,000 signature target at which the government must issue a response. Launched by north London-based consultant in internal medicine Dr Ash Sadighi, it accuses Hunt of ‘alienating the entire workforce of the NHS by threatening to impose a harsh contract and conditions on first consultants and soon the rest of the NHS staff’. A separate petition launched via Change.org calling on the health secretary to resign, or Prime Minister David Cameron to remove him from his post, has received over 90,000 signatures. Both petitions were launched by consultants angered by Hunt’s speech at The King’s Fund last week, in which he threatened to impose his terms for the new junior doctor contract and accused the BMA for being out of touch with its members. His petition read: “In essentially calling doctors lazy and suggesting they need “a sense of vocation” he has offended the whole NHS workforce and demonstrated how little regard he has for us and how little he understands what we do.”
NHS England backs down over another data extraction scheme: NHS England has backed down from yet another data extraction scheme, after details emerged of backdoor plans to gather patient appointment information. The Register has seen the original letter sent to EMIS by Tracey Grainger, head of digital primary care development at the NHS. It said: “We are seeking your assistance to obtain extracts of de-identified patient level data from systems that either record appointments or record consultations or in some cases both. This extract needs to be in place by September 2015.” Roger Goss, co-director of campaign group Patient Concern, said that such a move would destroy patient-doctor confidentiality. “This is quite apart from the legality [and] ethics of what she proposed. And given NHS England’s record of attempting to launch care.data nobody will believe her claim that she only wants aggregate data and will not use individuals records in who knows what ways if she gets hold of them,” he said. Following the revelations the body has said it will instead work with GP surgeries directly to support them in collecting information needed about appointments, rather than using IT suppliers to extract the data. NHS England will receive data providing information about numbers of appointments, patterns of activity through the week, and the impact of the access innovations being introduced by practices, it said. Speaking at a techUK event this week NHS chief data officer Geraint Lewis has dismissed a number of media stories not being based on truth, reported ComputerWorld. “A lot of it [media coverage] unfortunately was not based on truth. There were lots of scare stories being run that the data would be used for insurance purposes,” he said
Patient access to coded GP info by April: GP practices must offer patients online access to detailed coded information from their medical record by April next year. NHS England is close to defining what will be included in this coded information set after working with professional bodies such as the Royal College of GPs and British Medical Association. Dr Masood Nazir, NHS England’s national clinical lead for the Patient Online programme, told DigitalHealth.net the organisations are weeks away from announcing an agreement. Common coded information includes test results, immunisations and vaccinations. “Any coded information that doesn’t cause any harm to the patient or reference third parties should be shared, but we have to find a safe way of doing that,” he said. “We’re working with the professional bodies, which are helping us define that accurately for the practices; that’s ongoing and we will share that shortly.” Under the GP contract, practices had to offer patients online appointment booking and ordering of repeat prescriptions along with access to the same summary information as is held in their Summary Care Record, by April this year.
Experts propose e-mails to cut face-to-face GP consultations: Experts have proposed that pilots are run to see if GPs communicating with patients vie e-mail is a viable way of reducing demand on GPs’ time, reported OnMedica. GP leaders, however, have warned that such a “virtual” approach might actually increase workload so should be road-tested first. A major new report commissioned by health secretary Jeremy Hunt and prepared by the Primary Care Workforce Commission set up by Health Education England, has been published containing many recommendations to improve general practice. In The future of primary care: creating teams for tomorrow report, the authors say: “If 5% of GP consultations could be dealt with by e-mail, this would save 17 million face-to-face consultations a year.” The authors admit, however, that they do not know to what extent e-mails from patients would generate additional demand. They recommend that e-mail correspondence between GPs and patients should be piloted prior to becoming a routine part of NHS care. They also suggest that e-mail correspondence and electronic messaging should become routine between GPs and hospital specialists, allowing both to seek advice and give guidance on patient care. Although this would need “protected time” in the working day, there were significant potential cost savings in terms of reduced referrals to hospital.
Devolution amendment could halt most ambitious local health proposals: Some of local government’s more ambitious proposals for the devolution of responsibility over health could be blown off course by an amendment to the devolution bill passed in the Lords, reported Health Service Journal (subscription required). The amendment, moved by former Labour health minister Lord Warner, said regulatory or supervisory functions could not be transferred from national NHS bodies such as Monitor, the Care Quality Commission and NHS England. Peers had already passed a government amendment to the Cities & Local Government Devolution Bill preventing other public bodies’ regulatory functions being transferred to a combined authority or council, but Lord Warner said this didn’t go far enough. Lord Warner’s amendment specified that where health functions are devolved the newly responsible body must adhere to national standards and information and accountability obligations. His Labour colleague Lord Hunt said on Twitter this would “protect the national nature of the NHS”. The amendment could be overturned in the Commons but if it stands it could derail some of the devolution proposals put forward in Greater Manchester and the ambitions agreed by London council leaders and the capital’s mayor.
E-Referrals back up to 40,000 a day: The number of referrals being made on the new NHS e-Referral Service has risen to 40,000 a day, the same as were made using the Choose and Book system, reported DigitalHealth.net. In the days after replacing Choose and Book on Monday 15 June, users of the e-Referral Service reported that it was running slowly, and there were several periods during which it was unavailable. This meant the number of referrals being processed each day was significantly reduced. But following weeks of stabilisation work, the number of referrals being made using the national electronic system are up to the levels recorded before its introduction, at around 40,000 a day. While the service has been stabilised for GPs, patients and commissioners, NHS England’s director of strategic systems and technology, Beverley Bryant, said there are ongoing issues for provider organisations and referral management centres. “Providers have had to work harder to make it work than they did before which is not good, so user experience is not as good as with Choose and Book and we always said it would be better.” She said the e-Referrals team is entirely focused on fixing the system, rather than work on developing it and improving uptake, which will happen once it is fully stabilised.
Caps on costs of care to be delayed until 2020: The government’s plans to introduce a £72,000 cap on citizens’ individual lifetime care costs have been shelved until 2020 as part of austerity measures reported Integrated Care Today. The cap on care costs had been scheduled for introduction from April of 2016, but has been delayed until 2020, health minister Lord Prior said. Because of continuing cost cuts across government, Prior said that introducing the system for April as previously planned was not the “right moment to be implementing expensive new commitments such as this”. Izzi Seccombe, the Local Government Association’s community wellbeing board chair said “we cannot try and reform the way people pay for adult social care when the system itself is on such an unstable foundation” with the care system having a growing annual funding gap.
Solihull partners on population health: Solihull Council is working with three local NHS organisations to pilot new ways of working across health and social as part of a deal with Caradigm, reported DigitalHealth.net. The Integrated Care and Support Solihull (ICASS) programme is a collaboration between the council, Birmingham and Solihull Mental Health NHS Trust, Heart of England NHS Trust and Solihull Clinical Commissioning Group to create a more joined up system of care and support for the frail and elderly local population, in particular those with dementia. ICASS will spend the next 12 months working with Caradigm – a joint venture between Microsoft and GE Healthcare – on how to make better use of information and analytics to support this joined up care model. Dr Patrick Brooke, accountable officer for Solihull CCG, said that Caradigm will allow the trust to use “more sophisticated healthcare analytics about how our workforce is being used and how we are using health resources and the health systems.” The company will also support ICASS around care coordination and care management. This includes improved workflow automation, which will enable ICASS to “map care around individuals and patients to a higher degree”, said Brooke.
Awards
Healthcare IT champion of the year: The voting is now open to find this year’s Healthcare IT Champion. Click here to view the shortlisted candidates. Voting closes on Friday 11th September at 1600. Good luck to all the shortlisted individuals. The winner will be announced at the EHI Awards ceremony on Thursday 1st October 2015.
Opinion
Nurses must be familiar with acute kidney injury guidelines
The first line of defence against acute kidney injury (AKI) is prevention and early detection, says Richard Fluck, in a blog on Nursing Times (subscription required) this week.
Fluck, the national clinical director (renal) at NHS England, consultant renal physician at Derby Teaching Hospitals Foundation Trust and chair of the Think Kidneys Programme Board, gives a story of the personal impact on one patient who he once saw with acute kidney injury, and goes on to explain that nurses have an important role to play in prevention.
“The challenge of detecting and managing AKI varies and nurses need to be aware of the escalation guidelines and processes in place for their work environment, be it a walk-in centre, a nursing home or a hospital ward,” says Fluck. “For most nurses, the Kidney Disease: Improving Global Outcomes definitions, as well as the national algorithm, may be new territory. But it’s important that nurses learn about the principles because so often you are the first line of defence in prevention and early detection.
“So, do you know who is at risk on your ward or among your caseload? What advice do you give to those patients? Someone may have inherent risk factors, such as complex drug regimes or pre-existing medical problems. A trigger event – an operation, an infection, sickness and vomiting – may then result in AKI. What should you do? To whom do you go to seek advice?
“There are perhaps 40,000 excess deaths associated with AKI in England every year – a high proportion of those may be preventable.”
CIOs need to reboot supplier relationships
IT leaders need to rethink the balance of spending time between maintaining traditional suppliers and introducing innovative new providers says Cliff Saran in Computer Weekly this week.
“While large amounts of IT spending still goes to maintaining systems from the big four software providers – IBM, Microsoft, Oracle and SAP – all the real innovation seems to be coming from elsewhere” writes Saran.
“At the same time, experts are talking about “bimodal” or two-speed IT, where back-office IT systems that support corporate “systems of record” applications, are separated from a more agile, customer-facing IT function, working directly with the business on social, cloud, big data and mobile initiatives – so-called systems of engagement.
“Given there is a lot of innovation coming from startups and tech suppliers the IT department may not have previously used, CIOs should be assessing why large sums of expenditure are still going on maintaining systems from the likes of IBM, Microsoft, Oracle and SAP.
“By starting from scratch with an IT strategy that considers the role of an IT department, the CIO has the opportunity to consider alternative approaches to making IT fit the needs of business more closely.
“One of the problems for some CIOs is that IT has expanded to the point where the IT department has attempted to take ownership of almost anything computer-related. Over-zealous adherence to regulatory compliance has meant that rather than facilitating the business, IT has behaved as a barrier under the guise of protecting corporate data.”
NHS’s financial problems need one solution, not many
A collaborative approach is needed between local and national systems to ensure the NHS stays within its 2015-16 budget, says Chris Hopson on the Guardian Healthcare Network.
“The latest evidence, such as The King’s Fund Quarterly Monitoring Report (QMR) published last week, shows that the NHS faces a significantly more difficult challenge to stay within its budget this year than it did last year.
“There are a number of possible responses from NHS frontline leaders to this problem. One would be, ‘the only way we can manage 2015-16 without the system crashing is for the government to inject more money and admit the current challenge is undeliverable’. Another might be, ‘making the NHS numbers add up is a system level responsibility of the department of health and the arm’s length bodies, not ours’. A third would be, ‘we can only deliver by forgetting about everyone else and sorting out our own problems’.
“Failure by the NHS to stay within its 2015-16 budget would risk a crisis of confidence in central government and across Whitehall. We need to be alert to the arguments that others will make. If the NHS can’t deliver financial balance with all these advantages, why put more money in? Why frontload the NHS’s extra £8bn (which we desperately need)? Let the NHS demonstrate appropriate financial discipline first. Why bother investing in an NHS transformation fund if the health service will always be a bottomless money pit that cannot transform? There have already been mutterings of this kind in the national media.
“The Five Year Forward View talks about the importance of a new relationship in which the national NHS system supports local leaders. A collaborative local-national partnership to ensure the NHS delivers its 2015-16 budget would be a great place to start.”
£1.5bn of NHS savings the government must not miss
Promises of a paperless NHS may have been a bold move from Jeremy Hunt, but an approach in Surrey could still save hundreds of millions if scaled up across the health service, writes Apira director Geoff Broome on The Information Daily.
“Pre-election promises made very little reference to continuing Jeremy Hunt’s plans for a paperless NHS, some might say with little surprise. Many doubted the realistic nature of the fully digital ambition from the moment it was first set out at the beginning of 2013,” he says.
“But before voters reached the ballot box in May this year, a collaboration of trusts in the South of England went through rigorous negotiations that, backed by Department of Health cash, placed them on track for a paperless system. The move will save significant sums – estimated at millions of pounds every year.
“Scaled up to all 156 acute Trusts in England, this approach could save the NHS £1.5bn over the next 10 years. A paperless NHS might not have featured in the Conservative manifesto, but it was in the Five Year Forward View and it is something the newly elected government cannot afford to miss.”
Blog
In this week’s blog The government’s new communication plan has a focus on public health, prevention and reducing NHS demand. But is something missing, asks Matthew D’Arcy.
