News in brief
Surgeon data: ‘Historic’ move for NHS:The first wave of new performance data for individual surgeons in England is being published in what is being hailed as a historic moment for the NHS, reported the BBC. Vascular surgeons have become the first of a new group of nine specialities to publish the information, including death rates, that appears on the NHS Choices website. The other groups will follow in the coming weeks. However, the move has been overshadowed by some surgeons refusing to take part. They were able to do this because of data protection laws, although earlier this month health secretary Jeremy Hunt warned that those refusing to take part would be publicly named. Just six out of nearly 500 vascular surgeons, who specialise in procedures on the arteries and veins, including stents, have opted out. However NHS Choices states none of the six had results outside the normally expected range. They have been named as Richard Bird, Patrick Kent, Robert Lonsdale, Manmohan Madan, Peter McCollum and Leszek Wolowczyk. They and their reasons for opting out are detailed on the website.
Government announces £3.8bn pooled fund for health and social care services: The government is to create a pooled health and social care fund worth £3.8bn to help get elderly patients out of hospital, which will include £1bn of the current NHS budget, reported Pulse. In his Spending Review, chancellor George Osborne announced the £3.8bn fund will be used to jointly commission services across health and social care by 2015/16 to ‘help end the scandal of older people trapped in hospital because they cannot get social care support’. The Department of Health said the pool will include: £1bn taken from the existing NHS budget; £800m that has already been announced for social care; and £2bn of new money being invested. However, Professor Clare Gerada, chair of the Royal College of General Practitioners, warned the government it must halt the continued defunding of general practice – the ‘cornerstone of the NHS’. She said the college ‘welcomes the focus on integration between health and social care’.
Department of Health responds to the Spending Review: Commenting on this week’s Spending Review health secretary Jeremy Hunt said: “For decades we have been talking about better integrated health and social care services and today we’ve put our money where our mouth is. We need to work differently to respond to the changing needs of the population and that means making joined-up services the norm, not the exception. That’s why we’ve agreed extra money to meet growing pressures, but with conditions that ensure the money is spent where it is needed the most. The NHS budget will continue to be protected, but at a time when efficiencies are vital this settlement will help make sure we get maximum value out of every pound spent.” Click here to read care and support minister Norman Lamb’s comments on the spending review.
10 per cent admin budget cut could leave CCGs ‘unsustainable’: The further 10% real-terms cut in health administration budgets revealed in the Spending Review could render some clinical commissioning groups (CCGs) “unsustainable”, NHS commissioners have warned. Under spending plans set out this week, the Department of Health’s administration budget will be cut to £2.7bn in 2015-16 – a real-terms cut of 10%. The budget pays for the running of NHS England as well as internal departmental running costs. It also funds CCG running cost allowances, which in turn fund commissioning support units. “A cut of that size would make some CCGs unsustainable”, said Steve Kell, co-chair of NHS Clinical Commissioners. CCGs are barely able to function at the current level of the running costs allowance, which is itself an incredibly blunt tool that doesn’t recognise local need or organisational size.” The administration budget cuts could also force NHS England and commissioning support units to restructure. A senior NHS England source told HSJ (subscription required): “I cannot see 10% less admin in NHS England without a rethink on local area teams.”
Clinical support key to patient access: Patient involvement and clinical support are key to increasing online access to GP records, reported eHealth Insider. NHS North of England has published a report about how to increase the number of GPs offering patients online access to their records and transactional services. The NHS reorganisation means it no longer exists, so the report was created to ensure lessons learned by staff were, “not lost in the transition to the new organisations”. Health secretary Jeremy Hunt has pledged that all patients who want it will have online access to their GP record by March 2015. As of April this year, 37% of practices in England were offering appointment booking online and 40% were offering repeat prescription ordering online. However, only 0.75% were offering online access to records.
NHS chief Sir David Nicholson admits culture of ‘denial’: The NHS in England has a culture of denial and defensiveness when it comes to handling complaints from patients, its outgoing head has admitted, reported the BBC. Sir David Nicholson said efforts were underway to change that in the wake of the Mid Staffs and Care Quality Commission (CQC) scandals, however he told a committee of MPs that some NHS managers were struggling to adapt. He also said he regretted not listening to patients when he was head of the body overseeing Mid Staffs. Nicholson has faced a high profile campaign for him to quit over his involvement in the Mid Staffs scandal, in which high death rates and patient mistreatment were ignored. Giving evidence to the public administration committee, he echoed criticisms in the Francis report into care at Mid Staffs and comments by health secretary Jeremy Hunt, who has accused NHS managers of being too defensive, after recent revelations about serious failings at the CQC. Sir David told the MPs: “I do think there a real issue about defensiveness and a lack of transparency in the way that we work.” Asked whether complaints should be viewed as a “good” rather than a “bad” thing in the NHS, he said: “There has been a tradition and a culture in the NHS, for some time which has been counter to that.”
Northern Ireland gets electronic care records: Northern Ireland has launched the country’s first electronic care record (ECR) system, reported eHealth Insider. Health and Social Care Northern Ireland signed a £9m, seven-year contact with Orion Health in May 2012 for a portal-based ECR. Health minister Edwin Poots said the new system gives clinicians a window into all the important health and care information that they need to provide the best care for a patient. “They will be able to look at information currently held in a multitude of different systems across the Northern Ireland health and social care sector, to see details of past or ongoing diagnoses and investigations or treatments,” he said. Its national roll-out follows a successful ‘proof on concept’ pilot of the portal at the Ulster Hospital Dundonald, the Belfast City Hospital, and two general practices in 2009 and 2010. Colin Henderson, the UK and Ireland managing director of Orion Health, said: “The HSC ICT strategy is not a future ambitions document – integrated care is here.”
Doctors pass motion of no confidence in health secretary Jeremy Hunt: Doctors have put themselves on a collision course with the coalition by declaring they have no confidence in the health secretary, Jeremy Hunt, over his handling of the NHS, reported The Guardian. The British Medical Association’s (BMA) annual conference endorsed by an overwhelming majority a motion expressing no confidence in Hunt. It came after a succession of speakers accused Hunt of “denigrating the NHS” and heavily criticising health professionals. Delegates supported a motion proposed by Dr Jacky Davis, a hospital consultant and member of the BMA’s ruling council, which took Hunt to task for claiming there was too much mediocrity in NHS care and too many hospitals were “coasting”. The leader of the doctors’ union, Dr Mark Porter, broke with tradition by endorsing the move, which risks straining the BMA’s relations with the Department of Health.
CCGs claim leading role on primary care commissioning: Some clinical commissioning groups (CCGs) have told HSJ (subscription required) they are preparing to take a leading role in redesigning primary care, amid what they called a “hiatus” of action from NHS England. Several CCGs said they were developing plans for the future of primary care in their areas, which they want to be signed off by their local health and wellbeing boards, and NHS England local area teams. Under the Health Act, NHS England holds general practice contracts. However, CCGs also have a responsibility for helping improve primary care quality. The arrangement is designed to avoid GP-run CCGs having a conflict of interest in being both provider and commissioner. However, it leaves CCGs’ role in relation to general practice unclear. A source at a CCG in the south, which is planning to significantly change how acute care is provided in its county, said it was also planning to become the de facto primary care commissioner.
Tesco-style NHS plan ‘ridiculous’: Calls to create a 24/7 “Tesco NHS” are ridiculous, according to the leader of the British Medical Association (BMA), reported the BBC. Dr Mark Porter said it was simply not possible when the health service could “barely afford its current model”. Dr Porter spoke out at a BMA conference amid calls to create the same standard of care in hospitals at weekends and nights as during normal hours. The NHS has made 24/7 care one of its key priorities in its review of urgent and emergency care. Data shows that mortality rates increase during out-of-hours provision. Last week NHS England highlighted figures that showed if the same standard of care could be provided seven days a week more than 4,400 lives could be saved each year. There have also been suggestions that routine care – non-emergency operations such as knee and hip replacements, for example – should be made available.
All go at Liverpool Heart and Chest: Liverpool Heart and Chest Hospital NHS Foundation Trust went live with its Allscripts electronic patient record system on Wednesday, reported eHealth Insider. The trust has been working towards the go-live for the past 15 months and has deployed the system across the hospital. Dr Johan Waktare, the trust’s clinical lead for EPR and consultant cardiologist, told eHealth Insider that apart from a few minor hiccups, the go-live had gone very well. “It went up at 7am (Wednesday) and we’ve had a very successful go-live. What’s been so interesting is that we switched on everything simultaneously. It went live everywhere at once…It was a bit painful for the first few hours, but no red flags. The main issue was that some of our staff hadn’t bothered to get their Windows log-ins, so our head of IT got a new job as a log-in engineer for a little bit. Although the EPR is now live across the trust, some wards are running on reduced activity for the first few days, to make it all manageable.” The trust has been working closely with US company, Allscripts to implement the system the way clinicians wanted it.
Misleading data a crime – Hunt: During a speech on patient safety delivered last week health secretary Jeremy Hunt said that it will become a criminal offence for NHS providers to supply false or misleading data about their performance, reported eHealth Insider. Hunt also said he wanted the NHS to be the first healthcare system in the world to publish the relative likelihood of a harm-free patient experience across every hospital in the country. He said safety in the NHS was not as good as it should be as 3,000 people died last year because of harm done by the health service. While this was a tiny proportion of the three million people treated in the NHS every week, he acknowledged that it meant 500,000 people were being unnecessarily harmed every year. The health secretary said that in order to improve safety, the health service must foster an “open and transparent culture where problems are always aired and never swept under the carpet.”
Sir David Nicholson criticises public and press over portrayal of NHS care scandals: Sir David Nicholson, the outgoing head of NHS England, has criticised the public and press for a “lack of balance” in their portrayal of patient care scandals, which have led to the deaths of hundreds of people, reported The Telegraph. Sir David who is stepping down as chief executive next year after criticism over his role in the Mid Staffordshire scandal, said that while a “small minority” of people have been harmed by the health service, the overall number of hospital deaths has fallen. Within the space of a year, he claimed, the NHS has gone from being given “near religious” status after the Olympic opening ceremony to being branded “one of the worst health care systems in the world”. He said: “In truth, neither of these two things are true, and this is the dilemma. Over the last few years hospital mortality has fallen significantly. At the same time the NHS has continued to fall short in the care of some of our patients. Indeed, for a small minority it actually causes them harm. Both of these statements are true, and if you chose to ignore either than we are in trouble.”
Mounting pressures on London’s NHS threatening patient care: Mounting pressure on London’s NHS is putting patient care at risk, and a radical overhaul of service provision is urgently needed, concludes a new report published by health think tank, The King’s Fund, reported OnMedica. Four out of the five most financially challenged NHS trusts in England are located in the capital, and most of its hospitals are struggling to meet new standards for the quality of care, the report points out. Without major changes to reorganise hospital services, improve primary care, and shift more services into the community, London’s NHS could become financially unsustainable, putting patient care at risk, it warns. But the structures put in place under the government’s health reforms are unlikely to deliver the changes that are needed, argues the report, so it will have to decide whether to allow organisations to attempt to rise to the challenge or bite the bullet and engineer a radical overhaul, it says. Chris Ham, chief executive of The King’s Fund, and one of the report’s authors, commented: “Without change, London’s health system is at risk of becoming financially unsustainable, and patient care could suffer. The stakes could not be higher, yet the structures now in place are not fit for purpose. Courage will be needed to implement a radically different approach capable of delivering the changes required.”
Telehealth framework worth up to £420m: The Eastern Shires Purchasing Organisation has issued a tender for a telehealth and telecare systems framework worth between £60m – £420m, reported eHealth Insider. The tender notice, published in the Official Journal of the European Union, says the framework will run for four years. It says the public sector procurement organisation wants to provide a cost effective service to local authorities and the framework may also be open to NHS organisations. The telehealth framework would cover products such as patient monitoring systems, telecommunication services and equipment, community health services and health and social work services. It will consist of three lots. The first is an online catalogue of telehealth products, the second lot is for a managed service for commissioners who want to outsource their telehealth services and the last lot will include specialist consultants who can provide advice to commissioners and assist in implementation and management of telehealth services. “We intend to award this element of the framework agreement to a single supplier, whose role will be to produce, host and maintain a ‘one-stop shop’ catalogue of relevant telecare and telehealth products” the notice says.
CQRS payment system launched for GPs: A new service to calculate payments for GP practices is launching for the 2013/14 financial year, the Health and Social Care Information Centre (HSCIC) has announced, reported National Health Executive. The Calculating Quality Reporting Service (CQRS) will replace the existing Quality Management and Analysis System (QMAS) system from Thursday 27th June. CQRS will assess GP practice achievement against the quality and outcomes framework (QOF), directed enhanced services, and other clinical services. The system has been piloted in four areas, and training is available to make the switchover as simple as possible. It will reduce the time spent by GP practices, allow payments to be calculated for nationally-commissioned enhanced services, be available for longer periods of time to allow for earlier measurement of achievement and provide greater flexibility for GPs. Beverley Bryant, director of strategic systems and technology at NHS England, said: “Credit must be given to the HSCIC for delivering CQRS under challenging circumstances. Feedback from the pilot sites has been particularly positive and we look forward to CQRS playing an integral part of the end to end service to support commissioners and service providers across the NHS.”
Opinion
Simple solutions: Can we be paperless by 2018?
Doctors have now passed a motion of no confidence in Jeremy Hunt leaving his paperless NHS ambition on unsteady feet. Colchester Hospital University’s Orlando Agrippa discusses in Public Technology the ‘simple solutions’ that are needed.
“Jeremy Hunt’s announcement earlier this year that the NHS should be making information digitally and securely available by 2014 shows that the government is moving along the right lines with the right ambitions for the organisation. To make the best decisions for patients, the NHS needs to be able to harness vast quantities of data to provide information and insight through appropriate analysis, learn from trends and patterns in order to provide the most effective care, while ensuring privacy controls are in place to protect the patient.
“I see the paperless NHS challenge as one which requires simple solutions; solutions which everyone can relate to and without this sort of through process the task is virtually impossible.
“At Colchester Hospital University NHS Foundation Trust (CHUFT), we started providing visibility to frontline staff 18 months ago by deploying a number of Business Discovery applications. We use the QlikView Business Discovery platform from QlikTech, or the ‘high-powered speed boat’ as I like to call it, and the trust has already changed dramatically. Like most organisations in the NHS currently, before installing QlikView we were lagging behind when it came to digitising all our systems.
“Ultimately, the shift to a paperless environment should be encouraged because of the truly tangible benefits. It is a case of taking a leap and making that initial investment so in the long-run the organisation can start to analyse data. Our trust has been using existing intelligence to deliver efficiencies by providing more visibility and instant interrogation of disparate and large datasets to its clinical, operations, finance and commissioning teams. The most important thing is that we drive efficiencies, whilst ensuring better outcomes for patients.”
Patients, pillows and pounds
This week on eHealth News EU Stuart Rankin, CEO of Cayder, discusses how Patient Flow Management (PFM) can help to solve many problems within NHS England.
“With the NHS in England needing to find between £15 and £20 billion in efficiency savings by 2015, there is clearly a very immediate case for helping ward staff work as productively as possible. In addition, there are concerns over shortages in frontline staff, including a potential shortfall of nearly 200,000 nurses, reported by Nursing Times back in February this year. Something needs to change; healthcare organisations are currently taking too long to deploy solutions to critical and well-publicised problems.
“Patient Flow Management (PFM) can help solve these problems. It focuses on the practicalities of admitting, discharging and transferring patients, as well as scheduling and tracking a wide range of planned activities including nursing procedures, such as catheter changes, therapy sessions, portering and cleaning. This reduces the level of administration and unnecessary interruptions for frontline staff, allowing them to concentrate on the patient’s needs.
“Many IT personnel will dismiss the immediate need for PFM after buying into a global company roadmap that has promised this functionality in the future. This, in their eyes, excludes the need for deploying a niche supplier, as the solution is already on the shopping list. The problem is that it is too far down the shopping list, as frontline staff need the technological support now. In some cases, these large organisations are simply not delivering what they promised. They rarely provide tools that allow carers to design the solution they want with the ability to continuingly improve it as they move forward.
“The challenge is deploying the technology it desperately requires now, not in the future.”
We need to take better care of NHS staff
This week, Narinder Kapur, professor of neuropsychology at University College London, discusses in HSJ (subscription required) the importance of better management of NHS staff to decrease stress-related deaths and employment disputes within the workforce.
Kapur explains that suspending a medical practitioner can have three consequences of “stopping the doctor earning a living; harming their reputation; and depriving them of the opportunity of demonstrating excellence in conduct and performance” and can seriously impact the quality of care:
“The NHS spends huge sums on settling disputes and on legal costs – money that could be saved and spent on patient care if a fair and just management system were put in place. If staff are demoralised or feel victimised, this will inevitably make it less likely that better clinical outcomes for patients will be achieved.
“The NHS has developed a widespread culture more of fear and compliance than of learning, innovation and enthusiastic participation in improvement.”
Looking ahead, Kapur suggests that NHS reforms must address the treatment of whistleblowers; management attitudes towards clinicians; grievance, dismissal and appeal procedures.
Community-based interventions: how do we know what works?
This week, Dr Martin Bardsley, director of research for the Nuffield Trust, discusses whether or not service innovations actually lead to a change in service use.
“One of the problems in evaluating care for people with complex health problems is that simply looking at change in health care use over time can be deceptive. The difficulty is that people are often selected to receive a new service because they have a high level of hospital admissions – and we know in that case there will be a natural tendency for their use of inpatient care to fall anyway, whatever we do to them.
“This means to assess the impact of something you need some form of comparator group. As randomised trials may be difficult in these settings, that means using some clever stats and data linkage.
“The new service models we have studied have the right aims, and very often require considerable effort and energy to implement. Though they may not be achieving the magical reduction in emergency admissions, there are times when labelling these as failures is overly harsh and we are in danger of rejecting good ideas if our evaluations are too restrictive.”
Bardsley concludes by saying: “Ideally, formative evaluation would be linked to quality improvement initiatives with technical assistance to monitor fidelity to the intervention and share learning between sites.”
I am a CEO and I make mistakes
In this week’s Commissioning GP, Shane Tickell, CEO, IMS MAXIMS reflects on blame culture within the NHS.
“My name is Shane Tickell, I am a CEO of a health technology company and I make mistakes, probably everyday. As the leader of an organisation, I am accountable for those mistakes, need to learn from them and, where possible, rectify them. In addition to that, every single member of my team has a specific set of responsibilities and when they make a mistake they too must recognise it and be accountable for that. This is not so that they can be blamed, it is so that further mistakes are not made which could eventually lead to a larger problem.
“In July 2001, the press published the following headline: ‘UK government and doctors agree to end “blame culture”.’ The then health secretary, Alan Milburn, said the joint statement was aimed at ‘raising standards’ of care and added: “Medicine is not a perfect science. Even the best doctors can make the worst mistakes. Twelve years on and we have seen some of the most horrendous examples of poor care, cover-ups and blame culture in the history of the NHS.
“I have absolutely no doubt that there were people in these organisations that saw something was wrong and tried to help, others probably knew that they were making mistakes themselves, so why did it happen?
“As Sir Liam Donaldson, former chief medical office for England once said: “To err is human, to cover-up is unforgivable, to fail to learn is inexcusable.”
Highland Marketing Blog
In this week’s blog, Myriam McLoughlin asks whether the Care Quality Commission should stay or go.
