News in brief
NHS managers expect more funding to achieve ′Paperless NHS′: NHS managers say they will need extra funding to achieve the goal of a ‘paperless NHS’, reported the British Journal of Healthcare Computing. The target date of 2018 has been set by health secretary, Jeremy Hunt, as the target for much greater use of information and communications technology within the health service, particularly extensive use of electronic patient records. The latter was not achieved under the Government′s £12bn National Programme for IT, despite around £4.3bn being either spent or committed to vendors, in the last decade. However, despite such huge sums being spent already, 200 health IT leaders polled over the summer say they cannot deliver on Hunt′s vision with the resources they currently have. A survey carried out by independent research firm, Vanson Bourne, published this week, says a majority, 60%, of those contacted believe the Department of Health should pay for all Paperless NHS activity. So far, the government has only set aside around £500m for this activity via its ‘Safer Hospitals, Safer Wards′ Technology Fund, expecting local spending on technology to account for the bulk of the work towards going paperless. The respondents also doubt that the 2018 deadline is achievable, with a large proportion of those interviewed citing 2021 as a more realistic goal. There is also some confusion on exactly how far the sector has marched towards Hunt′s goal. NHS heads of trusts think over half (58%) of patients have digital records now, clinical staff think it′s almost two-thirds (65%) – while rank and file NHS IT staff believe that only 41% of patients are in this position.
Dementia diagnosis: Britain’s national shame: Less than half of people suffering from dementia are being formally diagnosed because doctors fear stigmatising their patients, according to the health secretary. Jeremy Hunt will disclose a “dementia map” of England showing that in some areas, fewer than four in every 10 dementia sufferers have their condition recognised by the NHS, reported The Telegraph. The disclosure comes as the government begins a campaign to boost diagnosis rates, which will include Britain leading a Group of Eight conference on the issue next month. The Department of Health estimates that 670,000 people in England are suffering from dementia. However, only 319,000 have been diagnosed, NHS figures show. Overall, 48% of the estimated dementia cases are being formally recognised by the NHS. In some areas, the diagnosis rate is as high as 75%. But in the worst performing areas, it falls to 39%. Hunt said he was disclosing the diagnosis rates in an effort to drive up standards and end what campaigners have called a postcode lottery in the treatment of dementia sufferers. The figures used in today’s map show stark differences in diagnosis rates even between neighbouring clinical commissioning group areas. Ministers suspect that in many cases, doctors are declining to make a formal diagnosis of dementia because they believe that doing so will cause undue distress to patients and relations. The sense of stigma surrounding dementia means that many sufferers are not properly treated, holding back the search for a cure, the health secretary said.
NAPC joins forces with NHS Confederation: The National Association of Primary Care (NAPC) is to merge with the NHS Confederation to become its primary care provider network, reported Pulse. The NAPC, which promotes clinical commissioning, will join the NHS Confederation over a transition period up to April 2015. The confederation, which this month appointed Rob Webster as its new chief executive following the resignation of Mike Farrar, represents NHS commissioning organisations and trusts across the UK. Earlier this year, the NHS Confederation appointed Dr Johnny Marshall – the former chair of the NAPC – as its head of policy. NAPC chair Dr Charles Alessi, also a GP in south London, said: “The opportunity for greater organisation and innovation within primary care, both at home and abroad, as an integral part of the local care system has never been greater or more pressing. The NHS Confederation provides the right platform for us to act as the exclusive vehicle for primary care provision. This will allow us to expand our membership base and increase our influence and effectiveness in all area of our work.” NHS Confederation chief operating officer, Matt Tee, said: “We envisage this collaboration as an opportunity to further widen the diversity of primary care providers within the NAPC and to ensure that they have a central role to play within our membership in shaping innovative care provision.” The agreement will not have an effect on NHS Clinical Commissioners, which the NAPC is a member of, the two bodies said.
Three sites to be IDCR exemplars: Three sites are set to become exemplars in digital record integration between health and social care by March 2015, with support from the ‘Safer Hospitals, Safer Wards’ Technology Fund, reported eHealth Insider. The ‘Integrated Digital Care Records (IDCR)’ Rapid Accelerator programme is identified as one of five key programmes for achieving an IDCR and is discussed in new terms of reference for the IDCR Strategy Group. The document does not name the sites, but says three applicants for the technology fund are seeking to push digital record integration between health and social care by March 2015. “We will work with them to achieve their ambitions to provide an exemplar to other health and social care economies of how it can be achieved and lessons to be learned,” it says. The IDCR group is a sub-group of the Informatics Services Commissioning Group and the terms of reference were presented to its meeting this week. “We want local health and care services to use digital technology to ensure that vital, patient-related information can be viewed by an authorised user in a joined up manner,” the IDCR vision statement says. This will “transform clinical effectiveness and outcomes and reduce the administrative burden on frontline staff”, it adds. Other programmes listed as building blocks for achieving an IDCR over the next few years are: the £510m capital investment promised by the two technology funds; the Summary Care Record programme; the NHS Open Source Foundation; and the Local Service Provider Delivery Programme.
A&Es to get extra beds this winter: The government’s additional £250m funding for accident and emergency this winter will be spent on more than 2,000 extra beds and extra staff, Jeremy Hunt has said. The health secretary said “winter is tough” but that the extra resources will make sure patients “get the excellent care they expect, no matter what season it is”, Health Service Journal (subscription required) reported. Almost 2,500 extra beds will be made available across England as a result of the funding, information from hospital trusts shows. The equivalent of almost 3,000 extra staff will be brought in to help the NHS cope with winter pressures, the Department of Health (DH) said. This consists of temporary staff, extending the hours of existing staff and creating new positions. The majority of the funding was distributed earlier this year to 53 areas where hospitals were identified as being under the most pressure. The DH said the extra staff is the equivalent of up to 320 extra doctors and 1,400 extra nurses, as well as up to 1,200 other NHS staff including physiotherapists and occupational therapists. A further £150m was announced by NHS England last week to help other health trusts cope with the cold weather. Hunt said: “We’re backing our hard-working NHS staff with the extra doctors, nurses and beds they need to make sure patients get the excellent care they expect, no matter what season it is. Winter is tough, but the NHS has never been better prepared.”
New UK patients’ champion to fight bad care: Sir Robert Francis has agreed to become president of the Patients Association, promising to do all he can to rid the NHS of bad care, the BBC reported. Francis’s appointment to the UK’s most high-profile patient group has coincided with it publishing its annual dossier of patient stories. The 14 case studies detail “shocking” examples of poor care. They include lapses in both hospitals and nursing homes. Common themes include patients not getting the help they needed eating, drinking or going to the toilet, being treated with a lack of dignity and having delays in their treatment. The publication of the dossier comes just a week after the government published its response to the public inquiry into the Stafford Hospital inquiry, which was chaired by Robert Francis. The “blueprint” promised the introduction of set nurse-to-patient staffing levels, a new law of wilful neglect and a barring system for poor managers. The measures were set out after the Francis Inquiry, published in February, highlighted a series of cultural problems in the NHS. Francis praised the Patients Association for being “ardent campaigners” and promised he would be doing his best to continue the “invaluable work”. He said: “The experiences of patients and relatives remain the best way to detect care that is being delivered without care and compassion. Let us all hope that in the near future we will stop having to listen to disturbing reports of poor and unsafe care in many different places and instead be looking at a service which has learned from the mistakes, and has ensured that the excellent practice we know exists has become the norm.”
20 northern trusts publish data: Twenty northern acute trusts are publishing a range of quality and safety datasets today as part of a programme that will be extended to the rest of the country and other care sectors. eHealth Insider has reported that the pilot will involve 20 acute trusts in the North of England publishing data on: pressure ulcers developed in hospital; falls in hospital; the results of the NHS safety thermometer and MRSA infections. Also, Friends and Family Test scores; patient and staff experience survey questions; and patient stories. The data will be displayed on each trust’s web site and on NHS Choices. A link to the data will also be available on the NHS England website. Other northern trusts are due to start publishing next month and the aim is to ultimately expand this to the rest of the country and other care sectors. The announcement was made by chief nursing officer for England, Jane Cummings, at the annual Chief Nursing Officer’s Summit in Birmingham. Cummings used her address to call for further improvements in care standards and transparency in the NHS saying that: “Absolute transparency is the key to driving improvements in standards of care. We need to ensure that every single patient receives great care, every time.”
NHS hospitals ‘are where people go to die’, says former health boss: Hospitals in England are “where people go to die”, the former head of the NHS Confederation has said, reported The Telegraph. Mike Farrar, who was once tipped as a candidate to become NHS England’s chief executive, has attacked the health service for using care in hospital by default and failing to offer alternatives to patients. Speaking at a conference for NHS managers he said that the service had been “over-medicalised” and for critically ill patients hospitalisation is now the only option. He compared the NHS with the healthcare system in other countries, where spending can be targeted directly at the patient so that care can be continued in the home. “Rather than have hospital by choice we have hospital by “default”,” said Farrar, who stood down as CEO of the confederation which represents health service managers. His own mother was admitted to hospital after being diagnosed with vascular dementia because her husband was unable to provide her with round the clock care. “I saw with my own mother that hospitals are where people go to die … We haven’t built the system properly to have a proper alternative,” Farrar told the Hospital Directions 2013 conference at London’s Excel centre. Farrar, who in the past has run two health authorities and worked as Head of Primary Care at the Department of Health, said that expanding hospitals is a short-term solution.
NHS to launch Tripadvisor-style website: The NHS is to establish a patient feedback website, styled after the popular travel site TripAdvisor, to allow patients to post complaints online – including those containing potentially derogatory comments about medical staff – and show hospitals’ responses to them in real time. In an interview with the Guardian, Tim Kelsey, the NHS director in charge of patients and information, said a low-key three-month trial involving 20 hospital trusts on the Care Connect website had seen complaints and reviews logged, mapped and dealt with, night and day, in London and the north-east. The scheme will be rolled out nationally next year. Kelsey pointed out that serious issues had already been tackled using the system – highlighting one instance when an elderly patient recovering from a cancer operation had been “left without morphine for a few hours – something she needed every four to five minutes”. Her daughter posted on the website that “the surgeon came into the room and not only berated the staff again but said ‘this unit is really going downhill’. The whole experience is surely unacceptable in this day and age.” Kelsey said that this was not about “naming and shaming” but instead allowed the NHS trust in question – St Helier in south London – to contact the patient within hours of the complaint, before escalating it to the patient liaison service within 48 hours. “It’s what any consumer of health services would expect,” he said. While the public can access Care Connect online, by text, phone, Twitter and Facebook, their complaints and reviews are first assessed by case handlers who moderate the posts for privacy and, if out of hours, they contact the hospital to ensure the issue is taken up immediately.
Commissioners to see pathways: From February a new tool for analysing NHS Pathways data will be available to commissioners, reported eHealth Insider (EHI). The NHS Pathways Intelligent Data Tool has two strands; the Continuous Quality Improvement (CQI) dashboard, and the Directory of Services Analysis (DOS) dashboard. Paul McIntosh, NHS Pathways senior information analyst, told EHI that the tool is in beta testing with people from NHS England and clinical commissioning groups. They are providing weekly updates, which are helping to refine the tool before its launch next year. NHS Pathways and its integrated directory of services is the underpinning technology for all NHS 111 services and 52% of 999 calls. Each month, around half a million calls are triaged through Pathways and its integrated directory of services. The CQI dashboard allows commissioners to performance manage every call made using Pathways. It provides a detailed breakdown of each call that has been triaged through NHS Pathways including average call length per site and per user, and the percentage of calls directed to different services. The DOS dashboard is designed to provide commissioners with key information on service usage, demand and supply and is available on a three-year licence, which will cost around £1,000. It can be split geographically, allowing commissioners to benchmark themselves against other areas of the country. NHS England sponsors NHS Pathways, which is delivered by the Health and Social Care Information Centre.
Over half of public want a response to an email from a doctor within a day: The majority of the public and doctors are concerned for the security of medical records if they become accessible online, according to a survey carried out by the Medical Protection Society (MPS). The poll, which sought the opinions of 1,700 members of the English public and 650 MPS members, found that 80% of the public and 86% of MPS members were unsure about how secure their records would be if they were online, Commissioning GP reports. Furthermore, patients expressed concerns about people other than those in the medical profession accessing their records, as more than two-thirds (69%) of the public agreed that their medical records should only be accessible to a healthcare professional. The government is planning to have patients being able to access their medical records online from 2015, which the MPS has argued could transform patient care. However it has also called for patients to receive “much-needed” support and advice on how to use the system safely and appropriately. Dr Stephanie Bown, director of policy and communications at the Medical Protection Society said: “We should not be afraid to grasp the potential that digital healthcare can provide and we welcome a world where patients can check their medical records, book appointments and order prescriptions online and, ultimately, have virtual consultations with their doctors. However, we have to be mindful of the risks patients face with online access to medical records, particularly in ensuring their private information is safeguarded. We need to ensure that patients will receive support to look after their personal data and give careful consideration as to whether particularly sensitive information should have restricted access to provide extra peace of mind for patients.”
Scotland has new telemedicine activity database: A new database of telehealth and telecare projects and service developments active north of the border has just been announced, reported the British Journal of Healthcare Computing. The site will act as a new searchable resource for all those working in, or with interest in the field of telehealth, say its creators – the Scottish Centre for Telehealth & Telecare – across geographic area, organisation, users and technology. The database will grow over time and will help stakeholders review the uptake of technology used to enable the delivery of care, promises the Centre. It will also help the community better understand priority areas for the uses of technology, it is claimed. The database will contain information on – telehealth and telecare services and projects active across Scotland, services and projects which involve stakeholders or, are led by health, local authority, housing and voluntary sector organisations and contact points for the individual services and project. The database will be updated and maintained by the Centre, though the latter does note that as telemedicine/telehealth “is a rapidly developing field,” it cannot keep the records up to date and comprehensive without your help.
NHS managers pledge to ‘transform’ primary care services: NHS leaders are promising a transformation of GP services in London, which will involve a ‘shift of resources’ from secondary to primary care, the potential end of enhanced services and practices joining federations to improve access for patients, reported Pulse. The ‘call to action’ consultation document for primary care, issued by the London NHS England local area team, represents former Royal College of General Practitioners chair Dr Clare Gerada’s first major piece of work since she took her new part-time role at NHS England as chair of London’s Primary Care Clinical Board. The consultation ends in April 2014, and – while there are no concrete proposals – the document signals a ‘direction of travel’ that will see resources being shifted into primary care, Dr Gerada said. The report said that ‘practice finances are declining in real terms’, and ‘delivering smaller pump-prime investment in primary care initiatives has the potential to release greater cost efficiencies over time. It added: “London needs to deliver an economic analysis that identifies the cost efficiencies that can be achieved by investment in building primary care capacity and capability.” Dr Gerada, who is a co-author of the report, told Pulse that this document signals that NHS managers are committed to increasing investment in primary care.
Waiting list hike leads to delays for some treatments: A deliberate slowdown in the treatment of people with less serious ailments and the discovery of groups of patients who were not previously recorded in national statistics could be behind growing waiting lists, experts have said. The latest NHS England data on 18-week referral times for elective operations shows an additional 260,000 people were waiting for a procedure in September compared to the same point last year, reported Health Service Journal (subscription required). This year’s figures show the usual seasonal variation in elective waiting lists, with the total rising over the summer and falling after August, however levels are far higher. In August and September, there were 2.94 million and 2.9 million waiting respectively − the highest two monthly totals recorded since April 2008. Compared to the first six months of previous years, the hospital sector is performing more procedures on admitted patients, whose conditions are often more serious. The NHS performed 1.84 million elective procedures on admitted patients in the first half of 2013-14 – 62,000 more than in the same period in 2012-13. However, the 5.01 million procedures it performed on non-admitted patients was 156,000 fewer than the previous year. Waiting times experts suggested trusts may have allowed non-admitted lists to grow as they focused on more acute patients.
NHSmail2 worth £20m a year: The business case for NHSmail2 is worth up to £20m a year and has been approved by a sub-group of the national health informatics co-ordinating body, reported eHealth Insider. The case is now subject to confirmation of affordability by the Star Chamber – a collection of NHS England senior managers. The update is provided in a report from the Investment Approvals Sub-Group at the Informatics Services Commissioning Group (ISCG) meeting this week. The ISCG has members from across the health and social care system and is chaired by NHS England’s national director for patients and information, Tim Kelsey. “The outline business case for NHSmail2 was approved for onward submission subject to affordability being confirmed at the Star Chamber,” the investment report says. “The £20m per annum funding envelope condition was discussed and clarified at the meeting.” A nine year contract for NHSmail was awarded to Cable and Wireless in 2004 and was worth around £30m a year. This has been extended to June 2014. Procurement of version two of the mail service will be done by creating a secure email ‘lot’ on the Public Services Network framework. A new contract is expected to be awarded in late summer 2014.
Orion Health Opens Office in Istanbul: To build on its growing success in Europe and the Middle East, Orion Health, New Zealand’s largest software company, has announced the official opening of its new Turkish office, that is planned to service the whole Eurasia Region, reported eHealthNewsEU. Portal. This new facility is home to the company’s Turkish-based services, development and technical support teams. It also announced its first major deal in Turkey. Charles Scatchard, president of International at Orion Health, said: “Turkey is seeing significant new investment occurring in healthcare and eHealth projects. The opening of our new Istanbul office in Europe’s fastest growing economy and a regional hub is a natural next step for us as we look to establish a strong local team to expand our business in Turkey and the surrounding region. We understand the value of being able to support projects locally and believe our physical presence in Turkey sets us apart from many of our competitors.” Orion Health’s Hospital Information System (HIS) has been selected against strong competition for two hospitals managed by the Koç Group. The HIS will be rolled out at the prestigious Koç University Hospital in 2014 and the Vehbi Koç Foundation American Hospital, a premium private health institution in Istanbul, the following year. Scatchard said: “Orion Health is committed to designing a better healthcare future for everyone, everywhere. Our expanding presence in Turkey will enable hospitals to confidently invest in health IT solutions that are proven to help deliver better patient outcomes and reduce healthcare costs.”
Opinion
Putting patient safety first: how long will it take before the NHS learns from its mistakes?
Candace Imison, acting director of policy for The King’s Fund, discusses how the valuable lessons learnt from past mistakes should be used to improve patient safety.
“One of the most powerful contributions to our Annual Conference was a presentation by James Titcombe, the father of Joshua, a baby boy who died aged only nine days after signs of his deteriorating condition were missed by the staff at Morecombe Bay NHS Trust. James presented data from a regional confidential inquiry into 25 cases of perinatal death. Only 24% of the 140 possible contributory factors identified by the inquiry team had been identified in local investigations at the time of the incidents. So 76% of the learning from the incidents had been missed; a situation that there is an urgent need to improve.
“James said that we would only achieve Don Berwick’s ambition for the NHS to ‘place the quality of patient care, especially patient safety, above all other aims’ if we have candour when mistakes happen and acknowledge all medical errors.
“Since James presented to us, the government has issued its response to the Francis Inquiry report. But to what degree does this response address James’ recommendations? There is a lot that is relevant – as well as the new statutory duty of candour, the ‘cultural aspects of care’ will now form part of Care Quality Regime (CQC’s) inspection regime. Greater use will be made of incident data, including a commitment for CQC to consider each hospital’s review of serious untoward incidents as part of its pre-inspection activity. NHS England will also launch a programme of new patient safety collaboratives, which will be expected to provide expertise on learning from mistakes and help to provide a ‘rigorous approach to transforming patient safety’.”
Imison concludes by suggesting that: “The key to success will be the degree to which these national aspirations are owned and adopted at local level, to create a culture that rigorously uses data to monitor quality and progress.”
The NHS must keep its pledge to embrace tech entrepreneurs
In the Guardian this week, Pascal Lardier explains why he thinks creative solutions to the health sector’s problems are unlikely to come from inside the NHS or from large IT companies.
“Never before have we heard so much support for small and medium enterprises (SMEs), or witnessed such a vibrant start-up scene in Europe. But in the health sector it’s a different story, especially for SMEs that have had their fingers burned trying to do business with the NHS.
“We surveyed 125 entrepreneurs from the health tech sector around the world and found that three quarters would rate their experience of working with the NHS as difficult or very difficult. Only 30% of UK respondents said they had worked with the Academic Health Science Networks (AHSNs) – the bodies that were set up in April 2013 to work with the private sector, academia and the NHS to encourage innovation.
“Entrepreneurs could help drive innovation in the health sector. As Tim Kelsey, director for patients and information, NHS England said: “We need entrepreneurs to be given the opportunity to promote their tools and services to anyone who is interested because they are the ones who will help create a better model of care for patients.” The most creative technical solutions to the health sector’s problems are unlikely to come from inside the NHS or from large IT companies.
“SMEs should be talking to patients directly to encourage them to adopt this technology and take responsibility for their health. And patients should be turning to their local communities for support and funding.
“It’s often said that American entrepreneurs get all the limelight – but, truth be told, it’s the US that is coming up with successful business models and exit strategies that inspire investors, providers and payers. There are brilliant minds and promising technologies coming out of Europe – let’s make sure that we foster this talent.”
The tenders that offer hope for a beleaguered provider
In this weeks’ Health Service Journal (subscription required), James Illman explains that a critical run of tenders is going to determine Cambridgeshire Community Services Trust’s future shape and visibility.
“News last week that the Care Quality Commission had uncovered concerns regarding a children’s ward run by the trust presented another unwelcome headache during a challenging period.
“The development came just weeks after the collapse of a bid the trust was part of for an older people’s services contract in Cambridgeshire and Peterborough. This work currently accounts for about a third of the £157m-turnover trust’s income.
“Cambridgeshire Community Services last year faced restructuring before being thrown an 11th hour reprieve by the NHS Trust Development Authority. It remains confident about its future, despite the prospect of losing a large chunk of its existing income.
“It points out that the authority, while mindful of its vulnerability, views it as a viable concern, and its existence is secure until 31 March 2015 at least.
“Cambridgeshire Community Services is also among the bidders for its local county council’s integrated community sexual health and contraception services and Peterborough City Council’s integrated sexual health services.
“However, with winter closing in and out of hospital service providers reporting 12-15 per cent increases in demand for their services, the challenges ahead appear unlikely to abate.”
The NHS must create a better climate for innovation
This week, Sir Bruce Keogh, NHS England’s medical director, tells the Guardian Healthcare Network how leaders can empower more staff to share their ideas and improve services.
Keogh described how the NHS has a lot of catching up to do in creating the right conditions for new ideas to thrive, and highlighted some reasons: “First, in many cases we try to go too far, too quickly because organisations fail to set visible, unambiguous goals. Ambitious people, without a clear focus and defined objectives, tend to do too much. It’s human nature. The best leaders recognise this and provide a clear set of common objectives around which staff can focus their creative energies.
“Second, people need to be empowered to innovate. It is not enough for leaders to just give out the right signals and expect a culture of innovation to emerge. They need to walk the talk – by putting in place organisational structures that ensure staff know where to go when they have an idea and that, when they do, they’ll be listened to and heard.
“The NHS has been built on innovation. Today’s great ideas are out there among the frontline staff who deliver care every day, recognise the issues and know how to make things better. But all too often good ideas are allowed to wither on the vine owing to a lack of development, recognition or and reward.
“A third area focuses on nurturing the innovation “hot-house”. In every organisation there is a core of emerging leaders – junior doctors, graduate trainees, clinical scientists – who possess the ideas, energy and passion to become the engine room for change.”
Highland Marketing blog
In this week’s blog, Gemma Thomson discusses whether mobile health technology is a help or a hindrance.
