News in brief
Three IDCR exemplars named: NHS England has announced the three exemplars in digital care record integration, and confirmed that the next round of the ‘Safer Hospitals, Safer Wards: Technology Fund’ will focus on integrated care. A paper presented to the Commissioning Board last week says Cumbria, Bradford and Bristol will all receive funding from the first round of the tech fund “to create integrated digital care records across care settings”. The same paper says that the second round of tech fund will launch in early February and focus on integrated care records between health and social care. Dr William Lumb, a GP and chief clinical information officer for NHS Cumbria, told eHealth Insider that Cumbria had received funding for three different projects. These include ongoing work to share GP and community records with out-of-hours providers via Healthcare Gateway’s Medical Interoperability Gateway and to implement a Strata Health region-wide resource matching and e-referral system. The third project involves Cumbria Partnership NHS Foundation Trust, which has just gone out to tender for an electronic patient record system that will form a “fundamental building block for a common platform for information sharing across all organisational boundaries”. The tech fund was launched in mid-2013, to support health secretary Jeremy Hunt’s vision of a “paperless” NHS. Bidding for the first round of money took place last year. The NHS England paper says that £218m was awarded to 234 projects; although these have not all been announced, and other figures have been given. All funding must be matched by the NHS trusts.
Patient access to online records to be restricted to ‘prospective’ information, says minister: Ministers have said that patients will not be able to read any retrospective information from their GP records when they are allowed to access them online next year, reports Pulse. Health minister Dr Dan Poulter told MPs that the government had decided that patient record access will be ‘prospective’ from the time they are allowed access in 2015. The move follows advice from the Royal College of General Practitioners in their ‘Patient Online: The Road Map’ sign-posting document published last year, which argued that the risks of patients seeing unsuitable information would pile work on practices to check all retrospective records. Dr Poulter said in response to a parliamentary question: “Electronic access to patient records will cover new information placed on the patient’s record from the point that online access is made available in the patient’s general practitioner practice. This will apply to both existing patients and any new patients who register at the practice.” The government has an aim for all patients to have access to online patient records no later than April 2015, but the plans have been significantly watered down over recent months. Pulse revealed last year that the GP contract for 2014/15 will include the requirement for GPs to provide online access to the information included in the Summary Care Record ‘as a minimum’. NHS England also recently said it is looking at introducing a ‘time delay’ so GPs can manage how ‘certain test results are communicated’ in patient records.
NHS Scotland has more time for patients thanks to mobile technology: NHS doctors and nurses are using the latest mobile technology across Scotland to speed up admin tasks and spend more time with patients, according to ComputerWeekly.com. A £1m Scottish Government fund has been used to purchase a range of technologies, including digital pens, tablets, iPads and mobile devices. The use of these devices allows community-based staff to access important patient information and update patient records electronically. This reduces the amount of time spent on administration, freeing up time for staff to spend with patients. The NHS in the Western Isles of Scotland has been able to spend 50% more time with patients following the roll-out of digital pen technology. “Technology is invaluable for staff who work in community settings, and I set up this fund to enable staff to choose what device works best for them,” said health secretary Alex Neil. “Traditionally, community nurses had to wait until they returned to the hospital to update patient records, but now they can be updated automatically.” Other NHS Scotland technology roll-outs include: a community nursing team in East Dumbartonshire using iPads to record information. This has freed up to 10 hours a day across the team, and increased patient safety through not having to transcribe information two or three times. NHS Highland is planning to use digital pens to capture data for the Keep Well anticipatory care programme, NHS Lothian is purchasing 550 mobile devices, and NHS Ayrshire and Arran purchasing around 100 iPads.
CSUs face job cuts but not privatisation: Commissioning support unit (CSU) staff numbers are being reduced by up to 5%, but the units will not be privatised under new plans released by NHS England, revealed eHealth Insider. England’s 17 CSUs provide a number of support functions to the country’s clinical commissioning groups, including IT and business intelligence services. A national consultation started this month on redundancy options at the units, which will run until 20th February. This affects around 9,000 CSU staff who are employed by the NHS Business Services Authority, which has delegated authority to NHS England to manage the process. A consultation paper published by Central Southern Commissioning Support Unit says that a year after their creation: “CSUs are in a better position to price services, react to changing customer demands and structure themselves in the most efficient way possible.” The paper says that some units will have no redundancies and “we anticipate that the majority of these reductions will be met as a result of voluntary redundancy and the removal of vacant job roles.” Up to 5% of staff are expected to be affected. NHS England is seeking approval for a voluntary redundancy scheme which will reduce the number of potential compulsory redundancies. CSUs will also be asked to identify and close unfilled roles in their structures,” the paper says. CSUs will be hosted by the national commissioning board until 2016, but are preparing to become autonomous bodies, which have to compete for work both amongst themselves and against commercial or voluntary providers.
Half of hospital appointments still made on paper: Only half of outpatient appointments made by GPs are through the flagship Choose and Book online service – costing the NHS tens of millions of pounds every year, reports UKAuthority. Introduced a decade ago – at a cost of £356m – the electronic system speeds up treatment and has even been credited with cutting costly ‘no shows’ by patients. One NHS trust, Doncaster and Bassetlaw Hospitals, reported a 60% fall in the number of missed appointments in some services, because patients had picked the time and date at their own convenience. However half of all appointments – around 40,000 a day – are still paper-based, made either by email or even by fax, a National Audit Office (NAO) report has found. Choose and Book is believed to save the NHS around £16m annually, but could save a further £51m if it was used for all appointments, the NAO found. Its report says: “Choose and Book is already available to primary healthcare services (for example, GP practices), trusts and patients online, but is not fully utilised. The main savings would arise from reductions in process and staff costs, as patients book their own appointments and are less likely to fail to attend clinics. However, our case study evidence suggests that the full benefits of Choose and Book will not be realised until all trusts’ services and appointment slots are made available on the system.” The NAO did not estimate what proportion of services were unavailable on Choose and Book, having received information from 60% of 158 NHS acute trusts. The gaps are worrying for the department of health, which has made a pledge to create a ‘paperless’ NHS by 2018, updating the online service in the process.
GPs doing well on data protection – ICO: Most GP surgeries have good patient data protection schemes in place, a report by the Information Commissioner’s Office (ICO) has concluded. The report, published this week, sums up 24 advisory visits by the ICO to GPs across England in the past year. It says the majority of GPs had good data protection policies and awareness of data issues, including proper security and patient confidentiality, reported eHealth Insider. Many surgeries incorporated information governance and confidentiality requirements into employment contracts and that staff “generally showed a good awareness of information governance and security issues”. However, it also highlights that most practices are still quite paper-heavy and that paper records take up considerable space. “Paper medical records were a challenge to manage at most locations due to the amount of space they take up,” it says. “Records were usually held in lockable filing cabinets or in separate lockable areas.” The report adds that the security and quality of storage space varied. And while surgeries showed “a strong awareness of the need to dispose of confidential paper waste securely” the report argues that some need better procedures for systematically reviewing files. Surgeries were aware of standard NHS guidelines and timeframes for records retention and disposal, but there was a general lack of specific local procedures or protocols to review files and meet these standards,” it says. The ICO report also argues that some improvements are needed in IT procedures, particularly where these used to be covered by services provided by primary care trusts, which have been disrupted by their abolition and the introduction of clinical commissioning groups.
Nesta analyses GP innovation trends: Open data can offer huge potential for GP innovation, a new report by Nesta suggests. The research identifies when and which GP practices across England have taken up innovations, based on analysis of open datasets from the Health and Social Care Information Centre and demographic data. GPs have the potential to become early adopters of innovation, Nesta said, but few are serial early adopters. Larger practices tend to be in a better position to adopt new innovations, and fellow GPs and national guidance are influential sources of information for doctors looking to adopt, according to National Health Executive. The Academic Health Science Networks and clinical commissioning groups also have an important role to play, the report recommends, and calls for public services to use this information to improve, adapt and change. Professor Richard Barker OBE, director, Centre for the Advancement of Sustainable Medical Innovation, said: “It’s widely accepted that the NHS does not adopt effective new technologies fast enough. This study points the way to better performance. The recently-formed Academic Health Science Networks have an important role to play. Building on the lessons in this report, they can champion earlier adoption of important new medicines, diagnostics and IT tools.” Jo Casebourne, director of public and social innovation, Nesta, said: “Advances in treatment options and new IT processes need to be taken-up and used by GPs if we are to improve the quality of NHS care. Now it is easier to see who is doing what and where in our public services thanks to the greater availability of open data. This knowledge is powerful. It will allow those working in healthcare to make real changes and will help us all to encourage more doctors to take-up tested new ideas.”
Six NHS trusts under fresh scrutiny over high death rates: Six hospital trusts are under fresh scrutiny after NHS data revealed that they had “higher than expected” mortality rates, according to The Guardian. Two of the six, Colchester Hospital University NHS foundation trust and East Lancashire Hospitals NHS trust, are already in special measures following NHS medical director Professor Sir Bruce Keogh’s review last year into 14 trusts with apparently high death rates. Another of the six, Blackpool Teaching Hospitals NHS foundation trust, was also among the 14 but was not among the 11 put into special measures. The NHS’s Health and Social Care Information Centre (HSCIC) said that those three, plus Mid Cheshire Hospitals NHS foundation trust, Aintree University Hospital NHS foundation trust in Liverpool and Wye Valley NHS trust in Herefordshire, all had unusually high death rates in 2012-13, as judged by the summary hospital-level mortality indicator (SHMI). The SHMI is one of the key ways of measuring if a hospital trust is seeing an average, higher or lower than average number of deaths among patients. It is one of four mortality indicators used by the healthcare information specialists Doctor Foster Intelligence to produce its influential annual hospital guide. The SHMI captures and compares the number of patients who die while being treated as an inpatient or within 30 days of their discharge from hospital. The HSCIC said: “The SHMI is the ratio between the actual number of patients who die following treatment at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there.”
Healthcare technology providers turn to Mena region: The Middle East and Africa has become one of the most lucrative markets for healthcare technology providers as budgetary constraints in the US and Europe increase, reported The National. General Electric (GE) Healthcare is eyeing growth of up to 20% in the region, while Philips is expecting growth of about 15%. “You go around the world and you see two things: We’ve got more patients,” said John Dineen, the president and chief executive of GE Healthcare. “Everybody has a higher disease burden because of the demographics, and populations are getting older. Diseases are chronic and more complicated. But at the same time governments around the world are either fiscally challenged like the US or Europe or are carefully trying to build out their healthcare systems. Everybody is struggling with the economics of healthcare.” According to Markaz research, healthcare expenditure in the Gulf Cooperation Council (GCC) has been increasing at about 7.9% a year over the past 10 years. Total healthcare expenditure is expected to rise to $79.2 billion by 2015 in the GCC alone. “Growth in healthcare is really being driven by regions like this. Developing markets around the world are taking a front seat for medical technology companies,” said Dineen. “There is a tremendous build-up of governments in the region that are thoughtfully investing in their societies…[and the] Middle East and Africa is one of the most strategic markets for us.”
Monitor interventions double in response to Francis: The number of regulatory actions taken by Monitor against foundation trusts so far in 2013-14 is already more than double the level of the whole of last year, Health Service Journal (HSJ, subscription required) analysis reveals. Enforcement action has been taken on 21 occasions in the first 10 months of this year, compared to just nine instances in the whole of 2012-13. Monitor licences foundation trusts and uses its enforcement powers when trusts breach or are suspected to be in breach of their licence. Where Monitor took regulatory action against the same provider on different occasions over the year, HSJ classed these as separate actions. In the year to date, Monitor has formally intervened in 16 foundation trusts, whereas in 2012-13 it announced regulatory action against just eight. Speaking to HSJ last week, Monitor chief executive David Bennett admitted the regulator’s “arm’s length” distance from foundation trusts had become “a little shorter” as it intervened more readily. He said increased monitoring and intervention was explained by “a declined appetite for risk” among “Parliament, the government and the public”. Saffron Cordery, director of policy and strategy at the Foundation Trust Network, said a “Francis effect” was one of the reasons Monitor “isn’t giving trusts the latitude it might have given them previously”.
‘Every patient is a person’ – Hunt: National Health Executive reports that health secretary Jeremy Hunt has urged doctors to think of patients as people, not just numbers. In a speech at St Guy’s and St Thomas’s hospital in London, he warned that the current system can often see patients passed around between referrals. Hunt also backed the campaign started by Dr Kate Granger to encourage clinicians to greet their patients and give them their names. He said: “Every patient is a person. A person with a name. A person with a family. Not just a body harbouring a pathology; not a diagnostic puzzle; not a four-hour target or an 18-week problem; not a cost pressure – and most certainly not a ‘bed-blocker’. Dr Kate Granger has highlighted the importance of treating patients as people. She has started the campaign #hellomynameis, which has become increasingly well-known based on the simple but vital courtesy of introducing yourself when meeting patients for the first time. We can all learn from that approach.” Dr Anita Donley, clinical vice-president president of the Royal College of Physicians, said: “In future, we will also need more doctors who have the knowledge and skills to diagnose, manage and coordinate continuing care for the increasing number of patients who have multiple and complex conditions, including the older patient with frailty and dementia. This will mean changes to the education and training of doctors and a focus on the generalist skills needed to do this. We welcome the secretary of state’s support for a ‘whole stay doctor’ who is responsible for the standard of care delivered to each patient during their hospital stay. The Future Hospital report had recommended that there should be a named consultant responsible for the whole of the patient’s stay.”
Alert system will name and shame unsafe providers: The names of organisations that fail to comply with patient safety alerts are to be published online each month as part of a revamped warning system being introduced by NHS England. The patient safety alert system is being upgraded to spread information about emerging concerns throughout the health service more quickly, in response to recommendations of the Francis report and the Berwick review into patient safety. The previous system was operated by the National Patient Safety Agency, which was abolished in 2011. NHS England’s national director of patient safety Mike Durkin told Health Service Journal (subscription required) that whereas the agency used to take “months” to issue alerts, NHS England intended to be more responsive. It will consult expert patient safety groups on whether to send out an alert, rather than setting predetermined criteria. Dr Durkin said: “It’s best to take every emerging risk on its own merit. One of the lessons learned from around the world is it’s only by triangulating and bringing together whole system approaches to reporting do you start to match that an emerging risk is popping up across the whole piece.” Under the new three stage system, a stage one alert will be issued to ensure emerging concerns are shared as soon as possible with providers. This will be followed soon after by a stage two “resource” alert, with more in-depth information and advice on dealing with the issue. Finally, a stage three “directive” alert will be issued, setting out what actions providers must take to mitigate the risk.
Annual recap of the best healthcare technology infographics created in 2013: Over the past 12 months, HIT Consultant has covered some of the most in-depth and well-designed healthcare technology related infographics in this industry. Infographics provide a great way to display complex information or research data in a visually appealing format. Themes this year covered the range of healthcare technology including trends transforming the health IT industry, duplicate medical records, patient engagement and much more. For their annual recap, HIT Consultant collected 20 of their favourite healthcare technology infographics of 2013, based on the following criteria: storytelling, valuable information, data visualization and design creativity, data sources, insightful key takeaways and popularity (number of social shares).
Tech firms seek ‘healthy’ returns: Nintendo has announced plans to launch a new health “platform” that will operate independently from its video game business, after weaker-than-expected console sales led to a 30pc dive in profits for the third financial quarter, reported The Telegraph. At a meeting with investors, Nintendo president and CEO Satoru Iwata said that, over the next 10 years, the company will try to build a “platform business” that improves people’s quality of life in enjoyable ways. The new platform business will use integrated hardware and software, but will not include mobile phones or wearable devices. Instead, it will be characterised by what Iwata calls “non-wearable” technology. It is not yet clear what this non-wearable technology will be, but when questioned by investors, Iwata said that it is “not necessarily something you will use in the living room”. He referred instead to “preventive measures” which would involve monitoring people’s health. While it may seem strange for a games console company to be getting involved in healthcare, Iwata claims that Nintendo’s experience of keeping consumers engaged and entertained means it is well-placed to motivate people to stay focused during exercise. “When we use ‘health’ as the keyword, some may inevitably think about Wii Fit,” he said. “However, we are considering themes that we have not incorporated in games for our existing platforms. This is where our strength as an entertainment company comes into play, assisted by the non-wearable feature, which is the biggest differentiator of this new business field,” said Iwata.
HSCIC Appoints New Chief Executive: The Health and Social Care Information Centre (HSCIC) has appointed Andy Williams as its new chief executive. Williams has extensive experience in overseeing large transformational technology projects in the UK and around the world having led teams in companies such as IBM, Alcatel-Lucent and CSC during the last three decades. He has worked across a variety of industry sectors, usually being involved in programme governance, introducing complex new technology and managing change. He has an international reputation and the companies he has worked with include many well-known names both in the UK and abroad. Williams said: “I am delighted to be able to bring my experience and expertise to a role as important as this. The HSCIC, since its creation in April last year, has made good progress in establishing itself as a highly influential source of information and analysis, as well as a provider of systems and services on which the NHS depends. No role in technology is more important than supporting the delivery of better patient care. I look forward to taking up my post in April and building on this early success.” Kingsley Manning, Chair of the HSCIC, said: “Andy’s track record speaks for itself. His integrity and analytic skills, coupled with his extensive contacts across the informatics industry, will give HSCIC a further boost as it builds its reputation for information services.”
Opinion
Why positive press is just as important as the negative
In this week’s Health Service Journal, Dr Karen Castille, an associate director at the NHS Confederation and chair of its urgent and emergency care forum, explains why positive press is just as important as the negative.
“Pick up any newspaper, listen to the radio, or watch TV and it is not hard to find another negative NHS story. Worse still, we frequently see a named and blamed villain (or villains) responsible for the reported debacle. The imbalance between the number of negative and positive stories about the NHS is stark. Is this a fair reflection of what is happening in the NHS, and are there any potentially damaging consequences?
“The NHS spends billions of taxpayers’ money and there is a good reason for it to be publically exposed and held to account for any failings. But why are the majority of publicised stories negative and what is the ripple effect of this? All too often good stories are neither published nor promulgated. The media assert that they are simply “giving the public what it wants”. Indeed, history is littered with examples of people luxuriating in debase and scurrilous remarks but, for the NHS, this is not without repercussions.
“Frequent media reports that make sweeping statements blaming “callous and uncaring NHS staff” turn staff into villains and risk damaging their sense of wellbeing and feeling valued and safe. Consequently, we know that this also affects patient safety and care. We even see instances where patients are portrayed as the villains.
“Talking up the NHS is important. Not because it makes us feel good but because it is what is needed to give the service a chance to meet the challenges it faces. It creates trust, confidence and discretionary effort, just at the point when it is needed.
“We can all play our part by making sure that for every negative story we hear about the NHS we tell two positive ones. We must also stop shying away from the leadership challenge and resist the temptation to hide behind heroes and villains.”
Integrated care needs people to make it happen
In the Guardian this week, Andrew Clegg, clinical specialist at Orion Health, explains that the way healthcare staff work with colleagues across different organisations must change to achieve the vision for integration.
“Integrating health and social care has been on the national agenda for more than 20 years yet, despite the introduction of various policies, strategies and initiatives to deliver it, we are still not there yet.
“Encouragingly we are seeing adjustments to the way colleagues in and out of the NHS are addressing these issues. Non-acute providers such as community pharmacies are expanding their remits to help ease inpatient pressures on hospitals, and care professionals are able to manage their relationships with community patient groups with the support of service redesigns and new technologies.
“However one crucial factor [is] missing and that is the attitudes of people – nurses, GPs, clinicians and management – involved in delivering care.
“In England, health and social care professionals at all levels are being asked to form and build relationships – working together for the greater good. But this does not always happen naturally and sometimes personal politics get in the way, making it hard to pull in the same direction.
“The many changes going on throughout the NHS, including the transparency of provider performance, heavier scrutiny of regulation and the introduction of new legislation, lead to a fear of the unknown for many care professionals.
“The future is about our ability to harness relationships that overcome that fear. If there is a willingness from people to tackle future challenges together then we will have a much better chance of achieving our goals. Integrated care needs people to make it happen – everything else you can get past.”
Collaboration is the Future
This week, Shane Tickell, CEO of IMS MAXIMS, blogs in a recently launched ‘Last Witness’ website, which brings together the experience and personal stories of NHS IT professionals.
In his first contribution to the website, Tickell talks about the need for organisations both in and out of the NHS, to collaborate in order to proactively manage the NHS’ protracted £30 billion funding gap.
“To plan for the future, we should reflect on the past and despite the loss of skills in some areas over the past decade, our healthcare service has seen the implementation of a lot of systems in the eighties and nineties, and the experience and knowledge that comes with that activity is invaluable. Many organisations have good systems in place but we now not only have an opportunity to upgrade and enhance them, but to prepare for the next generation of healthcare, and that involves sharing and collaborating now.
“Sharing could mean something as simple as going over to the local or surrounding trusts, or even taking it a step beyond that like University Hospitals Birmingham NHS Foundation Trust and forming a partnership to impart IT wisdom with another organisation in need of informatics support.
“On a grander scale, it could mean a central resource, a place where healthcare IT personnel past and present from a huge array of backgrounds can share best practice, experiences, and work towards a national standard. Here, healthcare providers can learn from each other and apply shared knowledge. While it is crucial for each individual trust to identify its own requirements and aims, having the opportunity to share and learn at any given time is vital.”
Better Care Fund: feeling the love?
As the deadline for Better Care Fund bids approaches, Richard Humphries, assistant director, policy at the King’s Fund, asks: How’s the chemistry between NHS organisations and their local authority partners?
“Valentine’s Day is known for expressions of romantic affection, when the love-struck hope that Cupid will work his magic. But this year Cupid’s arrows will be sharing airspace with the first cut of 152 local Better Care Fund templates winging their way towards NHS England to meet the 14 February deadline. The success of the £3.8 billion Better Care Fund – designed to promote integrated care and help shift care closer to home – depends on a different kind of chemistry between local NHS organisations and their local authority partners.
“So will the Better Care Fund help disperse the gloom? In the latest quarterly monitoring report (QMR) survey, opinions about whether the Better Care Fund would help or hinder organisations to maintain performance in key priority areas, such as delayed transfers of care, were mixed. Directors of adult social services were the most optimistic – slightly more than half of those surveyed thought it would help. This view was shared by only 12% of NHS trust finance directors, nearly half of whom thought it would be a hindrance. CCG finance leads were somewhere in the middle, with 38% seeing the Better Care Fund as helpful.
“These findings reflect some of the challenges and risks, as well as the opportunities, offered by the Better Care Fund and it is entirely unsurprising that these are perceived in different ways by different parts of the system.
“If used successfully, the Better Care Fund will see a reduction in hospital activity and income. This is potentially big, risky and hard to do. It’s difficult to get a sense of whether many places have really got to grips with the tough choices that are the inevitable consequence of the fact that the Better Care Fund is not new money.
“A final thought is that the world of politics and policy-making tends to over-estimate what can be achieved in the short term and under estimate what can be achieved in the long term. Some of the best examples of integration took years to achieve. As 14 February draws nearer, it will be the strength of long-term relationships – not short-term plans – that will bring us closer to the prize of integrated care.”
Highland Marketing blog
In this week’s blog Matthew D’Arcy looks at the rights and responsibilities involved in sharing patient data.
