News in brief
Plans for £230m GP IT spend released: NHS England has released its plans for how more than £230m in GP IT funding will be spent over the next year to ensure all practices across England have high-quality IT systems. According to eHealth Insider, an updated operating model for 2014-2016, ‘Securing Excellence in GP IT Services,’ aims to “improve the quality of GP care by enhancing patients’ experience of services, supporting and encouraging greater integration of care and providing efficiency benefits for practices by reducing paperwork, freeing up more time for patient care”, a statement from NHS England says. The new document confirms that GP IT funding will now be paid to clinical commissioning groups (CCGs) on a per-head-of-population basis, with some funding kept back to form a ‘transitional fund’ to which CCGs can apply if they need it. From the total pot, £140m will be allocated equitably by GP registered population. This means a payment of around £2.60 per patient. Another £20m will be available as part of the transitional fund. This money is classed as revenue and is for day-to-day running costs such as staff and operating expenses. Tracey Grainger, programme head of primary care IT at NHS England, said: “These arrangements will continue to give general practice providers a choice of high quality clinical IT systems that are tailored to local requirements while enabling the flexibility and innovation we recognise the service needs. This is underpinned by an on-going commitment from NHS England to continue to support and encourage the development of a world class IT infrastructure across health and care.”
Health and care integration priority for new NHS boss: The new chief executive of NHS England has launched a drive to integrate health and social care on his first day in the post, reports Public Finance. Simon Stevens said that there was a fundamental need to find ways of better coordinating health and social care for people with high levels of need. The government has announced the creation of a £3.8bn Better Care Fund from 2015 to integrate services. However, after visiting one of 14 integration pioneers in South Shields where the NHS, local council and voluntary groups are working together, Stevens said his aim was to ensure that integration began this year. “My aim is that NHS England and our local government partners get going, this year, on supporting and testing some practical new models that don’t need structural re-organisation. There are many current initiatives to build on, plus some international approaches that we should now try.” Among the areas to examine was how GPs could be involved in integration efforts, he added. Stevens said: “[One] of my first steps is going to be considering with our partners how the newly agreed GP contract – which goes live today – can best support our most vulnerable older patients.” However, Stevens also warned that the recession and a tight spending settlement from government had left the NHS facing its most sustained budget crunch in its 66-year history. Greater coordination will not be a panacea to this, he added. “No-one should pretend that just combining two financially leaky buckets will magically create a watertight funding solution – it’s going to take more than that.”
Information Centre urged DH to intervene in care.data last year: The Health and Social Care Information Centre (HSCIC) urged the Department of Health (DH) in December to intervene in NHS England plans to publicise the controversial care.data project, reports Health Service Journal (HSJ, subscription required). HSCIC chair, Kingsley Manning wrote to a senior DH official to raise concerns about the “adverse impact” he believed NHS England plans would have on “public and professional opinion”. The correspondence reveals tensions between the two organisations over the programme, which is owned by NHS England but in which the Information Centre plays the key delivery role. The letter, obtained by HSJ under the Freedom of Information Act, was addressed to Karen Wheeler, then director general of the DH’s information and group operations directorate. She has since joined NHS England. The letter, dated 6 December 2013, said: “We have always been concerned with the potential impact of the proposed mailshot planned for January, which has been required by the [Information Commissioners’ Office]. These concerns have been reinforced by the planned publication by NHS England of a ‘care.data prospectus’. We are worried that the publication of this document, as currently drafted, would have an adverse impact on public and professional opinion.” Mr Manning added that “it would be helpful if [the DH] could become involved [in discussions with NHS England], so that we can jointly consider the best way forward”. A DH spokesman said the department had responded to concerns about care.data by “making significant amendments to the Care Bill, providing rock-solid assurances that confidential patient information will not be used for commercial insurance purposes”.
RoI evidence needed for tech strategy: NHS England’s IT strategy will focus on telehealth, customer service and integrated digital care records, Beverley Bryant has said, according to eHealth Insider. The technology strategy was due to be published in December last year, but was then delayed until March and has now been pushed back until June this year. Bryant, the director of strategic systems and technology at NHS England, said the reasons for the delay included a lack of evidence about the return on investment that technology could deliver. Another reason is that NHS England needs to do more work with its stakeholders. “We are not going to develop a tech strategy for just the NHS,” Bryant said. “If our mantra is integration, our mantra is interoperability; so we need it to speak to all health and care. [That means we need a] bit longer to converse and draw in partners from across the wider care system. We also need some evidence. I need an evidence base saying ‘if you spend money in an organisation this is what you can expect in return on investment’. Creating that is going to be key in convincing the Treasury and future government that this is not only good for patient experience and safety but for efficiency and finance.” NHS England published its business plan for the next two financial years, setting out 31 business areas through which it will try and help the NHS to deliver “high quality care for all” and to develop as an organisation. The business plan includes timescales for the development of new business models for urgent, acute, primary, and community and social care, to address the £20 billion ‘Nicholson Challenge’ to bridge the gap between flat funding and growing demand.
NHS may need to apply more patient charges, says report: More patient charges may need to be introduced in the NHS, including fees for hospital and GP appointments and removing the blanket exemption from prescription charges for the over-60s, according to a report from the King’s Fund, which suggests the current health and social care systems are no longer fit for purpose. According to The Guardian, the interim report from the five-strong Commission on the Future of Health and Social Care in England, chaired by Kate Barker, a former Bank of England economist, has been published as all three main parties decide how to approach the issue of social care in their election manifestos. The report concludes that social care is already in crisis and that the NHS is heading the same way. It points to “hard choices” that must be looked at “squarely in the eye”, with several possible means of increasing revenue. Outpatients could be charged £10 for hospital appointments while those who fail to turn up could also be charged as a penalty. Costs for hospital stays or hospital treatment may also be considered. Extending charges for dentistry could also increase revenue, and a fee for visiting the GP – £5 to £25 – could be introduced, the report said. The independent Barker commission was set up by the King’s Fund to re-examine the postwar settlement, which established separate systems for health and social care. The Financial Times (subscription required) also reports that a radical change to the way the NHS is funded, including a £10 a month NHS “membership fee”, is needed if other public services are not to be bankrupted by the rising cost of healthcare, according to a former Labour health minister. Lord Warner, who was in charge of health service reform under the Blair government, says the health service has much to be proud of, but has failed to adapt quickly enough to the burdens imposed by chronic illnesses.
Trusts must publish ‘Hard Truths’ staffing data on wards: All NHS trusts with inpatient areas must now display staffing information about nurses, midwives and care staff deployed for each shift, compared to what has been planned, if they do not already, reports National Health Executive. Trusts have been given until the end of June to comply with the new ‘Hard Truths’ commitments, under guidance issued by NHS England and Care Quality Commission (CQC). In a letter to CEOs of trusts and foundation trusts with inpatient areas, Jane Cummings, chief nursing officer for England, and professor Sir Mike Richards, chief inspector of hospitals at the Care Quality Commission, stated that research demonstrates that staffing levels are linked to the safety of care and that staff shortfalls increase the risks of patient harm and poor quality care. “Patients and the public have a right to know how the hospitals they are paying for are being run, and so the government has made a number of commitments in Hard Truths: The Journey to Putting Patients First to make this information more publically available,” they added. Trusts will have to produce a board report describing their staffing capacity and capability, following an establishment review and be presented to the board every six months. Trusts have been advised that for those wards where staffing levels fall short of what is required to provide quality care, they must review the reasons for the gap, assess the impact and ensure actions are being taken to address the gap. This report must be presented to the board every month. Following this, by June 2014, the monthly report must also be published on the trust’s own website, and trusts will be expected to link or upload the report to the relevant hospital(s) webpage on NHS Choices.
GPs feel even less involved in commissioning one year after CCGs took control: Almost two-thirds of GPs feel no more involved in commissioning under clinical commissioning groups (CCGs) than under primary care trusts (PCTs), revealing an increasing disenchantment with the NHS reforms 12 months after they were introduced, a Pulse survey has found. The survey of 479 GPs in England, a year on from the reforms shows that nearly 63 per cent of respondents feel they did not have any more involvement now than they did under PCTs – a rise of eight percentage points on the same results last year. Only 33 per cent said they feel more involved with commissioning than they did with PCTs, compared with 36 per cent last year. The results are part of a Pulse investigation into the commissioning reforms one year on, which revealed that GP representation on boards had decreased since 2012, when CCGs were in shadow form. GP leaders have said that GPs are feeling increasingly disillusioned, warning that there is a disconnect between practitioners and CCGs. The survey found that more than half – 55 per cent – of the GPs surveyed said that they did not feel that ordinary GPs in their area had a say in the commissioning decisions made by the CCG. It also revealed that just 13 per cent felt that the switch to GP commissioning had a positive effect on patient care, while 38 per cent felt the variation in treatments provided in different areas was even more acute. Dr James Kingsland, president of the National Association of Primary Care, said: “Many of my colleagues are saying it is difficult to know the difference between the CCG and the PCT in terms of personnel, outlook, delivery style, process. How does transformational change occur in a system that looks very similar to the last?”
Scotland creates innovation portal: NHS National Services Scotland (NHS NSS) has developed an innovation portal to encourage the uptake and development of innovative technology products, according to eHealth Insider. The aim of the Health Innovation Procurement Portal is to work with companies, especially small and medium enterprises, that have ideas and innovations and find out how to help develop these into technologies that may be of use to the NHS. Jim Miller, NHS NSS’s strategic sourcing director, helped to develop the portal and said that it can also be used for suppliers with existing products that want to develop these further. “There are thousands of people working in or supplying NHS Scotland. Those on the front line are often most likely to spot an idea for a new product or technology which can make it easier to do our jobs, help patients or make savings,” he said. “But what’s been lacking in the past is a single point where NHS Scotland and industry can feedback and review new ideas and future requirements – that’s where the innovation portal comes in.” The portal, which is part of NHS Scotland’s response to the Scottish Government’s ‘Statement of Intent for Health and Wealth’, provides information, guidance and support to help the companies present ideas. When a product has been assessed, it will be rated red, amber or green based on not being suitable, having potential or being worthwhile. “If your proposal looks promising, the feedback from the portal will hopefully provide a platform for further development and discussion,” said Miller. NHS Scotland has set out 12 priority areas for improvement which are of particular interest: person-centred care; safe care; primary care, unscheduled and emergency care; integrated care; care for multiple and chronic illnesses; early years; health inequalities; prevention; workforce; innovation; and efficiency and productivity. The portal is still in early stages, but is live and accepting submissions.
Electronic observation system for NHS trust: Hull and East Yorkshire Hospitals NHS Trust (HEY) has agreed a five year deal with Nervecentre to deliver their e-Observations Decision Support System trust-wide, reports ProHealthServiceZone. The solution, the deployment of which has been speeded up through an award from the £100m Nursing Technology Fund, will enable the trust to reduce mortality, improve patient safety and reduce harm. The Nervecentre solution provides clinicians with the ability to record and monitor patient observations via a mobile device. Its key functionality includes sophisticated cascading escalation, with deteriorating patients’ vital signs being relayed to the most appropriate clinician in order for a “recognise and rescue” plan to be put in place. In addition, specialist functions such as Hospital-at-Night, will allow escalations out of hours – ensuring patient care remains consistent 24 hours a day and helping HEY to achieve standard 243 of the Francis Report – recording of routine observations. Steve Jessop, the trust’s chief nurse information officer said: “We needed smarter and more efficient ways across the organisation of detecting the sick, deteriorating patient, and providing a timely and effective response to this by clinical staff. This included the ability to target messaging to services and clinicians such as critical care outreach, junior doctors and the infection control team. This solution will enable us to have visibility of all deteriorating patients so that we can pro-actively intervene improving the care, management and outcomes of patients 24/7, including out of hours periods, and at weekends and bank holidays, when it can be particularly difficult to escalate manually.”
Health and Social Care Information Centre publishes data audit: The Health and Social Care Information Centre (HSCIC) approved 459 data releases to 160 organisations between April and December last year, an audit report reveals, reports eHealth Insider. Of the organisations that received patient data, 56 were commercial. The centre has published a report detailing the data it has released since its creation. It has also commissioned an audit of the data releases of its predecessor, the NHS Information Centre (NHS IC), which is due for publication at the end of next month. The report is a response to the intense public scrutiny of the bodies to which the NHS is releasing patient information that has followed the care.data row. Although supporters of care.data have sought to reassure the public that information will not be ‘sold’ to potentially controversial users, such as insurers, or sent abroad, it has been revealed that the NHS IC sold Hospital Episode Statistics (HES) data to an insurers body and allowed another organisation to process it using Google servers. HES forms the backbone of care.data, which wants to combine an expanded HES data sets with GP and other data and make the information available to researchers and others, with the public given the chance to opt out of the new service. The report shows that between April and December 2013, there were 347 releases of pseudonymised data and 75 releases of identifiable data by the HSCIC to 160 organisations. HSCIC chair, Kingsley Manning said: “By placing this register before the public the HSCIC is taking an important step towards the full transparency needed to help the public gain confidence in the services we provide. This is about ensuring citizens and patients are clear about how data is used to improve the health and social care received by them directly and by communities as a whole.”
NHS trust under private management faces deficit again: Private healthcare provider Circle is expected to have to dip into its own coffers for the second year running to cover a deficit at Hinchingbrooke Health Care Trust, reports Health Service Journal (HSJ, subscription required). The trust is likely to record a year end deficit in the region of £600,000 to £700,000 for 2013-2014. Such a figure would be a considerable improvement on the £3.5m deficit recorded by the trust in 2012-2013, the first full financial year in which Hinchingbrooke was under Circle’s management. However, it would also mean the company will have injected more than £4m into Hinchingbrooke in two years, having originally pledged to bring the trust into the black in the first year of the management contract. Under the terms of the landmark ten year franchise deal, Circle is responsible for balancing the trust’s books. The agreement stipulates that if Circle is forced to put more than £5m into Hinchingbrooke, either the trust or company can terminate the contract early. A Hinchingbrooke spokesman said the deficit had to be viewed in context of what the company inherited and emphasised the clinical improvements it had made over this period. He said: “By the end of next month, we will have reduced our £10m annual deficit by more than 90 per cent, successfully delivered efficiency savings of six per cent per year, more than twice as large as average for foundation trusts, and we are expecting to break-even during 2014 for the first time in years, safeguarding crucial services for the future.” It is understood that the expected deficit for 2013-2014 was driven in part by a need to bring in locum staff to deal with a recent rise in GP referrals to hospitals in the Cambridgeshire region.
Patients to be allowed to ‘enhance and update’ GP records: Patients will be allowed to ‘enhance and update’ their GP record eventually as part of NHS England’s plans to expand online access, says the body’s IT lead. According to Pulse, Beverly Bryant, NHS England’s director of strategic systems and technology, said patients being able to add to GP records was a ‘basic building block’ of what they were trying to achieve. The 2014/2015 GP contract regulations requires GPs to provide patients with access to the information in their summary care record by 2015, as a part of the government’s drive towards a ‘paperless NHS’ by 2018. Bryant went even further when speaking at a Westminster Health forum event, saying that patients should be able to add to their own records. Bryant said: “I feel we’ve talked about telehealth too much in terms of the technology, too much in terms of the kit. We need the basic building blocks in place – which means access to GP records, the patient being able to see what is held about them and – within time – enhance and update it.” She added: “The focus needs to be on interoperability and information sharing between and across care settings, because then telehealth will really have its place at that front end working for the patient to help them manage their care.” An NHS England spokesperson said: “We are still working through the details with British Medical Association and Royal College of General Practitioners colleagues.”
Dementia diagnosis drive raises concern: The BBC reports that questions are being raised about the government’s drive to increase dementia diagnosis rates in England. Fewer than half of the estimated 670,000 people with dementia have a formal diagnosis, but ministers want to see this rise to two-thirds by 2015. But a GP writing in the British Medical Journal (BMJ) warned the push could lead to over-diagnosis. Meanwhile, the Alzheimer’s Society said it was being undermined by the lack of support after diagnosis. There is no cure for dementia, but there is some evidence that access to drug treatment and services, such as memory clinics, and activities such as singing and physical exercise, can help people remain independent for longer. George McNamara, of the Alzheimer’s Society, said: “Demand for post-diagnosis support is already outstripping supply so if we are to cope with the increase in diagnoses, access to these services must be improved. But the trouble is the squeeze on funding is making that difficult.” The BMJ article by Surrey GP Dr Martin Brunet questions whether it is right to have targets based on estimations of under-diagnosis. The diagnosis rate is calculated by using the number of formal diagnoses and comparing that with the number of people thought to have the condition based on previous research. But Dr Brunet said there are no guarantees that figure was correct and the desire to drive up diagnosis rates could lead to people being wrongly diagnosed. “The potential harms inherent in setting targets for diagnoses have not been analysed despite the obvious danger that working towards targets can lead to perverse behaviours and outcomes,” he said.
Orion Health supports new HIMSS Europe continuity of care maturity model: A new model for evaluating the technological capabilities of European health and social care organisations delivering care across the patient journey has been launched by HIMSS Europe. eHealthNews.EU Portal reports that the new model has received active support from leading global health software provider, Orion Health. The new Continuity of Care Maturity Model (CoCMM), to be unveiled at the World of Health IT (WoHIT) Conference & Exhibition, reflects the growing maturity of technology required to coordinate healthcare across multiple care settings. The model has been developed to complement HIMSS’ Electronic Medical Record Adoption Models (EMRAM) for the acute and primary sectors. Charles Scatchard, president of international at Orion Health said: “Our experience shows that integrated care works best when underpinned by IT – helping to increase clinician productivity through services such as secure data sharing, workflow coordination and patient involvement in the care process. The other important contributor to successfully delivering integrated care is the involvement of clinical staff from the start of IT projects. This concept is embedded in our own ehealth methodology. Early clinical engagement in ehealth encourages swift adoption, allowing clinicians to more quickly focus on patient care.”
Opinion
Can Simon Stevens build a coalition for change?
This week NHS England’s new chief executive, Simon Stevens, takes up his post with an inbox that will be full to overflowing. Three issues demand his immediate attention, says Chris Ham, chief executive at The Kings Fund.
“The first is ever-increasing financial and service pressure and the effect this is having on performance. While the deficit among providers will be compensated for on the commissioning side, a number of CCGs will also end the financial year in the red. His first priority must therefore be to work with Monitor and the NHS Trust Development Authority to plan how to deal with widespread financial distress in the absence of the traditional brokerage arrangements used by strategic health authorities and of any financial reserves on which to draw.
“Second, he must build on the work of David Nicholson and his colleagues at NHS England to make the case for the new models of care described in their call to action. In September 2012, we set out the case for fundamental change when we launched our Time to Think Differently programme. Eighteen months on, there appears to be consensus about the need for change but little clarity about how it will be taken forward.
“Third, agreeing with ministers and national partners on how to achieve transformational change is an urgent requirement. One of the ironies of the reforms is that intentions to ‘liberate the NHS’ and ensure that it operates free from political interference have given way to a period when political involvement in the NHS and performance management are tighter than ever before, with inspection the instrument of choice of ministers. Fresh thinking on how to make a reality of new models of care is desperately needed.
“Having worked closely with Simon more than a decade ago, I know he will have been thinking hard about these issues and will be impatient to make his mark.”
Another view of Code4Health
In eHealth Insider this week, GP Neil Paul explains he has time for the much-derided Code4Health project; but thinks a lot more will need to be done if clinical staff are going to be able to make use of data – and even build apps – to help others.
“Code4Heatlh is a much-derided plan to teach the NHS programming, for which I have some sympathy. I learned BBC Basic back in the day, programmed in Turbo Pascal for an A level project, and remember – age 17 – thinking that this new language called C looked interesting.
“An understanding of how to query a database and different data types has allowed me, over the years, to write searches and to analyse data while automating it in Excel or Access. So perhaps it would help if more people knew what data they could get out of a system or what they could do with it once they had it.
“After all, the NHS needs to save money, to be more efficient, and to work in different ways. We also want to drive up standards and improve quality and safety. Most people would argue that data helps drive most of these imperatives.
“Knowing what you want to achieve, what inputs you have, what stages you have to go through, how to do that as efficiently as possible, might be a useful skill for everyone to have, if we are all to improve productivity. Even so, is it programming we need to teach, or a combination of basic programming, informatics, statistics and systems improvement?
“It’s all a lot more complicated than ‘teaching 100,000 doctors to code.’ But that might be where the logic of Code4Health takes us.”
A debate around how hospitals use data is needed
Roger Taylor, co-founder and director of research at Dr Foster Intelligence, writes in the Guardian this week about the serious of mis-recording of hospital data, and looks into why suggestions of ‘fiddling’ information is ripe within the NHS.
“There are many people who think that inaccurate recording is often deliberate. There are others who are quite convinced it is all innocent mistakes. Take the report earlier this year from the National Audit Office, which found that a number of NHS hospitals had provided inaccurate information about their waiting times. The Department of Health was at pains to say that nobody had deliberately changed the information to mislead.
“Both points of view are unhelpful. Accusations of fiddling do not, on the whole, help to identify the best way to fix the problem. Protestations of innocence are even worse, as they are too often understood to mean that there is not really a problem at all.
“An audit at Royal Bolton hospital found they had been wrongly coding patients as having sepsis (with no comment on the intentions of those involved). A second investigation by a separate auditor confirmed this finding but concluded the errors had not been intentional. The organisation felt vindicated by the second report, despite it concluding they had recorded data inaccurately.
“Speculating on the deliberateness or otherwise of inaccurate data recording is unhelpful, partly because people understandably respond very emotionally to accusations of dishonesty. But also, because it misses the real causes of inaccurate information – the fact that we knowingly run public services in a way that is bound to produce inaccurate data – even if everyone is acting with the best possible intentions.”
Influencing GPs and the expanding role of Clinical Commissioning Groups
This week Holly Holder, fellow in Health Policy at the Nuffield Trust, discusses the expanding role of the clinical commissioning groups (CCGs) and their ability to influence GPs.
“Since clinical commissioning groups moved into the driving seat of the commissioning system 12 months ago, the breadth of the job they are expected to do has become apparent.
“Spectators wondered if NHS England would become the natural driver for improvement, given that they hold the contracts for GPs. And if CCGs tried to do so, would that lead to fractious relations locally, with GPs resenting colleagues bossing them about from their new pedestals?
“The answer to both questions appears to be no. GPs who took part in a survey conducted as part of an on-going three-year study being conducted by the Nuffield Trust and The King’s Fund, were more likely now to agree to the involvement of the CCG in their day-to-day practice than this time last year.
“As with much of the new structure of the NHS and other new local health and social care organisations, how well CCGs and area teams do in improving general practice seems to depend on the one element that can’t be designed or reorganised by policy-makers – historical and enduring relationships between individual managers and clinicians at a local level.
“You don’t need to be a cynic to suspect that further reorganisation looms for general practice. Already, influential voices are asking whether the contracting and oversight job now done by area teams should be partly handed over to CCGs; or fully handed over to them; or given to Health and Wellbeing Boards. Politicians should be careful not to lose the progress that has been made over the past year.”
Highland Marketing blog
In this week’s blog, Chris Marsom asks whether Twitter is a must-have for NHS leaders and communications teams.
