Change the Record

© Hurricanehank

Earlier this week Health Secretary Andrew Lansley published the Department of Health’s long awaited Information Strategy whitepaper “The Power of Information”. It details plans to take all patient records online by 2015…but haven’t we heard all this before?

Back in 2002/3 the National Programme for IT (NPfIT) was born. It promised to do much the same thing, as part of the overall revolutionary plan for NHS interoperability. We all know what happened next – at the last count the Programme had spiralled to £12.4 billion and was officially ‘axed’ in September 2011 with us being years older and no wiser.  I accept that we are a little closer than before to the goal of a standardised, electronic system for patient records across the NHS…but what needs to change to make Mr Lansley’s vision a reality this time around? Here are some pointers:

  1. Break down barriers to change – the NHS Spine has been in existence for many years…it’s not the technology that’s holding us back but the attitudes. However, things are moving and nearly 15m Summary Care Records have been created. It is interesting to note that a patient’s ability to “opt out” was a huge sticking point…to date only 1.29% have chosen to do so.
  2. Identify patients by one unique number – incredible as it may sound, a patient’s NHS Number is not always the primary identifier for an individual across all sections of the NHS. This needs to change so we move to a one patient, one record system.  This is a key message from the Information Strategy.
  3. Clean up ‘dirty’ data –in the last couple of months we’ve had news that 20,000 pregnant men and 95,000 ‘ghost patients’ remain on the NHS books. This needs sorting and much of this process can be automated.  As an example, Quicksilva’s orQestra® system is helping our customers to verify NHS Numbers…in one case resulting in a 1.1% improvement in verified records in the first month…when you’re talking about 1.3m records, that’s getting us there.
  4. Pharmacies need to be encouraged to provide electronic transmission of prescriptions using barcodes – the Electronic Prescriptions Service (EPS) shows promise, but is far from the universal standard. Greater take-up will improve the quality of the data online and remove the need for routine appointments, a significant overhead for GPs.

No one can pretend that any of this will be happening quickly. One of my main concerns is that there is no optional central guidance as to what solutions can be used to deliver on the Strategy. Mr Lansley has instead called on GP surgeries and hospitals to use “imaginative solutions”. It’s true that the top down approach of NPfIT did not work but I think more guidance is needed for those healthcare providers who cut their IT budgets leaving them with no-one to help them make important decisions which will affect their future in competition with the private sector.

NHS Data – which one are you, again?

© Matthew Collingwood

Last week’s news that the NHS has saved £6.1 million by removing about 95,000 ‘ghost patients’ from its GP lists sounds impressive, but it only exposes the tip of the iceberg.  Removing these outdated records from GP lists is a step in the right direction, but there are other pressing reasons why a concentrated clean-up of patient data is needed.

The quality of data supporting the NHS has been poorly controlled for years and now that healthcare information is beginning to be shared between care providers the true extent of the issue is set to be highlighted.   With NHS Trusts under relentless pressure to measure and publish quality outcome indicators and with the increased accountability that directly affects their budgets the need for clean, accurate and accessible data is more important than ever.

To enable health care providers to identify which patients they are actually treating the NHS maintains its Personal Demographics Service (PDS).  The PDS is where data on every recorded NHS patient is held; it’s used by hospitals and other care-providers as the most up-to-date repository of patient identity available.  However, matching the details a patient has given about who they are against the hospitals own database and then verifying with PDS is not always straight forward.

If patient A is recorded in one database as living on ‘Salisbury Road’, and on another database as living on ‘Salisbury Rd’ then to a computer you have a failed match and there is an error, whereas to a human user the records are clearly the same and perfectly usable.  However, where the flow of information is electronic, and interpretation performed by computers the situation becomes very much more polarised and a minor error can lead to the failure of the referral mechanism, resulting in a patient being unable to book treatment, or to unknowingly receive treatment under a separate identity.  Such situations are often propagated as treatment staff, having recognised registration problems, will often not have the authorisation to make the changes needed.

It is not surprising then that A&E departments find themselves treating unknown or non-NHS patients which results in the hospital not being able to claim back the cost from the Department of Health.  As part of the NHS Reforms hospitals will become reliant on their own income to fund treatment.  Without being able to verify who they are treating, hospitals will lose out to “ghost patients” and “health tourists” meaning they won’t be paid and won’t have the cash available to maintain their service levels. It is vital to address wider data quality issues now, before the Reform Bill changes the NHS beyond recognition.

NHS Bill – the devil’s in the detail

Last month I commented that the NHS Bill risked losing hearts and minds and drew some parallels with the way differences of opinion on NHS reforms have been handled in the past, that is, by just ignoring them. Well, the reality is now upon us and whether we like or not, the thing is signed.

Many of the arguments against the Bill have been deeply emotive with health sector groups denouncing the Bill with evangelistic fervour…an ideal scenario if you want to dilute and detract from the smaller voices warning that the Bill is privatising health care by the back door. If you’re wondering whether this is the case or whether I am just scaremongering, then maybe it’s worth considering that this Bill has been ushered hastily through at a time when surveys show record levels of satisfaction with the NHS.
Being a “business person”, you’d think I would see the sense in privatisation and in most markets I can, but how can directors of private companies put patients first when their statutory duty is to put shareholders first?

These questions are the ones that generate a most unhealthy response in me:

  • Once hospitals are forced to take the Foundation route, they become independent of government and subject to GATT rules (showing my age) and EU competition. What will happen to them should they start to fail?
  • What will happen to the supply contracts currently in place with NHS orgainisations that are being scrapped? We’re talking about everything from cleaning to catering to IT and building maintenance. Will they be novated?…or worse, who’s left to manage the suppliers?
  • Even before the bill was passed, we had an example in Hounslow where the new GP consortium has appointed a multi-billion dollar American company to vet patient referrals according to a set of rules. How is this improving patient choice?
  • What happens when GPs start running out of money to commission services? If I should suddenly get ill in March, would I have to wait until the new financial year in April until I get hospital treatment?
  • Where will the 1 million staff work whose jobs are set to be privatised by 2014?
    Most patients do not see GP practices as private sector organisations, but they are, and at least in the past we have had referrals to hospital staff to provide treatment for the patient independent of profit considerations.

This Bill will take that safeguard away…and personally I would rather be treated by an NHS not-for-profit organisation than a “multi-billion dollar American company”.

NHS Reform – follow the money

follow the money

© Photographer Juha Tuomi Agency:

The Government’s NHS Bill is causing more unrest than any other bill I can remember…and yet it appears that it’s being pushed through far too quickly for something as important as this, leaving outsiders and insiders alike feeling railroaded.

The recorded aims of the Bill is to: create an Independent NHS Board; promote patient choice; and reduce NHS costs seem reasonable; so what’s going wrong?

Firstly, Mr Lansley’s approach to consultation has yet again got stakeholders’ backs up.  The Government seems to have learned nothing from the last major upheaval following the formation of the NHS National Programme for IT (NPfIT) in April 2005.  By August of that year, health sector bodies were complaining about the lack of consultation, an issue which dogged the life of the Programme and made every change unpopular with front line staff regardless of its expected benefits.

And now history is repeating itself…the latest news is that David Cameron has organised a summit with healthcare professionals to discuss how to implement the reforms excluding his critics.  Press reports say that some of the Royal Colleges such as the Royal College of General Practitioners have been excluded.

In life, most successful people learn that it is better to engage with their dissenters and work through the issues patiently and methodically…or face challenge at every step.  Half-hearted attempts to “listen” won’t cut it, especially where an institution as precious as the NHS is concerned.

The Government have already had one “pause for thought” and are saying that they are not planning a second indicating that they will be pressing on with what seems to be the most unpopular reform to hit the NHS…even in the light of an e-petition on the government website attaining 120,000 signatories calling for the bill to be dropped.

Secondly, what are we all missing in the small print?  I have been hearing the arguments for and against, but I am now beginning to feel uneasy enough to see for myself.  I thought I’d have my own reading of the Bill, which seemed like a good idea, except that the bill has over 350 pages, containing over 280 clauses.  Not many people will have read the Bill and I doubt whether those voting on it will have put in the time and effort to understand the consequences of its reforms.

My suspicions have increased…in situations like this my key thought is “follow the money”…who will be benefiting financially from this? Is that why it needs to be so complicated?

Over the next couple of weeks I’ll be reporting on my findings.

Watch this space.

What would Nye Bevan do?

Concerns over Poly Implant Prostheses (PIP) implants.

The news about Poly Implant Prostheses (PIP) implants has been breaking like waves on the shore over the last few months.  It’s a worrying situation if you happen to be an NHS patient who has had implanted material, but at least the NHS will stand by its responsibilities and offer you treatment if you have concerns that an implant is failing.

As for the people who have chosen to pay for implants, while I wouldn’t want to detract from their concerns the situation is different.  Let’s consider the scenario without the pathos.

If we were talking about, say, a tattoo instead of an implant, both a matter of choice, both carried out by a skilled operative, both using products to enhance a “look”, there is a strong parallel…

…and then let’s imagine that we found out that the ink used could break down in 10% of cases and slowly poison its host…how would we apply the logic?

Firstly, anyone that became ill as a result would still be treated on the NHS.  Anyone who did not become ill would probably still look for someone to sue for damages.  Now that the focus is on “whiplash” scams, it would be an ideal cash cow replacement for the personal injury lawyers.

So, let’s now revert back to the implant clinics who claim they “can’t afford” to compensate the people they have helped to injure.  Where is their surgeons’ Professional Indemnity Insurance?  Why is no one making a claim against it? Why should the Tax Payer foot the bill instead?  If it was a tattoo it wouldn’t even be suggested…

Well, if surgeons do have successful claims made against their PI Insurance, then their premiums would rise enormously to prohibitive levels and they would be unable to practice…is that their fault or should they have an implant approvals body to fall back on?

Funnily enough, we have an option in Wales, the Surgical Materials Testing Laboratory, based in Bridgend will approve medical products, but England has no such approvals agency.

England seems to rely on the European CE marking…pip, pip!

New Year, New NHS Experience

When did we become so surly?I hope your New Year has been less eventful than mine…sort of through the looking glass for me as I moved to the sharp end of the NHS instead of the cloudy world of NHS Spine connectivity.

My Mum had a DVT on Boxing Day and as we sped to hospital with the blue light flashing, I had time to reflect on the service that our software supports.

So far so good. The paramedic and the ambulance crew were excellent, even though they were working under difficult circumstances, it being the “holidays” and all.  With an ambulance headlight out and no maintenance team to fix it…crew working out of their area so no directions for the hospital…skeleton staff only, so we had a team leader attending our call out (this turned out to be a good thing)…we had a smooth passage into NHS land.

The A&E was an eye-opener.  The staff were jogging along, the assessment was soon underway…in fact all surprisingly acceptable considering the regular reports in the Press of poor treatment in hospitals.

The problem I had wasn’t the staff at all…but the patients and their entourages of moaning relatives.  When did our society turn into such a surly, ungrateful bunch?

In the end, I stopped engaging with anyone but medics to avoid, as best as I could, the waves of negativity swirling around the beds and waiting areas …but how on earth does it affect the staff?

I can only assume, from the blank faces, that they cope by turning off any external emotion and therefore any ability to communicate using the interpersonal skills available to them.  No tone of voice, no pace, no smiles, no frowns, guarded eye contact…a kindly bedside manner is out of the question until they work out what you are…a pain or a patient?

…and who can blame them?

The behaviour I saw was often rude and verging on aggressive…one chap was loudly complaining that his 9 am appointment the next day meant he was going to have to get out of bed far too early…the rest were complaining about having to wait, the prescribed treatment, having to smoke outside or not getting a mobile signal…on and on…

Yes, I know people are under stress in a hospital environment, but are we now so self-absorbed that we can’t have empathy with the NHS staff? The people who are trying to help us within the constraints of the resources available to them?

The answer seems to be no, we can’t.

Tale of Two…Extremes

Two news items last week caused me some thought…firstly, expectant mothers are to be allowed elective caesareans on the cash-strapped NHS because women are too scared to give birth naturally in today’s maternity wards and secondly, the Human Rights Commission finds that care of the elderly is abusive.

Two extremes of life and we can’t seem to get it right at either end…

As a society, we are extremely short of “care” and “kindness”. So what’s behind it?

A look at our animal roots could provide an insight which is over simplistic (hopefully)…when resources are scarce, animals isolate the old and restrict births to preserve the strongest in the herd…

Please prove me wrong…random acts of kindness needed urgently.


Welcome to the Anthill

“You’re one in a million” used to be an appreciative term…there’s no-one like you in the world…but times have caught up with us and now the world’s population is likely to hit 7 billion by the time our next MerQury Newsletter hits the internet.

I suppose we aren’t really feeling it much out here in the countryside as most of the birth boom is centred on cities (although 5 of our female staff are pregnant or have new-borns)…and then not much of a boom in Europe anyway. Working in the health sector, you become very aware of the growth in the “aging population” and acutely aware of the strain on all health resources that this brings…as a female in the UK my life expectancy is running at around 81.7 years.

See the BBC site and put in your date of birth to see where you fit in the scheme of things.

I’m around the 2,907,285,744th person to be born and so I am one in 2,907 million…doesn’t have the same ring, does it?