FrontPoint Systems Ltd

The Public Accounts Committee report receives wide coverage in the media.

Mr Edward Leigh added: “Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected.

“The programme is not looking good. And, four years down the line, the costs and benefits for the local NHS are unclear.”

Committee member Richard Bacon called for the scrapping of Connecting for Health, the agency responsible for the IT programme.

“It is a nightmare organisation and I think the NHS would be better off without it.”

Health minister Lord Hunt criticised the MPs’ report. “This is based on a National Audit Office (NAO) report that is now a year out of date.

“Since then substantial progress has been made and the NAO recommendations have already been acted on.”

If so release current information. Somehow I do not believe you.

Edward Leigh MP, Chairman of the Committee of Public Accounts, today said: “There is a question mark hanging over the National Programme for IT, the most far-reaching and expensive health information technology project in history. Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected.

“The Programme is not looking good. The electronic patient clinical record, which is central to the project, is already running two years late. The suppliers are struggling to deliver. Scepticism is rife among the NHS clinicians whose commitment to the Programme is essential to its success. And, four years down the line, the costs and benefits for the local NHS are unclear.

“Given that the total cost of this hugely ambitious project is expected to top £12 billion – and who can be confident that even this massive sum will not be surpassed? – the Department of Health is playing for high stakes indeed.

“Resolute action at this stage by the leaders of the Programme can do much to diminish the risks. The Department must get a grip on what it and the NHS are spending. It must thrash out with its suppliers a robust delivery timetable in which everyone, including local NHS organisations, can have more confidence. It must also launch reviews of the ability of the suppliers and local service providers to deliver against their contracts.

“The leaders of the Programme have talked long and loud about the benefits which it will bring to the NHS. The time for talking has ended. If dissident clinicians are to be persuaded, then they will have to see the advanced electronic patient record systems up and running. And if these systems cannot be delivered within the framework of the Programme, then the local NHS should be given greater freedom to look for alternative systems which do work.”

Patients are “unlikely” to see any “significant clinical benefits”.

Richard Bacon in the Telegraph:

They are miles behind schedule, yet the limited deployment has already caused havoc, with significant delays in providing inoculations to children, waiting list breaches, missing patient records and the inability to report activity statistics. Not to mention the trifling matter of the largest computer crash in NHS history, when 80 hospitals had no access to patient administration systems for four days.

Timetables are fictitious and the programme is now years behind.

Doctors, nurses and hospital managers have been left spitting with rage. Most GPs think the appointment booking system is a joke.

One expert told our committee: “It was like being in a juggernaut lorry going up the M1 and it did not really matter where you went as long as you arrived somewhere on time. Then, when you had arrived somewhere, you would go out and buy a product, but you were not quite sure what you wanted to buy. To be honest, I do not think the people selling it knew what we needed.”

Sounds very familiar, almost as if it was me saying it, though I did not get called.

A brief mention in the Times.

The Guardian kicks the LSP’s while they are down.

Their report called for an urgent independent review of the performance of three regional contractors - CSC, Fujitsu and BT. A full audit of their work would detail the multimillion-pound payouts and cash advances they have received, the contractual milestones they have missed and what benefits they have delivered.

The Press Association has an overview.

And in the Financial Times:

BT, CSC and Fujitsu, the current suppliers, hold £5bn worth of contracts but were “clearly struggling to deliver”, the Commons public accounts committee said.

The key recommendation - that other suppliers be allowed in - challenges the structure of the programme where BT, CSC and Fujitsu, the so-called local service providers, are charged with supplying, installing and operating the various components of the programme. They use just two software suppliers, Cerner and iSoft, for the core patient record.

Well, it all becomes clear when you read this. Forcing two very different sets of working practices into one straitjacket that fits neither is a route to disaster.

Meanwhile news from across the pond is that New York is to try giving Medicaid practices free medical software with a 19 million buy.

“We will cover half of all the high-volume Medicaid providers in the city, those where over 30 percent of their patient encounters are Medicaid or the uninsured,” said Farzad Mostashari, an assistant city health commissioner overseeing the project.

Over the next two years, the city’s Department of Health and Mental Hygiene will distribute the software to about 1,500 medical practices, from small neighborhood doctors’ offices to large clinics, including the medical offices at the Rikers Island jail. City officials, and makers of patient records software, said they do not believe any state or large local government has tried such a thing.

The department spent months shopping for an electronic records system before awarding a $19.8 million contract to eClinicalWorks, a Massachusetts company that is a sales leader in the field. The medical practices will have to supply the computers. Some already have the equipment. Others that do not might qualify for a state program that awards grants to upgrade medical technology.

Let’s hope they have better luck.

Share This

So the Public Accounts Committee report on the NPfIT programme (pdf) from CfH is out today and it has plenty to say (html). I will let the report speak for itself.

1. The delivery of the patient clinical record, which is central to obtaining the benefits of the programme, is already two years behind schedule and no firm implementation dates exist. By now almost all acute hospital Trusts should have new NPfIT patient administration systems (PAS) as the essential first step in the introduction of the local Care Record Service. As of June 2006 the actual number was 13 hospitals. In June 2006 the Department wrote to us stating that by October 2006 there would be a further twenty-two. So far as we are aware, up to the end of February 2007 the number has increased by only five acute hospitals. The introduction of clinical as opposed to administrative software has scarcely begun; indeed, essential clinical software development has not been completed. The Department should develop with its suppliers a robust timetable which they are capable of delivering, and communicate it to local NHS organisations who may then have greater confidence as to when systems will be delivered.

There is still an unwillingness to accept the failures inherent in the current approach. an honest re-evaluation is needed.

2. The Department has not sought to maintain a detailed record of overall expenditure on the Programme and estimates of its total cost have ranged from £6.2 billion up to £20 billion. Total expenditure on the Programme so far is over £2 billion. The Department should publish an annual statement outlining the costs and benefits of the Programme. The statement should include at both a national and local level original and current estimates of total costs and benefits, costs and benefits to date, including both cash savings and service improvements, and any advances made to suppliers.

Hopefully the claims made by Richard Granger that the work done by the suppliers is “at risk” is sound. But as witnessed in the case of Acccenture, getting them to actually pay up is going to be a different matter due to all the cock-ups from CfH.

3. The Department’s investment appraisal of the Programme did not seek to demonstrate that its financial benefits outweighed its cost. The main justification for the Programme is to improve patient services, and the Department put a financial value on benefits where it could. The Department should also quantify non-financial benefits, even if they are not valued, to better inform decision making and to provide a baseline for work after implementation to ensure that the intended benefits are being fully realised. The Department should commission and publish an independent assessment of the business case for the Programme in the light of the progress and experience to date.

The procurement was truly woeful but not much different from other recent contracts. The quality of purchasing by the DoH is shameful.

4. The Department is maintaining pressure on suppliers but there is a shortage of appropriate and skilled capacity to deliver the systems required by the Programme, and the withdrawal of Accenture has increased the burden on other suppliers, especially CSC. The Department should review with suppliers their capacity to deliver, and use the results of this review to engage, or to get suppliers to engage, additional capacity where required. It should also regularly review suppliers’ performance for any signs of financial difficulties potentially affecting their ability or willingness to discharge their obligations. In view of the slippage in the deployment of local systems, the Department should also commission an urgent independent review of the performance of Local Service Providers against their contractual obligations.

I could say a lot about the quality of resourcing by both CfH & the industry but it is a waste of time when people who do not know healthcare IT are running the show. Incompetence is the key word.

5. The Department needs to improve the way it communicates with NHS staff, especially clinicians. The Department has failed to carry an important body of clinical opinion with it. In addition, it is likely that serious problems with systems that have been deployed will be contributing to resistance from clinicians. It should ask the heads of the clinical professions within the Department, such as the Chief Medical Officer, to review the extent of clinical involvement in the specification of the systems, and to report on whether they are satisfied that the systems have been adequately specified to meet the needs of clinicians.

There needs to be a period of re-evaluation. The goals are far too important to be treated like this.

6. We are concerned that leadership of the Programme has focused too narrowly on the delivery of the IT systems, at the expense of proper consideration of how best to use IT within a broader process of business change. The frequent changes in the leadership of the Department’s work to engage NHS organisations and staff have damaged the Programme and convey that the Department attaches a low priority to this task. The Department should avoid further changes in the leadership of this work, beyond those necessary to improve its links with clinicians, and strengthen the links between the Programme and the improvement of NHS services that the Programme is intended to support.

I would argue for a change of leadership as there is too much sunk capital for them to accept their mistakes.

7. The Department should clarify responsibility and accountability for the local implementation of the Programme. At a time when many changes are taking place in the configuration of the local NHS and a range of other initiatives require implementation, it is essential that Chief Executives and senior managers in the NHS understand the role they need to play in the implementation of the Programme. The Department should make clear to Chief Executives and senior managers their objectives and responsibilities for local implementation, and give them the authority and resources to allow local implementation to take place without adversely affecting patient services.

Local implementation should be governed by strategy, not expedience & there need to be clinical personnel at the helm who understand IT.

8. The use of only two major software suppliers may have the effect of inhibiting innovation, progress and competition. In addition, the fact that the Programme has lost Accenture, Commedica and IDX, three key suppliers, is running late and is having difficulty in meeting its objectives raises doubts over whether the contracts will deliver what is required. The Department should seek to modify the procurement process under the Programme so that secondary care trusts and others can if they wish select from a wider range of patient administration systems and clinical systems than are currently available, provided that these conform to national standards. This approach could have the benefit of speeding up the deployment of new systems and of making it easier to secure the support of clinicians and managers. We are concerned in particular that iSOFT’s flagship software product, ‘Lorenzo’—on which three fifths of the Programme depends—is not yet available despite statements by the company in its 2005 Annual report that the product was available from early 2004.

See comments above about the procurement process & my previous posts about the belief in “big is beautiful”.

9. At the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period. As a matter of urgency the Department must define precisely which elements of functionality originally contracted for from the Local Service Providers will be available for implementation by the end of the contract period and in how many NHS organisations it will be possible to have this functionality fully operational. The Department should then give priority to the development and deployment of those systems of the greatest business benefit to the NHS, such as local administration and clinical systems.

So pretty much nothing I can seriously disagree with. A look at the full report will happen when there is more time.

Share This

So today is the day that maternity report comes out & there are more dissenting voices.

Home births were at least twice as likely to result in foetal death as hospital births, even for women considered at low risk, said James Drife, professor of obstetrics and gynaecology at Leeds General Infirmary.

“I don’t think the Government is being realistic about what can be achieved or entirely honest about the risks,” he told The Daily Telegraph.

Prof Drife, a former vice-president of the Royal College of Obstetricians and Gynaecologists, said it was “very doubtful” that the Government’s promise could be achieved because of the midwife shortage. Home births required two midwives to be present and it was hard enough to achieve one-to-one care in a hospital, he said.

Jim Thornton, professor of obstetrics and gynaecology at Nottingham, said: “It is wasteful proposal. Giving birth at home is a minority preference and relatively expensive in terms of midwives’ time.

Even advocates of home birth turned on the Government, saying there were simply not enough midwives to do the job.

Dr Sheila Kitzinger, Britain’s leading expert on childbirth, said the Government was being “deceitful”. She added: “This plan is just spin. It cannot be done.”

Yes, but people seem to forgetting all those maternity support workers who will be covering the shortfall.

The Lib Dems quantify the losses incurred as a result of the dental contract at 55 million pounds.

Some 78% of respondents reported a shortage in revenue from patient charges.

The shortfall amounted to £55,658,754 among the 86 trusts that responded to the survey. Another 66 PCTs did not provide figures.

Geriatric care which is often neglected gets a mention in the Times. After all it is not as high profile as things like cancer. People forget that there are going to be an awful lot more of the elderly around.

“Nursing home care is moving towards residential home care, and residential home care is moving towards domiciliary home care.”

The National Screening programme for cancer has a few concerns about its own role.

Julietta Patnick, head of the national screening programme, said: “When a postmortem is done on a man in his 80s most of the time he will have prostate cancer. These men are dying of other causes, they’ve never been diagnosed before. Prostate is an extreme example but it follows to a lesser extent for other cancers.”

I’m not sure that I agree. Prostate cancer causes a lot of morbidity & gets a lot less attention than breast or cervical cancer. Until we can predict individualised odds for survival, it is hard to see how one can be tested for while the other isn’t.

That report on radiotherapy waits gets more press time in the Telegraph.

More than half of all cancer patients are having to wait longer than the Government says is acceptable for life-saving radiotherapy treatment, it was disclosed last night.

There is also a huge disparity in the provision of radiotherapy services across the country, with “black holes” where treatment is very poor, a report by an NHS advisory group is said to show.

The study, by the National Radiotherapy Advisory Group, is being looked at by ministers, but it has not yet been published. It has reportedly found that half of all cancer patients are waiting longer than the Government’s “maximum acceptable delay” of four weeks for the treatment.

Last night, a Department of Health spokesman refused to discuss the report’s contents. He said the report was with ministers and no decision had been taken on publishing it.

Really? You think problems will go away if you refuse to acknowledge them? It appears that this approach is shared by the folks below.

Cerner Millennium isn’t getting a good press from the hospitals to have had it installed. Milton Keynes General Hospital went live for the PAS option a few weeks ago but is already in the news following a letter from the staff.

the software is “awkward and clunky”. “In our opinion, the system should not be installed in any further hospitals.”

E Health Insider follows up.

Reported problems include clinics not being available, patient notes being lost or unavailable, staff being trained on a different system to the one implemented and problems with reporting around key areas such as 18-week waits. One senior clinician from the trust described the situation in outpatients as “a nightmare”.

And Computer Weekly says that CfH tried to suppress the BCS report into the NPfIT which says that

the “value for money from services deployed is poor”, that political pressure has caused health officials to “deny problems and to defend the indefensible”, and that implementation plans have frequently ranged from the “optimistic to the unreal”.

The report’s author, Ian Herbert, who is vice-chairman of the BCS Health Informatics Forum, told last month’s HC2007 Healthcare IT conference that Connecting for Health chief executive Richard Granger, after seeing a draft, did not want the report published.

“It was an interesting process developing that report. Richard Granger was not keen that we publish it, he was keen that we did something else rather more opaquely behind closed doors. We were not prepared to do that. We owed more to our members. So we produced the report,” said Herbert.

When your foundations are wonky, it is hard to get the superstructure right, that is if you even try.

An opinion that the Ferret Fancier apparently shares as he keeps up the pressure on PMETB. And this non-apology isn’t good enough.

Share This

Patricia Hewitt seems to have this problem of making statements with little knowledge or understanding. I look forward to her backing up her claims.

NHS dentistry stays in the limelight with an in-depth examination in the Independent.

Tony Blair pledged at the Labour Party conference in 1999 that everyone would have access to an NHS dentist. Last week, more than seven years later, the Department of Health slipped out figures showing that 55.7 per cent of adults and 70.5 per cent children had been seen by an NHS dentist in the previous 24 months. Yesterday, a report from the National Association of Citizens Advice Bureaux revealed that 77 per cent of the 4,000 respondents to their survey said they could not find an NHS dentist prepared to accept them. There is still a very long way to go to meet Tony Blair’s pledge.

The Telegraph weighs in:

Ms Winterton told the Today programme on Radio 4 that it was “unfair” for some dentists to seek extra cash at the expense of others who planned their work better.

She defended the system after being told of a practice in Fulham, south west London, which had been forced to put seven of its eight dentists “on holiday” despite demand.

Over 85% of dentists feel that access has worsened since the new contract was implemented.

Susie Sanderson, chair of the BDA’s executive board, said: “When the Government is failing to meet even its own success criteria for the new contract, then it’s time for urgent action.

“We now have a reductive, target-driven system that is failing both patients and dentists.

Rosie Winterton, the health minister, said: “The overall picture is that, despite the speculation, the number of dentists is growing and rather than leaving they are actually keen to expand their work for the NHS - hardly indicative of a failing system.”

Not in most observers eyes, it isn’t.

One in ten teens faces addiction! I will let you think about that headline for a while.

As for this, sorry, no one is cheering. Services have been decimated across the board & returning the money now is not going to bring them back.

More about money

The National Health Service is to get a minimum of 3 per cent real-terms growth a year between 2008 and 2011, Patricia Hewitt, the health secretary has said.

Following last week’s Budget, and the chancellor’s settlement for education in the comprehensive spending review, Ms Hewitt told the Financial Times that the NHS “will continue to grow, and grow faster than the rate of economic growth -generally”.

Asked if that meant a minimum of 3 per cent, given Treasury forecasts that the economy will grow at 2.75 per, she said in an interview: “That is your deduction, but I am not dissenting from it.”

The figure of 3 per cent is below the 4.4 per cent that the 2002 Wanless review suggested was the minimum the NHS was likely to need after 2008.

The service will head towards reducing the total maximum wait for treatment to 18 weeks, and that “will not be an old, top-down, performance-management target”, but would be achieved by staff themselves reshaping the way services were provided.

The “staff” want to improve services. The last few years have been all about hobbling their ability to do so with increasing layers of management.

Hospital readmissions are on the rise,

prompting claims ministers are pressuring the NHS to release patients early to help cut waiting times. Government figures, obtained by the Conservatives, showed that the number of emergency readmissions had risen by nearly a third since 2002.

Shadow health secretary Andrew Lansley said hospitals were discharging people too early because of NHS targets.

The government said readmissions were often unrelated to the earlier visit.

In the last quarter of 2002-3, 5.5% of patients were readmitted as emergency cases less than a month after being released.

By the last quarter of 2005-6, this had risen to 7.1%.

A Department of Health spokeswoman said: “The decision to discharge patients is made by clinicians.

I am sure that there will be plenty of clinicians available to test that statement.

As this perennial complaint shows

An NHS Alliance poll of 651 GPs found 70% often received papers late and many said the forms were not complete, compromising safety.

It was things like these that the Electronic Patient Record was supposed to fix, simple solutions using existing technology.

Among information which was reported to be missing were the patient’s name, contact details, medication and treatment.

Incorrect or insufficient data on medication, such as potentially toxic drugs like warfarin, has even led to patients being readmitted to hospital because of complications such as internal bleeding and strokes.

In one instance, a discharge summary was received but failed to mention that the patient had just spent a week in intensive care following a stroke and heart attack.

Some 58% of GPs reported the problems meant clinical care was compromised in the last year, with 39% claiming it had put patients at risk.

Overworked staff with no time to even document what treatment they have provided sounds familiar all right.

Speaking of IT systems,

Professor Michael Thick, clinical officer of Connecting for Health said that interoperability was an issue which would be high on the computing agenda for a while, citing the two main systems suppliers in the National Programme for IT as an example of the problems being faced.

“The standards of Cerner and iSoft are based on different structures which are not necessarily compatible at the moment and given that we have not been able to agree on a consensus on coding, interoperability is something we are hoping for but will not necessarily happen.”

Which makes this rather more important than is generally realised.

Connecting for Health has today issued its tender for bids to join the catalogue of ‘additional systems suppliers’.

The tender in the Official Journal of the European Union (OJEU) for an ‘Additional Supply Capability and Capacity (ASCC) Framework Agreement’ is open to a maximum of 500 suppliers, for a period of up to four years. The estimated value of the tender is £100m.

The Guardian seems to think that IBA Health is not making much headway at winning over CSC in its efforts for control of Isoft.

Share This

What is your price?

I try to look at motives, the behind the scenes machinations why a position is taken & make it a point not to be influenced unduly by any personal consideration or gain. Well, I try anyway but not always successfully. Claiming to be holier than thou is not realistic.

I am sure that my outspokenness on here has put off a few potential clients but there is only so much I can compromise on. Wired goes into it in a little more detail.

Radical forms of transparency are now the norm at startups - and even some Fortune 500 companies. It is a strange and abrupt reversal of corporate values. Not long ago, the only public statements a company ever made were professionally written press releases and the rare, stage-managed speech by the CEO. Now firms spill information in torrents, posting internal memos and strategy goals, letting everyone from the top dog to shop-floor workers blog publicly about what their firm is doing right - and wrong.

“You can’t hide anything anymore,” Don Tapscott says. Coauthor of The Naked Corporation, a book about corporate transparency, and Wikinomics, Tapscott is explaining a core truth of the see-through age: If you engage in corporate flimflam, people will find out. He ticks off example after example of corporations that have recently been humiliated after being caught trying to conceal stupid blunders.

No, this post is not brought on by any major crises of faith or ethical dilemmas & I am not aware of the location of a smoking gun.

But just how far will people go to hide negative opinions, especially if personal gain is involved?

I recently posted a few comments on a major newspaper’s website, nothing libellous or close to but pointing out mistakes / economies with the truth of one of their star columnists. None of the comments made it past moderation. Once is possibly an error, twice less likely to be so. More than that & there is likely to be something going on.

Today, I posted on a site that takes in quite a bit in industry sponsorship. The comment questioned the value of a particular transaction & drew attention to its poor record of performance. No show. I can only think that the fear of offending an advertiser was greater than the commitment to telling the truth.

Hiding from the truth doesn’t make it less correct or even go away. Intellectual honesty is a pre-requisite.

I just have less respect for this site now.

Everything comes with a price tag & the bill has to be paid at one time or another.

The co-founder of iSoft, the embattled IT company at the heart of the government’s troubled £6.2bn NHS IT upgrade project, was sacked yesterday after being suspended since the beginning of August.
The company said Steve Graham, former commercial director, had been “removed as a director” and had “ceased to be an employee of iSoft.” This move follows his suspension on full pay of £385,000 from August 8, “following an initial investigation into possible accounting irregularities in the financial years ended 30 April 2004 and 2005.” Another employee was suspended alongside Mr Graham, but the company refused to disclose their identity. A spokesman for the company said the financial terms for Mr Graham’s departure had not yet been agreed, but added: “It is not our intention to pay any compensation.”

As I do for the BMA or the Royal Colleges, especially after their behaviour over the years.

I am not capable of the cognitive dissonance, the moral bankruptcy of the position that “I’m al-right jack” & that other peoples problems are of no consequence.

The MDU guidance on the Electronic Patient Record is worth considering fully. It is difficult for me to understand how anyone who considers fully the positions being eluded can go along with current CfH plans.

“GPs will need to consider, therefore, whether they can rely on implied consent, or whether they need to seek express consent from their patients in order to upload their data onto the summary care record.

“GPs will need to consider a number of things. They will need, for example, to satisfy themselves that the CfH [Connecting for Health] publicity campaign had indeed reached all their patients, that all their patients had read and understood the leaflets and, if the GP had not heard from them, had decided not to seek an appointment with the GP to ask any questions, and not to ‘opt out’.”

E Health Insider touches upon it in detail.

In clinical medicine, these are the current ethical transgressions that are being ignored. Is a life in the “Third World” any less sacrosanct than one in the West?

And this is what we are being led towards, by misdirection. To pretend that this is an aberration is to lie.

Tens of thousands of elderly Americans have received life-prolonging care as a result of their long-term-care policies. With more than eight million customers, such insurance is one of the many products that companies are pitching to older Americans reaching retirement.

Yet thousands of policyholders say they have received only excuses about why insurers will not pay. Interviews by The New York Times and confidential depositions indicate that some long-term-care insurers have developed procedures that make it difficult — if not impossible — for policyholders to get paid. A review of more than 400 of the thousands of grievances and lawsuits filed in recent years shows elderly policyholders confronting unnecessary delays and overwhelming bureaucracies. In California alone, nearly one in every four long-term-care claims was denied in 2005, according to the state.

“The bottom line is that insurance companies make money when they don’t pay claims,” said Mary Beth Senkewicz, who resigned last year as a senior executive at the National Association of Insurance Commissioners. “They’ll do anything to avoid paying, because if they wait long enough, they know the policyholders will die.”

Insurance companies make money when few people claim successfully. The $1.6 billion dollars that the chairman of United Health was paid over 14 years needed to come from somewhere.

Share This

The Summary Care Records Service (SCRS) trial gets more attention both in the BBC & in the Guardian with a repeat of the talking points as framed by CfH. What I will be interested in is the detail of the patient education & the ease of the process for opting out as applied in practical terms. Also interesting will be access controls on the data, the detail of which I am sure will be keenly awaited.

Given that Dr Hannan’s previous attempt at patient education took 2 hour sessions I am not too impressed by the proposal for just a glossy leaflet & a canned video. Will the risks be adequately stated or will the usual tactics of obfuscation be used? Let us see.

Dr Crippen has his own take on the situation.

A press release from the Local Government Association also covered by the BBC emphasises that social care for vulnerable people is being squeezed as a result of NHS deficits.

A survey of 60 council social services departments found that:
• 40% said that the financial situation was worse than last year and 51% believe that the financial situation will stay the same or get worse in the next financial year.
• More than two in three responding had found that the financial deficit in their local NHS had an adverse effect on their council services.
• Half had seen bed closures in the NHS and more than one in five had seen a reduction in district nursing capacity.

Something that a lot of people have been pointing out.

Another 14% said there were increased waiting times for NHS services, such as admission to hospital while 13% said community hospitals had been closed.

In addition, more than a third of the councils in the LGA survey say they are having to take responsibility for more cases normally dealt with by the NHS.

Everyone knows that this is an unsustainable cut in services brought on by political imperatives. Which is why announcements like the one whose treatment David Brindle bemoans here are not received with reverence.

The continuing care of elderly patients is the main area where responsibilities overlap.

Almost a quarter (24%) say the local NHS is failing to fund agreed or joint services.

This might involve cuts to nursing services, meaning home helps have to take on tasks such as changing wound dressings or checking insulin levels.

However the NHS Confederation said there were two sides to the story, and some local authorities have being pushing costs the other way by tightening their criteria for looking after people.

David Stout from the confederation’s primary care network said: “Pressures include increased admissions into residential care and increased workload for community based staff as well as increased pressure on out-of-hours services.”

And finally the letters page of the Guardian is rich in NHS material today with an illustration of the cuts in services at PCT level as well as a letter from a number of senior medics (professors actually) calling the review & its aftermath a “charade”.

We are alarmed by the new process for selecting young doctors for specialist training, called Medical Training Application Service (MTAS). This introduced an untested online system which abandoned long-recognised measures of the clinical skills required by successful doctors, and forbade use of CVs at short-listing or interview. The resulting lottery, compounded by overwhelming numbers of applicants from the new EU, has resulted in gross injustices. Thousands of our brightest trainees have no hopes of progression in their area of greatest aptitude (medicine, surgery, general practice etc), while thousands more have been discarded altogether.

While we initially welcomed the reported climbdown (Climbdown over NHS job rules for doctors, March 10), this appears a charade as thousands have been forbidden permission to re-apply. Almost 1,500 doctors, senior and junior, have answered our online questionnaire since the weekend, of whom 90% have called for the process to be stopped altogether and 95% wish its architects to resign.

MTAS is part of a wider overhaul of medical training known as Modernising Medical Careers, introduced like MTAS by government diktat without involvement by those experienced in medical education and training. The threat to the NHS and people with medical problems in future decades is very real. We support the need to modernise medical training, as successfully undertaken in other countries. The chaos of MMC/MTAS has delayed progress and those responsible should depart.

Morris Brown, consultant physician and professor of clinical pharmacology, University of Cambridge
Hugh Barr, consultant surgeon and Dean of the Faculty of Medicine and Bioscience, Cranfield Postgraduate Medical School
Nick Brooks, consultant physician and president, British Cardiovascular Society
Edwina Brown, consultant physician and professor of renal medicine, Imperial College, London
John Camm, consultant physician and professor of clinical cardiology, St. George’s hospital medical school
Mark Caulfield, consultant physician, professor of clinical pharmacology, Queen Mary, University of London
Shern Chew, consultant physician and professor of endocrine metabolism, Queen Mary, University of London
Edwin Chilvers, consultant physician and professor of respiratory medicine, University of Cambridge
Paul Corris, consultant physician and professor of thoracic medicine, University of Newcastle
Paul Durrington, consultant physician and professor of medicine, University of Manchester
Paul Emery, consultant physician and professor of rheumatology, University of Leeds
John Gibson, consultant physician and professor of respiratory medicine,University of Newcastle
Ashley Grossman, consultant physician and professor of endocrinology, Queen Mary, University of London
Alistair Hall, consultant physician and professor of clinical cardiology, University of Leeds
George Hart, consultant physician and professor of medicine, University of Liverpool
Tony Heagerty, consultant physician and professor of medicine, University of Manchester
Humphrey Hodgson, consultant physician and vice-dean, professor of medicine, Royal Free & University College School of Medicine
Philip Home, consultant physician and professor of diabetic endocrinology, University of Newcastle
Richard Hughes, consultant physician and professor of neurology, Kings College London
Kay-Tee Khaw, consultant physician and professor of clinical gerontology, University of Cambridge
John Lazarus, consultant physician and professor of clinical endocrinology, University of Cardiff
David Leaper, emeritus professor of surgery, University of Newcastle
Peter McCollum, consultant surgeon and professor of vascular surgery, University of Hull
John Monson, consultant surgeon and professor of surgery, University of Hull
Professor Philip Poole-Wilson, consultant physician and professor of cardiology, Imperial College, London
Stephen O’Rahilly, FRS, consultant physician and professor of clinical biochemistry, University of Cambridge
James Ritter, consultant physician and professor of clinical pharmacology, Kings College, London
Brian Rowlands, consultant surgeon and professor of surgery, University of Nottingham
Wendy Savage, former consultant obstetrician and professor of obstetrics & gynaecology
Julian Scott, consultant surgeon and professor of vascular surgery, University of Leeds
Alan Silman, consultant physician and professor of rheumatic disease epidemiology, University of Manchester
Robert Sutton, consultant surgeon and professor of surgery, University of Liverpool
Deborah Symons, consultant physician and professor of rheumatology, University of Manchester
Roy Taylor, consultant physician and professor of medicine & metabolism, University of Newcastle
Doug Turnbull, consultant physician and professor of neurology, University of Newcastle
Hugh Watkins, consultant physician and professor of cardiology, University of Oxford
Robert Wilcox, consultant physician and professor of cardiovascular medicine, University of Nottingham
Nick Wright, warden, Queen Mary College, London

Glad to see that not too many have been taken in by the spin. Who exactly are these people being asked to go? Is it just the MMC teams & the various Deaneries or do the Royal Colleges share some of the responsibility?

Share This

The local IM&T plans are due for submission at the end of the month and I thought it would be interesting to see the guidance from the DH on preparing them.

Also, the deadline for the submission of responses to the Commons Health Select Committee review of the National Programme for IT is the 16th.

Choose & Book comes in for some stick.

NHS South East Coast said figures for last November showed 24% of referrals were made using the “choose and book” system, against a target of 59%.

It indicates the South East has the second lowest take-up rate in the UK for the scheme.

A reminder of what errors in judgement look like in the Times.

Taurus is not a word to mention lightly to older denizens of the London Stock Exchange. It was the code name for a grand project to replace the overstretched back offices of stock market firms with a fully computerised settlement system. The project stalled ahead of the 1986 Big Bang, then multiplied in scope and complexity as the various participants insisted that it cover all known contingencies and variations. Finally, after many delays, it was readied for stress testing and failed miserably. It was the pioneering big computer project disaster. If only the NHS, for instance, had examined why it went wrong, it might have saved billions.

Some encouraging news from Winchester that Millennium is becoming “more robust” but this is a statement from the IT lead & refers only to the PAS system. I wonder what the clinicians have to say.

I think I have previously mentioned the parlous position of Choose & Book in the GP contract negotiations but it is worth a reminder.

The nebulous state of access restrictions on patient data even under the new privacy schema is highlighted by Dr Thornton. This ties in with what I have said before, headlines all being very well, give us the detail.

A reminder again of the study by Professor Pamela Briggs, from Northumbria University:

Researchers found people use an initial weeding out process to deal with the minefield of health information of variable quality available. However, this tends to mean they quickly eliminate most NHS and drug company websites, they said. The study was funded by the UK’s Economic and Social Research Council.

The researchers examined the internet search strategies of people who wanted to find specific health information on topics such as high blood pressure, the menopause and hormone replacement therapy (HRT).

They found that many websites were dismissed at quite amazing speeds.

“One thing that really put people off was advertising, so people clicked off drug company websites straight away.

“People don’t have the patience to scroll through pages in order to find something useful.

“Ease of access is so important.”

Something to consider when building resources but also hopefully something that good designers have had in mind for a long time.

An interesting story on the marriage of digital dictation & workflow, given my past interest in the field.

The CUI project gets some airtime.

The NHS CUI project is intended by CfH to provide a standard user interface for clinicians using different clinical systems across the health service. EMIS is to become the first major clinical software vendor to the health service to incorporate elements of the new NHS Common User Interface (CUI), developed by Microsoft on behalf of Connecting for Health, into its software.

In the long term the vision was of a single user interface across the NHS. “This will probably not be completely standard but have standard elements so that if you want to look at a patient’s details you’ll be looking at a standard screen.”

Good for Microsoft, good for providers with Windows solutions, though I wonder if it will be available for Linux. And I am yet to see a proper implementation as well as the fact that Microsoft’s UI designers have not exactly had stellar reputations niggles at me.

A feel good story about innovations in medical IT in the Guardian but which also points out they happened inspite of and not because of CfH.
As I have previously pointed out, trusts & the DoH combined forces to strangle so many other ideas at birth.

And the starting gun has been fired.

Approximately 14,500 patients will have a summary of the GP record, containing details of name, address, medication history, serious illnesses and allergies, uploaded to a national database unless they choose to opt-out during after an eight week consultation period beginning today. Letters and leaflets explaining the programme will go out in the next few weeks.

By July, eight weeks after the end of the consultation phase, Bolton’s out-of-hours provider and A+E department will be able to view the summary record.

Professor Mike Pringle one of the two clinical leads behind the project told E-Health Insider: “This is the starting gun for the early adopter programme for the Summary Care Record.” He said he expects a total of seven PCTs to be involved in the programme by the end of the year.

The first two practices are Keardley Medical Centre and the Kirby, Page, and McMillen practice, Bradshaw Brow. Both practices use InPractice Systems GP software. Other practices, initially from Bolton PCT, will follow over the next few months.

Share This

Choose & Book gets its share of the headlines on what appears to be a slow news day with the Guardian running a piece on the divisiveness of choice.

The government wanted 90% of referrals by GPs to run through the system by March, but usage is well below that. However the figures hide a more complex picture, with some GPs enthusiastic about the system and others critical.

Usage is currently at 37% and he now expects the 90% target to be met nationally later this year.

…half of GPs use the system for more than 40% of referrals. But among these regular users, 90% say it increases the time taken to refer a patient to hospital and 70% think it is detrimental to patient care or makes no difference.

For something that is not so directly influential in patient care, C&B gets more than its fair share of mostly negative attention precisely for that reason. Most clinicians cannot understand the focus on C&B when there are far more pressing needs in the system, even more so when the manipulation of appointments etc. to manage demand detract from its supposed focus.

E Health Insider has a similar story focussing on a recent BMA survey.

The unpublished survey of 279 GPs and 128 consultants carried out between 30 November 2006 and 10 January this year shows that members’ views have changed little since then. Of those who responded to the survey, 78% of GPs and 77% of consultants said they currently used Choose and Book.

A total of 57 % of GPs and 81% of consultants described their experience of Choose and Book over the previous month as negative or very negative and 87% of consultants and 71% of GPs said they would not recommend Choose and Book to a colleague.

Asked about whether patient choice had improved with Choose and Book the majority of GPs (68%) reported that in their view it had not as did 56% of consultants with a further 30% of consultants saying that they did not know.

Consultants appear to be even unhappier with the e-booking system’s impact on patients than GPs with almost 92% of consultants disagreeing or strongly disagreeing with the statement that patient feedback had been generally positive compared to 64% of GPs.

I would consider this a minor indicator of the state of affairs considering the small sample size and the fact that the response rate was quite low. However the results are similar to previous surveys of this nature & illustrate why it is not performing.

One GP commented: “We have just decided to stop, having been in the top 100 practices for usage, as the local hospital has started to tell patients that there are no appointments available, when the patient rings to book, and asking the patient to contact our practice! - what are we supposed to do?’ Another said: “Complaints from patients over difficulties in getting through . . . all of this fed back to me in wasted surgery time.”

There is also coverage of the slow progress of Isoft’s Evolution Maternity Information System with the pilot customer dropping it.

Royal Shrewsbury Hospital NHS Trust, Shropshire, which has been waiting for almost two years for its local service provider Computer Sciences Corporation to implement iSoft’s Evolution MIS have now deployed the Eclipse system from Huntleigh Diagnostics in a bid to save up to £0.5m annually through reduced clinical negligence liability costs.

In other medical news, the Telegraph highlights the scheduled march in both Glasgow & London at the weekend.

There is also some tough talk from the Healthcare Commission in the Telegraph re the issue of hospital acquired infections. The point that most healthcare professionals would make though is that what is required is a re-imagining of care processes with the patient being the centre of the web & attention being paid to providing the best care, not frequent transient campaigns when something becomes too hot to handle. Sloppiness is now a part of the chain, exacerbated by the pressures on staff & improvements in one area are accompanied by an increase in failings in others.

High bed occupancy increases the risk of infection. The survey showed that when bed occupancy was over 85 per cent cases of MRSA were 16 per cent above the average. Where bed occupancy rates are more than 90 per cent MRSA infection was 42 per cent above average.

The commission is proposing that trusts will have to show that they are fully complying with the NHS hygiene code which includes guidance on hand washing, staff education and involvement in infection control at board level.

I had missed this one about United Health earlier but nice job if you can get it, pity about the departure under a cloud but $2 billion would keep me cocooned from it all.

I have a feeling that this price for DEXA scans is going to cause a few furrowed brows at the PCT’s who will be paying more for the same procedure through the Diagnostics IS contracts. Time to get the calculators out again?

A quick reference to the cost of the war in the Independent & how the money could have been put to better use paying for healthcare.

“This is the politics of Mad Hatter priorities,” said Alan Simpson, a Labour opponent of the war. “The Government is throwing money into an unwinnable war zone in Iraq at the same time as withholding money that creates a war zone in our hospitals.”

The state of the British smile got a mention in the Mirror who review the NHS dentistry contracts, brought on by this non-story. The performance figures for the dental contracts are here.

Share This

The world at large got a glimpse of the damage control ongoing after Andrew Rollerson’s description of the CfH programme as

in danger of delivering “a camel, and not the racehorse that we might try to produce”, as he told a parliamentary committee that this can only be solved with more ‘visionary and proactive leadership from the NHS.’

Good luck with that search, there is more chance of me winning the lottery.

I expect the minutes of the session to turn up here but for the moment, let’s go with the report.

Andrew Rollerson, who was credited as ‘formerly practice lead of the healthcare consultancy at Fujitsu’ , told the Commons Public Accounts Committee that he had faith in NPfIT but felt some issues needed correcting first.

He has since been suspended from his duties by the company, pending an internal inquiry which could lead to disciplinary procedures.

Yup, shoot the messenger for the message.

He revealed to the committee that Fujitsu, local service provider for the Southern cluster, had found NPfIT a difficult project to manage.

“If NPfIT was left to IT departments to control, it would fail because the end users would not be engaged. If we’re not careful the driver will become the technology itself.”

An understatement if ever there was one. The dialogue with the users in the NHS needed to happen before the system requirements were set out & contracts signed. Anything else had no chance whatsoever as too many compromises would have to be made. Watch out for similar problems from the ISTC programme, especially the data integration between the new private sector facilities & the CfH solutions, both of which do not propose to deliver the actual requirements of clinicians on the ground.

Rollerson spent all of his time away from the hearing surrounded by senior colleagues from Fujitsu. He told the committee that he felt reporting in Computer Weekly was out of context from what he thought was a presentation intended to be supportive of the national programme.

Using another analogy, he said that it was like designers at Boeing who were considering replacing the 747 with a jumbo jet, before realising that a new design would be a much better and effective design for everyone involved – CfH should look at NPfIT in the same sort of light as this.

So are we going to get a proper review of the programme? One that involves stopping the waste of money that the current one is?

I’m not holding my breath.

Video of that committee.

Share This

The Guardian has picked up on the story first broken by E-Health Insider that CfH will be tendering for alternative approaches to electronic medical records.

E-Health Insider

Plans for a catalogue of ‘additional systems suppliers’ covering a wide range of specialist clinical systems are in the final stages of being drawn up by Connecting for Health (CfH), the agency responsible for delivering the £12.4bn NHS National Programme for IT.

E-Health Insider understands that the supplier catalogue plans being drawn up may cover all major departmental systems and clinical specialities, together with areas such as A+E, maternity and theatres. Services such as acute data migration and infrastructure are also thought to be covered.

Sources indicate that the plans – being termed Additional Systems Capacity and Capability (ASCC) – are at an advanced stage of development. “Granger’s [Richard Granger, head of CfH] team are working on it at the moment and trying to work out the details,” one senior source told EHI. “It’s in the pipeline.”

EHI understands that if negotiations are completed the plans could potentially due to be unveiled within weeks with an OJEU (Official Journal of the European Union) procurement, similar to that now underway for GP Systems of Choice (GPSoC).

CfH told E-health Insider: “Yes. NHS Connecting for Health is currently formulating an OJEU in support of the “Supplier Catalogue” announced by Richard Granger in October 2006. It is anticipated that this “Additional Services Capability and Capacity” (ASCC) OJEU will be issued during March. The GPSoC model, based on systems having to meet interoperability criteria and deliver broadly defined levels of functionality is thought to provide the template for the new catalogue.”

The Guardian

The NHS will start recruiting alternative software suppliers to its troubled £6.2bn IT upgrade project this month, in a move which could see the government’s vision for a single IT system for the health service in England unravelling.
The move is a tacit admission that a fully integrated IT system may never be completed. NHS bosses had until recently discouraged hospital trusts from deserting the scheme. But disaffection is now so widespread and delays so long that officials are working on a list of accredited alternative suppliers, which is widely seen as a move to appease hospital trusts.

Under the government’s National Programme for IT (NPfIT), trusts were promised centrally bought software to be installed from mid-2004 - all free of charge to them or heavily subsidised. As a result, hospital trusts held back from buying new systems, content to get by with their old software in the belief that NPfIT would soon deliver replacements. But these have now been delayed for so long that trusts are seeking alternatives.

Trusts essentially stopped considering independent procurement from early 2001 leading to the early death of numerous innovative solutions, most of which could not recruit customers for love or money. I should know, I was leading one of them. There is very little likelihood though that I will be resurrecting my plans, even though I feel distinctly underwhelmed by most of the products on the market. There are far better ways for me to waste my time unless there is a radical change of personnel & policy at the DoH & CfH.

I wonder though how much of this IBA will take this into consideration when pricing Isoft as Lorenzo might not have much of a market when it is finally out of the incubator.

Share This