Smart Healthcare: Hospitals & acute care | SmartHealthcare.com

MP calls for inquiry into BT deal

Fri, 03 Sep 2010 16:28:25 GMT

Conservative MP Richard Bacon asked the National Audit Office (NAO) to investigate a £546m deal awarded to BT under the National Programme for IT

The MP for South Norfolk wrote to Amyas Morse, head of the NAO, detailing his concerns about the "additional money" given to BT by the Department of Health (DoH) last year and asked the watchdog to "examine whether expenditure of this sum represents value for money".

Bacon, a member of Parliament's Public Accounts Committee, says by his own calculations the deal should be worth around £100m at most, adding that "the remaining £446m is, in my mind, not accounted for, and so raises questions of the proper conduct of business and the proper use of public money".

He estimated that the deal should have included £25m for 25 RiO site installations at community and mental health trusts; £35m for support at seven existing Cerner Millennium sites over five years; £30m for new Cerner installations at three sites; and £10m for the transfer of work from Fujitsu's data centre to BT's.

"I am aware that the DoH was in a difficult position. Once Fujitsu had withdrawn, support was needed for the NHS trusts that had installed Cerner systems from Fujitsu. I am concerned, however, that support for those trusts was bought at an extreme cost to the taxpayer," Bacon said in his letter, dated 20 August 2010.

"No department should put itself in the position where it has to pay whatever a supplier wishes to charge. Indeed, any department that puts itself in such a position leaves itself open to accusations of maladministration."

He goes on to to say that an that an investigation would be "useful" in clearing up any ambiguity over costs.

"If nothing else it would be put to rest the concerns that many in the NHS are expressing over these extra payments," Bacon concludes.

Scottish NHS tenders for audiology system

Thu, 02 Sep 2010 15:04:50 GMT

NHS National Services Scotland (NHS NSS) has published a tender worth up to £1m for the provision of a computerised audiology system

The four year framework agreement is on behalf of NHS Lanarkshire, but NHS NSS said that other health boards with similar requirements will be able to access the contract.

"NHS Lanarkshire's audiology service operates across multiple sites, and a key requirement is for the system to operate efficiently over a wide area network providing access to information which is updated in real time," the service said.

"The ability for the system to integrate with other third party applications and business processes that influence the operations of the audiology service are of high importance."

NHS NSS said it envisages that a total number of five suppliers will participate in the framework.

Other Scottish NHS organisations that may be included in the deal include: Ayrshire and Arran; Borders; Dumfries and Galloway; Fife; Forth Valley; Grampian; Greater Glasgow and Clyde; Highland; Lothian; Orkney; Shetland; Tayside; and Western Isles.

Digital dictation: a voice for healthcare

Steve Gold — Wed, 01 Sep 2010 08:00:00 GMT

SmartHealthcare.com looks at eight of the main UK suppliers: BigHand, Dictate IT, G2 Speech, Nuance, Softech, SRC, Voice Technologies and WinScribe

Digital dictation (DD) suppliers are split broadly into two camps: those with their own platforms, and integration vendors that develop bespoke systems for clients. Most sell through resellers and partners, with support functions split between the partner and the vendor.

Most will supply an integrated system that interfaces with, for example, a patient administration system (PAS) and electronic workflow systems, but some - notably Nuance - will supply shrink-wrapped software for healthcare IT departments to deploy and customise.

The market is evolving rapidly, largely owing to the increasing speed of PCs, servers and smartphones. The following list, organised alphabetically, is not intended to be exhaustive but provides a guide to some of the major suppliers.

BigHand (site)

London-headquartered BigHand was set up in 1996, and its DD software is now used by more than 100,000 users in more than 1,000 organisations. The firm is financially backed by the private equity division of Lloyds TSB.

As well as offering a server-based DD system, the BigHand3 platform is available for the BlackBerry, iPhone and WindowsMobile smartphones in areas as diverse as legal and healthcare. In August, it launched a healthcare specific version of its suite of products, with product features designed specifically for the NHS.

The firm's latest flagship trust project is at the Mid Yorkshire Hospital trust, which services a population of 500,000, with new hospitals entering service in Pontefract and Wakefield this current financial year.

BigHand has been quite successful in signing new NHS trusts to its list of clients, including the Princess Alexandra Hospital trust and, more recently, three trusts using the Yorkshire and Humber NHS framework deal for DD: Basildon and Thurrock University Hospitals, The Ipswich Hospital and Airedale NHS foundation trust.

Dictate IT (site)

Another London-based firm, Dictate-IT has two flagship NHS trusts, Derby Hospitals foundation and Newham University Hospital, and has a platform based on software originally developed by GPs and other doctors.

With a total of 27 trusts using its technology - including Imperial College Healthcare, The Royal Free, St George's Healthcare, Barts and the London, Barnet & Chase Farm Hospitals, Guys & St Thomas Foundation, East and North Hertfordshire - the firm claims its product is unique in terms of its GP origins.

The company boasts a wide range of partnerships with Cerner, EMIS and iSoft, as well as Microsoft for Windows and Philips. The firm's DD technology interfaces with some PAS and electronic patient record (EPR) systems.

In April 2010, Barnet and Chase Farm Hospitals trust integrated Dictate IT's technology into a Cerner Millennium electronic patient record system following two years of usage. The trust is now using it general surgery, paediatrics, cardiology and 22 other specialities.

In July 2010, the company won the UK's largest ever NHS outsourced transcription contract with Barts and the London, covering an estimated 7m lines of text a year.

G2 Speech (site)

Founded in 1998 by two medical professionals, G2's technology centres on speech-to-text technology, which it claimed is up to seven times more efficient than traditional transcription systems, with a direct cost saving of 30% compared with conventional secretarial support services. The firm has offices in Belgium, Ireland and the Netherlands, as well as the UK.

The company, which unlike some of its rivals is focused on healthcare, claims to have 10,000 users of its technology. UK trusts are serviced from two offices, in Leeds and London.

In March 2010 G2 was nominated in three categories at the Philips Partner Awards Ceremony for its marketing, partner and technical prowess. The firm won the former category award. Since then the company has aligned its technology with the Dragon voice recognition platform and most recently with Microsoft Windows 7.

The firm's flagship trusts include Scottish health board NHS Borders and Southampton University Hospital foundation trust, where its MediSpeech platform was installed earlier this year.

Nuance Communications (site)

Massachusetts-based Nuance supplies both speech and imaging software to a variety of sector including healthcare, where its Speech Magic and newly-introduced Dragon Medical packages are in widespread use.

The firm's technology is based on the old Dragon Naturally Speaking speech recognition platform, which dates back to the early 1990s and has been updated to support medical terminology in 75 specialities and sub-specialities.

The firm claims that Dragon Medical is up to 99% accurate when used out-of-the-box, allowing staff to 'drive' their own speech-text sessions, with the resulting files then stored in EPRs.

Nuance's software is sold as a shrink-wrapped package for trusts to install themselves, as well as through DD partner firms.

Softech Global (site)

Formed in 1990, Softech has its headquarters near Brighton, with a sales and marketing operation in North Yorkshire and research and development operations at two sites in India. Over the last eight years the firm has invested more than £2 million in R&D.

Its Nomad DD system is used by a number of trusts, including Leeds Teaching Hospitals, Oxford Radcliffe Hospitals and The Rotherham foundation trust.

Earlier this year, Softech announced an expansion of its software's use at University Hospital Birmingham foundation trust where, after a year of usage, around 400 users in 29 departments across two sites are using Nomad.

In April 2010, The Rotherham started a complete implementation of Nomad, following a series of trials lasting four years, during which it was integrated into the trust's McKesson PAS. The system is already live in orthopaedics and rheumatology.

SRC (site)

SRC sells and services DD systems from Grundig, Nuance, Olympus, Philips and Winscribe. The London headquartered firm has systems installed at more than 2,500 sites in different sectors worldwide.

NHS clients include Chesterfield Royal Hospital, Dartford and Gravesham trust, Ealing Hospital, Royal Wolverhampton Hospitals, Taunton and Somerset Hospitals, Trafford Healthcare and more than 40 others.

In February 2010, SRC secured a 2,000-user contract with University Hospitals of Leicester. Spanning three sites, the Winscribe system supports the DD needs of 50 specialities in nine clinical directorates, making it the largest acute hospital implementation in the UK.

This summer (2010), the firm deployed a trust-wide electronic discharge summary system for the Hillingdon Hospital trust in west London, catering for 800 patient discharges a week.

In August the firm launched a web-based clinical correspondence platform in conjunction with Bluewire Technologies, following trials with two NHS trusts. As with many DD systems, this integrates closely with PASs as well as with SRC's Winscribe system.

Voice Technologies (site)

Voice Technologies, with offices in Glasgow and Sheffield, claims to be the largest supplier of DD technologies to the NHS, with its systems in use by more than 350,000 clinical staff worldwide. Covering the health and legal sectors, the firm is a Philips and Winscribe senior partner.

In July 2010, the firm won a contract to supply its WinVoicePro platform to NHS Tayside, NHS Highland and NHS Dumfries & Galloway boards in Scotland. The system is being used for inter-department electronic documents, as well as workflow with GP practices.

WinVoicePro, the firm's flagship software, was launched in March 2010 and is in active use by six trusts in England and Wales, interfacing with PASs from several vendors, notably Cerner Millennium, iSoft, Philips and SCI Store.

Winscribe (site)

Founded in 1995 by Amtel Communications in New Zealand, Winscribe is in active use across sectors including healthcare, with more than 350,000 users worldwide. The firm's technology extends beyond DD into workflow management.

The company has offices in the US, New Zealand, Australia, Switzerland and in Reading, and has more than 100 service partners around the world.

As well as offering a server-based DD platform, the firm supports BlackBerry, iPhone and Windows Mobile smartphones using a mobility suite that relates data, once transcribed, to the server, allowing 'dial-in' access to DD services.

In July 2010 the firm linked with Nuance Communications to allow close integration between the firm companies' products. The move effectively embedded speech recognition into Winscribe's software-based DD, transcription management and workflow routing system.

Steve Gold

Patient from Hell: I'll have a patient record afore ye

Dick Vinegar — Wed, 01 Sep 2010 08:00:00 GMT

The Patient from Hell tries to drag English doctors out of the primaeval slime involved in guessing their patients' medical histories

Good news from Scotland. Libby Morris, the author of a coming survey of progress on the Scottish emergency care summary (ECS) patient record project, has written a letter to the British Medical Journal saying that the survey will find that the ECS makes clinical decisions more timely, accurate and patient-centred.

She writes: "Over 200,000 records are accessed every month by clinicians working in NHS24, accident and emergency departments, and out-of-hours teams – over 5.1m accesses in total, with a 37% increase from 2008 to 2009. Feedback from users is overwhelmingly positive." So much for Trisha Greenhalgh's recent negative report on the SCR in England.

I presume that Libby Morris has written this letter, in advance of the publication of her full report, to try to dissuade any hasty decision by English health ministers from cancelling the English summary care record (SCR). This is good of her, to save us English patients from gung-ho English medics continuing to make wild guesses about their patients' past histories.

This news has set me wondering why English doctors are so negative about patient records compared to their Scottish colleagues – and indeed other nations' doctors. It was not always like this. A Scottish contemporary, a retired consultant physician, tells me that in the 1950s when he trained at the Middlesex, there were rudimentary hospital records, but when he returned to Edinburgh, he found only ward records and no central hospital records. The mind boggles with horror.

So Scotland has moved faster on patient records from a lower point to the higher plane of a national electronic record. England remains in a primaeval, paper-based, fragmented, localised slime.

And many English doctors seem to want it to stay that way. The British Medical Association says they want more electronic records in principle, but they don't say how they would use them. I suspect they don't know.

Let me help them by saying why I am so obsessive about electronic records. In general, I feel that a doctor treating me should know more about my medical history than the immediate ailment I am suffering from. This, to me, is a no-brainer, and I can't understand why doctors think it is safe to just guess about my past.

More specifically to my own case, I have been treated during the last two years by two separate hospitals for two unrelated diseases, both of which appeared life-threatening at the time. Neither hospital has a clue about the treatment being given to me by the other hospital. Nor do they seem to care. The only information they got was from me, if I felt inclined to give it. They could in theory ring my GP who does know what the other hospital is doing, but would they?

To me, this lack of interest is both dangerous and expensive. Treatment is duplicated; I have recently received an echo cardiogram – which doesn't come cheap – from both hospitals. That there is no formal record for each hospital to check to see what the other hospital is doing to me seems rather 19th century. To me, a central record would seem to be the handiest source to access if in doubt.

My other reason for wanting a central record is advancing years. Despite priding myself on being still more lucid than most patients of my age, I find I cannot remember the names of the five medications I take every day. I am becoming an unreliable witness, and any doctor I encounter would find my summary care record a much more trustworthy source of data than what I say.

Why English doctors don't recognise the fallibility of their elderly patients – who are the majority of the patient population – and learn to love the SCR is beyond me. Scottish medics are clearly much more rational.

Dick Vinegar

NMC signs for IT support

Tue, 31 Aug 2010 10:21:19 GMT

The Nursing and Midwifery Council has signed a £5.2m deal for the hosting and management of its core computing infrastructure

Its five year arrangement with Business Systems Group (BSG), a subsidiary of Advanced Computer Software, will involve the hosting of its servers and networks, disaster recovery, systems monitoring, technical design and ongoing consultation.

BSG will also be provide database and operating system support, and manage NMC's Microsoft Exchange email, Citrix desktops and telephony (using Cisco CallManager).

The NMC currently has a four person in-house team providing the service, but has made the change in an effort to obtain better value for money and access to a larger pool of IT skills.

Jolyon Ingham, interim head of ICT for the NMC, said: "In addition to being able to provide an economic alternative to managing IT in house and hiring external consultants, it is clear that BSG can deliver enhanced service levels, expertise and security as well as an effective disaster recovery solution. We look forward to developing a long term strategic partnership with BSG."

Under the terms of the contract, BSG is required to ensure 99.9% service availability and timely incident management. All four NMC in-house IT staff will be transferred to work for BSG under a TUPE arrangement.
All software applications will also be hosted by BSG.

Incapacity team rolls out EPR

Fri, 27 Aug 2010 09:50:16 GMT

A partnership providing support to incapacity benefit claimants has implemented an electronic patient record system

Tees Valley Condition Management Programme (CMP), which consists of five NHS organisations in the district and the local Jobcentre Plus, has set up a system based on AxSys Technology's Excelicare software to replace a manual system.

The partnership supports people claiming incapacity benefit or employment benefit allowance who consider their health condition to be one of the barriers preventing them from returning to work. Referral to the programme is routed via an advisor at the Jobcentre into Tees Valley CMP.

The EPR, which went live in May, provides records from referral to discharge, including clinicial assessments and scoring. It is used by 19 remote workers, including administrative and management staff, nurses, occupational therapists and health psychologists operating at 12 localities.

Jayne Robson, associate director, Tees Valley CMP, said it had begun to develop a solution in-house when it discovered that AxSys had produced a similar solution for CMP in Scotland,
and found it was adaptable to its own work processes.

It has now added details of about 200 patients to the system.

Auditor calls on NHS to improve payments coding

Thu, 26 Aug 2010 10:42:27 GMT

The Audit Commission has said there are still problems with the data used to assess more than £200m of payments under the NHS's Payments by Results scheme

In a report published on 26 August 2010, the commission says it has identified some £9m of financial errors due to incorrect clinical coding used to identify how NHS trusts are paid for treatment.

The errors are most relevant to data on health resource groups (HRGs), which bring together clinically similar treatments that are judged to consumer a similar amount of resources.

The situation has improved, however. "When we started the audits in 2007-08, on average, 16.5% of diagnosis and procedures were not accurately coded," says the document. "In 2009-10, on average, 11.3% of diagnosis and procedure coding was inaccurate."

Despite the overall improvement, the actual error rate for the HRG increased in 2009-10 because most Payment by Results tariffs moved to new and more complex set of Health Resource Groups, known as HRG4.

Over the past three years the commission has carried out random sample audits on four specialities - general medicine, trauma and orthopaedics, cardiology and paediatrics - at all trusts that deliver them.

The commission has estimated that £1bn of the £21bn expenditure, or 5%, in these four specialties was paid on the wrong HRG between 2007-08 and 2009-10.

Nationally, primary care trusts were not over or undercharged for the work, however, because the average net financial error rate is less than 0.5% in the four specialities audited.

The report goes on to say that, despite the overall improvement in clinical coding, there are significant variations between the best and worst performing trusts. HRG error rates range between 0 and 28% and the clinical coding error rate range is similar.

Its key recommendations for improvement are:
- regular internal audits on clinical coding and the quality of outpatient data;
- clinical coders to be well trained and follow national standards;
- clinicians to be engaged in improving the accuracy of inpatient and outpatient data;
- up to date policies and procedures for data quality; and
- source documentation to be of a good quality, accurate and readily accessible to those inputting data.

"Our work has highlighted problems in the consistency and interpretation of national guidance and definitions that affect data quality," says the commission. "We will work this year on specific data definition issues with the NHS and key partners to look at how these can be resolved."

Scotland measures up its NHS for cuts

Wed, 25 Aug 2010 08:00:00 GMT

A report suggesting that Scotland should reconsider ring-fencing the NHS budget has triggered a debate over the service's efficiency

The NHS in Scotland is not used to talk of "cuts". Since power was devolved in 1999, government spending on health has risen year on year, while even in the supposedly dark days of the Thatcherite 1980s and 90s the health section of the old Scottish Office budget continued to increase, albeit modestly. All that, however, is about to change – or is it?

It is according to the report of the Independent Budget Review (IBR) panel, which was published last month. This panel of "three wise men" was given the unenviable task of reviewing the SNP Scottish government's spending options in light of UK government plans for 25% cuts in spending. "We think", said the panel's chairman Crawford Beveridge with considerable understatement, "it's going to be very difficult."

The figures concur. Total government spending in Scotland is expected to fall by 12.5% in real terms by 2015 (£4.3bn). With health constituting more than a third of the Scottish government's budget, the IBR suggested a two-year pay freeze for all nurses – as an "essential first step" – reconsidering the bonus scheme for senior doctors, freezing the phased withdrawal of prescription charges and, perhaps most importantly, thinking "very carefully" about the policy of "ring-fencing" health spending.

John Swinney, the finance secretary, refused to comment on the detail of the panel's report – which was generally acknowledged as a thorough piece of work – while a Scottish government spokesperson points to the recent UK Budget, which committed the coalition government to "providing the National Health Service with real increases throughout the Parliament".

"We will pass on any Barnett consequentials from an increase to the health budget in England to the health service in Scotland," says the spokesperson. "We don't yet know what those consequentials will be. We do know that any increase to next year's health budget will be significantly smaller than the health service has been used to in recent years. The health service, like the rest of the public sector, faces serious financial challenges."

Ring-fenced thinking

Despite that caveat, continuing talk of "increasing" health spending concerns the former Scottish health minister Susan Deacon, now an honorary professor at Edinburgh University's School of Social and Political Science. "My view is that we need to be asking every political party, not just the SNP, for a different kind of debate," she says. "This ring-fencing mentality doesn't just ring-fence budgets, it ring-fences thinking and ring-fences discussion.

"We need some real political leadership in Scotland around this," she adds. "It takes us right back to inputs versus outputs. At the moment it's all about how much you spend, but when you're thinking about improving the health of the nation there's not a simple correlation between how much you spend and how much you improve that. What's important is that we think about what kind of society we want to live in, and that's not just about public purse, it's about the role of the private and voluntary sectors too."

Tom Miers, author of a recent Policy Exchange report, Devolution Distraction, agrees, citing a series of independent studies that have concluded that the Scottish NHS is performing more poorly than in other parts of the UK. "Yet these outcomes are barely recognised in Scottish political debate," he says. "Instead, discussion in political circles and the media focuses on lifestyle problems.

"It is almost as if the problems of the NHS were the fault of the Scottish people," Miers adds. "For there is very little discussion about how to run an effective health service – a service which has barely changed in the last 10 years."

The IBR panel also hinted that cuts provided an opportunity for creativity, recommending that if the Scottish government decides to ring-fence the health budget, then it should "consider alternatives… that allow for a broader interpretation of health spending", including "non-NHS services that support the health and well-being of the community, for example, early intervention programmes across the public sector".

Spending cuts are, of course, political decisions, and with elections to the Scottish Parliament taking place next May, those bidding for power are naturally anxious to avoid being seen to wield the axe. But, as Susan Deacon warns, "if they all go into the election having a bidding war over who can protect the most things, then we're never going to have an informed discussion and the likelihood is we'll end up in a worst place as a result".

ICO rebukes Wolverhampton Hospitals

Tue, 24 Aug 2010 14:00:43 GMT

The Information Commissioner's Office has criticised Royal Wolverhampton Hospitals NHS Trust over the loss of over 100 patient records

It has said the trust was guilty of breaching the Data Protection Act (DPA) in losing a CD with scans of 112 patient records from the Intensive Care Unit of New Cross Hospital's Heart and Lung Unit.

The CD was discovered at a bus stop near the hospital and was unencrypted with no password protection.

Investigations have failed to establish why or how the data was transferred to the CD, although it was established that there were areas of weakness in the trust's data protection procedures. This included a lack of timeliness in recalling patients' charts that had been released to consultants.

The trust has agreed to a formal undertaking to process personal information in line with the DPA. It will also implement a number of security measures to protect personal information more effectively, including ensuring that patient charts released to consultants are signed for on receipt and chased for return after just one week.

Mick Gorrill, head of enforcement at the ICO, said: "The fact that this information was several years old is of no consequence – patients' personal data should always be handled in accordance with the Data Protection Act. I am pleased that the trust has agreed to take remedial steps to ensure such an incident does not happen again."

Scotland's auditor calls for better data systems

Thu, 19 Aug 2010 11:53:27 GMT

The variety of IT systems used to gather information about emergency departments makes it difficult to compare data, says Audit Scotland

In a report published on 12 August 2010, the official auditor says that most NHS boards use the nationally procured Emergency
Department Information System, but six use different systems.

In addition, some minor injuries units use manual systems to record patient information. The auditor calls on those units with high levels of patient attendances to consider whether an electronic system would be more effective.

"Across Scotland, emergency departments use a variety of information systems which creates problems in trying to compare data," the report says.

As a consequence of this inadequacy, the auditor found that it was impossible to separate figures of people who self refer to emergency departments from those who dial 999, or have an ambulance requested for them by the emergency services.

Information Services Division (ISD) Scotland is working with NHS boards to improve data in this area and the auditor said that it has shared its own data to help with this work.

"Until accurate data are in place it will be difficult for NHS boards to actively manage demand for these services," said Audit Scotland.

It added that there are similar issues in England, where the published guidance is also unclear and open to interpretation.

Although ISD Scotland set up an "A&E data mart" to monitor performance against the four hour waiting time standard, the data were found to be incomplete, and used different definitions which limited their use.

"These issues need to be resolved so that NHS boards can use the data to identify potential improvements on an ongoing basis," says the report.

Auditor General for Scotland, Robert Black, said: "Emergency care is a vital part of the health service in Scotland and more people are attending these services. Patients are happy with the care they receive and the length of time they wait to be treated has reduced with the introduction of a four hour target.

"However, information about the quality and effectiveness of care provided is limited. There are also emerging staffing issues, such as shortages in junior doctors and the impact of European working hours legislation, that must be tackled at a national level, not just locally.

"All of these factors highlight that there is a real need for a clear national approach to emergency care so that we can get the best out of the resources available."

Patient from Hell: Why did the National Programme for IT fail?

Dick Vinegar — Wed, 18 Aug 2010 08:00:00 GMT

Because medical consultants and IT staff didn't talk to each other, says the Patient from Hell

Why is the road to electronic healthcare so much more rocky than computerising other bits of the economy? Other professions, including bankers, accountants and lawyers, have made the jump, some 30 years after the advent of personal computers. Even musicians, poets, journalists, artists, philosophers and MPs have got up to speed.

Why can't health professionals do the same? And did their failure have any impact on why the National Programme for IT (NPfIT) failed? This question is important right now, as the coalition government decides what should replace NHS Connecting for Health, which has managed NPfIT.

There were many reasons, like bad management and a lack of empathy with the culture of the NHS, but may I postulate one overriding cause? It came to me in a flash back in around 2005, at a conference held, rather bizarrely, in the boardroom of Aston Villa football club. An IT manager from a Birmingham hospital gave a speech which basically said this: "We asked the consultants to vet what we were planning, under the NPfIT. And they said, 'we are too busy right now to give you an answer, but come up with a working solution, show it to us, and then we will tell you what we think about it.' "

The IT manager did as he was told and carried on writing systems dreamt up by the IT "experts" of Connecting for Health, doubtless thankful for not having to refer the whole time to pesky clinicians who might put up objections.

I was amazed at the time by the irresponsibility, primarily of the consultants, who were effectively opting out of the planning process. They showed no interest in playing a part in designing a new way of working – for themselves, for nurses and all others involved in the revolutionary changes which digitalisation would bring to their working practices. When, two years later, they came to see what the IT people had dreamt up, they realised too late that it was not fit for purpose.

Being an ex-IT person myself, I was even more critical of the IT manager, who accepted the consultants' request that they – the users – would play no part in the design process. This offends the most basic rules of system design, which I imbibed with my mother's milk more than half a century ago. An IT manager with any basic understanding of elementary system design should have insisted that the consultants – the users – should have been fully involved.

I was alarmed that this particular NHS IT manager was that day appointed as chairman of Assist. I wrote off NPfIT as an inevitable failure that day.

I fear that communication between clinician and IT has now got so contaminated that crazy solutions will come out of the deliberations of the coalition government on the future of IT in the health service. All I ask is that clinicians and IT people talk to each other. Is that so hard?

Dick Vinegar

NHS faces £65bn PFI repayment bill

Sade Laja — Fri, 13 Aug 2010 13:50:14 GMT

The Department of Health has said that the NHS will eventually pay six times the original value of Private Finance Initiative (PFI) buildings

A spokesperson for health secretary Andrew Lansley said such payments are already increasing sharply, telling SmartHealthcare.com that the coalition government will have to pay "twice as much in PFI payments as Labour did in the last five years" over the same time period.

DoH figures show that overall unitary charge payments for PFI projects from 2010-11 to 2014-15 are expected to reach £7.2bn, compared with £3.9bn in real terms for the equivalent five year period from 2005-06 to 2009-10.

PFIs allow private companies to fund the building of hospitals and mental health units, while the NHS pays for the facilities over a number of years.

According to data obtained by the BBC, 103 PFI projects that were originally valued at £11.3bn will cost the NHS more than £50bn to repay. Once extra costs such as maintenance, cleaning and catering are considered the NHS is due to pay back £65.1bn over the lifetime of the deals, some of which last 25 years.

"Labour said they were using the unprecedented increase in NHS spending to build new hospitals, but in truth they left the bill to be picked up by us," Lansley's spokesperson said.

"Though the new hospitals which we are now paying for are welcome, other financing options should have been on the table. Our recent white paper sets out our intentions to give foundation trusts greater freedoms, which will involve their being able to access borrowing in a more flexible manner."

According to DoH data, the NHS currently pays back a total of £1.25bn each year, but this figure is expected to increase until 2030 when it will hit £2.3bn. The final payment will not be made until 2048.

The NHS budget has been ring-fenced, but the government has said that it expects the health service to make £20bn in efficiency savings by 2014.

Victor Almeida, healthcare analyst at Kable, believes that although the coalition government is committed to granting trusts more liberties including flexible borrowing and unlimited patient chargeable services, it will not be easy for hospitals to extricate themselves from PFI deals lasting years or decades.

"It will be very challenging for some trusts to spend up to 15% of their budget on PFI payments and on top of that make a further 20% efficiency savings in order to cope with our population's increasing health demands, despite the improved financial and funding freedoms," Almeida said.

He also thinks there would be "disastrous consequences" if some hospitals were allowed to go bankrupt before their PFI term was finished.

"Given the state of the economy and government austerity measures, it is extremely unlikely that new PFI initiatives will be created in the next few years. But they could certainly recur in five to 10 years, once the 'anti-previous government' rhetoric has worn off," Almeida added.

Sade Laja

Lincolnshire send A&E waits by text message

Wed, 11 Aug 2010 11:34:11 GMT

NHS organisations in Lincolnshire have created a text message service to update A&E patients about waiting times

The service, created by United Lincolnshire Hospitals NHS Trust, NHS Lincolnshire, NHS Choices, Directgov and Businesslink, was announced on 3 August 2010.

It provides patients with a free mobile service that replies to a text message with the word WAITING sent to 64746 with the latest waiting times at accident and emergency departments in Lincoln County Hospital, Pilgrim Hospital, Boston and Grantham and District Hospital and at the Lincoln walk in centre.

The NHS in Lincolnshire and NHS Choices have also created a desktop widget which provides guidance about getting the right treatment in the Lincolnshire area. They claim the downloadable tool, available on the United Lincolnshire Hospitals NHS trust website, is the first of its kind in the UK.

If a patient decides medical assistance is needed urgently, the widget also displays current waiting times in the same way as the text message service.

Peter Buckley, emergency care programme director for United Lincolnshire Hospitals NHS trust, said that both tools are designed to improve patient experiences.

"As the numbers of patients attending our A&E departments continues to rise, caring for the clinically most needy and vulnerable patients is a priority." he said.

"We hope that when patients use the waiting text alert and dashboard they can and will make more informed decisions about whether alternative care, of similar high quality, that is available throughout Lincolnshire might well be a better choice for them.

"This will free up the time of our clinical staff to concentrate on those that really need the services of an A&E department."

Royal Berkshire cuts up to 600 jobs

Mon, 09 Aug 2010 13:55:38 GMT

A hospital trust is cutting hundreds of non front-line jobs as part of plans to save £60m over three years

A spokesperson for Royal Berkshire NHS Foundation trust told SmartHealthcare.com that 500 to 600 posts were likely to be cut, but was unable to confirm the accuracy of reports suggesting that the jobs will mainly be lost in IT, human resources, facilities and other back office functions.

However, the trust did say that front line staff will be protected from the cuts, which will include 200 posts this year.

"This year we have to identify and deliver a savings plan of £20m, around 6.5% of our total budget, and over three years need to save a total of £60m. This is the local effect of the £120m savings across West Berkshire and £15bn to £20bn across the NHS," said Jonathan Fielden, the trust's chief medical officer.

"We have to make these savings to help meet the growing costs associated with increased life expectancy, medical advances, lifestyle changes and the greater demands these will place on the NHS in the coming years. One of the areas the trust needs to look at is our workforce cost, which is the largest fixed cost at over 60% of turnover."

Royal Berkshire said it wanted to make clear that "we are talking about posts not necessarily people and we will be managing the process of reducing posts very carefully".

Separately, the Chartered Institute of Personnel and Development (CIPD) has "floated" the idea of banning strike action by workers involved in essential services like that of the NHS. In a report, Developing Positive Employee Relations, the HR and staff development group highlights some of the pros and cons of the government taking such action.

"The nuclear option would be banning strike action among essential services. This appears to be the simplest legislative solution in principle, although this also carries with it the highest risk of confrontation," says the document, published on 6 August 2010.

A spokesperson for CIPD described the idea as "just one of the options available," adding: "Our real argument is that prevention is far better than cure, and that the real answer is serious effort to build public sector leadership and management skills in the public sector in order to make a real difference to employee engagement."

CIPD's suggestion comes as public sector unions have warned of possible industrial action against large spending cuts by the government. The Trades Union Congress has put the subject on the agenda for its annual conference in Manchester in September.

Scotland launches multi-channel advice service

Thu, 05 Aug 2010 23:05:00 GMT

The Scottish government has launched a national service offering information online, on the phone line and face to face

NHS Inform will offer general information on medical conditions, health zones providing advice on issues including health rights, back pain and alcohol, a calender of health events and NHS information in local areas including links to all NHS boards' websites.

The government said that the service brings together health information from all sections of the Scottish NHS for the first time.

Health secretary Nicola Sturgeon said the new site will provide a single place for patients to turn "for all of their health information needs".

"Having access to quality health information will give people the power to help improve their health and allow them to be partners in their own healthcare. This is part of our vision of a mutual NHS," she said.

"In this tight economic climate, NHS Inform will also provide greater value to money as it will reduce the amount of duplication across national and local health organisations and ensure that patients can access the right part of the service on the first occasion."