Smart Healthcare: Wales | SmartHealthcare.com

Freeing health's data: opening access to government information

Michael Cross — Wed, 03 Mar 2010 09:00:00 GMT

Politicians are trying to open access to government data, but this may expose problems with the accuracy of NHS information

Even before the Francis report into mortality at Mid Staffordshire trust, the quality of NHS data was emerging as a hot political topic. Over the past year, the government and the Conservatives (but, surprisingly, not the Liberal Democrats) have been trying to outdo each other with promises to empower patients with openly available data about the NHS. As yet, however, there are few signs of the promised consumer revolution.

The centrepiece of the government's efforts is the website www.data.gov.uk, launched last November by worldwide web inventor Sir Tim Berners-Lee and Professor Nigel Shadbolt of Southampton University in their roles as the prime minister's cheerleaders for opening up the vast resource of public sector information (PSI).

The idea, originally floated by the Cabinet Office in its 2007 Power of Information programme, is to create a central clearing house for access to PSI data sets and information about what use is being made of them. The site emulates a similar effort launched in May 2009 by the Obama administration in the US, where there is a long-held assumption that federal government data should be freely available for re-use. It is too early to say whether the same culture will take off in the UK.

Officially, of data.gov.uk's 7,500 data sets, 400 relate to healthcare. They provide the basis for a handful of applications already listed on the site, including iPhone apps for finding GPs, pharmacies and dentists from supplier Elbatrop. Another recent offering is Best Care Home, which helps people find the right care home for themselves, family members or clients from Care Quality Commission data. The site includes extracts and the full text of all inspection reports from the regulator, and ranks 18,500 care homes in order of quality performance.

The bulk of NHS datasets listed on data.gov.uk come from England's NHS Information Centre, including hospital episode statistics (HES) and national care quality indicators. The Welsh health service has also contributed data and access to a mapping visualisation system, and Scotland has also released a limited number of datasets on areas including abortions and alcohol interventions.

The launch of data.gov.uk coincided with that of a new licence model for re-using government data by the National Archives, replacing its pioneering, but little used, "click-use" licence. Unlike the click-use licence, the new "non-transactional Creative Commons approach" explicitly allows data to be re-used both for commercial as well as non-commercial purposes.

Right to open data

If the Conservatives form the next government, a sizeable number of new datasets could be made available under these arrangements. David Cameron, who can now count among his advisers Tom Steinberg of the MySociety web activist group (and co-author of the 2007 Power of Information report) is relying heavily on free data as a tool for improving public services.

While decrying the "Google government" tag, he says the web "allows us to make big change in the relationship between government and citizens, giving power to people on an unprecedented scale". Cameron's most eye-catching pledge is to publish in full every government contract worth over £25,000. But he has also promised that health data "currently locked away in vaults" will be published "in an open and standardised format".

The promised explosion in the availability of NHS data raises two interesting problem for the next government. First, if a new generation of commercial and community websites springs up on the back of the new data, what role remains for the NHS's own citizen-facing presence on the web? One pillar of the Power of Information agenda is that the state should not duplicate or compete with independent web-based services. The government has not yet followed this logic through, but a Cameron government might. An obvious way to cut the cost of the NHS Choices website, for example, would be to trim it to a core of essential data feeds and rely on the private and third sector to create citizen-facing applications.

The second problem concerns the quality of information. The more use is made of NHS data sets, the more their accuracy, currency and comparability will come under scrutiny. Commenters at the data.gov.uk website have already observed that the most recent available list of GPs dates from 2006 - and covers only England.

If as simple a list as the up to date GP register is impossible to open up, what hope is there for more sophisticated and controversial data sets? One key finding of the Francis report into the Mid Staffordshire scandal is that a working group led by Professor Sir Bruce Keogh, the NHS's medical director, develop a "single, clearer" measure of hospital mortality ratios for use by the NHS and its patients. The problem is that clarity and simplicity don't always go together with accuracy.

Michael Cross

NHS to develop online jobs service

Fri, 05 Feb 2010 16:45:36 GMT

The health service will look for a provider able to develop the existing online recruitment website NHS Jobs

In a prior information notice in the Official Journal of the European Union, the NHS North West Collaborative Commercial Agency said it plans to launch a tender for "the provision and development of the NHS jobs electronic recruitment managed service" in April.

The agency confirmed it will run the tender on behalf of organisations nationally, rather than just for its region. The prior information notice invites interested suppliers to join meetings to discuss the tender, "to test at a high level some of our assumptions around the scope of the tender before we finalise our tender documents".

NHS Jobs is run by NHS Employers, part of the NHS Confederation which represents health service bodies. Methods Consulting and Jobsite UK won the £6m five year deal to run the site, then covering the health service in England only, in October 2003. Local pilots began that year and it was fully introduced in 2004.

The site now covers Wales as well as England, with every health service organisation in the two countries using it. NHS Employers has said the site receives more than 6m visits and 250,000 applications each month, and that it has saved the NHS more than £240m since its launch.

A major step forward: comment by Welsh health minister Edwina Hart

Wed, 03 Feb 2010 09:00:00 GMT

Informatics in Wales is benefiting from the country's incremental and collaborative approach to healthcare

As health minister it's my belief that we need to do all we can to deliver top-quality services, for all patients whether they live in towns, valleys or rural areas. This is particularly true during a time of economic downturn, and relies on our ability to make the best use of resources.

We have to do more with what we have, and we know that better use of information and technology can help us meet increasing demands for care against a finite supply of health resources.

I am confident that the Welsh Clinical Portal will help us do just that. It has the merit of using new technology to connect existing valuable sources of information that will make it easier for our doctors, nurses and health professionals to access vital information, centred on the needs of the patient. This is a major step forward.

But it's not just about the technology. It's about how it's used to support care, particularly for those living with long-term conditions, and how it can increase efficiency and patient safety. In Wales we have an estimated 800,000 people with at least one chronic condition, one in three of the adult population.

From the start we said that increased use of technology and better information would go hand in hand with changed working processes. And this is where the collaboration and engagement undertaken by Informing Healthcare has proved so valuable. We are delivering what health professionals want to do their job in a modern health service.

To find out how patients want to use technology to carry out day-to-day health tasks we asked around 2,000 people how they wanted to use the internet to support their own health needs. Overwhelmingly, they wanted to make it easier to contact their GP surgery.

So, I'm very pleased that later this year citizens and patients will be able to use the internet to make it more convenient to manage their own care by making GP appointments and requesting repeat prescriptions online.

Following devolution, the Welsh Assembly Government adopted a different approach to the way the NHS is organised and run in England. We firmly rejected the privatisation of services and the internal market, we don't have foundation trusts and our emphasis is on working together through collaboration and participation.

As a small country we recognise the value of looking outwards and Informing Healthcare's successful incremental approach is informed by evidence from large scale public sector programmes elsewhere.

Informing Healthcare has focused on delivering tangible benefits for patients through small service improvement projects that allow us to adapt and learn from new ways of using or linking information. Once we know they work and meet the expectations of both clinicians and patients we then move ahead with a national solution. This is the approach taken for the Welsh Clinical Portal, My Health Online and the Individual Health Record.

It's also a cost-effective form of delivery that's quick, adaptable, reduces risk and ensures the people using the systems get what they want.

Financial allocations are made on the basis of a series of business cases which justify investment in the overall programme of activities. These are developed in the context of specific healthcare policies and ensure that investment in information technology is aligned to benefits and avoids the risk of IT projects begin perceived as stand alone investments disconnected from patient care.

I'm passionate that all we do is shaped by what people want and, I believe strongly, the systems and services developed by Informing Healthcare, will improve the patient experience and support best clinical practice.

Cwm Taf pilots single care number

Fri, 22 Jan 2010 11:10:51 GMT

Wales will spend £310,000 to set up a new single point of contact for health and social services for one of its health boards

- Welsh informatics benefits from 'socialist' healthcare

Due for completion in 2011, the centre will enable those covered by the Cwm Taf health board to call one number to access health and social services. The Welsh Assembly Government expects that it will take an average of 700,000 calls a year.

The "communications hub" will be the largest in Wales, according to the health minister Edwina Hart. It will manage call handling and the coordination of several health services, including GP out of hours services, non-emergency ambulance bookings, district nursing services and local authority services, in one location.

New IT will connect previously separate systems, with the aim of allowing patient information to be accessed quickly and securely. The government has provided its funding to Rhondda Cynon Taf Council, which will develop its existing call centre at Ty Elai in Tonypandy for this purpose.

"Patients currently access NHS services through a handful of different phone numbers," said Hart. "The new centre will allow patients in the area who are unsure of where to go for advice to call one number to access a range of services.

"Traditional routes of help such as 999 and NHS Direct Wales will still be available, but for those who require help that is not an emergency, the call centre will direct patients to the most appropriate care, ultimately reducing pressure on services and improving patient care."

Dr Chris Jones, chair of Cwm Taf Health Board, said: "We do not underestimate how difficult it is for people to navigate complex services and the extended Communications Hub aims to simplify this process so local people can easily access a wide range of services."

The NHS in England is working along similar lines with its introduction of the 111 phone number for non-emergency care. A Welsh government spokesperson said: "We will await the outcome of the proposed pilots in England before considering the introduction of the 111 number in Wales." The spokesperson added that it has yet to decide the number for the new Cwm Taf service.

Capita gets £133m from NHS BSA

Thu, 21 Jan 2010 10:19:45 GMT

The NHS Business Services Authority has confirmed Capita as the recipient of a seven year deal for a higher price than expected last year

The authority had made Capita its preferred bidder in September for its dental contract support services and managed IT infrastructure services deal. At that time, Capita had told the Stock Exchange that the deal "will be valued at slightly over £100m".

However, the authority said on 21 January 2010 that the final value of the deal is £133m, through an announcement in the Official Journal of the European Union.

The contract, which will see about 150 staff transfer to Capita, covers the outsourcing of work by the NHS BSA's dental services division, including processing about 40m payments made each year to dentists in England and Wales for NHS work.

It also covers IT managed infrastructure services for the organisation's corporate requirements, including the prescription processing division.

Wales confirms £2.5m patient record system

Mon, 11 Jan 2010 11:40:06 GMT

Health minister Edwina Hart has announced funding for a system providing a single online view of patient information

The Welsh Clinical Portal, a secure system which will draw patient information from a variety of legacy systems and databases across the Welsh health service, will be developed with £2.5m from the Welsh Assembly Government, Hart said on 8 January 2010.

Informing Healthcare, the Welsh NHS IT organisation, said the portal will bring together information which health professionals use on a day to day basis. It is has undergone a pilot phase in West Wales General Hospital in Carmarthen.

Health care organisations in Wales currently have separate systems to deal with information such as test results, referrals and administration details. These systems rarely communicate with each other, leading to staff using different computer systems and paper records.

The portal aims to provide fast access to information about patient care, to reduce reliance on paper records and ultimately to improve patient safety, according to Informing Healthcare.

It also aims to gives doctors and nurses a personalised workspace with access to their own patient lists. The organisation said that healthcare staff will be able to log on at terminals anywhere in a hospital and view patient records and results.

"Getting to the final product will be a step-by-step process. As each stage of the design and development is completed it will be rolled out across Wales so any lessons can be learned and acted on, and the benefits seen quickly," said Hart.

A spokesperson for Informing Healthcare told Smart Healthcare: "It is an incremental project and we are working in West Wales and with all the health boards to create implementation plans. A lot will depend on their own resources, but we are hoping for implementation plans to be completed by the end of March."

Wales is also introducing My Health Online, to provide patients with electronic access to their records, and Individual Health Records, a limited set of data drawn from GP systems for emergency use, similar to Scotland's Emergency Care Summary. The latter is already in use in Gwent.

Wales to make GP appointments online

Tue, 05 Jan 2010 14:35:15 GMT

Health minister Edwina Hart has announced funding to enable patients to obtain GP appointments and repeat prescriptions online

The Welsh Assembly Government will provide £1.7m for My Health Online, a bilingual NHS website and a part of the Informing Healthcare programme to modernise healthcare across the principality.

Initially the site will allow patients to book appointments at their local surgery and order repeat prescriptions. However, there are also plans to provide patients with access to their medical records through the site and allow them to update general details such as change of address.

The funding announcement follows four pilot projects at GP surgeries in Swansea, Anglesey, Carmarthenshire and Bridgend.

A spokesperson for Information Healthcare said that market research had shown that patients in Wales wanted to use the internet to carry out basic health tasks, such as contacting their GP practice and ordering medicines.

A survey of 313 internet users in Wales in summer 2007 indicated that 78% would order repeat prescriptions, book an appointment with their GP or update their details online if these services were available. Two out of three (66%) also said they would be happy using the internet to send medical queries to their doctor.

"We are delighted that the outline business case has been approved and we are now in a position to move forward," said the spokesperson. "Work will now start on developing the exact details and requirements of the website."

Edwina Hart said: "The Welsh Assembly Government is committed to improving access to health services for people living in rural communities. My Health Online will particularly save lengthy journeys to GP practices.

"The website will also help empower people to take responsibility for their own health through the completion of a health diary which can be shared with their GP."

Welsh informatics chief joins UKChip

Mon, 14 Dec 2009 11:31:46 GMT

The head of health informatics in Wales has taken a position on the board of the UK Council for Health Informatics Professions

Jackie Barker, who is also in charge of professional development, was already on the council of UKChip and has moved onto the board as vacancy opened up.
One of her first duties has been taking part in a workshop to set out a route map for the future of the organisation.

It was set up in 2002 to promote professionalism among health informaticians, and in 2004 launched a voluntary registration scheme. The move indicates the support of Informing Healthcare, the organisation in charge of NHS IT in Wales, for the cause.

It said this should also raise awareness of the Informing Healthcare Health Informatics for Professional Development programme.

England: big enough to fail

SA Mathieson — Wed, 25 Nov 2009 09:00:00 GMT

Provincial England's health service suffers from its size when trying to develop informatics

Last week's Queen's Speech included a pledge for further devolution from Westminster to Scotland and Wales. This was quickly dismissed as inadequate by the Scottish Nationalist Party, which plans to unveil its plans for a referendum on independence next week.

But the Scottish and Welsh health services have no need of further devolution: they have been independent of England for a decade. As a result of the significant differences between their political natures and Westminster's, significant gaps are starting to show – and in general, on informatics, they are doing better than England.

England is probably too big to run as a single health service. Elsewhere in Europe, health is usually run by regional government, or on an insurance basis with many organisations providing services. Only in England does one parliament – which currently has Scots in the two most important jobs – manage the public sector healthcare of 50m people.

Both Scotland (5m) and Wales (3m) face specific challenges. Scots suffer from high rates of heart attacks, Wales has to serve its people in two languages, and both countries have a legacy of older and retired manual workers with work related complaints, along with many patients living in remote locations.

But Scotland has made the greatest general progress in the UK in developing health informatics, with its Emergency Care Summary patient record system covering all but 1,400 refuseniks and celebrating four years of existence. It now plans to develop this system into new areas such as patients' end-of-life wishes. Wales is moving more slowly, but expects to have common systems running across the country by 2011.

Meanwhile, England's National Programme for IT is notorious for its failure to deliver. This reputation is somewhat unfair – it has established several national systems, such as the N3 high capacity network (shared by Scotland) and email. But on patient record and administration systems, progress has been slow.

England's progress has not just been hampered by scale. Tony Blair and his government mistakenly pursued a one-size approach for the National Programme, pushing all kinds of trusts to use the same systems to get economies of scale.

England also undermined public and professional trust in its Care Record Service patient records through making the scheme opt out, getting it bracketed with 'surveillance state' projects such as identity cards. (Scottish practitioners asks permission to access patients' records on every occasion, except if someone is unconscious or incapable.)

On both counts, policy has been softened, with more localisation and changes to policies on privacy.* But it takes a long time to turn around a supertanker.

Capital idea

It is notable that one part of England seems to be doing better than the rest. NHS London, the capital's strategic health authority, is taking a distinctive path for its 7m population. It has its own local service provider under the National Programme (BT), is planning a move to polyclinics and is going to introduce the Care Record Service across the capital. But such regional management looks unlikely to work outside the M25.

The answer for the rest of England might draw on the other part of the UK: Northern Ireland, where health and social care delivery are combined for the 2m residents. The last reconfiguration of England's NHS bodies left most primary care trusts contiguous with county and unitary authorities. Local authorities run social care, as well as other services complementary to health such as education.

The Conservatives, who look likely to win the next Westminster election, say they are keen on localism, and dominate England's local councils. So why not bring PCTs and councils closer together, or even merge them?

The (current) government's Total Place programme is already encouraging cooperation across the state sector in an area. Herefordshire Council's chief executive Chris Bull also runs the area's primary care trust, and the two are saving money by merging their offices and back office processes.

People in England often identify with their council area, particularly if it is a county or a city, far more than their region. Merging PCTs into councils could result in organisations with a holistic view of health and well-being in their areas. They could give provincial England health organisations big enough to function, but small enough to innovate – and with local democratic accountability.

* Illustrating how the NHS in England has moved on privacy of patient records, a Department of Health spokesperson emailed after publication with the following comments: "The consent model for Summary Care Records in England was revised in September 2008 so that permission is sought from patients when a clinician has a need to utilise records from outside their own organisation.

"Patients have the choice of saying they do not want to be asked in every situation in which the record might be viewed. Otherwise they will be asked for their consent in every situation. In cases of an emergency where a patient is unconscious or incapacitated, clinicians will access their record if safe treatment requires it."

SA Mathieson

Welsh informatics benefits from 'socialist' healthcare

Wed, 11 Nov 2009 10:52:34 GMT

Informing Healthcare is exploiting the country's unified approach to healthcare to set up interoperable systems

David Davies, director of engagement for NHS Wales' Informing Healthcare organisation, said that by 2011 the country was likely to have just two patient administration systems in use, compared with 10 in 2004.

Neither will be a commercially available system. Cardiff and the Vale is likely to retain its existing in-house system, while the rest of the country is set to move to the Myrddin (Merlin) PAS as a result of mergers, although Davies said healthcare organisations are not being forced to shift.

He told a session at the e-Health Insider conference in Birmingham on 9 November 2009 that by 2011, it was also likely that Wales will be using single systems for laboratory information, radiology, pharmacy and child health. There will also be a national GP systems contract.

"We still have what you could describe as socialist healthcare systems in Wales and Scotland," said Davies, in comparison to the competition and patient choice policies of England. "There's a statutory obligation in Wales to collaborate, not compete."

He said the Welsh NHS has access to more than 100 developers who work for its constituent organisations, whose work can be reused across the country. However, it is also prepared to buy IT where appropriate, as well as building on its legacy systems.

Wales has decided that GP records will act as the country's main patient records, but that they will be made available through the Welsh Clinical Portal, an online system. "It's what I call the Doctor Who concept," said Davies, in that a single portal will act as the gateway to numerous legacy systems. He added that Wales eschews replacing existing working systems.

He added that GPs are well placed to act as the guardians of their patients' data, partly as they are paid to maintain its data quality. "GPs control what goes into them, GPs control what goes out of them," he said.

The country is also introducing Individual Health Records, a limited set of data drawn from GP systems for emergency use, similar to Scotland's Emergency Care Summary system. These are already in use in Gwent.

Informing Healthcare is also working on My Health Online, which will provide patients with web access to their records. In addition, social care services will be able to link to the national infrastructure: providers already using health's network and set to share data centres as well. The arrangements are reinforced by the presence of Gwyn Thomas as head of Informing Healthcare and chief information officer for the Welsh Assembly Government.

Davies said that the country's national infrastructure depends on the Welsh Demographic Service and its master index of patients, which in turn relies in information from GP systems. He said that good demographic data is particularly important in Wales, where 10 surnames account for half of the population.

Asked about plans to exchange data on the 3-4% of Welsh patients treated by English institutions, Davies said it is working with NHS Connecting for Health on a gateway capability. The systems are not yet in place, although picture archiving and communication systems (Pacs) are a likely first area.

Wales merges health trusts into boards

Fri, 02 Oct 2009 13:30:30 GMT

The Welsh government has merged its health organisations, which spend more than £59m on ICT annually, into seven health boards

From 1 October 2009, the NHS in Wales will have seven integrated health boards, covering all services in their areas. The move means that Wales has abandoned the internal market system used in England, where primary care trusts buy services for their patients from organisations such as acute trusts.

According to Kable data, the 12 largest trusts which have been merged into health boards spent an estimated £59m on ICT in 2008-09.

The seven new health boards are Abertawe Bro Morgannwg University (Swansea and environs), Aneurin Bevan (Gwent), Betsi Cadwaladr University (north), Cardiff and Vale University, Cwm Taf (the Valleys), Hywel Dda (south-west), and Powys Teaching.

In one case, the Betsi Cadwaladr University Health Board has absorbed all the six health boards and two trusts across north Wales and Anglesey. In another, Cardiff and the Vale NHS Trust, which was previously the biggest Welsh NHS trust in terms of ICT budget, has merged with Cardiff Local Health Board and the Vale of Glamorgan Local Health Board.

Announcing the move last year, health minister Edwina Hart said: "The local bodies will be organised in ways which make cooperation between them easier to achieve and which helps eliminate the last outcrops of the competitive market ethos inherited from Conservative Party policies."

Three national NHS trusts remain: Welsh Ambulance Services, Velindre (which provides specialist services) and Public Health Wales.

Time for professionals to stand out: comment by Wales' Informing Healthcare

Wed, 30 Sep 2009 08:00:00 GMT

It's time for informatics professionals to have clear career paths to follow

As the professions within health informatics develop, the ability for individuals to find career support is becoming more necessary. Informing Healthcare, the Welsh Assembly Government programme set up to improve health services by introducing new ways of accessing, using and storing information is spearheading professional advancement for health informatics in Wales.

Historically in health informatics across the whole of the UK and beyond, there has been no clear entry point, no established career pathways and a lack of visibility. It's essential all those working in the profession have the opportunity to develop and show how they contribute to the delivery of a modern healthcare service.

That opportunity can lead to more than just staff satisfaction and pride. It also demonstrates to other healthcare professionals and the public that the right people with the right skills are in the right job.

The Health Informatics Career Framework (HICF) is one step toward achieving those goals. The idea behind the framework is that climbing the professional ladder or moving into a different informatics area is much easier when you can see where you're going.

The framework offers a comprehensive map for careers in health information within the healthcare environment, bringing together competences, underpinning knowledge, training and qualification routes and a database of job descriptions across nine career levels and more than 100 job roles in a user friendly, interactive format. Informing Healthcare has led the framework's development for use across the UK, with collaborative input from Connecting for Health (the English health IT programme) and Skills for Health (the Sector Skills Council for healthcare).

According to my colleague John Meredith, IT service manager for Cardiff and the Vale NHS Trust: "The emphasis on informatics has changed quite dramatically over the past few years, and is only being capitalised in areas where the importance of what the field can provide to a service is recognised. The HICF is part of that by providing a framework from which to build on, and acting as a guide to the sorts of roles and expectations that can be derived form a field as diverse as health informatics."

The framework is more than just a guide. It firmly plants health informatics as fundamental cogs in the engine driving the NHS. It places health informatics in the mainstream of healthcare.

Besides the framework, Informing Healthcare's 'HI-Profile' professional development programme provides online access to career information, personal support and professional development for Health informatics including ways of accessing education and training. It offers advice and information for those interested in a future career in health informatics and points the way toward opportunities for improving the IT and information management skills of the work force throughout the UK.

The programme also establishes bursaries for appropriate academic and for vocational qualifications. It also offers a number of courses which are free to all health informatics staff in the NHS in Wales. The courses cover project and programme management, service management, statistical analysis, benefits management, facilitation, presentation and writing for publication.

Informatics are contributing to modernising the NHS, improving the skill levels of workforce. As information and IT tools are moving increasingly centre stage, it's important the health informatics profession expands in stature, knowledge and rewards.

Wales' auditor calls for 'seamless' health hotline

Tue, 15 Sep 2009 15:56:05 GMT

The Wales Audit Office has called for NHS Direct Wales to be better integrated into the healthcare system

In a report published on 15 September 2009 the audit office says the 24 hour phone and internet health advice service is not seen as a core part of the unscheduled care system and is poorly understood across the NHS.

In 2008-09 NHS Direct Wales cost just under £9m and received more than 340,000 calls and 450,000 web visits. Although the costs, which average £26 per telephone call, are comparable to similar services in England, the report says there is scope to improve call handling times.

Some callers are waiting longer than target times to access NHS Direct Wales, with 87.9% of calls answered within 60 seconds after the welcome message during 2008-09.

There is also scope for better promotion of the service, particularly among older people, the report says.

It recommends that NHS Direct Wales should share information on cost and performance to improve understanding of the demand for unscheduled care and support the planning and funding of services.

NHS Direct Wales should monitor patients' behaviour and choices more effectively and take action to support more appropriate forms of unscheduled care, as well as service improvements.

The report says health boards should examine how the service could act as a hub through which patients are directed to the most appropriate pathway for their clinical needs, informing them about how best to access unscheduled care and how to improve their health and well being.

The Welsh Assembly Government and health boards should consider how NHS Direct Wales could help manage chronic conditions, drawing on the skills of its nurse advisers and health information specialists to improve services for patients and provide value for money.

Auditor General for Wales, Jeremy Colman, said: "While NHS Direct provides valuable services which most people seem to like, there is scope for it to be much more effectively integrated within the unscheduled care system, providing a more seamless service for the public.

"I hope the wider NHS will take on my recommendations in order to realise the potential of NHS Direct to help make the unscheduled care service easier for the public to use."

IT spending will ride out NPfIT problems

Wed, 02 Sep 2009 09:08:23 GMT

Spending on UK healthcare IT is set to grow strongly over the next five years, despite doubts about the future of England's NHS National Programme for IT (NPfIT)

A new report from Kable, publisher of SmartHealthcare.com, shows that while there are major uncertainties over the direction of the programme, work on implementing the Care Record Service (CRS) is likely to proceed, fuelling a growth in the market for software systems. This will combine with an increase in remote and mobile working to support continued investment.

UK healthcare market profile 2013-14 forecasts that annual spending in the sector will rise from £2.34bn in 2007-08 to £3.48bn in 2013-14, representing a compound annual growth of 6.9%.

The growth is predicted to come largely from software revenues, associated with moves to begin using the central electronic patient record developed under NPfIT. Although the CRS has been delayed by two years, its development has now reached a tipping point and should prompt the signing of a large number of contracts over the next two years.

These will cover clinical, logistical and managerial applications, ranging from patient administration systems to more complex operations such as asset and contract management, risk assessment, remote telemetry and recording details to comply with the Mental Health Act. The market will also open up as NHS trusts are given the freedom to choose alternatives to the core systems – Cerner Millennium and iSoft's Lorenzo – previously specified within NpfIT.

These factors should combine to boost spending in the field from £86.5m in 2007-08 to £364.4m in 2013-14.

The other main driving forces are the shift to telecare, which is encouraging the adoption of the relevant technology, and the growing use of mobility enablers such as smart cards, RFID tags, PDAs and BlackBerrys.

Among the other significant factors at work are the increasing use of outsourcing and shared services, and a move away from in-house software development towards turnkey applications from specialist providers. It is also significant that most NHS organisations do not have a specific budget for IT but tend to draw funds as needed from central budgets. This leads to a less settled investment approach and makes it harder to develop robust relationships with suppliers.

Report author Victor Almeida, a senior analyst at Kable, commented: "The health industry has the largest budget in the UK public sector and its modernisation is a paradigm not only for the rest of the UK government, but to health systems all across the world. For example, critics and supporters of 'universal healthcare' in the US often refer to the achievements and faults of the NHS in order to corroborate their arguments.

"Everyone in UK public sector and the rest of the world the has something to learn from the NHS."

* Read an extract from the report on the future of the National Programme for IT

MCAs under the microscope

Wed, 26 Aug 2009 08:00:00 GMT

Mobile Clinical Assistants are starting to be used at patients' bedsides across the UK

Health service organisations in England, Scotland and Wales are starting to see the arrival of customised notebook personal computers known as mobile clinical assistants, or MCAs, arriving on the wards. Underpinning them is another relatively new technology for hospitals, the wireless network.

The Princess of Wales Hospital in Bridgend in south Wales, has installed one of the largest wireless networks of its kind in Europe to revolutionise patient care. The technology allows consultants and doctors to spend more time with patients because they can access reams of electronic information about a patient from their bedside.

Carl Mustad, assistant director of IT with Abertawe Bro Mogannwg University NHS Trust, says this means patients' latest test results are now available at the touch of a button, and staff no longer have to leave the hospital bed to view X-rays and other scans.

In place of the traditional paper notes found at the end of each patient's bed at the Princess of Wales unit is a tablet-style MCA. There are 57 MCAs in wireless carts in active use across the hospital, which can display virtually all of the patient's notes and tests.

When a patient is discharged, an electronic transfer of care (eTOC) plan is sent to their GPs. The eTOCs generated by the MCA-based IT system at the Princess of Wales unit are actually created when patients are first admitted and material is added throughout their stay. As staff add data on the patient through the MCA at the bedside, so information on diagnosis, procedures, test results and changes to medication is added to the eTOC.

Such has been the success of the MCA-based wireless network at the Princess of Wales that the technology has been copied at the nearby Neath Port Talbot Hospital.

Novel on campus

MCAs are also being progressively introduced across all wards at NHS Grampian, whose Aberdeen group of hospitals - the Royal Infirmary, Children's Hospital and Maternity Unit - use a campus-wide wireless network.

Paul Allen, head of ICT for Grampian, says the project to equip the wards and allied patient care departments at the three units, known as the Forresterhill campus, started earlier this year when Carillion IT Services was contracted to supply the five-year installation and rollout.

The first stages of the campus wireless network are due to go live in October, and early indications are that the Panasonic MCAs are being well received by staff. "It's still early days with the MCAs, but we are also looking at extending the project to include personal digital assistants and even smartphones," says Allen.

Allen says that access to patient records through the Panasonic MCAs is not going to be wholly wireless as there will always be a need for cable-connected units, such as in offices and other sites where higher speed network access is required.

St Bartholomew's Hospital (Barts), England's oldest hospital and part of Barts and The London NHS Trust, has just completed a year-long trial of MCAs and wireless network technology in the hospital's accident and emergency ward.

The Philips notebook PCs are connected using a wireless network in a project that cost £300,000 during its 12-month trial. The plan now is extend the trial to the opening of Barts' new 300 bed unit, which is due to open next year.

Doug Howe, the trust's head of client services for ICT, says that he and his IT services team are due to gain access to the new unit during September, at which stage they will install a wireless network to support the use of MCAs, as well as RFID-based asset tracking and a Star Trek-style badge-to-badge and badge-to-desktop PC voice communications system.

The longer term plan is for Barts to extend the use of MCAs to its new Royal London hospital site, which opens on a phased basis between 2012 and 2016. The site will include three towers, each of which will be 16 storeys high.

"One advantage of having a new unit is that we can install the IT system from scratch, which means we can go all-wireless and support the use of portable devices at the bedside with ease," he says.

However, Howe says that clinical staff have tended to shy away from using MCAs on their rounds, as they found the laptops were too cumbersome to carry around with them. "Conversely, pharmacy staff love them to bits, as they allow staff to prescribe at the patient's bedside, which is a real advantage," he adds. "They like the ability to be able to pull up the Millennium (pharmacy system) software and prescribe right there at the patient's bedside. Pharmacy staff have taken to the MCAs like a duck to water," he says.

Seeking approval

The use of MCAs in hospitals is not all plain sailing, however. Jean-Louis Evans, managing director of TUV Product Systems, a 'notified body' that approves IT equipment for use under different conditions, says there are a lot of standards approvals required before a laptop can be allowed on wards.

Evans says that the MCAs have to be certified as safe for use in a clinical environment. "This is on top of the RF emissions tests and other checks that are required under the Radio & Telecommunications Terminal Equipment (R&TTE) directive," he adds, adding that, because modern laptops are effectively now radio transmitters on multiple wavebands, they have to be tested with all their systems operating at the same time.

"That is the essence of why we test on the RT&TTE front, to check that, with WiFi, cellular and Bluetooth systems operating, the laptop is perfectly safe for use in a hospital ward, as well as anywhere else," he explains.

Before an MCA can be approved for use in a hospital, Evans adds, it must meet the stringent safety terms of the European Medical Devices directive. "It all comes down to the electromagnetic output of the MCA - it must not, for example, generate any RF interference as, if it does, it could interfere with other medical equipment in use on the wards," he says.

The strict standards requirements imposed on MCAs for use in a hospital environment start to explain why, even though you can buy a portable PC for under £300 these days, a specialised MCA - even without any software installed - can run into four figures.