Salford Royal Foundation Trust is celebrating after a new initiative by nurses saw patient satisfaction levels soar.

The Trust’s Transparency Report for June revealed that out of 10,053 patients one individual suffered a fall whilst in their care and seven people suffered a pressure ulcer – six device related.

Yet despite the incidents a new measure by nurses to visit patients on an hourly basis to check their welfare led to 98% of respondents indicating they would recommend the trust if a friend or relative required treatment.

The Trust said it was “delighted with the feedback” it had received from patients and staff about the new working practice.

But results from the survey were not as positive when patients were quizzed over the treatment they received at meal times. Slightly more than two-thirds (69%) said they always received a high standard of help. But more than a fifth (22%) disagreed.

In tackling pressure ulcers, the Trust said it is working with its nursing teams and is “determined to see these harms continue to reduce”.

The Trust also said it is in the process of improving the care and services it provides through the development of a new patient experience strategy.

Patients will be able to choose where, when and how they receive some of the most common medical tests for the first time under new proposals from the Department of Health.

From April next year, individuals can select where they receive essential medical tests to make it more convenient for them after discussions with their GP.

Health Secretary Andrew Lansley said the plans are designed to make “medical tests work for you, not the system”.

Individuals will be able to choose from locations closer to home or work instead of being told where the nearest available option is. The decision will be made in partnership with their doctor, who will advise which option is most appropriate.

“Our NHS reforms are all about making life easier for patients,” Andrew Lansley commented.

“No two people are the same, and that’s why our plans will offer patients more personalised care, ensuring that ‘no decision about me is made without me.’”

The DH is also proposing a change to the system that GPs and patients use to choose which hospital they visit for treatment.

Choose and Book will include details on waiting times and provide patients and doctors a better sense of how long they may wait for treatment.

The proposal is part of the DH’s model of a shared decision-making process along the patient pathway.

ABPI President Simon Jose believes the UK pharmaceutical industry and the NHS will become partners within the next three to five years.

The President predicts a change in the relationship between the industry and the health service will result in improved levels of patient health and care.

See the full interview below.

ABPI President Simon Jose believes the UK pharmaceutical industry and the NHS will become partners within the next three to five years.

The President predicts a change in the relationship between the industry and the health service will result in improved levels of patient health and care.

He commented that the relationship between pharma and the NHS will “evolve to one that’s less transactional and one that is much more based on partnership”.

Greater collaboration across disease pathways, he said, is expected as the industry looks to promote its services and products and the NHS extracts value for money where possible.

“For me it all starts with the fact that we are perusing the same mission which is essentially improving the health and care of patients,” he said.

“I think you’ll see the industry think much more about patient pathways instead of simply thinking about products and I think you’ll see more collaboration across the pathway.

“For me our role is partnering with the NHS to ensure that they and their patients can get the best out of our medicines, rather than seeing this as a simply as a transactional, supplier, procurer relationship, which I think is one we’ve come from in the past.”

Mr Jose also discussed the recent collaboration guidelines formulated by the Ethical Standards in Health and Life Sciences Group.

The guidelines, which promote positive collaboration between health organisations and the pharmaceutical industry, were backed by the Association.

“The power you get when you bring all of the constituent parties together, when you start talking to each other, understanding each other, and suddenly finding there is an awful lot that unites us than divides us is really powerful,” he said.

Click here to view the full interview.

Information, and more importantly access to it, has been identified as being key to delivering better care, better outcomes and improved efficiencies in the NHS. Health informatics systems have a major role to play in making the transition towards an era of ‘shared decision-making’. But success will not be achieved by technology alone. Michael Thick looks at the journey ahead.

When plans for the vision of the future of healthcare in the UK were recently announced, one of the central aims would be to bring NHS resources and decision-making ‘as close to the patient as possible’. The phrase “No decision about me, without me” not only provided a neat sound-bite to encapsulate the message, but it also casually condensed a multitude of major challenges into just six words. Moreover, it threw down the gauntlet to stakeholders across the marketplace that those responsible for designing and implementing health informatics systems needed to raise their game.

And though IT itself cannot lead change, its suppliers can show leadership and influence others to drive cultural change. The most effective suppliers will add true value to the dialogue. They will have an
intrinsic understanding of the NHS and how it operates at senior levels – and will be able to contribute meaningfully to discussions around service design because of it. There are savvy suppliers out there already working with the NHS – and patients – to enable healthcare to be provided in new and innovative
ways.

The challenges ahead are significant. The White Paper identifies information, combined with the right support, as being the key to better care, better outcomes and reduced costs. It speaks of an environment where patients have sufficient data on all aspects of healthcare to enable them to share in decisions made about their care. Moreover, it promises to correct an ‘imbalance in who knows what’, to give patients access to their own records, and, furthermore, to enable them to communicate with clinicians online. These are all worthy goals. But, as we move towards 2012, UK healthcare is some way off from achieving them.

The emerging customer
Against this backdrop of radical and ambitious reform, much of the current architecture for health
informatics in the UK is not yet in place. Improving it is a collective responsibility; for clinicians, for
NHS management, for back office suppliers, and, most of all, for patients.

The emergence of the patient as being central in the development and delivery of health care services is no longer rhetoric. But until the market as a whole recognises this and takes a holistic approach to the development of services to support the White Paper’s ambitions by engaging all key stakeholders and
influencers, the potential for success is reduced.

It is time for a shift in our cultural mindset. Clinicians, administrators, informatics experts, suppliers and patients must all work together to make the information revolution – and indeed the patient revolution – happen. This is about changing attitudes as much as it is about changing technology. The development process must be consultative and inclusive.

Technology in the revolution
IT can play a major role in driving, facilitating and delivering change, but plans for any new architecture
must capture input from all stakeholders right at the outset. And that must include the patient. For too long, informatics has had the clinician as its primary customer, but as patients begin to take more responsibility for their health and shared decision-making becomes the norm, it is clearly time for a rethink. In tomorrow’s world, the end-user is as much the patient as it is the doctor. To correct the imbalance, the tools being used must change to reflect this.

Making the patient’s needs central to the process – and building that patient’s needs into every stage of the development of a service – its design, implementation and evaluation, has to be the way forward.

The teaching of medicine and nursing has traditionally been focused on relieving the burden of care from the patient, but there is strong argument to suggest that increasing the involvement of the patient in their own care will bring better outcomes. Medical and nursing education does not currently teach people how to use health tools with patients, partner with patients or empower them using health information and this will need to change moving forward.

It is here where technology suppliers can play a valuable role. They understand patients’ perspectives and how their use of health IT is likely to grow in the future. Supplier expertise in providing packages for patient care is there to be exploited. Those who best understand patient needs should be involved at the earliest possible stages in the development of any service, rather than simply brought in at the compliance end of things.

The key voice
The approach is perhaps best exempli­fied by developments at NICE, which, as we know, has been appointed the arbiter of effectiveness, usefulness and quality. Charged with responsibility for designing around 150 Quality Standards in the next five years, NICE has identi­fied the patient experience as being central to this work. It requests that when new systems are being implemented, patients are consulted to establish the relevance and value of any changes. This is a fundamental requirement of the implementation of NICE guidelines – and the same approach should be taken in the development and implementation of health informatics systems to support them. This is certainly the case at those technology suppliers who are already aware of the role they have to play and routinely consult the patient in all plans for the implementation of NICE guidance. It’s a commitment to the spirit of “nothing about me, without me.”

And so as the health sector approaches the NHS Information Revolution mandated by its government, it’s clear that consultation phases engaging all stakeholders involved in the design and delivery of health services is paramount. Key voices, not least those belonging to patients and technology suppliers, must no longer be excluded from the process.

Conclusion
Success will not be won by technology alone. For real change to take place, collective buy-in to the wider principles of the empowered patient must be achieved. Clinicians, suppliers and patients must engage and collaborate to identify the most effective and efficient ways to improve health outcomes. A clear roadmap must be agreed up front before beginning the process of supporting it with an implementation. If we do things the other way around – as has often been the case in the past – we will not succeed.

“Nothing about me, without me.” It makes sense on every level.

Michael Thick is VP Clinical Strategy and Governance, McKesson.

Inconsistent NHS leadership questioned

The NHS has suffered due to inconsistent leadership over a prolonged period, peers in the House of Lords have been told.

Baroness Cumberlege, a Conservative peer, told the House the number of different health secretaries in recent times has led to a lack of trust and confusion by the health service.

Speaking during the committee stage of the Health Bill, Baroness Cumberlege compared the Sir Alex Ferguson’s 25-year reign at Manchester United and asked “what difference it might make to the NHS” had it had a leader for a similar tenure.

Since 1997, there have been seven different health secretaries – six of which under the previous Labour government.

“One of the real problems that we have, and it exists even if it is the same party in power for a length of time, we lack a consistency of leadership, because the Secretaries of State are here one minute and gone the next,” said Baroness Cumberlege.

“I think that contributes to an NHS that gets confused, that gets fed up and is mistrustful of its masters.”

Despite the ongoing criticism of the Health Bill as it passes through the House of Lords, structural changes are still happening at ground level. Dr Thoreya Swage outlines the timescale for changes as PCT clusters switch responsibilities to CCGs.

The momentum of reform of the National Health Service in England continues to gather pace. Following a four month hiatus while the wise and the good of the NHS Future Forum pondered and produced recommendations for the adjustment of the Bill, the DH published further guidance on the developing role of the Primary Care Trust (PCT) clusters.

Although the 151 PCTs have been squeezed into fifty-one PCT clusters in preparation for their demise in April 2013, it seems that they have a vital part to play in the development of the emerging Clinical Commissioning Groups (CCGs).

This guidance or ‘shared operating model for PCT clusters’ has been produced by the mandarins at the DH to ensure that the commissioning landscape is as consistent and smooth as possible in time for the takeover by the CCGs. This is so that the nascent NHS Commissioning Board inherits a robust enough system to take account of further developments and improvements in healthcare in early 2013.

A shared model

There are six main functions or ways of working for the shared operating model for the clusters. These have been identified where consistency of approach is considered to be of importance and they are listed as commissioning development, financial and operational issues, ensuring quality, emergency planning, development of providers as Foundation Trusts and communications.

CCG development

The most important function is the preparation of CCGs for authorisation as soon as possible following the successful passage of the Health Bill through Parliament. The process of authorisation to become fully fledged commissioners is due to begin in the second half of 2012.

Although this is a year away, CCGs can commence their preparations now using a self diagnostic tool – an interactive computer-based assessment that helps them to determine their capability in six domains and identify their development needs.

The areas covered include:

• A clear clinical focus of the CCG commissioning plans to include tackling health inequalities and improving primary care
• Demonstration of meaningful involvement of patients and the wider community
• A plan for development that is clear and credible which, in particular, delivers the QIPP (quality, innovation, productivity and prevention) agenda
• Capacity and capability of the CCG, i.e. robust constitutional and governance arrangements which enable the CCG to commission care effectively and ensure financial control
• Collaborative arrangements for working with other CCGs, local authorities and the NHS Commissioning Board
• Capacity and capability of the CCG leadership which ensures effective working.

The tool helps the CCGs identify priority development areas which form the basis of the developmental plan paving the way to full authorisation.

To support all this work CCGs will receive £2 per head from the PCT clusters as well as extra management resource to help the groups hone their commissioning skills and capability.

CCGs experiencing difficulty in defining their boundaries will have guidance from PCT clusters on how to resolve this. PCT clusters also have the unenviable task of engaging the reluctant practices that so far have not participated in their local CCG discussions, with the aim of being part of a viable commissioning group by October.

Separating commissioning functions

All through the last quarter of this year a very detailed exercise is being carried out by PCT clusters to identify and segregate the service areas that CCGs and the NHS Commissioning Board will be responsible for. Although CCGs will be commissioning acute, mental health, community and ambulance care there are other services that PCTs currently commission which will need to be transferred to the Board.

Services such as GP and other primary care contractor groups – primary dental care, pharmacy and optical services – secondary dental care, prison, specialised and military health services are set to go under the umbrella of the NHS Commissioning Board. Even though the contracts for GP services are held by another body, the CCGs are expected to have an input into primary care development and improvement.

Quality assurance

A vital component of the commissioning process is ensuring the quality of healthcare. Practices may have been involved to a greater or lesser degree in various quality assurance processes in the past. However, CCGs are required to take on board these responsibilities seriously.

There is a whole raft of procedures and measures including delivery of better health outcomes for patients, meeting the Care Quality Commission (CQC) requirements for safety and quality of services, standard contracts, the NHS Operating Framework, professional guidance and other relevant requirements that CCGs need to get to grips with.

This could potentially be a vulnerable time for the development of the CCGs if attention wanders and serious patient safety incidents are not acted on promptly. Clinical governance processes must therefore be extra secure.

Budgets and responsibilities

Over the next year or so there will be a period of dual functioning and handover as the CCGs mature and the PCT clusters delegate more and more responsibilities until April 2013. The handing over of the baton has started now with PCT clusters having identified a “clear percentage of budgets” to CCG pioneers or pathfinders in August and plans for future delegation of budgets set by October.

Sandwiched in between will be the agreement on which mental health and community services will be subject to ‘Any Qualified Provider’ (AQP). This policy is set to be implemented from April next year when GPs can refer to providers of certain services eligible for AQP from a list of approved organisations, including the private sector, drawn up by the DH.

A review of commissioning support required by CCGs has already been undertaken in July with clear arrangements agreed by the end of the year.

In March next year, CCGs will be required to enable the development of the local health and wellbeing boards supported by their PCT clusters – health and wellbeing boards being the mechanism for joint health and social care planning and commissioning locally.

Meanwhile, individual PCTs will continue to carry out their statutory functions through the clusters until their abolition in April 2013. The statutory functions include contract monitoring, ensuring that providers meet their QIPP obligations and other statutory requirements, for example, safeguarding children and vulnerable adults.

The big challenge for CCGs will begin when they will be required to lead the next planning round for 2012/13. This begins in the latter part of this year and is a function previously undertaken by the PCTs.

This will involve doing a needs analysis, identifying local inequalities, understanding demand and activity for local services, negotiating and setting priorities with partners and developing the local strategic vision. Handover of commissioning functions will continue with CCGs being an active participant in the subsequent contract negotiations and agreement.

The outside world

It is apparent that despite the pause for reflection on the proposed changes in the NHS earlier this year, the momentum for restructuring and dissolving healthcare organisations continues. The picture remains a little confusing however, as CCGs are in varying stages of development and maturity and it is not clear that all will be truly viable by the tight deadline set for October.

What is clear is that that work of commissioning and delivering healthcare has to go on and now is a good time to find out who the key movers are within the CCGs.

It is at this point in time when the developmental needs of CCGs will be uppermost and it is here that pharma can provide some input. Skills and knowledge in leadership development and highlighting therapeutic areas where evidence-based care really works are two such possibilities.

CCGs will be keen to smooth patient pathways across primary and secondary care and nowhere is this more pertinent than in prescribing effectively. Delegated prescribing budgets are now very real for CCGs and they will be keen to ensure value for money and improvements in care for their patients. This provides a good opportunity for pharma companies to demonstrate the effectiveness of their drugs in specific disease areas.

On the commissioning front, by December of this year, CCGs and PCT clusters will have had to agree what commissioning support they need to carry out this function. Given the requirement to reduce costs, commissioning skills and expertise may actually be thin on the ground within CCGs.

Bearing in mind that effective commissioning will be judged by outcomes achieved as outlined in the NHS Outcomes Framework, pharma is well placed to demonstrate how their products can meet the requirements of domain 1: preventing premature deaths, domain 2: enhancing the quality of life of people with long-term conditions and domain 3: aiding the recovery of people who have an acute illness or injury.

The next few months will be busy while the NHS sorts itself out structurally. Once the picture begins to clear, pharma will need to engage with the new clinically skilled commissioners who now have the financial responsibility for making decisions about healthcare.

Dr Thoreya Swage was formerly an NHS clinician and a senior manager in various NHS organisations covering acute and primary care. She has expertise in commissioning health services and is currently working for a number of NHS organisations, including DH agencies, to develop a more commercial approach to the commissioning of healthcare.

Sometimes, reporting on the UK pharmaceutical industry feels a bit like Bill Murray’s Groundhog Day. In the late 1990s, when I edited my first title for UK pharma, all the talk was of the move from GP Fundholding and the imminent introduction of Primary Care Groups.

By 2000, New Labour’s NHS Plan promised a revolution in healthcare built around delivering improvements in ‘partnership, performance, patient care and prevention’. The politicians were about to ‘modernise the health service’.

Fast forward almost 12 years and we’re still being read the same script; new politicians, the same old lines. Four Ps – partnership, prevention, productivity and patient care – continue to dominate airtime, only this time, of course, it will be different.

Different? Some hope. This is Groundhog Day. So how is the UK pharmaceutical industry responding to change? Its customer-base, meticulously redrawn through 10 years of implementing the NHS plan, is yet again being reshaped. PCTs are on the way out. CCGs and Clinical Senates are on the way in. Keeping track of decision-makers and influencers is critical. Getting in front of them in the right volume, at the right time and with the right message is life and death.

The industry is currently pinning its hopes on Key Account Management (KAM), supported by a Customer Relationship Management (CRM) philosophy that promises to enable the field force to have a more detailed understanding of individual customer needs across a diverse and complex landscape.

The tools to support the CRM approach are impressive, established and evolving in time with the modern technological advancement. They also provide huge value to medical sales professionals, and the ability to enhance customer interactions.

But, as ever, this is Groundhog Day. Twelve months ago, Pf’s annual survey into field force attitudes revealed an apathy amongst some sales professionals towards the use of CRM. A year later and it appears that, despite its many advantages, the value message for CRM is still not being heard by all of those who can undoubtedly benefit from it.

This year, 90% of Pf’s survey respondents have access to a CRM system – but only 43% of these find time to use it in the field, and more than a fifth admit that they fail to record post-call reports accurately.

In a fast-moving, dynamic marketplace, generating, sharing and maximising real customer insight is one of the best ways for sales professionals to achieve competitive advantage. CRM tools provide the perfect mechanism for this. Only the foolish would pass up the opportunity.

I feel like I am repeating myself. But then again, this is healthcare Groundhog Day. Next month: more NHS reform.

Chris Ross
Editor

The UK’s blood transfusion service’s testing of new IT projects could save the NHS £40 million while also improving supplies to hospitals, the Department of Health has predicted.

The DH’s review of the NHS Blood and Transplant (NHSBT) service recommends pilot schemes to improve service in 2012, starting with an online ordering service system for hospitals.

New pilot schemes to be established in the next year will explore a potential national integrated blood stock system and automatic replenishment systems, along with integrated transfusion laboratories.

Lynda Hamlyn, Chief Executive of NHSBT, said: “We are working in partnership with trusts to identify ways we can better improve the management of blood and blood products within hospitals – so that we make best use of the voluntary donations from our 1.4 million donors.”

At least one of the new initiatives is likely to be centred around the “electronic blood transfusion service” at John Radcliffe Hospital in Oxford. The system uses a combination of barcodes, wireless connectivity and handheld computers to improve the quality of patient care.

The system connects patients to blood products using sensors and scanners, tracking blood supplies between hospital laboratories and wards, improving transfusion accuracy and safety.

According to the DH, the service costs John Radcliffe £350k each year, but saves them £400k a year by reducing the amount of blood required, and a further £500k through less nursing time needed to handle the blood.

The DH noted that the system may not be appropriate for every NHS Trust, but it should be considered as good practice.

Hamlyn added: “We plan to pilot a number of different models in the coming year and are confident we can improve performance and deliver further efficiencies to reinvest in frontline patient care.”

Mobisante has launched its MobiUS SP1 in the US, the world’s first smartphone-based ultrasound imaging system.

The device joins other portable point-of-care diagnostics that have recently entered the mobile health sector, including GE’s handheld visualisation tool Vscan and Siemens' Acuson P10.

The £4,700 MobiUS SP1 is designed for use in foetal, cardiac, pelvic, paediatric, musculoskeletal, peripheral vessel and abdominal imaging, providing the potential for enhanced patient care in any location, even remote areas.

The mobile health technology uses both cellular and WiFi networks, and consists of a Windows Mobile 6.5-based Toshiba TG01 smartphone, an ultrasound probe and computer software.

The manufacturer claims that the system could also be more suitable for use in low-income regions than traditional ultrasound equipment due to its lower operating costs and the increased convenience it would provide for patients.

Mobisante actually received FDA clearance for the device in February 2011, but it took eight months to implement necessary FDA-mandated controls.

The company is exploring the option of making a version of the product for healthcare-specific tablet computers as well.