NHS chief executive says that politicians have to help explain healthcare's shift away from hospitals

Sir David Nicholson has called on politicians to help sell reconfiguration of the NHS to the public, in a speech to health service managers.

Addressing the NHS Confederation conference in Manchester, the chief executive of the NHS in England said that the recent arguments over the health service have generated "a ringing endorsement" of the NHS's tenets of a tax funded service free at the point of the delivery, from the prime minister and others. It has also seen growing awareness of the financial pressures facing healthcare.

But he added that the results of this, particularly the move in treating long term conditions closer to people's homes, have to be explained and backed by politicians. "We believe the acute sector, in the number of beds, will have to reduce," Nicholson said. This can improve patient outcomes and save money, such as London's move from 30 stroke centres to fewer than 10. "Some parts of the NHS will not do everything in the future."

He said that most ministers start without a realisation of the value of NHS managers, but that this changes when they are in power. "I'm absolutely convinced, at the highest level in the government, they get what management does. We make it happen. We provide leadership," he said.

Nicholson also said that he had wavered over his commitment to the government's changes to the NHS, including not liking them and wanting to leave, wanting to see them through but not being convinced. "I literally went through all of those categories, sometimes on a daily basis," he told the audience. But he was convinced through the support of the NHS by ministers and the challenge of the financial climate.

He said that the current year will be the last in which management cost reductions will be set for commissioning organisations – a criticism of many health service managers. In future, the government will look at overall running costs. However, Nicholson added that NHS managers did themselves no favours through their criticism of each other, particularly in different sectors, encouraging the belief that management had little worth.

Nicholson listed targets that had been met, in areas including 18 week access, dental services, mixed sex accommodation and cancer screening, as well as running a surplus of £1.5bn in a year with a difficult flu season over the winter. "You should be enormously proud of what you've delivered," he told the audience.

This article is published by Guardian Professional. Join the Guardian Healthcare Network to receive regular emails on NHS innovation.

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"The function of science fiction is not always to predict the future but sometimes to prevent it."
- Frank Herbert

Health secretary announces a fifth wave of pathfinder commissioning consortia, while defending his criticism of bureaucracy

Andrew Lansley has urged NHS managers to "regain the momentum" on restructuring the health service, following changes to his health and social care bill.

In a speech to the NHS Confederation conference in Manchester, Lansley announced a fifth wave of clinical commissioning groups, formerly known as GP commissioning consortia. The new set of 35 groups brings the total number to 257, covering 50 million people – 97% of the population of England.

The first clinical commissioning groups will take over statutory responsibilities from primary care trusts by April 2013, he said – meaning that only some areas will meet the original timetable for power to pass from primary care trusts (PCTs) to commissioning groups. They will start gaining authorisation from the national commissioning board by October 2011.

Lansley also said that the health service will publish more data on clinical outcomes in future, as part of the government's move towards greater transparency. "In coming years, we will give England the most transparent healthcare system in the world," he said.

Describing the pause in the legislation as "an unusual step", Lansley said the bill has been improved as a result of the listening exercise carried out by the Future Forum group led by Professor Steve Field, who he will meet next week to discuss future work it may carry out. The health secretary also said the pause had helped the government to "reconnect" with the public and staff.

"The pause let us build a greater sense of ownership," he said. "People feared, perhaps were told they should fear, that the bill would undermine the values of the NHS. I would never let that happen." Addressing the core concern over the bill, he said: "Competition will only ever be used as a means of improving care for patients." But he added that, despite changes, the "guiding principles" of his reforms remain in place.

"The pause is over. It's now time to act," he concluded.

Lansley's speech was received with polite applause, but he faced several hostile questions over whether he valued NHS managers, given cuts to management costs and thousands of PCT staff expected to take redundancy. In reply to one question, he said: "I'm not responsible for what the Daily Mail writes. I'm opposed to an over administered NHS."

In reply to another questioner who said he had to work to convince his friends and families that what he did in NHS management was worthwhile, Lansley answered: "I've consistently, over years, made it clear that what I am looking for is high quality leadership." When then asked why politicians never defend NHS managers, he replied: "I've just done it," adding: "Trying to remove wasteful bureaucracy is not a denigration of good managers."

This article is published by Guardian Professional. Join the Guardian Healthcare Network to receive regular emails on NHS innovation.

Councils in north west England are drafting a bylaw for minimum drink prices, but Scotland may get there first

The new Scottish National Party-controlled government in Holyrood may introduce the UK's first minimum unit price (MUP) for alcohol, when it reintroduces a bill that fell in Scotland's previous parliament towards the end of this year.

"Basically, we have confirmed that in the next term of parliament, in the autumn, there will be a bill for minimum pricing of alcohol," a spokeswoman for the Scottish Government told Guardian Healthcare.

Meanwhile, authorities in Greater Manchester have drafted a bylaw that would introduce an MUP across the conurbation, but not all the 10 councils have yet agreed to it, according to Alan Higgins, director of public health for Oldham.

In a presentation at the NHS Confederation conference in Manchester, Higgins said that while work with the drinks industry is useful in educating the public, further regulation is also needed. Quoting health secretary Andrew Lansley's point that further regulation of alcohol could be used "as appropriate", Higgins said of an MUP set at 50p per unit: "It's appropriate now."

Lansley caused controversy when involving major food and drink manufacturers in developing public health policy, leading to some organisations withdrawing from work with the government.

Higgins said that the number of hospital admissions attributable to alcohol in England has risen 107% between 2002-03 and 2009-10, compared with a rise of 27% in all admissions over the same period. Alcohol consumption has risen by around 10% over the last decade, both on sales and survey data.

Representatives of the drink industry were split on the desirability of an MUP. Mark Baird, head of corporate social responsibility for drink maker Diageo, said the company opposed it. "The objective is not to reduce consumption, the objective is to reduce alcohol-related harm," he said, adding that indicators of such harm show it falling over seven years. Higgins disputed this, saying that such indicators have been falling for less time and are not yet a certain trend.

However, representatives of pub firm Greene King and north west brewer and pub firm JW Lees offered measured approval for the concept. Mark Blythman, communications director for Greene King, said alcohol consumption has moved from licensed premises to off-sales, such as from supermarkets, where they are much less controlled. "Minimum pricing is a very straightforward, simple and I'd say cost-effective measure for tackling where the problems are," he said.

William Lees Jones, managing director of JW Lees, said that people are drinking less, but in different ways. Referring to Oldham, he said: "It's like the Wild West. It used to be a good night out." He added that it was important for new measures to be selective, so that they did not damage businesses like his which are increasingly selling food with alcohol. "The health lobby is risking demonising the drinks trade."

Diageo's Mark Baird said that the focus should be on co-operative between public health and the drinks industry. He said that firms including Diageo have signed up to voluntary health warnings on most products containing alcohol, advertising campaigns against binge drinking, new guidelines on alcohol sponsorship in Scotland. They have also supported initiatives such as street pastors in Nottingham, anti drink-drive campaigns in Exeter and the national alcohol awareness week. This is in addition to national initiatives such as Drinkaware and the Portman Group.

Supermarket Asda has agreed to remove alcohol from the front of its stores, brewer Heineken is weakening one of its brands to remove hundreds of millions of units each year and Diageo has used its marketing expertise to target 'irresponsible shamefuls', the 30% of 18-30 year olds who drink irresponsibly but are ashamed of doing so, through advertising campaigns, Baird said. But he added that one opponent has compared the firm's campaigning for responsible drinking as being akin to "putting foxes into the chicken coop and asking them to be nice".

This article is published by Guardian Professional. Join the Guardian Healthcare Network to receive regular emails on NHS innovation

On July 6, 2011, the University of California at Los Angeles Health System (UCLAHS) reached a settlement with HHS's Office of Civil Rights (OCR) regarding UCLAHS's potential violations of HIPAA Privacy and Security Rules. The settlement includes a payment of $865,500 and a corrective action plan (CAP). 

According to the HHS press release, this settlement "resolves two separate complaints filed with OCR on behalf of two celebrity patients who received care at UCLAHS. The complaints alleged that UCLAHS employees repeatedly and without permissible reason looked at the electronic protected health information of these patients. OCR’s investigation into the complaints revealed that from 2005-2008, unauthorized employees repeatedly looked at the electronic protected health information of numerous other UCLAHS patients."

We reported on possible privacy violations at UCLA Health System before. Specifically, in May 2010, we wrote about Huping Zhou, a UCLAHS employee who was the first person to receive a criminal conviction for a HIPAA violation. It is not surprising that OCR stressed the importance of training staff in prevention of such privacy violations in the CAP required by the settlement. The CAP "requires UCLAHS to implement Privacy and Security policies and procedures approved by OCR, to conduct regular and robust trainings for all UCLAHS employees who use protected health information, to sanction offending employees, and to designate an independent monitor who will assess UCLAHS compliance with the plan over 3 years."

Via HHS press release:

Through policies and procedures, entities covered under HIPAA must reasonably restrict access to patient information to only those employees with a valid reason to view the information and must sanction any employee who is found to have violated these policies.

<...> Covered entities need to realize that HIPAA privacy protections are real and OCR vigorously enforces those protections. Entities will be held accountable for employees who access protected health information to satisfy their own personal curiosity,” said Director Verdugo.

Covered entities are responsible for the actions of their employees. This is why it is vital that trainings and meaningful policies and procedures, including audit trails, become part of the everyday operations of any health care provider,” said OCR Director Georgina Verdugo. “Employees must clearly understand that casual review for personal interest of patients’ protected health information is unacceptable and against the law.”

CMIO Magazine

By Jeff Byers

The search for sustainable health information exchanges (HIEs) demands more than simply following the money. Driven by the desire or the necessity to stand on their own two feet, some HIEs have found a formula for success.

"Sustainability is evolutionary," says Ted Kremer, executive director of Rochester RHIO (Regional Health Information Organization), an HIE that connects the 15 hospitals in the Rochester, N.Y., medical service area and has more than 3,800 care providers currently accessing clinical information-including elderly care information and radiology images.

The Rochester RHIO started in 2006 with a mix of community and state grant funding, Kremer says. In the beginning, RHIO stakeholders looked at the barriers to realizing savings and efficiencies, then developed metrics goals that would enable it to overcome those barriers.

The obstacles were basic and would be recognizable to most HIEs, says Kremer. For example, "If you're going to propose queriable actions, patients have to consent their information to the HIE and there must be enough data to make the results valuable."

Supported by a $4.7 million state grant and a little more than $1 million in community funding to start up the exchange, Rochester chose Axolotl's Elysium platform to provide two core services: a traditional patient-centered clinical access portal and support for delivery of test results among hospitals and the 140 physician practices that currently have connected EHRs. Rochester RHIO reports that the query and support services have been operationalized and become sustainable, covering about $2 million in overhead in 2009 and 2010, Kremer says.

"We used early metrics to prove value to funders," he says. Those metrics included total number of users, volume of data and number of results Rochester sends out to third-party vendors.

"HIEs need to think of themselves as companies with customers-and we have an obligation to prove value. Metrics and performance values are critical," says Kremer. "Unless you can measure and demonstrate your HIE value, it's hard to get people to pay for those services."

Show me the data

By showing potential value through hard data, Cincinnati-based nonprofit HealthBridge built a solid HIE foundation that has attracted 5,500 physicians and more than 50 hospitals (28 of which are now live) in southwest Ohio, western Indiana and north-central Kentucky.

"On average, in a use case for delivery of results, we found [it costs] 75 cents per result to deliver clinical results on a hard-cost basis. Our cost to deliver that service was 12 cents," says Keith Hepp, vice president of business development at HealthBridge.

The HIE's business case has proven convincing-by "outsourcing" lab result delivery and other functions, hospitals and labs needn't maintain contact information for every provider, or incur the costs of faxing, scanning and sending those results, nor manage EHR interfaces, hardware or software fees. "In our financial analysis, the average cost for managing this infrastructure is approximately 75 cents per result, [but it] can be as low as 30 to 50 cents or higher than $1.25, depending on the level of automation that a data sender [hospital, lab or imaging facility] uses," Hepp says.

Rather than government grants, HealthBridge was financed by seven loans of $250,000 each from hospitals and health plans, Hepp says. From its inception in 1997, "the way we were funded forced us to have a very business-oriented focus. We had to return capital and for every dollar the hospitals paid us, we had to save them $1.50."

Because hospitals were investing their money, they needed to prove value by showing they were lowering their cost of doing business. The HealthBridge business model has allowed it to make significant infrastructure investments, retire loans early and be a profitable nonprofit every year since 2003, says Hepp.

Moving forward, HealthBridge is switching its operational game plan. "There's still a value to cost-based services, but what HIEs need to do for sustainability is to improve cost and efficiency of care transactions and inform pay-for-performance and disease-management programs," says Hepp. "Once we had clinical information in a single place and standardized, we began preparing for how quality-driven improvements would be able to bend the cost curve."

For sustainability, Hepp says: "There is no silver bullet; it's a series of services that you can wrap on top of expensive infrastructure." For example, HealthBridge added an ambulatory order entry system as a fee-based service on top of a basic communications platform (Axolotl). It was able to make this new service profitable because the system repurposes existing clinical data.

"The service doesn't cost as much incrementally because you're using existing infrastructure in new ways."

Please visit CMIO Magazine to read the complete article.

Oxford's Radcliffe Hospitals trust and oxford University sign joint working and licencing agreements

Oxford Radcliffe Hospitals NHS Trust and the University of Oxford have entered into formal agreements on joint working and the use of Oxford University's trade mark for future joint projects.

The trust said these will provide a "formal structure and governance to the relationship" between the two organisations, and improve their ability to share ideas, activities and to function as a joint venture.

Sir Jonathan Michael, chief executive at the trust, said: "The collaboration between the Oxford Radcliffe Hospitals and the university underpins the quality of the care that is provided to patients, the delivery of high quality research bringing innovation from the laboratory bench to the bedside, and the delivery of high quality education and training of doctors.

"The decision by the trust board and the university council to enter into these formal agreements reinforces this very important relationship."

Oxford Radcliffe said the university and NHS hospitals in Oxford have a long history of joint working. Existing collaborations include research programmes established through the National Institute for Health Research Biomedical Research Centre at the Oxford Radcliffe and at the Biomedical Research Unit in musculoskeletal disease at the Nuffield Orthopaedic Centre NHS Trust.

This article is published by Guardian Professional. Join the Guardian Healthcare Network to receive regular emails on NHS innovation.

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Quote

A difference of opinion is what makes horse racing and missionaries.
- Will Rogers