FT Editorial- Electronic records

The biggest failure to date of the National Health Service's £6.2bn programme - the biggest civil information technology project in the world - has been one of communication.
The programme is intended to provide an electronic patient record and much else - e-booking of appointments, electronic transmission of prescriptions and digital images available in hospitals up and down the land.
The potential benefits are huge - in terms of increased patient safety and convenience, better quality medicine and greater efficiency and flexibility in the way healthcare is delivered.
Repeated surveys have shown that the programme has failed to engage adequately with the doctors, nurses and therapists who will use it. But, worse, it has failed to explain clearly to the most important people of all - the patients - how the system will work and what their rights to confidentiality will be under it.
It is quite incredible that two years into the programme, and within a year of the first records beginning to go live, this issue has yet to be settled.
Patients will have two concerns. First will be security. Here there can be, in practice, no absolute guarantees, as the bitter experience of banks and other businesses that increasingly rely on IT-driven systems shows. Anything and anywhere, even the Pentagon, has proved hackable. And in the NHS as in other businesses, employees may prove bribable or subornable to provide information that should remain private.
That said, what is known about the planned security sounds reassuring. Access to patient records by NHS staff will be on a need-to-know basis. There will be a clear audit trail of who has accessed records and when, and clear penalties for misuse.
The second concern will be over confidentiality. It seems clear from ministerial statements that patients will have a right not to join the system - forgoing the potential benefits in terms of their own treatment and safety that the record can bring. But after that there is confusion.
The programme originally proposed that there should be a "sealed envelope" containing information patients might regard as sensitive - past mental illness, an abortion, sexual history perhaps - that would only be opened in an emergency or with their permission.
But the board that advises ministers on the programme has gone further and suggested that patients should have the further right to withhold information entirely while still having, in all other respects, an electronic record.
But it is unclear whether these proposals will be accepted and, even if they are, precisely how they will work.
A resolution to these issues has been long promised - and is now long overdue. If that does not happen soon - with patients' rights clearly spelt out - faith in the electronic record could well be seriously undermined and a £6.2bn investment could turn into a £6.2bn fiasco.

Published: April 1 2005 03:00

http://news.ft.com/cms/s/1aa8ef0c-a24b-11d9-8483-00000e2511c8.html

Political pressure is undermining finance reforms

Political pressure undermining finance reforms, warns Dredge- political manoeuvring could wreck the government's flagship NHS finance reform, a chief architect of the policy has broken cover to warn.
Former Department of Health head of financial flows Bob Dredge said political pressure from 'powerful teaching hospitals' was behind the government's decision in June to halt plans for 'fairer re-distribution' of training and research and development monies worth £5bn among acute trusts.
Mr Dredge went on to describe the DoH's decision in December to allow health economies to 'unbundle the tariff ' to reflect local patient flows and to make adjustments to the short-stay tariff as a 'political fudge' designed to 'show the NHS it was being listened to'. And he said that continued unbundling of the tariff undermined the reform and ran the risk of leaving finance systems 'back where we started'.
Speaking publicly for the first time since leaving his post in December, Mr Dredge outlined his fears that the government could 'lose its nerve' and delay PbR for a second time. Full PbR was due to be introduced next month, but in January the government announced its decision to delay total implementation by one year.
Mr Dredge told a Chartered Institute of Public Finance and Accountancy conference: 'The party line is that PbR will be rolled out for emergency and outpatients next year, but I question if they will hold their nerve now they've managed to delay it once fairly easily.'
He said his 'worry' is that the DoH now has a few 'intellectually credible get-out-of-jail-free cards' that they can deploy if they 'lose their nerve' again next year.
Mr Dredge said that fixing the system for full introduction for next year would 'take a lot of work' and suggested the DoH might use the risk of a possible imbalance across the NHS as an excuse for further delay as April 2006 approaches.
The DoH halted an April PbR start for emergency and outpatients care at the eleventh hour because of a £500m 'imbalance' across the NHS.
Mr Dredge, now a senior fellow in financial management at Keele University's Health Planning Centre, said he decided to speak out now to inspire informed public debate about the government's policy direction.
'PbR was designed to be a "destabaliser" - a policy that would rock the system, which it is starting to do,' he said. 'There is nowhere to hide under PbR, and it is challenging. However the question is: can we overcome the influence of certain powerbases and hierarchies to gain the real, evidence based cash benefits?' he added.
Mr Dredge saved his fiercest fire for the move to allow health economies to unbundle the tariff - which he described as a 'messy response' to pressure from parts of the NHS.
'If you allow a whole load of unbundling - where you pay for little bits of the healthcare resource from up here and there - you destroy the principles, don't achieve the benefits, and end up with locally based recovery systems, which is back to where we started with this reform. There is a view from parts of the NHS that wants lots of local systems and local rules, which is completely contradictory to a national system. Either you have a system or you don't.'
Dredge judges: the key dangers
* Emergency payment by results: the risks of imbalance will still be great next year and the government could 'lose its nerve'. The Department of Health is likely to halt further introduction to mental health and community care, which could lead to one set of rules for powerful foundation trusts and another set for other providers.
* Short-stay tariff adjustments: the DoH's response to PCT fears that trusts would collect a tariff for a long stay when the patient discharged after two nights is a 'political fudge'.
* Unbundling the tariff: allowing tariffs to be split locally according to care pathways threatens to undermine the foundations of PbR. Hierarchies forced this 'messy response' against the spirit of reform.
* Research and development and training: the government made a U-turn last June on plans to balance £5bn allocations for training and research and development more fairly across the NHS due to 'pressure from the powerful London teaching hospitals'.
* The market forces factor (MFF): there are too many different zones now that each PCT has been given its own MFF. It is too complex and the system can be simplified.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource=2089136

2 blatant MRSA lies

The DoH's pathetic statement in the article below "MRSA rates are falling - they're at their lowest level since recording began in 2001" contains two blatant lies in their desperation to cover their own fatal incompetence:
Lie Number One: MRSA was first discovered in 1964 and since it's infection can be fatal it is a "modifiable disease."
As the Lancet states in it's article on " Hospital infection past and present" stated:
In 1999, a UK NHS Executive Health Service Circular instructed health-care providers to strengthen the prevention and control of communicable disease and infection-control processes. Specifically they were asked to "put infection control and basic hygiene where they belong, at the heart of good management and clinical practice with appropriate resources": fine words, but actions speak louder than words.

http://www.thelancet.com/search/search.isa

Lie Number Two: Cases of MRSA have doubled not declined in the last 4 years of labour's misrule- please see the independent National Audit Offices report at:

http://www.healthdirect.co.uk/MRSA-kills.html

MRSA found on maternity ward

An investigation has found alarming evidence that the NHS is failing to win its battle against MRSA. Traces of the superbug were discovered in five out of six samples taken at the hospital where a two-day-old baby was killed by MRSA last month.
Swabs taken at Ipswich Hospital revealed high levels of MRSA on a corridor pay phone, a hospital trolley, and in the men's toilets.
Low levels of the bug were found in the lifts and on the maternity ward. A sample taken from the urology laboratory was negative.
Baby Luke Day, who died at the hospital aged 36 hours, is believed to be the youngest ever victim of the bacterium.
He was born an apparently healthy 7lb 7oz child, was dead two days later.
His parents, 17-year-old Glynis Day and Kevin Fenton, 24, were alarmed at the results of the Sky News probe.
Mr Fenton said: "It's not surprising the results have come back like this. It shows the bug is still there and it's a big worry."
Miss Day blamed the hospital for the infection. "I hope they can find a cure and pay the cleaners more so they clean the hospital properly," she said.
Sher added: "Luke had no symptoms or anything. As far as they were concerned he was just a normal healthy baby. There was no warning at all."
Luke's grandmother Cathy Day, quit her job as a family support worker at the hospital in disgust.
When the family went to sign Luke's death certificate they were shocked to find there was no mention of MRSA. They refused to sign the certificate until it had been changed.
A spokesman for Ipswich Hospital said: "Our biggest priority is is to minimise the risk to patients from MRSA and other infections through stringent cleaning and hygiene in all areas."
A Department of Health spokesman said: "MRSA rates are falling - they're at their lowest level since recording began in 2001.
"We've introduced a number of measures, but we're not complacent and there's still more to do."

http://www.sky.com/skynews/article/0,,30000-13318199,00.html

Data protection promise broken

Privacy fears over NHS database- there are fears patients will have no say over what details are stored. A new NHS computer database may threaten the privacy of patients' medical records, the BBC has learnt.
A senior Department of Health civil servant said people would not be able to decide what details are stored.
Critics say this goes against earlier government assurances that patients would be able to veto the information.
The DoH said people can still discuss with their doctor what details are recorded and control who can access them - except in an emergency.
The database, which is being installed as part of the NHS's £6.2bn IT upgrade, allows staff to access medical records wherever someone is treated.
Experts have warned the final cost of the system could hit £31bn.
Phil Walker, the DoH's head of digital information policy, made the privacy claims in an email to a Warwickshire GP.
The BBC's Andrew Hosken said Mr Walker stated patients do not have any right to determine what information is recorded about them by doctors, or to veto how it is recorded.
" I believe very few people will opt out of the records" John Hutton
The British Medical Association said this appears to contradict earlier ministerial assurances that patients will be able to withhold sensitive information from the database, to be introduced later this year.
Health Minister John Hutton has said patients would have the right not to have their medical records stored electronically at all.
A second option of sealing the most sensitive data in an "electronic envelope" for use only in emergencies is also being offered.
However, Mr Hutton said: "I believe very few people will opt out of the records. I hope and believe that patients will want to be part of this because it will help to save people's lives."
Richard Granger, director general for NHS IT, said the scheme was more secure than the old paper records system.

http://news.bbc.co.uk/1/hi/health/4392555.stm

Milburn scan deal hurting NHS

Labour orders MP to keep quiet over Milburn scan deal. The Labour Party has attempted to gag one of its own MPs who strongly criticised a £90 million deal between the NHS and a private health company linked to Alan Milburn, Labour's general election supremo.
Kevan Jones, the MP for North Durham, was rebuked by local party officials after revealing that patients from his constituency were being sent 20 miles for private MRI scans, even though their own local hospital had a machine standing idle.
Mr Jones came out strongly in support of John Saxby, the chief executive of the University Hospital of North Durham, who complained about the purchase of scans from Alliance Medical, while his own NHS scanner was "considerably under-employed".
The row originally appeared to be little more than a local furore. However, it led to serious concerns in the higher reaches of the Labour Party because of the links between Alliance Medical and Mr Milburn.
Mr Milburn was paid £30,000 for a six-month stint as a consultant to the venture capitalists Bridgepoint, which owns Alliance Medical. While he was on the company's books, during the period between his departure as Health Secretary in 2003 and his return to the Government last September, the £90 million scanner deal was signed.
The contract was announced by John Hutton, the health minister and a close friend and former flatmate of Mr Milburn.
Mr Saxby originally wrote to Mr Jones, claiming that money poured by the Government into the private sector with the aim of reducing waiting lists, could have been better spent on the NHS.
Mr Jones went public with a furious assault on the policy of private-sector involvement in the health service, which had been championed by Mr Milburn when he was Health Secretary.
He described the situation that saw patients told to travel 20 miles to a hospital in Middlesbrough as "frankly ridiculous" and warned ministers to put their plans for a greater private-sector involvement "to one side".
He added: "If it is the case that the zeal of certain people in the Government to continually push the boundaries of the private sector in the health service has led to a poor service for my constituents, then I think it does need a closer examination."
His comments, The Telegraph understands, provoked a telephone call to the MP from a Labour Party official demanding an explanation and warning him that they should not be repeated.
Mr Jones last night refused to comment on the revelation that Labour had tried to lean on him. However, he insisted that he would continue to ask ministers questions about the scanner deal.
He said: "There are a lot of questions to be answered. I can't believe this arrangement is in the interests of patients in my constituency or anywhere else."
In total, he has tabled 20 parliamentary questions to health ministers.
While he was out of office, Mr Milburn had to manage without his former £71,433-a-year minister's salary. However, he made use of his extra spare time to earn £85,000 from speeches, articles and advice, including his Bridgepoint role.
Since his return, with the official Cabinet title of Chancellor of the Duchy of Lancaster, he has been paid £130,347 a year, a figure that has provoked a political row. The Conservatives argue that the taxpayer should not have to fund Mr Milburn's salary because he is engaged almost exclusively on Labour Party, and not Government, business.

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/03/27/nmilb27.xml

750,000 UK flu pandemic deaths predicted

Mortuaries and emergency services are to be put on alert and told to prepare for up to three-quarters of a million deaths from a bird flu pandemic, The Independent on Sunday can reveal.
Emergency planners have begun to look for sites for special mortuaries, each capable of storing 1,000 bodies, and the Home Office is to hold an exercise this summer to practise coping with mass fatalities. The instruction, to go out from the Civil Contingencies Secretariat, the Cabinet Office body in charge of emergencies, explodes the Government's public position that the pandemic could be expected to kill only "around 50,000" people in Britain.
It shows that its true expectation is closer to the prediction made by Professor Hugh Pennington, the president of the Society for General Microbiology, in The Independent on Sunday two weeks ago that up to two million Britons could perish. The Secretariat also believes that a quarter of the country's workforce could fall ill, paralysing economic life.
A senior government official told a private seminar in London last week: "It may be somewhere between 20,000 and 750,000 extra deaths and it may be 25 per cent of the population off work. That is the shape of the event we are going to have to deal with."
He added that plans had been drawn up to confirm that emergency services and coroners had the staff and equipment to cope with such a crisis. Senior emergency planners said last week that they received official instructions at the end of last year to prepare for mass mortuaries to cope with a flu pandemic or a biological terrorism attack.
They said that most police authority areas normally had emergency mortuaries to hold 100 to 200 bodies, but they had now been asked to make provision for up to 1,000.
The authorities were now identifying greenfield sites and beginning to enter into contracts with firms to provide marquees and buildings to put on them. The planners said that these would be cooled to about the same temperature as household refrigerators, to store bodies.
The scale of the preparation suggests that the Government fears that the 14.6 million doses of anti-viral drugs it has ordered may not arrive before a pandemic. Even in a year's time, less than half of the order will have been met. The drugs have been delayed partly because ministers waited for months before making the order.
Last November an official flu exercise involving health bodies, emergency services and government - Exercise Icarus - identified the lack of anti-viral drugs as a key concern. The order was placed this month.
Dr John Simpson, of the Health Protection Agency's emergency response division, said the Government was planning more exercises, including preventing public gatherings, to stop the disease spreading.
Senior officials at the World Health Organisation (WHO) told the IoS that they predict the flu virus could circle the globe within two months.

http://news.independent.co.uk/uk/this_britain/story.jsp?story=624058