The doctors' union claims that England's medical records database is being pushed through too fast, with details sometimes being uploaded without patients' knowledge. But those behind the new system say many patients are astonished that hospital doctors still do not have access to basic information, and the process to opt out is very straightforward. What are the issues?
Doctors leaders have called for a halt in the development of a medical records database for patients in England. The British Medical Association says the computer-based Summary Care Records are being set up at "break-neck speed", sometimes without patients' knowledge. Ministers have expressed surprise at fears of fast change after previous criticism that it was moving slowly. The NHS IT upgrade will link more than 30,000 GPs to nearly 300 hospitals through an online appointments system. It will also feature a centralised medical records system for 50 million patients, e-prescriptions and faster computer network links.
At least 100,000 non-medical staff in NHS trusts have access to confidential patient records, claim campaigners. Big Brother Watch, who based the figure on 151 responses from trusts, said it demonstrated "slack security". The group says hospital domestics, porters, and IT staff are among those with access to records in some trusts. The Department of Health says the report muddles paper files and the newer electronic systems for which access will be strictly controlled. Big Brother Watch asked every NHS Trust in the UK for the number of their non-medical staff who had access to confidential patient records.
Checklists that spell out exactly how to care for patients with common conditions have dramatically reduced hospital deaths, say doctors. The British Medical Journal reported a 15% fall in the number of people who had died at one north London hospital trust using so-called care bundles. These are checklists covering dozens of conditions including strokes, heart failure and MRSA infections. The researchers said death rates could be "halved" using the system.
This article examines the implications for patient care, and for the future of rationing within the NHS, of the recent decision to permit NHS patients to supplement their care by paying for medicines — mainly expensive new cancer drugs — which are not available within the NHS. The starting point is the recommendations of the Richards' Report and their implementation through new guidance issued by the DoH and NICE. Practical challenges arise from the insistence upon the 'separate' delivery of self-funded medicines, and more flexible cost-effectiveness thresholds for end of life medicines may have repercussions for other patients. While undoubtedly part of the trend towards explicit rationing, top-up fees might also represent a significant step towards regarding the NHS as a core, basic service. Finally, the issue of top-up fees is located within the broader context of current cancer research priorities and persisting health inequalities.
GPs are considering whether to abandon their involvement in a scheme to put medical records on a computer database. BBC News understands that talks are continuing to try to make it easier for patients to opt out of the system. Thirty million people in England have already been formally contacted about the computer record. Health ministers from the coalition government insist the rollout will continue.
Although the number of patients seeking treatment elsewhere in the European Union is small,3 this could easily change, especially if people are faced with growing waiting lists or other forms of rationing as the new groups seek to control their budgets. British residents have had the right to obtain treatment in another EU country since 1971.4 Initially, the opportunities were limited mainly to people who fell ill when abroad or, less often, when the NHS agreed that there were good reasons for patients being treated abroad (for example, a citizen of another country resident here returning home to give birth
Patients in England will be able to inspect and correct their NHS and social care records online from 2015 if the coalition government’s vision for the use of IT in the NHS becomes reality.
National efforts to improve care at the end of life should be speeded up to maintain the progress made in some parts of England, it has been claimed. The health policy think tank the King’s Fund has warned against a loss of momentum on England’s end of life care programme in a new report published this week and has questioned the government’s intention to leave a review of this area until 2013. Around 500 000 people die each year in England. More than half (55%) of deaths occur in hospital and only 20% at home. The government has said that several surveys have shown that most people’s preference is to die at home.
The medicines watchdog, NICE, is to lose its power to turn down new medicines for use on the NHS. It will give advice on which drugs are effective, but will not decide whether patients should be given treatments their doctor recommends, the Department of Health has confirmed. Instead, groups of GPs will decide whether a drug should be funded or not. Ministers hope to make new drugs affordable to the NHS by negotiating with pharmaceutical companies on price. The plans, called value-based pricing, are set to come into effect in 2014. They are subject to consultation.
All new IVF treatment will stop in Surrey as the NHS tackles a deficit this year of £125m. The board of NHS Surrey met in Cobham on Friday to look at how to tackle "serious financial challenges". A spokesman said current courses of IVF would continue and women nearing 40 would still be considered, with IVF policy to be reviewed next November. NHS Surrey is also no longer funding some treatments including acupuncture and some cosmetic procedures. Treatments which would no longer be funded included male baldness, facial blushing, tattoo removal and spinal epidural injections for chronic back pain.
The National Institute for Health and Clinical Excellence (NICE) has confirmed there will not be NHS funding in England and Wales for the anti-cancer drug Avastin. It is used to combat advanced bowel cancer and research shows the drug can give an extra six weeks of life. About 6,500 people per year may be eligible for the drug. But the health watchdog argued that at a cost of nearly £21,000 per patient, the drug is just too expensive.
In the recent White Paper, Equity and Excellence: Liberating the NHS, there is a commitment to providing better value from the resources available to healthcare. This requires the NHS to address variations in activity and spend. Such variations indicate the need to focus on appropriateness of care, and to investigate the possibilities that there is overuse of some interventions and that some lower value activities are undertaken. In the Atlas, Right Care presents a series 34 of maps of variation selected from topics which National Clinical Directors and others have identified as being of importance to their clinical specialty. We have worked with a wide range of teams in the Department of Health, Observatory network and primary care organisations to create this Atlas.The Atlas also contains a guide to the tools and data available for analysing health investment.
Hospitals in north Merseyside are planning to use the anti-trespass powers used to ban “hoodies” from shopping centres to shift patients who are blocking beds. NHS Sefton board papers say that from this month patients deemed fit for discharge but who refuse “transitional” care home placements will be given 48 hours’ written notice to make their own arrangements. If a patient still refuses to leave, the hospital could seek a court order for possession of their bed. A well-placed legal source told HSJ the primary care trust’s approach would rely on trespass law, which allows owners to regulate the terms on which visitors occupy their premises.
An investigation is under way into how two transplant patients were given kidneys from a donor with a rare and aggressive form of cancer. The incident at the Royal Liverpool University hospital involved organs from a woman who died at another hospital, and was later found to have had a hard-to-identify disease called intravascular B-cell lymphoma. Both patients had been preparing for live transplants from their sisters but accepted the donor kidneys instead. The recipients are now receiving chemotherapy treatment. Although cancer transmission is a known risk of transplantation among clinicians, the case raises questions about guidance to patients and whether sufficient checks are made. One senior of
NHS Blood and Transplant associate medical director Professor James Neuberger said transfer of malignancy was a very rare occurance but more organs were likely to carry diseases as donors get older. He admitted the scale of the problem was not known. A research fellow has now been appointed to find out how often infected organs are passed on to patients. Professor Neuberger said his first role was to try and get all the data together from transplant centres and then to work out strategies with clinicians to reduce risk.