Information Governance (IG)

April 16th, 2011

What is information governance (IG)?

Information Governance is the way by which the NHS handles all organisational information – in particular the personal and sensitive information of patients and employees. It allows organisations and individuals to ensure that personal information is dealt with legally, securely, efficiently and effectively, in order to deliver the best possible care.

It provides a framework to bringing together the requirements, standards and best practice that apply to the handling of information. It has four fundamental aims:

  • To support the provision of high quality care by promoting the effective and appropriate use of information;
  • To encourage responsible staff to work closely together, preventing duplication of effort and enabling more efficient use of resources;
  • To develop support arrangements and provide staff with appropriate tools and support to enable them to discharge their responsibilities to consistently high standards;
  • To enable organisations to understand their own performance and manage improvement in a systematic and effective way.

IG has come about because of concerns about public sector data protection. A board-level Senior Information Risk Owner (SIRO) is required in each organisation for IG.

More info

How do SIRO and Caldicott Guardian differ?

SIRO and Caldicott Guardian should work together.  However,

SIRO

  • Is accountable
  • Fosters a culture for protecting and using data
  • Provides a focal point for managing information risks and incidents
  • Is concerned with the management of all information assets

The Caldicott Guardian

  • Is advisory
  • Is the conscience of the organisation
  • Provides a focal point for patient confidentiality & information sharing issues
  • Is concerned with the management of patient information

NHS White Paper July 2010

August 13th, 2010

Health secretary Andrew Lansley’s white paper on Monday 12 July reflects the Government’s wish to put clinicians and patients at the heart of the NHS, cut bureaucracy and put more power in the hands of frontline staff.

The white paper will have implications for all health organisations in the NHS, particularly PCTs and SHAs, which will be phased out under the proposals.

In the short term, however, SHAs and PCTs will have a role to play in the quality, innovation, productivity and prevention (QIPP) programme. This will continue with even greater urgency, but with a stronger focus on general practice leadership.

Empowering clinicians and GPs

GPs will be handed the majority of the commissioning budget and local authorities will be handed control of local health improvement budgets. Professionals will be free to focus on improving health outcomes so that these are “among the best in the world”.

NHS pay

Under the proposals all NHS trusts will become foundation trusts by 2014 and will have the same rights to set pay locally as Foundation Trusts do now. Pay decisions will be led by employers rather than imposed by the Government and it is recognised that many providers will want to continue to use national contracts as a basis for their local terms and conditions.

In the short term, during the two-year pay freeze, the Government will ask the pay review bodies to make recommendations for staff earning under £21,000 and will consult with employers and trade unions on long-term arrangements.

Healthcare skills planning

Healthcare employers and their staff will determine workforce development and training needs and these decisions will determine education commissioning.  The NHS Commissioning Board will provide national oversight of healthcare providers’ funding plans for training and education and GP consortia will provide this oversight at a local level.

Government consultation

The white paper is the start of an extensive consultation that will take place over the coming weeks. The Department of Health will shortly be publishing a number of consultation documents.

NHS five year plan 2010-2015

June 14th, 2010

The NHS five year plan 2010-2015
NHS 2010-2015: from good to great. Preventative, people-centred, productive
This sets out the NHS five year plan in the context of a new financial era and it is intended to give people working in the NHS a clear sense of direction and time to plan for the challenges ahead. Key aspects of the plan are:
Implementing our vision: a preventative, people-centred, productive NHS
• It is stated that change will be on an unprecedented scale for patients and staff and hard choices about resources and priorities will have to be made, delivering £15-20 billion efficiency savings over three years from April 2011 (£10billion by 2012/13). Savings are identified in the following areas:
o Productive NHS workforce – £3.5 billion
o Reduced management cost, back office support and procurement – £1.8 billion
o Care closer to home and self care for people with long term conditions – £2.7 billion
o Tighter control of the pay bill
• Reference is made to six challenges; ever higher patient expectations; an ageing society, the dawn of the information; the changing nature of disease; advances in treatments and a changing workforce.
• There is emphasis on reform and that this can only be achieved through clinical leadership and a change in current roles for NHS staff. There is commitment to support staff to make the changes necessary to shape services around the needs of patients – more care closer to people’s homes that are better integrated around people’s needs.
The deal for patient and the public
• The legally binding entitlements to staff, patients and the public are now set out in the NHS Constitution. There are 25 rights in the Constitution and a further 2 have been proposed:
o You have the right to access services within maximum waiting times.
o You have the right to an NHS Health Check every five years if you are eligible for one.
• There is acknowledgement that there should now be a shift from ‘diagnose and treat’ to ‘predict and prevent’ and that personalised care can only be realised by tailoring provision with services and organisations working together across traditional boundaries. Changing behaviours will continue through schemes such as Change4Life, NHS Stop Smoking Service and Total Place pilots.
• The introduction of NHS health checks is set to save thousands of lives by preventing
stroke and heart attacks.
• More screening and earlier diagnosis of cancers is planned through increased GP access and modern laboratory medicine.
• The following priority areas for achieving High Quality Services have been identified:
o further reductions in MRSA
o cancer care
o care for stroke patients
o care for those at risk of heart disease
o care for pregnant women.
• For the three interdependent areas of quality, as per Lord Darzi’s vision organisations will be required to:
o Safety. Focus on a wider set of safety challenges, safer care for patients, zero
tolerance of preventable infections
o Effective. Reduce the number of patients who die from VTE and increase prevention of pressure ulcers.
o Patient experience. Expand the measurement of patient satisfaction and for those to be included in Quality Accounts. There will also be a greater
proportion of provider income linked to patient experience and satisfaction – potentially up to 10%)
• There is clear requirement to have more choice for patients and to transform the care for groups of people with the following long term conditions; diabetes, heart failure, respiratory disease (including COPD), cancer as a chronic disease and dementia.
• More local care is seen to be delivered by GPs and community services rather than having to be seen in an urgent or emergency setting.

The deal for staff
• The focus is clinical leadership, collaborative working, reuniting doctors and nurses, managers and politicians and staff flexibility.
• Change needs to be fast moving as good practice cannot be allowed to spread at its own pace. An evidence base of around 70 examples of best available evidence will be used to escalate improvements. Organisations will be supported nationally but locally led. The Trust will be able to drive this through NETS and Service Improvement.
• With regards to pay, future pay awards will need to strike the balance between rewarding existing staff for increased quality and productivity and the need to maintain security of employment by retraining and redeploying staff to meet additional demand. A sustained pay restraint is required. It is recommended that consultants and very senior managers receive no increase in 2010/11 and GP practice income increases are restricted and they need to make at least 1% cash releasing efficiency savings.
• Work is ongoing exploring the pros and cons of offering frontline staff an employment guarantee locally or regionally in return for flexibility, mobility and sustained pay restraint. This may involve staff working in a different place or even a different organisation. The Trust will need to align training plans to support delivery of local clinical visions and new ways of working in support of retraining and redeployment of staff, utilising the new Staff Passport.
How the system will support NHS staff and organisations to deliver
The key levers include:
• Payment systems support improved quality and efficiency
o 0% maximum uplift for next four years (hospitals)
o Increases in payment linked to quality goals
o Incentivising the shift of care out of hospital settings
o Withdrawal of payments when care does not meet minimum standards
• Helping staff through change
o Empower and enable NHS staff to lead change
o NHS will be given the first opportunity to improve
o Commissioners will have a legal duty to secure best services.
• Strengthening regulation, dealing with failure
• Creating leaner, stronger commissioners
o Freedoms and incentives to high performing commissioners
o Poor performers to demonstrate clear and rapid improvement
o Improve information on management costs
o Significantly reduce management costs in PCTs and SHAs (30% over next four years)
o Permit reconfiguration where it leads to greater coterminosity between PCTs and LAs
• Integrating services, supporting high performing organisations
o Reduce variation in quality among primary care providers and practice based commissioners.
o Increase integration of services
o Alignment of incentives so organisations work better together
o Reform of provider services
o Reduce overheads and transaction costs
o Offer rewards and freedoms for high performers
o High performing FTs to expand their services
o Make it easier for high performing trusts to take over poorly performing organisations.
• Streamlining the reconfiguration process
o Further simplification
o Better engagement.
• Driving innovation
o £220 million Regional Innovation Fund
o Development of NHS Evidence
o NHS Life Sciences Innovation Delivery Board to support adoption of clinically and cost effective innovations

Temple report summary: Time for change

June 14th, 2010

Temple report- Time for Training: A Review of the impact of the European Working Time Directive on the quality of training
The report Time for Training was commissioned by Medical Education England at the request of the former secretary of state for health Alan Johnson. The report was instigated in response to the concern raised by many specialties, but by surgeons in particular, that after the introduction of the EWTD it was impossible to ensure doctors in training acquired a sufficient number of hours of supervised and hands-on experience to bring them up to an adequate standard. The report was published on June 9, 2010
The report looked at the impact of the 48-hour week on the quality of the training that is necessary to ensure the continuing supply of a world class workforce which is able to deliver high quality services to patients.

Problems with EWTD implementation:
• The reduced hours have necessitated a move to shift patterns of work in many
Specialties (Any doctor working to a rota that requires them to work different duty times at certain points on the rota can be considered to be a shift worker). Shift working has decreased training opportunities and impacted on trainee experience by reduction in trainer and trainee interaction and lack of continuity of patient care. Although with the reduction in hours there should be less sleep deprivation and better work–life balance for trainees, but shift patterns have possibly decreased the quality of life, as work periods, although shorter, are more frequent, less regular and more antisocial.
• The move to resident shift systems to accommodate the 48-hour week means that more trainee doctors are required to cover the out of hours care if the structure of service cover remains the same. This increased requirement for doctors results in an increase in the number of rota gaps. Recruitment challenges due to changes in immigration law have compounded the difficulty in fillings gaps. Rota gaps result in trainees being moved from their daytime, more elective training often at very short notice to fill service gaps. These are usually out of hours where there is minimal supervision and therefore less training opportunity. This results in the trainee missing out on the planned training that day and often the next due to compensatory rest. Although many rotas are compliant with 48 hours on paper, rotas have gaps.
• Rigid, poorly designed rotas result in trainees being unsupported and unsupervised.
• The impact of EWTD is greatest in specialties with high emergency and/or out of hours workloads

Recommendations
The report recommends that high quality training can be delivered in 48 hours. Any current problems will not be solved by either increasing hours or lengthening training programmes, says the report, which shows that despite an increase in consultant numbers of more than 60% over the past ten years, hospitals remain too reliant on junior doctors to provide out of hours services. There is a total of over 15,000 hours available to trainees working a 48-hour week in a seven-year training programme, but these are not all being used effectively for training.

It recommends the following to achieve high quality training within EWTD:
Implement a consultant delivered service: Consultants must be more directly responsible for the delivery of 24/7 care. The roles of consultants need to be developed for them to be more directly involved in out of hours care.

Service delivery must explicitly support training: Services must be designed and configured to deliver high quality patient care and training. Reconfiguration or redesign of elective and emergency services and an effective Hospital at Night programme are two of the ways in which healthcare can be changed to support training and safe services

Make every moment count
• Training must be planned and focused for the trainees’ needs
• Trainers and trainees must use the learning opportunities in every clinical situation
• Handovers can be an effective learning experience when supervised by senior staff, preferably consultants
• The co-ordinated, integrated use of simulation and technology can provide a safe, controlled environment and accelerate learning

Recognise, develop and reward trainers
Consultants formally and directly involved in training should be identified. • They must be trained, accredited and supported.

Training excellence requires regular planning and monitoring
Commissioner levers should be strengthened to incentivise training, ensure accountability and reward high quality and innovation

Resource for consultant application in Scotland

October 8th, 2009

Very useful info for those applying for consultant jobs in Scotland. BMA have put together a page of resources.

BMA Scotland resource for those applying for Consultant jobs

New GMC guidance

September 27th, 2009

GMC tomorrows doctors- new guidance

Student Assistantship is a new concept introduced.
This basically means that medical students (particularly final years) will learn by doing things that doctors are doing now. They’ll be supervised but they’ll be doing more hands on stuff during their final year.

Tricky ethical scenarios- interactive case studeis

September 27th, 2009

The GMC has launched a series of challenging online tutorials that tackle tricky ethical scenarios.

Visit the interactive case studies at www.gmc-uk.org/guidance/case_studies/index.asp and try them for yourself.

Useful for ethical questions at interviews

GMC- New confidentiality guidance

September 27th, 2009

Doctors in the UK should tell police every time they treat a victim of gun and knife crime, new guidelines from the General Medical Council will state.
They are also told they can breach patient confidentiality by giving police information if they believe a crime has or will be committed.
If a patient is diagnosed with a genetic disease doctors will be able to tell relatives, without consent.
The revised guidance on confidentiality will be published on 28th Sep 2009……BBC

I agree in principle.

Origins of Consultant Medical Interview

July 24th, 2009

I have been a fulltime consultant for almost a year now. I work in a semi-urban hospital somewhere in the north of Great Britain.  I write this to help trainees prepare for their specialist trainee or consultant interviews. I know interviews can be overwhelming especially with the conflicting advice often received.

What led to the site? Well, I was talking to a lot of my colleagues and friends regarding interview preparation on the phone. My wife was displeased (to put it mildly) about these long phone calls. The site was borne out of her suggestion to put my interview folder on the hard drive on the web. So here it is! The blog is an attempt to debate current issues and keep the site uptodate.