The must read stories and analysis from Wednesday

Cyber carrots and sticks

The government has finally responded to Dame Fiona Caldicott’s report on data security and opt-outs, essentially agreeing with all her recommendations.

The response is a jumble of new commitments (and reshashed old ones) on everything from giving patients access to data audits, to purging old technology, and new legislation to punish “reckless” data controllers.

Not surprisingly, the response leans heavily towards cybersecurity in the wake of the WannaCry ransomware attack, which infected at least a fifth of NHS trusts.

The carrot is an additional £21m of capital funding for trusts with major trauma centres to urgently improve cyber-resilience.

The stick is new obligations on boards and chief executive to prove their digital credentials, and regulator intervention when they fall short.

Expect NHS Improvement and the CQC to be asking tougher questions about unsupported software, staff training and resilience.

The response is a little more vague when it comes to the second pillar of Dame Fiona’s report, consent and patient opt-outs.

There will be a new national opt-out system, allowing patients to not share identifiable data beyond direct care, but it is not yet decided how it will work in practice. This will be subject to further consultation.

That leaves a lot of questions to be answered before the system is up and running in March.

Responses to the proposals are so far broadly, if tentatively, positive. Dame Fiona welcomed the response but said she did “not underestimate the challenges of this implementation”.

MedConfidential, a stalwart critic of the government’s last disastrous attempt to share patient data, said its first impressions were “cautiously positive”. “We hope lessons have been learnt, so we don’t end up back here in another four years,” the group said.

‘Perverse in the extreme’

East of England Ambulance Trust faces accusations of increasingly putting patient safety at risk over the last 18 months because of a “fixation” with hitting response time targets.

Senior local paramedics, Unison and former health minister Norman Lamb have all raised concerns. Their accusations appear to be supported by previously unpublished internal trust data, seen by HSJ.

North Norfolk MP Mr Lamb said the trust was “at risk of chasing a target, rather than improving patient care”, which was “perverse in the extreme”.

A senior local paramedic said “care, patient safety, and patient dignity [were] being really badly compromised” and in the past 18 months the situation had become “as bad as I can remember in decades”.

They said the trust, which insisted it “did not put targets before safety”, had increasingly used a practice referred to as “stopping the clock”, which HSJ understands other ambulance trusts are moving away from, and national leaders want to stamp out.