HSJ Catch Up: Nottingham IT nightmare, Tory party conference, and 'a bully writes'

Digital system in knots

HSJ has revealed “a rather big muck-up” at Nottingham University Hospitals Trust.

Outcry from senior consultants has forced NUH to review its £14m digital patient record system amid fears over patient safety.

Senior clinicians described the system as “unsafe” and a “disaster”. 

In an email chain shared with HSJ, they were scathing of the system, claiming vital records were often missing meaning they had to “guess” why patients were attending clinics.

In one case, an intensive care patient was treated from “memory” because none of their records were available. Another consultant said they were forced to play “medical charades” with patients by asking leading questions to get key information.

The problems stem from the trust’s DHR system, which has cost more than £14m over the last two years. It involves handwritten notes being sent to a private company to be scanned as images, which are indexed and added to a digital viewing system. A survey resulted in 97 out of 100 consultants saying they felt the system was unsafe in its current format. 

Trust medical director Keith Girling said he accepted the criticism and that the system was not working, and the trust would act. 

Hunt’s hits

While Jeremy Hunt’s Tory party conference speech sounded familiar to some observers, there were a few new announcements among the old soundbites.

The longest serving health secretary said the government would create an extra 5,000 training posts for student nurses from next year, an increase of 25 per cent. HSJ understands the commitment would require around £35m of new funding over three years, and that this is likely to be included in the autumn budget following negotiations over the apprenticeship levy.

He also said health workers would get first refusal on affordable housing built on sold NHS land. “From now on when NHS land is sold, first refusal on any affordable housing built will be given to NHS employees, benefiting up to 3,000 families,” Mr Hunt said.

PM confirms mental health review

Former Royal College of Psychiatrists president Sir Simon Wessely has been appointed to lead a review of the Mental Health Act.

The announcement was made by prime minister Theresa May at the Conservative Party conference.

It follows her pre-election announcement in May of her intention to rip up and replace the “flawed” act to tackle the fact that too many people are being detained under the legislation.

The announcement lacked any further detail as to the remit or timescale of the independent review, though HSJ understands it is hoped that it will be completed by the end of next year.

Mrs May’s only hint as to the direction of the review is her statement that detention rates under the act were too high, and disproportionately affected black people.

She has said that she will introduce a new Mental Health Treatment Bill, but what parts of the existing Mental Health Act 1983 will be amended or revised is not clear. 

DTOCs warning

Ministers are set to issue a fresh warning to councils deemed to have made insufficient progress tackling delayed transfers of care, amid a bitter row over the withholding of funding.

Health secretary Jeremy Hunt is due to write to around 30 local authorities. The letter will express disappointment and threaten to nationally direct how the councils use millions of pounds of social care funding next year if they do not improve.

Meanwhile, a separate but overlapping group of 20-30 councils has been threatened with the withholding of funding, potentially running into hundreds of millions of pounds, this financial year. It could be used directly by the NHS to buy care capacity instead.

The letters are expected to say councils’ share of the additional care funding pot, known as the “improved better care fund” – budgeted at £1.5bn in 2018-19 – would stay in their patch, but if they are judged as failing then the government may direct how it is spent.

It is unclear whether the letters will also be signed by a Department for Communities and Local Government.

They will be met with anger from councils, who have had big cuts to their budgets in recent years and believe an unjustified focus is being put on discharge delays at the expense of other care priorities. The Local Government Association has already condemned “the sudden and last minute setting of unrealistic and unachievable targets” for reducing delays.

Stamping out bullying

In an article almost universally described as “thought-provoking” by commenters on hsj.co.uk, retired hospital chief executive Kate Grimes reflects on recognising bullying in the NHS – including in her own behaviour.

Ms Grimes, who was chief executive of Kingston Hospital FT for over seven years, writes: “I was reviewing our updated ‘bullying and harassment policy’ and, as the trust’s chief executive, recognised myself among the behaviours given as examples of bullying. What could be seen as the normal give and take of professional debate among a team of peers became something very different for my staff in the context of my positional power. Particularly among a roomful of their colleagues, my robust challenge could easily become an experience of being bullied. How could I credibly lead the implementation of the policy if I didn’t first change my behaviour?”

She says to “truly change the culture of bullying across the NHS” the system “must tackle the anxiety apparent in the performance management systems desperately trying to drive the delivery of national targets”.