How dare you take the liberty to use my information in that way!

I thought this issue was most relevant for my latest blog – we may never hear the end of the issues surrounding the ‘News of the World’. I want to relate privacy of my healthcare record to my own general experiences – starting with two scenarios.

1)      I recently went to a closing down sale at a furniture shop (Dwell) who took my name and address. I was told by the assistant that this was because it’s a sale item and the shop insists on knowing who sale items have been sold to. Two weeks later I started receiving magazines and special offers by post.

2)      When I sign up for a social network site (this could be Facebook, LinkedIn or some other website) I get asked whether I want my information to be public, partly shared, private or whether my profile is completely hidden so that others cannot find it.

Both, in my mind, are core examples of why privacy is so important: choice. 1) I may never shop at the furniture store again because I wasn’t given the option of opting out and my information has been misused and 2) I have a choice of who sees my information on a social site.

The same applies in the NHS – I want to be assured that my information is safe in the hands of the data controller and any decision to use it or share it I want to be aware of. This brings me to another reason for this blog, is a recent Information Governance query I received about using and giving out sensitive information: I don’t believe there can be a rule book for this issue but it’s a question of where you draw the line.

Let’s take some more examples:

1)      When I was teenager I spent time in and out of hospital for Scoliosis surgery. I don’t mind if the clinical (sensitive) information is shared to help with other cases but I want to be informed that this is the case

2)      Taking the above example: If during that time I wanted a parent to make or cancel an appointment I would be happy if the hospital allowed this as I find it unlikely that someone would go to the effort to maliciously cancel an appointment of mine.

a.       Besides, this person should know my consultant, my condition and its time for the administrators assurance

3)      Again, taking the above example, if I call to book an appointment and the administrator tells me I cannot have an appointment in a weeks time because I’m booked in for an appointment at the sexual health clinic I would be somewhat unhappy that my information had been shared inappropriately.

We must remember that the patient needs to know when information is shared and consent to it because they have the right to that choice.  Staff across the NHS making the right decisions doesn’t fall down to a need for this to be ‘spelled out’, it’s a training issue about process and interpretation of policy - the difference between what isn’t and what is sensitive information being one key part of that understanding.

I imagine that one of the reasons for patients to have their own record is to give a sense of trust that they are in control of their information. My point is to say that with a combination of robust training and robust process the culture of the organisation should reduce the risk of a privacy breach and win the trust of patients because employees understand the sensitivity and value of the information they are in control of.

Improving the quality of Imaging Services

I recently came across a paper on the NHS Improvement website about delivering a Quality Imaging Service for Children across the NHS. When thinking about changing the service model of the NHS to ensure that there is no variation and every patient gets equal treatment this paper is directly realted- it raised a number of interesting points about the Imaging Service:

• There is a shortage of professionals in the area of paediatric imaging – at the time the paper was written there were three major hospitals without paediatric radiology consultants
• There is no incentive for radiographers to specialise because there is no formal career structure in paediatric radiography
• Much of the routine, emergency and trauma work takes place in DGH’s with variation in levels of expertise and support offered from specialist centres
•  A review of children’s imaging services finds it “necessary to balance the need for local imaging, with the need for an integrated service offering specialist support and expertise, which may not necessarily be provided local to the patient’s home."

The paper continues to discuss a potential model of serv ice delivery across three levels, ranging from level 3 being a service that provides the minimum plain radiography and ultrasound (essentially a satelite imaging dept.) to level 1 being a service located in a children’s hospital/major teaching hospital providing all possible modalities and services. The key to such a model is the networks between the three layers – communication is vital and the children’s hospitals should provide that expert support when needed (IT links are also essential).

It’s also worthwhile noting that this service delivery model is similar to one that can work for paediatric pathology across a geographical area. The concept of having a specialist paediatric laboratory that offers a number of specialised (and expensive) tests is similar to that of level 1 of the Imaging Services model for Children. The lab will also offer support to a laboratory in a DGH, which will perform a number of less specialised tests on children (similar to levels 1 and 2). The model is an interesting one because it encourages networking and improves quality and (potentially) cost as specialist work is only performed by few hospitals with the expertise.

My next question is how much data is available about Imaging Services for Children and what the next steps will be. I think it will be an interesting space to watch.

Quality should always be at the core

Recently I was able to attend an Intellect (intellect.co.uk) event held in Fleet Street, London with Jim Easton (National Director for productivity and efficiency) speaking. It was made clear that the NHS cannot sustain itself with current funding levels and £20Bn is the ‘qualified estimate’ of how much needs to be saved, recurrently, between now and 2015. It’s a huge task ahead and Jim Easton has to lead one of the toughest challenges to face the NHS in England – it was noted by Jim that mental health services have changed radically for the better in the past 30 years and acute trusts now have 4 years to achieve the same effort – a very valid point.

With that thought I have two observations to make:

Firstly,

It’s absolutely vital to note that quality should always be at the core. The statement “cutting costs puts services at risk of poor quality” – I don’t doubt it one bit. I think in projects it wrongly comes down to the separation of cost and quality – I think sometimes it’s easy for there to become a disconnect because a new cost improvement has been defined and although quality is always considered at the start it doesn't necessarily get discussed in project monitoring – if something starts late it’s the finances that suffer and they become more prominent. Quality metrics are challenging to define but they are needed to report on.

If a new project to improve the services offered by the Trust is delayed it:

1. Puts the financial plan at risk
2. Takes away the opportunity for the patient to receive a service of better quality during care/treatment. This may mean a shorter stay in hospital, one less visit to the phlebotomist or fast referral to the correct specialist.

Secondly,

I’ll start by pointing to page 4 of this article:

http://www.health.org.uk/public/cms/75/76/313/577/Rising%20to%20the%20challenge.pdf?realName=mcy7Hg.pdf

The article refers to evidence found by The Health Foundation on whether increasing quality saves money. It identifies that poor quality is common and costly but says complex organisational change offer great potential for savings but there is risk of failure. The reason for less evidence is obvious – its change which requires engagement of stakeholders from possibly multiple organisations, the risk of failure is high (as identified), it’s hard to meausre the improvement and it’s a tough project/programme management challenge. These are all factors that can be addressed with the right skills and this change is possible – pathology is an example area of where huge savings are possible.

Changes in areas which improve the clinical service also stop protesters on the street because of cuts to front-line services; questions like-

• Does the patient need that pathology test or MRI scan?
• Does the patient need to be in hospital this long (http://www.hsj.co.uk/news/primary-care/discharge-delays-questioned-after-patient-deaths/5025224.article)?
• Do we need to pay that much for this special drug?
• Can we improve the scheduling of this service to reduce cancellations?

Some of these ideas and more are mentioned here: http://www.bmj.com/content/341/bmj.c7239.full

Happy new year

All the best for 2011. Happy holidays!

Steve