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Health & NHS

After NHS restructuring, the Better Care Fund is a real step change – or is it a leap in the dark?

First year report on the coalition government’s major NHS shake-up – part two

The NHS is about to begin yet another major change in direction.  April 2014 sees the inauguration of the coalition government’s Better Care Fund (BCF) which will put NHS money into social care in a bid to reduce the NHS’ fast rising costs – largely fuelled by the ever increasing age of the population and the complexity of long-term illnesses.

The size of the problem is best seen in numbers: in Wiltshire the over 65s make up 21.8 per cent of the population.  But, Wiltshire Clinical Commissioning Group (CCG) reckon they use 47.4 per cent of the health services the CCG commissions.

Or, to put it another way, the CCG’s annual spend per head of Wiltshire’s 479,992 population is £1,023.  This increases to £1,600 for those between 65 and 74, to £2,917 for those between 75 and 84, and to £4,913 for those over 85 years old.

Wiltshire's Better Care Fund planWiltshire's Better Care Fund planThe BCF aims to reduce these costs by providing better social care for the ‘frail elderly’ in their own homes, treating them locally and avoiding inappropriate admissions to hospital.  And if they do have to be admitted it wants to make their length of stay shorter.

The basic means to those ends is the close integration of social care (the responsibility of the Council) and health care (the responsibility of the CCG.)  

The Fund was originally given the descriptive title of ‘Integration Transformation Fund’, then political spinners re-christened it with an aspirational title: ‘Better Care Fund’ – more like an election manifesto headline.  Will it deliver what it aspires to deliver?

In 2014-2015 the BCF will start with modest pots of money – Wiltshire’s will be £22.37 million some of which will come from the CCG’s budget.  In the first year, this money will be used “as a catalyst for stimulating integration of health and social services.”

For 2015-2016 Wiltshire’s BCF pot will rise to £29.51 million.  The money will only be available once each local authority-and-CCG has a jointly agreed plan that is approved (by ministers) detailing how the fund will be used.

The BCF will rely on projects and commissioned services agreed, planned and run jointly by the CCG and the Council acting under the Wiltshire Health and Wellbeing Board (HWB) which was set-up under the Lansley reorganisation.

There is one somewhat grey area: some of the fund will be allowed to fund mandatory changes brought in soon by the Care Bill (now before Parliament.)  And at least one CCG has agreed that it should fund existing social services on the grounds that they come under ‘preventative health measures’.

The BCF’s budget will not be new money.  So where is it coming from?  The BCF will largely be funded by ‘top-slicing the CCG’s annual budget’.
In Wiltshire it will mean the CCG surrendering – or ‘top-slicing’ – £15.52 million from its budget for 2015-2016.  This will go into the pooled budget together with existing council social care funds.

While this sounds eminently sensible and laudable, there are four main risks around the BCF.  

The first is that the CCG top-slicing will in fact come totally from the budgets of the foundation trust hospitals like the Great Western Hospital which would further destabilise this vital part of the NHS’ cradle to grave treatment regime.

When a Wiltshire Council committee examined the Council’s budget for 2014-2015, they delivered this analysis of the BCF: “The funding …will be drawn from the acute hospitals in the form of top slicing three per cent from their budgets to streamline services and form a centralised system aimed at providing more community care.”

If that becomes the norm England’s already struggling hospitals could become endangered species.  And when frail elderly people – not to mention other patients – are too ill or their condition too complex to be treated ‘close to home’, will there be beds and expertise left in the acute hospitals to treat them?

De-stabilising the acute hospitals is something that Wiltshire CCG’s finance director, Simon Truelove, has been warning against during the past year.  All the BCF money is going to social care and community health care – there is no money in the fund to bring about the necessary changes in our hospitals.

At the March board meeting of NHS England (NHSE), its chairman, Sir Malcolm Grant, gave a stark warning about the BCF: “I think this is one of the most challenging and daunting things that lies ahead of us…I think it carries very high risks.”

NHS England's Jane CummingsNHS England's Jane CummingsNHSE’s Chief Nursing Officer, Jane Cummings explained the BCF’s inherent risks: “We anticipate that emergency activity [in hospitals] will need to reduce by about 15 per cent.  There will be a massive risk if we continue to have the same system of patients in hospital and try and create this fund…there is quite a lot of risk associated with this.”

Where the BCF will show bright red on NHS risk registers is over the inevitable time lag between the steady build-up of relevant social services resulting in the promised “better care”, and the withdrawal of funds from acute hospitals leading to a swift reduction in their capacity.

The Wiltshire BCF plan lists seven areas of risk and they are all rated as ‘high’. The risk of destabilising hospitals is not among those risks – that is somebody else’s risk.

Outgoing NHS chief Sir David Nicholson warned the board meeting about the consequences of missing that 15 per cent reduction target:  “We’ve never quite done it in that way.  If we can’t do that we have to get hospitals to provide not [the existing] four per cent efficiency, but eight per cent – which I think is simply impossible.”

Or as one commentator put it: “Top slicing CCGs is fine, but there is the risk that the benefits of community oriented integrated care conforms to a longer timetable than that of the loss of funding created locally.”

Julie Jordan of the law firm Mills and Reeve, who specialises in health matters both NHS and independent, calls the BCF an “effective cut in the acute care budget” and she identifies another hurdle in the process of setting up the BCF.

This second risk stems from the change in CCG’s spending which will have to take place:  “The mechanics of extracting such a large amount from acute service contracts must demand a degree of service reconfiguration, so we should expect to see a raft of public consultations on proposed service changes in the months leading up to April 2015.”

“Won’t that be jolly when it coincides with the final months of the current parliament, as we head for a general election on 7 May 2015?”  (The Secretary of State’s new powers in Clause 119 of the Care Bill [see the third article in this series] may pre-empt any consultation.)

The third risk is that the money transferred from the CCG and from other NHS budgets will not be ring-fenced when it reaches the new pooled pot and may not be used only for its agreed purposes.

Ms Jordan, writing in the Health Service Journal, believes new legislation will be necessary to ensure ring-fencing is robust. And NHS England’s deputy chairman, Ed Smith, warned against “the diversion of money into other activities.”

And this brings us to the BCF’s final risk factor:  it is being overseen locally by the HWBs which are committees of local authorities and very new, untried institutions.

Wiltshire’s HWB is chaired by the Council’s leader, Jane Scott, with the Chair of the CCG, Dr Steve Rowlands, as her deputy.  It now meets in public and is responsible for the broad strategy for health and social care provision within the county.

But the CCG retains legal responsibility for the services it commissions.  If it sees money from its allocated budget going into social care services it does not rate or which are non-health social care services, sparks may fly.

Julie Jordan again: “Some CCGs have already expressed concerns that the pooling of budgets will in effect result in the NHS subsidising non-health social care services.  Not exactly the health and social care ‘happy families’ the government intended.”

MPs have called for HWBs to have a greater role in the move to integrated care.   The Commons health committee’s chairman, Stephen Dorrell, said HWBs should become “commissioners of joined up health and care services.”

But the committee also said that without ring fencing of social care funds, “…there is a serious risk to both the quality and availability of care services to vulnerable people in years ahead.”

Ed Smith again: “We are reliant on the HWBs.  I think the jury is out at the moment on whether they are sufficiently robust to be able to provide the assurances we need.”  

It should be noted that at the March meeting of the Wiltshire HWB Jane Scott said: “I don’t think it’s going to be easy – it’s going to be quite challenging for all of us.”  And she added that she was disappointed the BCF was restricted to the frail elderly.  She wanted to include disabled adults and children and mental health patients.

The outline plan for Wiltshire’s BCF had to be drawn up in a great hurry to meet government deadlines.  It already carries a list of seven risks rated ‘High’ with an outline of measures needed to mitigate those risks.

According to an NHSE executive the Wiltshire BCF plan has been “very well received – as being people centred.”

In its section on ‘Integration Aims and Objectives’ the glossy covered plan includes 17 principles for the integrated plan.  They include principles of very great interest to everyone in the county:

•    “Our principle: we will shift our services from being paternalistic to ensuring that services are designed for and with the people who use them.
•    Our objectives for integration: People will be involved in the redesign of integrated services.
•    Our measures: patients and service users will be involved in pathway reviews, service specifications and tendering.”

Whether it is ‘people’ or ‘patients’ or ‘service users’, Wiltshire Council and Wiltshire CCG are now committed to listen to and consult a very large proportion of the county’s population. We will see over the coming year how they intend to do that.

Marlborough News Online will be reporting on the specific projects the BCF is providing for Wiltshire.

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For the NHS there’s no escape from perpetual change - and uncertainty

First year report on the coalition government’s major NHS shake-up – part one:

A year ago root and branch changes in the NHS’ structure – embodied in the coalition government’s Health and Social Act - came into force.  

Having promised in the coalition agreement there would be no more top-down NHS reorganisations, the coalition allowed Andrew Lansley free rein – given a few bumps along the way – to embark on the most radical NHS reorganisation since 1948, re-shaping most of the national service’s institutions.  

At the important level of commissioning of health services for Wiltshire, out went the Primary Care Trust (PCT – known as NHS Wiltshire) and in came Clinical Commissioning Group (CCG – known as Wiltshire CCG) designed to be run by doctors from the county’s 58 general practices.

The respected NHS Managers blogger, Roy Lilley, reported in March on ‘the mood music I hear from Number 10’: “Lansley’s reforms have been a disaster; they have to be fixed by 2015 and competition isn’t going to help.  The only issue is money.”

At their March Board meeting, Wiltshire CCG were very upbeat about their progress and achievements.  Their chairman, Dr Steve Rowlands, declared they had in their first year made significant achievements and were “On the brink of a very exciting time for the CCG.”  

They certainly achieved a good financial result ending their first year spot on budget with a £5 million surplus put away for even rainier days – unless (see below) it is snaffled by the Treasury.

Two of the coalition Act’s aims were to increase transparency and decrease ‘bureaucracy’ and its cost.  The former simply has not yet happened at the local level.  

And in Wiltshire the latter certainly did not happen – the cost of running the CCG is significantly higher than for the PCT which had a considerably larger share of the budget and of commissioning to administer.

The Wiltshire CCG chose to organise itself into three ‘locality’ groups – the one covering the Marlborough area is “NEW” (for North and West Wiltshire.)  And a continuing problem is that these localities meet in private and give only fairly broad reports to the CCG’s (public) board meetings.

One year on the Lansley NHS at our local level looks much like the mirror image of the proverbial swan – beneath the surface the CCG is quietly paddling away at their task of re-shaping primary care services to GPs’ design plans.  

To absurdly tight timetables from the top, they have produced strategic plans for two years, five years and for the Better Care Fund [see Part Two]. And they are working closely with Wiltshire Council on joint commissioning plans.

Above the water there is some chaos and turbulence which will have distracted some CCGs.

First there was the NHS 111 debacle.  This was a government wheeze to save money by scrapping the NHS Direct telephone service and substituting it with a cheaper model for non-emergency inquiries.

Problems with the system were so great that in most parts of the country the introduction of the service was delayed until it was safe for people to use.  NHS Direct which had successfully bid for some of the contracts said the model was economically unsustainable and walked away from their contracts.

For Wiltshire, the contract holder was the private company Harmoni and the service was supposed to go live in April.  It took until October 28 for the CCG to accept the NHS 111 was safe.

In the process Wiltshire CCG had to pay out an extra £590,000 to support the service – all but £200,000 of this should be reclaimed from other CCGs using this Harmoni contract.

After NHS 111, the Department of Health now has another crisis on its hands.  The introduction by the newly formed Health and Social Care Information Centre of the care.data scheme was so badly bungled that its introduction has been delayed by six months.

This scheme will upload all medical records held by GPs into a central data bank - giving researchers access to all the pieces of the health care jigsaw.

The information will be anonymised at various levels so it can be used for researchers trying to design new drugs and treatments.

It has still not been made clear exactly who can access or buy information from these records.

The phrase that has been put forward is that release of information will only happen where there is a “clear health benefit”.  But, opponents of the scheme say, that could surely provide a criterion for any private insurer or health provider to gain access to the data.

In addition doubts over the ability of the NHS to prevent leakage of personal information remain a problem for care.data.

Hovering over the post-Lansley landscape has been the spectre of further and further privatisation of the NHS.  The debate about which services must be subject to open tender (costing the CCG a great deal of staff time and money) is still going on and will run well into 2015 as existing contracts run out.

One argument was over the Wiltshire-wide community health care contract held by Great Western Hospital: the Council believe that re-tendering this will disrupt the introduction of the Better Care Fund (see separate MNO report.)  The CCG fear a legal challenge if they do not put it out to tender and has decided it will go out to tender.

Perhaps the picture of the CCG quietly paddling away beneath all this turmoil is a little too benign.  

Throughout the year, most CCGs have suddenly found holes in their budgets as NHS England scooped up millions of pounds to pay for the specialist services (treatments for rare cancers and other rare diseases) they commission. This was a major deficiency in the coalition government’s reorganisation.

No one thought to define which treatments are specialist services.  Wiltshire CCG lost £2 million in September and now stands to lose another £3.9 million.  Keeping to the agreed annual surplus (as required by the Department of Health) becomes even trickier with this kind of uncertainty.

There have been other problems following the reorganisation.  One neighbouring CCG suddenly found itself being charged by PropCo (the company the Health and Social Care Act set-up to look after all NHS land and property) for the CCG’s headquarters which happened to be owned by Swindon Council.  

In another blow to CCGs’ finances, NHS England has proposed that all England’s CCGs should contribute to a £250 million fund in 2014-2015 to cover any ‘legacy debts’ left over from the PCT regimes – mainly unclaimed, retrospective costs of continuing health care.  

The Wiltshire CCG is putting aside £2 million as its share of this fund.  This will be especially galling for them as they inherited a handsome reserve from the Wiltshire PCT and have been working hard to pay off continuing health care claims.

This proposal goes directly against the promise made by Andrew Lansley that CCGs would not inherit liabilities from previous organisations.  NHS Clinical Commissioners, which represents the CCGs, says the proposal is a “significant concern” for its members.

Wiltshire CCG has been making steady headway in its commissioning plans – particularly in its plan to transform services so more people can be treated at home or nearer to their homes.  One example is the introduction of 23 Care Coordinators across the county to strengthen the Neighbourhood Nursing service and support the Council’s somewhat under-funded Help to Live at Home scheme.

Some of the Care Coordinators are trained in social work, some are trained nurses.  In some ways they foreshadow (or pre-empt?) the BCF – acting as links between GPs and at risk patients.

Apart from some ‘teething problems’, the only reported issue for Care Coordinators in our area is that one of them was given a workload she considered beyond her capacity.

In another innovation, the CCG has made a distinct difference in introducing much faster diagnosis of dementia – now less than four weeks rather than many months under the PCT.  This scheme is costing £600,000 and involves training for GPs.  

The only question to ask is why it took so long for GPs to push for faster diagnosis of dementia in this way.

And in the background is another coalition agreement promise: that the NHS’ annual budget would rise in real terms during the five year Parliament.  Whichever way you cut the figures the NHS is struggling within its tightly constrained budget.

Whether, for instance the budget went up by 0.09 per cent in 2011-2012 or up by 0.02 per cent depends on how and when you view the figures.  What is certain is that the budget has had to cope with the £2-3 billion costs of the Lansley restructuring – with its huge redundancies bill to be followed by many of those paid off returning to NHS employment.

And there have been annual repayments at year end to the Treasury of £1.9 billion (2010-2011), £1.4 billion (2011-2012) and £1.5 billion (2012-2013.)  

This last repayment included provisions made by the outgoing PCTs to pay for those claims for historic continuing health care money.  The Department of Health’s accounts say it was returned to the Treasury to “help in wider fiscal deficit reduction.”

Losing these provisions and having to fund the ‘legacy debts fund’ (mentioned above), local commissioning is being made to pay twice for such costs.

From April 1 another method of funnelling NHS money back to the Treasury comes into force. Changed guidance on old regulations for the VAT payable on outsourced services could lose the NHS £500 million a year.

You can go on adding sums of money that need to be spent and give NHS finance officers more sleepless nights:   the government’s instant reaction to the Francis Report on Mid-Staffs was that student nurses must spend time as healthcare assistants: this may well cost £225 million.

Just as the government has eased private providers’ access to the NHS pension fund, employer contributions will be going up by £125 million.

And then the Care Quality Commission, the health service regulator, asks for an extra £40 million to employ 700 more staff (yes, that is about £57,000 in employment costs each.)  Remember the promise to cut back room staff and push funds to frontline staff?

What is beyond dispute is that the NHS spend as a percentage of GDP is falling – the Office for Budget Responsibility’s chart shows this clearly.  And at least one expert expects there to be an NHS funding crisis before the 2015 General Election.


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Podiatrist offers free foot clinic for Marlborough residents

Podiatrist Emma AnsellPodiatrist Emma AnsellMarlborough residents with troublesome toes are being offered a free health check by podiatrist Emma Ansell this weekend.

Emma, who has been practising chiropody and podiatry for 14 years, will be holding the free sessions at the Marlborough practice of physiotherapist James Hatt & Associates on Saturday (March 15).

Last year, Emma brought her Hollywood-style med-ped treatment. Combining foot care with foot beauty, the treatment has been attracting customers from as far afield as Bath and Gloucestershire.

This weekend, Emma will be sticking to chiropody and podiatry - looking at problems including corns, calluses, verucas, ingrown toenails, fungal toenails, and dry and cracked heels, and advising patients on the best course of treatment.

Emma said: “As the demand for such services increases, accessibility through the NHS can be difficult. I’m seeing patients on a daily basis that have been struggling with their foot conditions for months, and in some cases years, and have been unable to get the appropriate treatment they need or want.”

She added: “I'm passionate about offering a complete foot care service, making sure that it's not just about cutting and filing toenails.

“It's important for each of my patients to understand their current foot health condition and if they have a specific foot related problem, that they are offered support and advice to help them manage their condition.”

Appointments are being offered on a first-come, first-served basis and can be made by telephone on 01380 730473.

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Care.data scheme in chaos as government signals new legislation

NHS England's jigsaw logo for care.dataNHS England's jigsaw logo for care.dataWhether or not you have asked your GP to opt you out of the government’s scheme to provide your confidential medical records now held at local surgeries to researchers and others, or whether you intend to do so soon, the care.data scheme has been pronounced as being in chaos by one of its firm supporters.

Just over a week ago, physician, academic and science writer Dr Ben Goldacre wrote in praise of care.data (generally spoken as care-dot-data.)  At the weekend he was embarrassed, he said, to have to write that the scheme was a mess in need of new primary legislation to ensure it is secure and will not sell information to commercial buyers.

At briefings on Friday evening it was revealed that Health Secretary Jeremy Hunt would announce this week that he will legislate on care.data, but as an add-on to the Care Bill that is currently before Parliament. He will have to hurry as the Bill starts its report stage in the Commons next Monday (March 10.)

However the briefings seemed to come up very short on what critics want.  Hunt said he would prevent data – even when made anonymous – being sold to insurance companies.

But the words used were that data will only be released when there is a “clear health benefit” rather than for “purely commercial” use by insurers and other companies.

This seems to be an empty promise as health insurance companies – like BUPA and the American health insurance companies the government is keen to get involved in the NHS – could easily argue that they needed the data to provide ‘clear health benefits’ for their subscribers.

The Health Service Journal’s version of the Friday briefing was that NHS England was even considering a total u-turn and making the scheme one that patients could opt in to rather than opt out of. As one comment on the HSJ site said: “If the default is ‘opt out’ then care.data is dead.”

The care.data shambles is fast becoming a major test of whether the NHS is safe in the hands of the coalition government. Part of the problem is that having talked up the benefits and absolute safety of the scheme, the government has been caught out by the revelation of a recent sale of confidential data to the insurance industry.

No sooner had care.data been put on hold for six months to give the government time to explain the benefits and safeguards to the public, than it was revealed that data for 47 million hospital patients had been sold to a group of insurers.

Some hours later, the head of care.data refused to tell MPs about this sale because his organisation was too new. However, it has been pointed out that the insurance industry’s report using the purchased data carried the logo of his new organisation.  He has further explaining to do.

And as though ministers had not enough problems, the chairman of the British Medical Association’s GPs committee has said doctors – who have the task of uploading the records from their surgeries to the central data bank – will have to be indemnified against potential legal action from patients who believe their records have been wrongly used.

That surely shows how little faith there is that our records will not be misused or will not be leaked or hacked.

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Care.data: take a look at what the Health & Social Care Act says

The NHS' Care.data leafletThe NHS' Care.data leafletThis morning you could hear John Humphrys on Radio 4’s Today programme trying to get his head round the confidentiality issues on the collection by a new NHS organisation of all medical records from GPs’ surgeries – and their dissemination to others.

The man behind this scheme is Tim Kelsey (NHS National Director for Patients and Information.)  He told Today there was no chance that confidential information revealing  the identity of the person the records were about, would ever leak out.

Humphrys should have asked him what section 256 of the coalition government’s Health and Social Care Act really means. 

This quotation from the Act probably needs to be read in a very quiet place:

“Requests for collection under section 255: confidential information
(1)A request under section 255 is a confidential collection request if it is a request for the Information Centre to establish and operate a system for the collection of information which is in a form which— (a)identifies any individual to whom the information relates who is not an individual who provides health care or adult social care, or (b)enables the identity of such an individual to be ascertained.

(2)A person may make a confidential collection request under section 255 only if the request— (a)is a mandatory request, (b)relates to information which the person making the request (“R”) may require to be disclosed to R or to the Information Centre by the person holding it, or (c)relates to information which may otherwise be lawfully disclosed to the Information Centre or to R by the person holding it.”

Section 255 does say “the Secretary of State may direct the Information Centre not to comply with a request specified in the direction which is not a mandatory request.” But it also says he “may direct the Information Centre to comply with a request specified in the direction which was made by a person outside England.”

This last sentence is probably there to ease the way for American companies to enter the health service in England under the forthcoming trade deal between the EU and the USA.

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Hospital seeks nominations for its annual People’s Choice Award for community staff

Last year Sue Tucker (right) won the People’s Choice Award in Great Western Hospital Foundation Trust’s annual staff excellence awards. She works as an antenatal and newborn screening coordinator with the hospital’s community health services.

Sue was nominated by a couple who said she had given them support well beyond what they expected when they lost their baby.

Now GWH is asking again for nominations from patients and service users across Wiltshire who have experienced great care from the Trust’s community staff.  These services include community hospitals, community and neighbourhood nurses, care coordinators, therapists and staff in the services for children and young people.

Oonagh Fitzgerald, the director of staffing at GWH, believes the awards are a great way to celebrate successes to which staff contribute so much: “In a busy NHS Trust we don’t always get the chance to step back and reflect on the difference our staff make to people’s lives.”

“This is why I think the People’s Choice Award is particularly special; it’s a chance for patients and service users, their relatives or their friends to acknowledge those teams or individual members of staff who have gone the extra mile for them, and a chance for our Trust to formally recognise them.”

Judges, including a patient representative, will select a shortlist from the nominations received from the public and all those shortlisted will be invited to the awards ceremony in June at the STEAM museum in Swindon where the winners will be announced.

The deadline for nominations is 5.00pm on Friday, March 7.  You can download a nomination form at the GWH website or contact This email address is being protected from spambots. You need JavaScript enabled to view it. or call 01793 604431 to request a nomination form.

You only have to listen to Sue Tucker to know it is worth taking the time to make a nomination: “I was so pleased to win: it was a real honour to be nominated.  It validates what you do on a daily basis when someone going through a difficult time makes the decision to nominate you.”

 

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Update: medical records & care.data - admission that patients ‘may lose trust’ in NHS

Our original report on 'care.data' can still be read below this new report.

NHS England, who are running the care.data scheme to share medical records with third parties, have issued a worrying risk assessment of their scheme.

It says that using medical records without patients’ consent may lead to them losing trust in the confidentiality of the NHS.  

The assessment says the scheme runs the risk of degrading patient trust in the NHS, putting information at risk of hackers and identifies ‘a small residual risk’ that patients will be identified.

A frame from the NHS England video: is privacy just like a jigsaw?A frame from the NHS England video: is privacy just like a jigsaw?But it states baldly that the projected benefits of the scheme (see our earlier story below) outweigh the risks to patient privacy.  One of the identified benefits is providing a boost to economic growth.

A GP who lives in the north of England where the leaflets have already been delivered, wrote to the GP’s magazine PULSE that she had not been told how patients should opt out.  She added that some GPs were telling their patients to opt out of the ‘summary record scheme’ which is not at all the same as care.data.

Pulse had previously reported a poll of GPs indicating that 40 per cent of England’s GPs would be opting out of care.data as regards their own medical records.

This GP pointed out that as information already given by patients was provided in strict confidence and good faith that it would never be shared, the default position ought to be that patients opt in to the scheme rather than having the responsibility to opt out.

She also says that the NHS’ own mandatory training on Information Governance states that consent must be sought each time information from medical records is proposed to be shared.  “How”, she asks, “can automatic sharing of these past records without actively seeking current verbal or written consent be legal under the data protection act?”

The basic problem is that at law medical records remain the property of the Secretary of State for Health – the man whose overall responsibility for the NHS was removed by the coalition government’s Health and Social Care Act.

The opt out form can be found here.

Go to this site to see the care.data leaflet.

And to this site to read the full risk assessment text from NHS England.

There is a short animated video promoting care.data on this page.

MNO's FIRST REPORT ON CARE.DATA STARTS HERE:

Before the end of the month we will all be getting a leaflet through the door about the government’s plans for our medical records.

The leaflet is titled “Better information means better care” and will explain how, from March, our medical records will be extracted from GP surgeries and passed to a new body called the Health and Social Care Information centre (HSCIC) so they can be placed on the ‘care.data’ database.

The idea is to allow medical records to be shared with other parts of the NHS, researchers and private pharmaceutical companies.  And the aim is to improve and hasten research that will lead to advances in medicines and treatments.

The information will be ‘anonymised’ – it will not include your name but will still carry your NHS number, date of birth, post code, gender and ethnicity.  And as people in rural post codes know it is very easy to identify who’s who among a small number of homes.

It has also been admitted that there is a small risk that some patients could be identified by insurers and commercial health providers who could match their own data against the anonymised records.

If they have got permission to use the records and you are a client, they could match the anonymised information with their own data.   They will have your date of birth and post code and could make a match with the same categories of information on medical records.

Then they could see whether you had a drink problem or a long-term illness or even if you had told your doctor a certain condition was prevalent in your family.

The scheme is backed by many medical charities who say they need it to speed up their research.  And it is opposed by some who see it as a breach of principle about keeping private our most private data.

Any organisation or researchers can apply to the HSCIC for data and each application will be considered individually. 

The HSCIC will charge a fee to cover its costs, but there is no control at all over the potential profits that can be made from the data.

The government’s original idea was to make the scheme compulsory.  But you will be able to opt out of it.  

However the leaflet will not contain an opt-out form.  To opt out you have to go to your GP. And there has been criticism that information about this route for opting out is pretty well hidden away.

When asked in the House of Commons whether the Department of Health had an estimate of the number of hours GPs will spend talking to patients about care.data, the minister, Dr Dan Poulter, Parliamentary Under Secretary of State in the Department of Health, had no clear answer.  But there is, he said, “a patient information line which patients can call if they have questions, which will ease the burden on GP practices.”

There is a possibility that the scheme will prove to be breach of new EU privacy rules.

The costs of this scheme have not been finalised.  But the leaflet distribution will cost NHS England £1.2 million.

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  • Town-Hall-2011-05-03 08-
  • IMG 8472
  • IMG 9097
  • Silbury-Sunset---10-06-08-----07
  • Marlborough-2013-04-18 St Peters