The NHS in England is improving the way it handles finances, but patients deserve better, a watchdog says.

According to BBC News, the Audit Commission review of 302 trusts found 282 were meeting minimum standards for balancing books, managing finances and getting value for money.

But it said the remaining 20 – 12 of which had failed for the third consecutive year – had to improve and more should be getting the top score. These were failed for not having good enough management in place or achieving value for money.

Now more than ever, Trusts need a robust reporting system capable of quickly costing individual patient records across all departments, to get a clear indication of the overall financial position of the Trust and to ensure that clinicians and managers have a shared understanding of the resources they use.

Finance managers need a patient level information and costing solution to highlight any problems and show where to look for the solution. Instead of monitoring service performance on the basis of broad average costs allocated in a top-down way to services, patient level costing solutions provide more accurate costings based on actual interactions and events related to individual patients and the associated costs.

In this way, Trusts can deliver sound and controlled financial management and make the best use of healthcare resources.

Computer Weekly this week reports that Assist, an association of 1,800 IT professionals in the NHS, has called for the NHS to adopt “simple systems” which can be configured locally – not more sophisticated systems which it says bring rigidity.

Assist quite rightly praises “stunning” IT-related successes over the past 10 years and the standards of IT in use in GP practices and goes on to say that the UK leads the world in the development of health information and IT standards. However, the association also believes that a “one-size-fits-all” approach does not work. We’re hearing this view from an increasing number of NHS professionals, and there certainly is a strong case to be made for more tailored IT solutions delivered by independent suppliers on a local level, working closely with individual PCTs to address the specific issues they face.

Assist’s members observe that difficulties in meeting government targets such as Choose and Book and the 18-week initiative are failures of planning and policy rather than IT, and that the 18-week initiative and others have led to “substantial, avoidable demands on limited informatics resources and capacity”.

This is often the case for in-house RTT monitoring solutions, which can all-too-often swallow up so much resource in building reports and collating information that staff cannot actually get on with the job of managing pathways and improving performance.

Conversely, Pathway Manager with its enhanced functionality to meet everyday issues and operational requirements, manages patient pathways from initial GP contact to acute or other hospital treatment, to ensure compliance with the 18-week wait rules.

Crucially, succeeds in freeing up staff time, letting them get on with the important task of helping to manage care delivery and improve overall healthcare outcomes.

The BBC has reported on the legislation put forward by the Scottish Government for its proposed 12-week wait initiative. The new NHS 12-Week Wait plans will radically improve access to care and transform the NHS in Scotland.

Ambitious targets for Referral to Treatment (RTT) waiting times take the form of a 12-week maximum wait from decision to admit to treatment. This decision is to be applauded, and will play a key role in boosting access to care and improving healthcare outcomes.

Inside sources expect hospitals to put in place systems to monitor performance against target in the course of 2009, and to be meeting targets well before the official deadline of 2011.

We fully support the legislation, and the ambitious targets, and with 19 Trusts already using or implementing its Pathway Manager solution to monitor RTT times in both England and Wales, we are well placed to make available to the Scottish NHS the information tools it needs to help it achieve its targets.

Pathway Manager’s rich functionality gives staff a prospective view of waiting times rather than a retrospective view. If a patient begins to drift towards the 12-week time limit, the ‘Pathway Analyser’ module will automatically advise staff there could be a potential problem, allowing staff to resolve the issue within the required time frame and ensure that patients get timely access to care.

Liberal Democrat shadow health secretary Norman Lamb has called for an immediate end to further spending on the NHS National Programme for IT, reports ZDnet.

The party believes the gains possible from the use of IT would more likely be realised if the programme were decentralised and control given to local organisations who could instead work on improving connectivity between health and social care.

With record investment in health over recent years, in the 60th year of the NHS we are seeing an unprecedented level of access to healthcare, and NPfIT has certainly achieved much, and has without doubt helped to drive up standards in healthcare delivery.

However, while noone would dispute the positive impact and benefits IT and better access to clinical data have had for healthcare professionals working at the coalface of the NHS, there certainly seems to be a growing case for looking at how best NHS IT systems are delivered, be that on a national or more local level.

There are strong arguments for a truly national system, but with Newcastle set to depart from the national programme, and questions being raised about the cost effectiveness and responsiveness of a large national body and its ability to adapt to change, perhaps we should be looking at a more manageable, regional approach, engaging with independent local suppliers to ensure a more tailored, responsive approach.

It will be interesting to see which way the barometer swings.

The Health Service Journal has reported that Primary Care Trusts are battling to stay clear of deficit as their finances come under pressure from a surge in secondary care work.

Referrals increased in April and May by an average of 12.7% compared with the year before.  At the same time many are trying to hit the 18-week referral to treatment target, which means clearing a backlog of patients with long waits.

Dudley Group of Hospitals NHS Trust used Pathway Manager from Ardentia to meet 18-Week regulations eight months ahead of time, dramatically reducing patient waiting times and meeting national targets of 90% for non-admitted patients and 85% for admitted patients.

With Pathway Manager, staff in the Referral to Treatment Team have a prospective view of waiting times rather than a retrospective view. If a patient begins to drift towards the 18-week time limit, the ‘Pathway Analyser’ module will automatically advise staff there could be a potential problem, allowing staff to resolve the issue within the required time frame and ensure that patients get timely access to care.

A key benefit of Pathway Manager is that it simplifies and streamlines the management of RTT requirements for Trusts – staff can save all the information they need on a patient’s pathway of care in one data system so they can easily report on waiting times and risks of breaches to 18-week regulations without having to go into multiple systems.

Newcastle Upon Tyne Hospitals NHS Trust is planning to break away from the NHS’s flagship £12.7bn National Programme for IT, reports Computer Weekly, as directors feel the scheme does not represent value for money.

Even though the Foundation Trust could receive “free” services under the national scheme, directors claim they cannot afford to wait until 2013/14 for implementation of the required systems, which under NPfIT would “require more ongoing system maintenance, service desk and life-cycle costs, which erodes into the recurrent savings achieved”.

Further breakaways from NPfIT will inevitably raise more questions about the programme and the billions of pounds worth of contracts with local service providers.

The news highlights the need for a fundamental review of the current healthcare IT infrastructure.  Large supra-regional bodies by their very nature cannot adapt quickly and respond effectively to change.

By opting instead to engage with a smaller number of independent suppliers, you not only get a faster response and resolution to any requests, you also get the advantage of highly specialised industry knowledge, to ensure your information infrastructure works harder for you.

Healthcare intelligence specialist Ardentia has launched an updated version of its Pathway Manager solution, enabling Trusts to easily and effectively meet 18-week wait Referral to Treatment reporting requirements.

Ardentia has worked closely with Trusts across England and Wales to develop Pathway Manager version 2, with enhanced reporting functionality designed to simplify the monitoring and management of referral to treatment (RTT) times for clinicians and managers ahead of the December 2008 deadline.

By streamlining the tasks involved in managing RTT requirements, from the build and analysis of pathways to collating information and producing statutory reports, Pathway Manager version 2 liberates valuable resources, enabling internal staff to focus in improving outcomes and optimising care delivery.

According to David Beeson, development director at Ardentia: “In-house RTT monitoring solutions can all-too-often swallow up so much resource in building reports and collating information that staff cannot actually get on with the job of managing pathways and improving performance.

“Pathway Manager, with its enhanced functionality to meet everyday issues and operational requirements, frees up staff time and lets them get on with the important task of helping to manage care delivery and improve overall healthcare outcomes.”

The enhanced functionality enables users to report on the RTT position of groups of patients, for example all patients attending a specific surgery or clinic, so that clinicians and manager can establish where all patients are on their individual pathways prior to consultation.

Pathway Manager version 2 also addresses some of the common issues faced by Trusts when reporting on patient pathways. It enables staff to enter Clock Stop information not appearing in standard data sets and allows for the special handling of patients discharged with no procedure carried out, for more accurate reporting and a more complete picture of the quality of healthcare delivery.

The solution can report on transfers in and out, and the effect this can have on pathways. Patients may be transferred in with little time left on their 18-week clock, and so it is important that Trusts can quickly access this information, in order to avoid a breach or alert commissioners if a breach proves unavoidable.

Developed with support from Microsoft, Pathway Manager manages patient pathways from initial GP contact to acute or other hospital treatment, to ensure compliance with the 18-week wait rules. Powerful functionality supports routine reporting and ad-hoc query reporting at patient, pathway and event level, enabling Trusts to meet national reporting requirements and also to drill down and investigate wider issues relating to patient pathways in greater detail.