I am very concerned at the moment about the implimentation of an Urgent Care Centre at my local London hospital. This same Hospital is a major UK HIV treamtment centre also. The concern relates to the potential disclosure, to your GP, of your HIV status because the PCT's who are implimenting this Urgent Care Centre within A&E have not listened to the very knowledgable staff within the Hospital nor bothered to engage with the active HIV patients forum at this same hospital, when it comes to HIV patients and how they will engage.
Let's start at the begining. The hospital in question has changed the way it deals with attendances at it Accident & Emergancy Department. If you have to go into A&E you are assessed or "triaged" to determine if your reason for attending is a medical emergency thus directing you to the usual A&E department. Or less of an emergency where you are then sent down the Urgent Care Centre route and effectively see a GP based in the A&E department.
The A&E function at this hospital is run on an computer system that is contained within the hospital. The Urgent Care Centre system is a computer system implimented by the PCT's involved to give your GP access to information collected during your visit.
When you attend, as it has been explained to me, you are booked in on the Urgent Care System. Once you are assessed, you are either transfered onto the A&E system or continue on the Urgent Care System.
When you are undergoing the Doctors consultation within the Urgent Care System, they will detail the consultation that will be accessible by your GP is you have one. Simply put any information given at this point by you including your HIV status if you raise it or it is mentioned may be recorded. UNLESS you specifically tell the doctor you do not wish the information to be disclosed to your GP.
In the A&E department of this hospital there are leaflets & posters on the Urgent Care System.
Personally, I have no problem with my HIV status being known. I am fairly open about it. However I do want to understand where my medical information goes and by whom it is accessible. I also know for many they value, very much, the control they have over disclosure.
If your Accident & Emergency Department has an Urgent Care Centre. Please find out how the data collected is used and disseminated. Not least as there are legal ramifications for the disclosure of data where you haven't given consent.
The patient forum and many medical professionals are extremely concerned at the potential for HIV disclosure given this system of "opt out at every attendance" rather than 'opt in". This is because people that are likely to attend will be sick, therefore more vulenrable and likely to not even think about what disclosing there HIV may mean at that time.
The HIV Patient Forum is exploring the issues of HIV confidentialiy with the hospital concerned however this is 'after the fact' as the service is up and running.
I have submitted some Freedom of Information Requests to the apprioprate bodies and will update this post appriopriately.
You may find this information from the General Medical Council (click here) , the British Medical Association (Click here) and the Royal College of Nursing.
PDF version Further to my initial post above, You will find two documents from the Cheslea & Westminster Foundation Hospital as to how there Urgent Care Centre works with A&E and patient confidentiality.
Answers to FOI request - click here
This is published to let you know the process. I know that the HIV Patient Forum are unhappy that they were not consulted here. If your hospital is planning this or has an Urgent Care Centre it may work like this. You can submit a Freedom of Information request to find out about confidentialiy and complaint resolution. Or get involved in the planning stages.
If you want to set up a HIV Patient forum. You might like to approach www.forum-link.org that may help.
Changing performance measures to improve patient outcomes
Accident and emergency departments and ambulance trusts will in future assess their performance on what matters most to patients – quality, experience and patient outcomes, Health Secretary Andrew Lansley announced today.
The move comes amid concerns that parts of the NHS feel pressured into meeting process-led targets for A and E and ambulances that distort priorities and lack any clinical justification.
From April next year the current four hour waiting time standard for A and E will be replaced with a set of eight new clinical quality indicators that promote quality and patient safety. Time will still be measured as part of the new clinical quality indicators as it is a significant risk factor for treating patients, but crucially time will no longer be the only factor. For example the new indicators will include:
The A and E indicators have been developed jointly by Professor Matthew Cooke, the National Clinical Director for Emergency Care, together with senior clinicians in the College of Emergency Medicine and the Royal College of Nursing.
At the same time Peter Bradley, National Ambulance Director, has been working with Professor Cooke to develop indicators for ambulance services. The two sets of indicators have been designed to complement each other.
The Category B, 19-minute response time target for ambulances (serious but not immediately life-threatening) will be replaced with a set of 11 new clinical quality indicators. This will improve the quality and safety of care by focussing on those groups of patients with the greatest clinical need rather than according to the categorisation of call alone.
Ambulance services will still be required to respond to 75% of all category A (immediately life-threatening) patients within 8 minutes and, where needed, to provide transport to these calls within 19 minutes.
The clinical quality indicators have been designed to look at the whole patient care pathway and to encourage discussion in the local NHS about how care can be improved. The aim is to promote a culture of continuous improvement involving clinicians, managers and commissioners.
Health Secretary, Andrew Lansley, said:
“The new measures will focus on the quality of care and what matters most to patients - giving a better indication of patient care than the previous process-led targets ever could.
“By putting patient safety and outcomes at the heart of the health service, A and E departments and ambulance trusts can demonstrate they provide safe and effective clinical care in a timely manner rather than meeting a specific target. This is not about hitting targets – importantly, it is about giving the NHS more freedom to deliver quality care.
“Patients should be able to expect a 24/7 accessible and safe emergency care service which is integrated across the NHS. By shifting the focus to a range of indicators we will ensure that patients receive the best possible care, in the right place, at the right time.
“I want to thank Professor Cooke and Peter Bradley for leading this work along with the Royal College of Nursing and the College of Emergency Medicine for their valuable contribution. This collaboration means that in future emergency care will combine clinical outcomes with patient experience, safety and timeliness of care.”
John Heyworth, President of the College of Emergency Medicine said:
“The College of Emergency Medicine welcomes this announcement. The introduction of measures to ensure timeliness of patient care in the Emergency Department and, crucially, time related incentives to maintain patient flow from the Emergency Department, will provide tangible improvements for our patients.
“The combination of measures of quality and time will drive the continuing improvement towards the world class standard of Emergency Medicine which the public expect and deserve. This is an opportunity to transform emergency care to ensure the Emergency Department becomes the jewel in the crown of the NHS in which the public can place their trust and confidence at any time of the day or night.”
Notes to editors:
1. Full details of the A and E clinical quality indicators can be found in the implementation guidance issued by the Department at http://www.dh.gov.uk/en/Healthcare/Urgentandemergencycare/DH_121239
2. A similar publication for the ambulance clinical quality indicators will follow in the New Year.
3. You can view the department’s Quarterly Monitoring of A and E data for monitoring the four hour standard at http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/index.htm
Data on performance against the ambulance service response time targets is available at
http://www.ic.nhs.uk/statistics-and-data-collections/audits-and-performance/ambulance
4. Health Secretary Andrew Lansley visited Chelsea and Westminster A and E department in London on Monday 13 December. You can obtain photos of the visit from the Press Association.
5. For more information, please contact the Department of Health press office on 020 7210 5221.
6. Quote from Professor Matthew Cooke
Professor Matthew Cooke, National Clinical Director for Emergency and Urgent Care said:
"The new clinical quality indicators for A and E and ambulance services offer a fantastic opportunity to ensure that we always deliver the best care and that timeliness is considered along with the quality of care and patient experience.
"We now have measures that, for example, will look at the proportion of high-risk presentations in A and E that are reviewed by senior staff or how quickly potentially life-threatening conditions are first assessed so that the emergency care system can be viewed as a whole to give patients the best possible clinical care.
"The new set of indicators will encourage discussion and debate in the NHS locally about the quality of emergency care. This will support continuous improvement, rather than simply meeting a target and this is the right focus when offering quality care for patients."
List of A and E indicators:
1. Percentage of patients with certain ambulatory care conditions admitted
2. Unplanned re-attendance rate
3. Total time spent in the A and E department
4. Left without being seen rate
5. Service experience
6. Time to initial assessment
7. Time to treatment
8. Consultant sign-off
List of ambulance indicators:
1. Outcome from acute ST-elevation myocardial infarction (STEMI)
2. Outcome from cardiac arrest – return of spontaneous circulation
3. Outcome from cardiac arrest - survival to discharge
4. Outcome following stroke for ambulance patients
5. Proportion of calls closed with telephone advice or managed without transport to A and E (where clinically appropriate)
6. Re-contact rate following discharge of care (i.e. closure with telephone advice or following treatment at the scene)
7. Call abandonment rate
8. Time to answer calls
9. Service Experience
10. Category A 8 minute response time
11. Time to treatment by an ambulance-dispatched health professional
In addition, ambulance trusts will continue to be monitored against the 19 minute transportation standard for Category A calls
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_122877