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					                              NHS Number Standard for Secondary Care (England)


   NHS Number Programme       Version        1.0
  NHS Connecting for Health
           Vantage House
                              Number
                                                                         Appendix
                     Leeds
                              Version Date   07-Nov-08
                                                                            E6




Exemplar Site Report: North Cumbria University Hospitals
                                              NHS Trust


               Appendix to Draft Operational Information Standard
Amendment History:

 Version    Date                 Amendment History

 0.1                             First draft for comment

 0.2                             Following comments from David Young and Tim Pilkington

 0.3                             Further updates by Trust

 1.0        07-Nov-07            Base-lined for publication




Related Documents:
These documents will provide additional information.

 Reference Number                Title                                                                  Version

                                 NHS Number Standard for Secondary Care (England)                      1.0 – Draft

Appendix A1                      Analysis and Consultation - Exemplar Community                        1.0




NHS Number Standard for Secondary Care (England)

Exemplar Site Report: North Cumbria University Hospitals NHS Trust | Appendix to Draft Operational Standard

Appendix E7 | v1.0 | 07-Nov-08                                                                                Page 2 of 10
Table of Contents
1.   Introduction .................................................................................................................................4
2.   North Cumbria Uni versit y Hospitals NHS Trust ..............................................................5
     2.1.   Introduction .........................................................................................................................5
     2.1.1. Profile ...................................................................................................................................5
     2.1.2. Contacts...............................................................................................................................5
     2.2.   Analysis and Consultation .................................................................................................6
     2.2.1. Analysis Summary ..............................................................................................................6
     2.2.2. Good practices ....................................................................................................................7
     2.2.3. Areas for improvement .......................................................................................................8
     2.3.   Strategy, Plans and Current Development ......................................................................10




NHS Number Standard for Secondary Care (England)

Exemplar Site Report: North Cumbria University Hospitals NHS Trust | Appendix to Draft Operational Standard

Appendix E7 | v1.0 | 07-Nov-08                                                                                                          Page 3 of 10
1.      Introduction
As part of the development of the Operational Information Standards “NHS Number Standard for
General Practice (England)” and “NHS Number Standard for Secondary Care (England)” a number of
sites worked in partnership with NHS Connecting for Health to undergo analysis and consultation. These
sites formed the Exemplar Community.

The purpose of the Exemplar Community was to gain an understanding of the processes, procedures
and working practices within the care settings. Many of the sites in the Exemplar Community also ran
demonstrators (pilot projects) in order to provide evidence of the feasibility of the operational aspects of
the standard and to ensure these are tested and refined.

This document provides information of the analysis and consultation undertaken in collaboration
between the NHS Number Programme and the Exemplar Site.




NHS Number Standard for Secondary Care (England)

Exemplar Site Report: North Cumbria University Hospitals NHS Trust | Appendix to Draft Operational Standard

Appendix E7 | v1.0 | 07-Nov-08                                                                                Page 4 of 10
2.       North Cumbria University Hospitals NHS Trust
2.1.     Introduction

North Cumbria University Hospitals NHS Trust agreed to work with NHS CFH as they are uniquely
placed in the border region between North West England and Scotland. Some 200,000 Scottish based
patients exist on their PAS. These are both active and historic patients. In order to achieve the directive
for complete adoption of the NHS Number, which currently they are unable to achieve without a Spine
compliant PAS, we needed to consider the ability to allocate an NHS Number outside of the organisation
so that it can be traced and validated within the organisation. This could be achieved ahead of any data
migration activity associated with a Lorenzo R2 replacement of their PAS (2010).

The Trust has strong Senior Executive and Directorate support and buy in to the work of the NHS
Number Programme, and are happy to provide examples of good practice, share experience and work
with NHS CFH in developing the use of the NHS Number.

2.1.1.   Profile

North Cumbria Acute Hospitals NHS Trust provides a range of services for a population of approximately
324,000 people across north and west Cumbria (Carlisle, Eden, Copeland and Allerdale) as well as the
south west of Scotland and parts of Northumberland. They have 3,370 WTE staff and an annual turnover
of £200 million.

Services are provided from two hospital bases located in Carlisle (Cumberland Infirmary) and
Whitehaven (West Cumberland Hospital). In addition, they provide a range of outreach services in
community hospitals and a maternity service at Penrith Hospital.

The main Commissioner is NHS Cumbria (Cumbria Teaching PCT) hosting locality commissioning
groups for Carlisle, Eden Valley, Copeland and Allerdale. The PCT also commissions specialist services
from tertiary providers - predominately in the area covered by NHS North East.

2.1.2.   Contacts

Address
North Cumbria University Hospitals NHS Trust
Cumberland Infirmary
Newtown Road
Carlisle
Cumbria
CA2 7HY

Telephone
01228 523444

Main Contact for NHS Number Programme work
Head of Information Management at N Cumbria Acute Hospitals is Paul Wiggins
Paul.Wiggins@ncumbria-acute.nhs.uk

Team:
Department                       Stakeholder                Contact Number
Head of Information              Paul Wiggins               01228 814007
NHS Number Standard for Secondary Care (England)

Exemplar Site Report: North Cumbria University Hospitals NHS Trust | Appendix to Draft Operational Standard

Appendix E7 | v1.0 | 07-Nov-08                                                                                Page 5 of 10
Management
Senior IT project
officer/PAS Manager
(North Cumbria Informatics
Service)                         David Young                01946 523612
Director of Pharmacy             Bill Glendinning           01228 814061
Pathology Information
Systems manager                  John Wrigley               01228 814548
Radiology
Jean –Professional Head
of Radiology                     Jean Grubb                 01228 814824
Ruth – PACS/RIS System
Manager                          Ruth Gilbert               01228 814358
NHS Cumbria - Provider
arm Head of Clinical
Systems Applications             Lin Kendall                01228 603202
Clinical Coding Service
Manager                          Nikki Wallace              01228 814072



Business Change Manager
(North Cumbria Informatics
Service)                         Joan Markwell              01228 603774


Address
North Cumbria University Hospitals NHS Trust
West Cumberland Hospital
Hensingham
Whitehaven
Cumbria
CA28 8JG

Telephone
01946 693181

Trust Website: www.ncumbria.nhs.uk

2.2.     Analysis and Consultation

2.2.1.   Analysis Summary

North Cumbria University Hospitals NHS Trust has been working with the NHS Number Programme to
understand the current processes and use of the NHS Number on all patient records and
communications in order to identify strengths and weaknesses of the organisation. They have been
particularly helpful in assisting the NHS Number Programme in identifying the issues experienced with
cross border patients and developing an approach which can be used by other organisations.

The Trust is working collaboratively with NHS Cumbria to achieve a high level of entry of the NHS
Number. Some 200,000 Scottish based mainly historic but with an unknown proportion of active patient
records exist on their PAS, without an NHS Number. Following discussion between the Acute Trust, at
Carlisle, and the PCT, the ability to allocate an NHS Number to active patients on or soon after was
considered. The feasibility another NW organisation hosting the set up of patients on LE2.2 or Lorenzo
NHS Number Standard for Secondary Care (England)

Exemplar Site Report: North Cumbria University Hospitals NHS Trust | Appendix to Draft Operational Standard

Appendix E7 | v1.0 | 07-Nov-08                                                                                Page 6 of 10
and allocate an NHS Number is being explored. This would help the Trust to achieve the directive
of complete adoption of the NHS Number, which currently they are unable to achieve without a Spine
compliant PAS

Discussion with NHS Cumbria
The discussion with NHS Cumbria identified that they are only responsible for the English GPs, not
Scottish patients. They are currently using an iSOFT iPM PAS 1.87 and will shortly be taking LE 2.2
which is Spine compliant and currently use the Patient Demographic Service to create and trace
patients. Discussions took place around whether it would be possible for the PCT to host a formal
arrangement for North Cumbria University Hospitals NHS Trust to allocate an NHS Number to active
Scottish patients, ahead of any data migration activity, associated with a Lorenzo R2 replacement of
their PAS in 2010.
This was also discussed with the NHS North West data quality team who were prepared to investigate
this option and work with the Acute Trust and the PCT.

Paper requests from the GPs, into Pathology, do not all include the NHS Number, however GP systems
locally are able to print standardised Codegate labels (developed with a local GP) which would
overcome omissions/discrepancies with NHS Number, but this function is infrequently and inconsistently
used by GP practices in the area. The reason given for GPs not using Codegate labels was lack of
funding from NHS Cumbria to provide adequate printers for this function. This was discussed again with
the NHS Cumbria and a willingness to investigate support of printers for GP practice to allow consistent
use of printed labels on GP requests, ahead of full electronic order comms, was agreed.

2.2.2.     Good practices

North Cumbria University Hospitals NHS Trust has been proactive in ensuring the majority of their
records hold the NHS Number. They perform routine batch tracing for all non-verified and absent NHS
Numbers on patient records held on their hospital patient administration system (PAS). This is currently
performed only once a month, mainly due to resource constraints within their small data quality team
who investigate any returns which are not matched or with which they have an issue. Their success rate
in batch trace returns is over 90% for records for English patients but their overall average is lowered by
the number of Scottish patient records that they hold. These carry the local identifier only but currently
the Trust has no way of allocating an NHS Number to these Scottish Patient Records ahead of
implementing a Spine compliant PAS (see 2.2.1). There is no facility to hold the Scottish CHI Number
and the impact on referring Scottish practices of using a “foreign” NHS Number in clinical communication
from hospital to GP has yet to be explored.

The Trust has introduced one large printed label, containing the NHS Number (where known) across the
entire Trust and these should be used on all patient notes, test requests and patient wristbands. The
labels are printed from information fed from the PAS, therefore the information is clearly visible, accurate
to that on the PAS and reduces the risk of errors in transcribing the information from various sources to
the patients label.
Case note labels have a barcode and this is attached to opposing corners of the physical patient record
so any user with a barcode scanner can use this where the case note is present.

Wristbands labels currently contain:
·        Last name (UPPER CASE)
·        First name (lower case with first letter being UPPER CASE)
·        DOB          (DD-MMM-YYYY)
·        Hospital / CRN number




NHS Number Standard for Secondary Care (England)

Exemplar Site Report: North Cumbria University Hospitals NHS Trust | Appendix to Draft Operational Standard

Appendix E7 | v1.0 | 07-Nov-08                                                                                Page 7 of 10
This MUST be hand written using black ink ensuring legibility of hand writing for example: -

             SMITH John

             28-Jan-1968

             2323232

From early July PAS printed labels for wristbands were discontinued, to conform to the requirement for a single
defined format. When the Trust procures Wristband printers they will be able to print a label with the NHS number
and barcode

This good practice complies with the NPSA Safer Practice Notice for Wristbands (SPN24, July 2007).
The only missing information which is recommended in the guidance is the inclusion of the barcode on
the band. The Trust plans to introduce a barcode on a wristband in line with NPSA requirements. As yet
no date has been set for this, although a deadline of July 2009 exists.

Additionally North Cumbria University Hospitals NHS Trust has implemented LSP provided RIS and
PACS. The Radiology Department has recently designed a new form for paper based referrals from GPs
to encourage the coverage of the NHS Number on GP referrals. The introduction of electronic requesting
is also being considered and this will also serve to capture the NHS Number as a mandatory item, thus
improving the NHS Number coverage further. PACS users are trained how to use the NHS Number as
the prime identifier for images viewed across the web. This is both practical and safe as images from
both Trusts at Carlisle and West Cumbria.

The NHS Number in respect of each birth is given to mothers in writing on discharge.

2.2.3.   Areas for improvement

There are a number of suggested improvements which could be implemented at North Cumbria
University Hospitals NHS Trust to increase the uptake and usage of the NHS Number as the unique
patient identifier on all records and communications. Some of the recommendations can be implemented
with minimal financial input or additional resources and could lead to an immediate positive effect on the
use of the NHS Number.

Potential improvements for the Trust to consider include:

1. Increased usage of existing printed labels (which include the NHS Number) on all requests into
   Pathology (currently, only 60% of wards regularly use labels). This could be improved with an internal
   directive from executive level as all wards are capable of printing labels from the PAS which could be
   attached to the paper requesting forms.

2. Paper requests from the GPs, into Pathology, do not all include the NHS Number. However, local GP
   systems are able to print standardised Codegate labels (developed in conjunction with a local GP).
   This would overcome omissions/discrepancies with NHS Number but this function is infrequently and
   inconsistently used by GP practices in the area. The reason given for GPs not using Codegate labels
   is lack of funding from PCT to provide adequate printers for this function at GP practice. This was
   discussed with the PCT (see 2.2.1).

3. Anglia ICE, an order comms requesting mechanism which stores the NHS Number and Hospital
   Case Note Number and which is capable of including the NHS Number as mandatory field. The
   introduction of this system initially for Primary Care requests by April/May 2009 will further improve
   NHS Number coverage. The pathology department would like to move to only accepting requests
   with NHS Number; however this could affect their ability to deal with emergency cases. The Anglia
NHS Number Standard for Secondary Care (England)

Exemplar Site Report: North Cumbria University Hospitals NHS Trust | Appendix to Draft Operational Standard

Appendix E7 | v1.0 | 07-Nov-08                                                                                Page 8 of 10
    ICE system is also capable of generating patient wristbands but its deployment within the secondary
    care setting on a tactical basis until LORENZO 2 is in place has yet to be confirmed

4. Changes to the pharmacy processes should include the use and display of NHS Number on
   pharmacy requests and dispensing of medication. In Pharmacy, where all requests are currently
   paper based, and therefore handwritten, the introduction of a replacement Pharmacy system called
   Ascribe, in January 2009 will assist this business change. Ascribe will have a feed from the PAS and
   could use the NHS Number. Pharmacy would like to use the NHS Number as the only unique
   identifier for the patient and this could be introduced as a mandatory field in the new electronic
   system. Pharmacy would like to insist that all prescriptions contain the NHS Number and that a
   request will not be processed without this data item, as the unique identifier. Discharge summaries
   could then be created to list all new drugs/all known drugs for that patient, and the NHS Number
   would be the safest identifier for information sent to the GP community as well as to wards.

5. Currently the A&E system is a legacy stand alone system not linked to the PAS and not capable of
   storing the NHS Number. When the A&E system is replaced in March/April 2009 (shortlisting under
   the ASCC procurement process being underway in October 2008) it will be linked to the PAS. . The
   need for business process change to locate the patient’s NHS number at the start of the journey has
   been identified

6. A staff awareness/communications campaign should be initiated to deliver the message that it is the
   responsibility of all staff members to ensure that the NHS number, where one exists, is entered onto
   the master PAS and all subsequent patient records and communications

7. All GP templates used when referring to Radiology should be reviewed and amended to include a
   field for the NHS Number.

8. Work with the Primary Care provider and GP community should be initiated to communicate the
   need to include f the NHS Number on referrals into the Acute Trust setting.

9. There should be a collaborative work effort with NHS Cumbria in running a public awareness
   campaign to help patients to know their NHS Number and to present for healthcare with their NHS
   Number where possible.

10. The use of the NHS Number as the key search criterion should be introduced (if NHS Number known
    on presentation to the service). This will then return electronic patient records for any patients who
    have previously been registered onto PAS and will identify duplicate Hospital Numbers for that
    patient.

11. New policies for replacement of old labels and wristbands once NHS Number is located after
    commencement of the patient journey should be introduced.

12. The logging of instances where the NHS Number is not recorded at key entry points to the hospital
    e.g. outpatients, pathology, etc. should be introduced. These can then be reviewed and failing
    organisations/GPs departments can be worked with in order to increase the inclusion of the NHS
    Number on all records and communications.

It is essential that North Cumbria University Hospitals NHS Trust continues to monitor the use of the
NHS Number at various points within the organisation; this will include a base-line of current services
that were not included in our initial data capture. Ongoing monitoring will be required to demonstrate
benefits at various stages of the patient journey, e.g. on admission, during stay, on ordering of
investigations, discharge medication.


NHS Number Standard for Secondary Care (England)

Exemplar Site Report: North Cumbria University Hospitals NHS Trust | Appendix to Draft Operational Standard

Appendix E7 | v1.0 | 07-Nov-08                                                                                Page 9 of 10
2.3.     Strategy, Plans and Current Development

North Cumbria University Hospitals NHS Trust has committed to gathering baseline data from various
points in the patient pathway; they are currently testing the data collection of referrals to:
     Outpatients
     Radiology (prior to introduction of a new GP Form)
     Pharmacy (prior to introduction of new electronic Pharmacy system)

They have already been capturing metrics from various departments. They are currently reviewing the
outputs and are considering which recommendations they can take forward now and which ones will
require further planning and identification of business case and funding to implement.




NHS Number Standard for Secondary Care (England)

Exemplar Site Report: North Cumbria University Hospitals NHS Trust | Appendix to Draft Operational Standard

Appendix E7 | v1.0 | 07-Nov-08                                                                                Page 10 of 10

				
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