It has been just over a year since the Francis inquiry into poor standards at Mid Staffordshire NHS Trust, and in that time there has been a huge amount of discussion surrounding the quality of health and social care services. However, despite the issue of quality being pushed to the top of the agenda, a report by the Nuffield Trust has suggested that although there is universal agreement that quality is important, there are questions as to whether or not we can actually afford it.
The QualityWatch programme was set up to understand what is happening to quality during periods of financial constraint. Much of the information is sourced from performance measures used within a service, but we also need to look across services too.
Martin Bardsley, director of research at the Nuffield Trust, has said we need to focus on models of integration around the obvious pressures on services like A&E, and on issues surrounding public health indicators – particularly the ones linked with prevention.
He explains that both these issues suggest the need to collate information, sometimes from providers, at a population level. Where information like this was once analysed by primary care trusts, it now resides between three new organisational types – clinical commissioning groups, commissioning support units, health and wellbeing boards and Public Health England. He adds:
“As money gets tighter it’s increasingly important that we watch carefully to ensure that economies do not adversely affect the quality of services and the well being of disadvantaged subgroups of the population.”
The Royal College of GPs (RCGP) have highlighted that GP services will be under huge pressure this year due to funding cuts. They are predicting that patients will fail to get a GP appointment when they are unwell on at least 34 million occasions in England.
The professional body says that GP practices are being “brought to their knees” by an unprecedented fall in money for healthcare in the community and rising demand for their services. This will inevitably result in further pressure on A&E departments, because more patients are likely to turn up at emergency wards if they are unable to get appointments at their local surgeries.
Dr Maureen Baker, chair of the RCGP, said:
“GPs and practice nurses can’t keep doing more for less and now that funding for general practice in England has slumped to just 8.5% of the NHS budget the service we provide is in crisis.
“All three political parties say they want to see more patients being treated in the community, where care can be provided to patients more economically, in their own surroundings, and yet resources are increasingly being diverted away from communities and into hospitals.”
Successive governments have promised to make it easier for people to get GP appointments, amid persistent complaints about unavailability in some areas. David Cameron last year said he would like to force surgeries to open from 8am to 8pm and over the weekend to ease pressure on A&E units, a scheme currently being piloted.
The RCGP said it calculated the 34 million figure from data in the GP Patient Survey, which found that 10% of patients who sought a consultation with a GP or practice nurse failed to get one. They added that almost 11% of the NHS budget was spent on general practice in 2005, compared with 8.5% in 2011.
However, the Department of Health accused the RCGP of using partial and conflated data, confusing the number of people and consultations. They say:
“The GP survey showed the vast majority of patients are satisfied with their GP and rated their experience of making an appointment as good.”
The chairman of the Care Quality Commission, (CQC), David Prior, has said that the NHS in England has a culture that “doesn’t listen” and that the NHS could go bust without “serious change”. The head of the health watchdog called for more competition to drive up standards, adding that rifts between managers and clinicians were jeopardising patient safety and blocking improvements in care.
Writing in the Sunday Telegraph, Mr Prior said, “Parts of the NHS have developed a culture that doesn’t listen – or worse, that stigmatises and ostracises those who raise concerns or complaints.”
“Too often, it delights in the ritual humiliation of those deemed to fail, tolerates and institutionalises outdated working practices and old-fashioned hierarchies, and can almost encourage managers and clinicians to occupy opposing camps.”
He called for successful hospitals to take over failing hospitals and community services, and for better care outside hospitals, and for larger centres of excellence.
He also called for changes to the way the NHS is held to account – particularly an end to trusts being “blindsided” by waiting time targets “that miss the point, skew priorities and have unintended consequences”.
Katherine Murphy, chief executive of the Patients Association, agreed with Mr Prior, saying,
“There is a culture in the NHS where process comes before humans. For years we’ve tried to highlight concern about poor care. We’re often seen as a nuisance for highlighting these issues. The behaviour and culture that was allowed to grow in Mid Staffordshire is no different from that in many trusts in many parts of the country today.”
The Department of Health said it was “focusing on poor care like never before” and was turning around 14 hospitals that are in special measures. A spokesman said, “We are clear that targets must never come before clinical need – and based on clinical advice, we have scrapped a number of them.”
Prof. Keith Willett, who led Sir Bruce Keogh’s review of urgent and emergency care, told a Westminster health forum this week that hospitals are too inflexible to meet patient’s demands and could learn from the way supermarkets cater for changes in demand from customers by paying more attention to variations in what care is needed by patients rather than trying to fit them into a rigid system.
Supermarkets use information like the weather forecast and the till roll at nine o’clock in the morning to predict which items shoppers will want when stocking their shelves, he said, whereas “our idea of season variation or predictive modelling is patients in corridors and outliers”.
Prof. Willett said that greater flexibility throughout the NHS could ease the burden on emergency cuts.
Speaking at the same event, Stephen Dorrell MP, the Chairman of the Health Select Committee, warned that hospitals are in danger of becoming “warehouses” for bed-blocking elderly patients due to poor planning, and questioned recent figures presented to the Select Committee by government ministers claiming that the problem of bed blocking was declining.
The Public Involvement Programme and the National Clinical Guidelines Centre are seeking applications from patients and carers to be part of a group that will develop a clinical guideline for the care of people with low back pain.
Members of this group will play a key role in making sure that the views, experiences and interests of patients and their carers inform the development of the guideline and the recommendations of the NHS. All group members will be asked to attend regular meetings and to prepare for them in advance, including reading relevant papers.
Applications are welcomed from people with experience or knowledge of low back pain, for example, someone who has suffered from or cared for someone who has suffered from lower back pain.
For more information and to find out how to apply, please follow this link to the NICE website- http://www.nice.org.uk/getinvolved/joinnwc/LayMemberLowBackPainUpdateGDG.jsp
Clinical Commissioning Groups (CCG) and how they perform
Clinical Commissioning Groups (CCGs) commission most of the hospital and community NHS services in the local areas for which they are responsible. Commissioning involves deciding what services are needed, and ensuring that they are provided. CCGs are overseen by NHS England, which retains responsibility for commissioning primary care services such as GP and dental services, as well as some specialised hospital services. All GP practices now belong to a CCG, but groups also include other health professionals, such as nurses.
Services CCGs commission include:
- most planned hospital care
- rehabilitative care
- urgent and emergency care (including out-of-hours)
- most community health services
- mental health and learning disability services
CCGs play a major role in achieving good health outcomes for the local population that they serve. NHS England has designed a set of performance indicators that will help measure how well an individual CCG is tackling theses health issues.
You can use these indicators to see how well your local CCG is doing and compare it both on national and local terms.
Not all the indicators are available yet, but you can already compare CCGs on how well they are:
- preventing people from dying prematurely
- enhancing the quality of life for people with long-term conditions
- helping people to recover from episodes of ill health or following injury
- ensuring that people have a positive experience of care
Simply use the clickable map above to select a CCG and view the data.
The Longer Lives project
The CCG indicators begin to show the effectiveness of local commissioning. In addition, Public Health England’s Longer Lives project aims to help communities to improve their collective health by highlighting the health challenges faced in each local authority area. It shows data on premature deaths for the five most common causes of mortality in England, which are:
It also shows inequalities in premature mortality across the country and provides examples of effective local interventions.
The project is currently in its early stages. However, new data sets will be introduced continuously, including data for county districts. Visit the Longer Lives website for more detailed information.
“Obesity killing more people than thought,” reports Sky News, which is among many media outlets that fail to mention that the headline is based on estimates of US obesity-related deaths.
Researchers wanted to know whether being overweight or obese was associated with increased risk of death among people in the US. They believed previous research had underestimated obesity-related deaths because of a failure to account for the different ways in which obesity can harm health.
They used data from nationally representative surveys over a 20-year period and estimated the percentage of “excess” deaths associated with being overweight or obese. Overall, they estimated that being overweight or obese accounted for about 18% of US deaths for people aged 40 to 85 years between 1986 and 2006.
These estimates don’t directly apply here because they are based on the US and not the UK. But it’s important not to be complacent. In the UK, 24% of men and 26% of women are now obese – only a little behind the US, where the figures are 27.9% of women and 29% of men.
A 2001 National Audit Office report put the figure for UK obesity-related deaths at 6%. However, in the words of a recent Public Health England report on the issue: “It … seems likely that more than 6% of all deaths will be attributable to obesity today”.
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The Dr Foster Guide rates best and worst hospitals in 2011
The Daily Telegraph revealed the findings of the latest Dr Foster Hospital Guide. The guide, published annually, closely scrutinises a range of healthcare data to measure hospital performance and detect trends that could save lives.
As well as listing the hospital trusts in England that score above and below average on a range of different mortality measures, this year’s guide also found that:
- The rate of patient deaths in England is 20% lower than it was 10 years ago, in part because of improved hospital care.
- For certain conditions, patients admitted to hospital at the weekend are less likely to get treated quickly and have a higher chance of dying.
- Hospitals that perform certain operations infrequently pose a significantly greater risk to patients than those which carry out high numbers of the operation.
- Patient comments and ratings, such as those gathered by NHS Choices, provide a valuable insight into standards of hospital care.
- Rationalisation and networking of hospital services, to create 24/7 centres of expertise in areas such treatment for stroke, saves lives.
The report also showed that the best-performing hospitals were generally in the south of England, while those found to be the poorest performers were mostly in the north. However, the report did not examine why this was the case.
Who is Dr Foster?
Dr Foster Intelligence is a joint venture between the Department of Health and Dr Foster Holdings LLP and their research partners at Imperial College London. It aims to improve the quality and efficiency of health and social care through better use of information. It provides comparative information on health and social care services to health professionals and organisations to help improve the standard of healthcare.
The 2011 report is the tenth Dr Foster Hospital Guide to be published. Further details are available here…