Merry Xmas from Healthcare Governance Review!

Whose NHS is it anyway? Have your say……

Welcome to the place where you can have your say about “whose NHS is it anyway?” The NHS Alliance – the independent voice bringing together everyone in primary health care – wants to know your answer to this question. All views are welcome. To air your views and to find out further information, please click here.

Governance of PCT provider services – discussion paper

Dynamic Change and The Good Governance Institute have published a paper that outlines current issues and provides governance guidance to PCTs and their provider services.  According to Dynamic Change “…in writing this paper it became clear that governance arrangements were often being developed in a hurry and without thinking through the ramifications for the future. Worse still, in many PCTs governance arrangements were being arrived at without a clear vision of what was to be governed.”

The purpose of the paper, according to Dynamic Change, is to encourage PCTs to pause before committing themselves further, and to be thoughtful about what it is they are doing. PCT leaders should think through what the aims of their provider de-merger is, the holistic nature of modern thinking on governance and only then start to put in place governance arrangements that are appropriate.

Readers will probably be familiar with the authors of this paper, Andrew Corbett-Nolan and Dr. John Bullivant of The Good Governance Institute.

To order your free electronic copy of the first draft of this discussion paper email liz.jones@dynamicchange.com

Dr Foster publishes 2009 Hospital Guide

Dr Foster has published its 2009 Hospital Guide, in which it has scored trusts on an overall patient safety measure and banded those with similar scores between 1 for the poorest performers and 5 for the best.

The Guide shows that overall, ‘Hospital Standardised Mortality Ratios’ (HSMRs) decreased nationally by 7 per cent last year and 32 trusts have low HSMRs. Mid Staffordshire NHS Foundation trust , which was criticised last year by the Healthcare Commission for failings in quality of care, has reduced its death rates by 34% compared to three years ago.

However, less positively the Guide found that 27 trusts still have significantly high HSMRs; seven trusts are not compliant with National Patient Safety Agency alerts; and 5024 people admitted with low risk conditions died in hospital last year (848 under the age of 65). Although it is inevitable that some patients with these conditions will die during or after treatment, comparing rates between hospitals and investigating those deaths that do occur are, says Dr Foster, useful ways of identifying failings in patient safety.

The Guide also reveals that last year at least 209 foreign objects were left behind in patients after operations, with 9 trusts recording six or more incidents, and 82 incidents of ‘wrong-site’ surgery took place (operating on the wrong body part). Whilst these incidents should never occur, the figures are, says Dr Foster, evidence that the NHS is developing a commendable culture of openness and reporting.

Roger Taylor, Director and co-founder of Dr Foster said: "Over the last nine years of the Hospital Guide we have seen a steady improvement in hospital performance but unacceptable variation between hospitals still exists. Dr Foster will continue to publish data in order to provide information to the public, drive improvement in patient care and save lives.

"Hospital trusts should use the Guide to carefully investigate where problems exist, even those who have performed well. Patients and the public should use the Hospital Guide to help make choices about where they want to be treated, to ask the right questions of their health professionals and to hold hospitals to account."

Through the website www.drfosterhealth.co.uk Dr Foster say thay will also provide an example ‘Quality Account’ that they hope will stimulate discussion as to how quality accounts should be used across the NHS.

Download the Dr Foster 2009 Hospital Guide here.

Linked article – Boards that don’t receive patient safety information are “irresponsible”

Monitor removes Chair of Colchester Hospital University NHS foundation trust

Monitor, the independent regulator of NHS foundation trusts, has used its regulatory powers to remove Mr Richard Bourne as Chair of the Trust with immediate effect and appoint Sir Peter Dixon as interim Chair of Colchester Hospital University NHS Foundation Trust with effect from Monday 30 November 2009.

The decision to intervene was taken by Monitor’s Board at its monthly meeting at which the Board found the Trust in significant breach of its Authorisation.

Regulatory action has been prompted by the Trust’s failure to comply with healthcare standards; its failure to exercise its functions effectively, efficiently and economically; and serious and wide ranging concerns as to overall governance and leadership at the Trust.

Having given full consideration to these issues, and the various options for regulatory action, Monitor decided a change in Board leadership was most likely to assist in a rapid and sustained return to compliance with the terms of its Authorisation. Monitor’s Board has therefore taken action to ensure that the Trust has the Board-level leadership capacity to secure on an ongoing basis safe, high quality care for its patients.

Commenting on the intervention, Monitor’s Executive Chairman, William Moyes said:

“We have taken this decision to ensure the Trust has the Board leadership capacity to address our concerns. Ultimately this is about making sure the Trust is in a position to identify risks and challenges that affect patient services and then deliver an effective response.

“Sir Peter Dixon is a highly experienced Chair of a successful foundation trust that has successfully addressed challenges of its own. I am confident his leadership will benefit Colchester Hospital University by providing strategic board-level leadership.”

Sir Peter Dixon’s term as interim Chair will conclude when the Trust has demonstrated that it can return to compliance with its Authorisation and at that time we will expect the Trust’s governors to commence a permanent appointment to the role.

Read Monitor’s full statement on this matter here.

NHS Alliance national online debate about NHS accountability ends in December 2009 – Make sure you have your say

The NHS Alliance online debate about NHS accountability, which is being conducted in association with Healthcare Governance Review, ends in December. A report will be prepared by the NHS Alliance based on the findings.

If you’ve not already participated then you have only a few weeks to register your views on this highly important subject.

Click here to register your views.

The NHS Alliance Press Release on the debate can be found here.

Boards that don’t receive patient safety information are “irresponsible”

A Health Service Journal (HSJ) article outlines survey findings by Dr Foster that indicate one in 10 hospital trusts do not regularly reporting patient safety and outcomes at board level. This finding comes more than a year after Lord Darzi’s next stage review said care quality should be “at the heart of the NHS”.

"Luton and Dunstable Hospital Foundation Trust chief executive Stephen Ramsden, who is director of the National Patient Safety Campaign for England, described the findings as “astonishing”. Boards not receiving such information were “irresponsible”, he said.

The results, released to HSJ early, will be published on the Dr Foster website on 30 November along with the high profile hospital standardised mortality ratio for each trust.

Read the full HSJ article here.

Notable quote: A concern for patient safety and quality of care…….

A concern for [patient safety and quality of care] which is sincerely held and repeatedly expressed but nevertheless, is not carried through into action, is as much protection from [needless patient deaths, harm and dissatisfaction] as no concern at all"

Inspired by Mid-Staffs and Basildon and Thurrock concerns and based on a quotation from the Clapham Junction railway accident inquiry

Monitor questions board effectiveness following poor inspection report at Basildon and Thurrock NHS foundation trust

The Care Quality Commission (CQC) recently rated Basildon and Thurrock NHS foundation trust “Good” for quality of services and “Excellent” on use of resources. But a few weeks after publication of these performance figures, an inspection by CQC inspectors found:

• blood-splattered equipment;
• blood stains on floors and curtains and badly soiled mattresses in the A&E department with stains soaked through;
• equipment being used repeatedly that should only be used once;
• resuscitation room equipment past its use-by date;
• blood pressure cuffs stained with blood, suction machines contaminated with fluid inside and out and evidence of mould;
• inadequate arrangements to treat children, with few specialist paediatric staff;
• the mortality rate in 2008 for all emergency admissions was 6.1% compared to the national average of 4.4%; and
• the trust’s own analysis also showed that between 18 and 20 patients per 1,000 had evidence of pressure sores, compared with a national average of 11 per 1,000 patients.

In a statement issued by Monitor, regulator of NHS foundation trusts, Dr Bill Moyes, executive chairman, said “Our concerns about board effectiveness, together with the concerns that the CQC has raised about quality of care, mean that we are placing a requirement on the trust to take action with immediate effect to resolve these issues.”

Patients Association director Katherine Murphy reportedly called for board members of Basildon and Thurrock University Hospitals NHS Foundation Trust to step down. She said “The board should most certainly resign – I would say the entire board……..If there was one member of the board who had any concern, they should have been raising that over the past couple of years.”

The Monitor statement can be found here.

NHS Scotland – National Clinical Governance conference, 2 March 2010, Glasgow

NHS Quality Improvement Scotland (NHS QIS) is holding their third national Clinical Governance Conference: ‘Tomorrow’s World’ on Tuesday 2 March 2010, at Hilton Hotel, Glasgow.

The aim of the conference is to share our learning, experience and intelligence in order to build for the future.

The plenary sessions at the conference are going to focus on the ‘bigger picture’ around quality improvement and why sharing and learning can be so difficult to spread and implement. The afternoon sessions will then focus this thinking around particular topic areas and breakout sessions are being held specifically around

• Patient safety
• HAI
• Learning from reviews of suicides

Registration for this event opens in January 2010.

Download a flyer for this event here.

NHS could save £9bn a year through clinical improvements

According to an article in the Health Service Journal (HSJ) “The NHS could save more than £9bn in a year if trusts improved their performance in just eight “high impact” clinical areas, the chief nursing officer for England has said.”

The eight “high impact” clinical areas identified by the chief nursing officer are

£1,050m – Cut pressure ulcer admissions in half

£3.8m – Cut patient falls in hospital by 25 per cent

£7,300m – Stop malnutrition and dehydration in hospitals and care homes

£10m – Reduce caesarean sections by 2.2 per cent a year

£105m – Give patients choice to die at home

£555m – Reduce sickness absence by a third

£31m – Nurse-led discharge to reduce unnecessary bed days

£124m – Prevent urinary tract infections

Total: £9.2bn

Healthcare Governance Review believes that given the NHS needs to save £15-20 billion, these clinical improvement savings, if realised, could go a long way to meet overall savings targets.

Read the full HSJ article here.

Kimberly-Clark website on healthcare-associated infections

Healthcare-associated infections (HAIs) are a global crisis.

Recognising the rapid growth in cases of infection like MRSA and ventilator-associated pneumonia being picked up in hospitals, Kimberly-Clark Healthcare has put together a useful website with a range of information and resources, including links to a wide range of organisations around the world, including the UK, concerned with healthcare infection-related matters.

Called “Not on My Watch” the website aims to educate patients and healthcare professionals. Kimberly-Clark’s goal is to eliminate these preventable illnesses and their often tragic consequences.

Click here to go to Kimberly-Clark’s “Not on My Watch” website.

Inspectors find Aberdeen Royal Infirmary’s infection control measures “ineffective”

A report by the Scottish Healthcare Environment Inspectorate has found Aberdeen Royal Infirmary’s infection control measures “ineffective” and ordered the hospital to “urgently review” aspects of it operations.

An announced inspection, carried out on 13 October this year, looked at the accident and emergency department together with four wards at the hospital. Inspectors found “no consideration” of risk to patients, their condition and their effect on fellow patients. The standard of cleaning in wards and public areas at the hospital was also branded “very poor”.

There is much that other hospitals can learn from Aberdeen’s experience. Download the Aberdeen Royal Infirmary inspection report here.

PAC report on reducing healthcare associated infections in hospitals in England

The Public Accounts Committee (PAC) has published a report on Reducing Healthcare Associated Infection in Hospitals in England.

According to the PAC, every year over 300,000 patients in England acquire a healthcare associated infection whilst in hospital. These infections cost the NHS more than £1 billion a year. They are caused by a variety of organisms and lead to a range of symptoms from minor discomfort to serious disability. For some they can be fatal, and in 2007, there were 9,000 deaths recorded with Meticillin resistant Staphylococcus aureus (MRSA) or Clostridium difficile infections as the underlying cause of a contributory factor.

This is the PAC’s third report on healthcare associated infection, which they describe as a “key indicator of quality and safety of NHS care.” In 2000, the PAC concluded that the NHS did not have a grip on the extent and costs of hospital acquired infection and that without robust data it was difficult to see how they could target activity and resources to best effect. In 2005, the PAC found that the progress in improving infection prevention and control had been patchy and there was a distinct lack of urgency on key issues such as ward cleanliness and compliance with good hand hygiene

In it’s current report the PAC concludes that there have been significant reductions in MRSA bloodstream and Clostridium difficile infections. However, there have been no measurable reductions in other, avoidable, healthcare associated bloodstream infections.

The PAC’s report also concludes that one of the greatest threats to infection control is the increase in antibiotic resistance.

Read the PAC report Reducing Healthcare Associated Infection in Hospitals in England here.

Dr Foster and Salford Royal NHS foundation trust event – ‘An intelligent NHS: leadership, delivery and safer hospitals’

Dr Foster and Salford Royal NHS Foundation Trust worked together to build an exciting programme around leadership, delivery and safer hospitals. Quality was the theme of the day and some excellent keynote presentations delivered by a group of national and international speakers including Stephanie Peditto, Director of Innovation, Johns Hopkins Hospital, Baltimore and Joe Rafferty, Chief Executive, NHS Central Lancashire.

The event was attended by over 150 delegates comprising of NHS, Chief Executives, Medical Directors, Directors of Governance and those involved in delivering quality.

Delegates were invited  to attend breakout sessions providing a unique opportunity to listen to presentations around specific issues including measuring patient experience, quality, patient safety, clinical leadership, board reporting and handling the media and to ask questions and debate the issues.

Copies of presentation slides together with summaries of various discussions are provided by Dr Foster on their website. These should be of interest to many concerned with healthcare governance matters. Click here for further information.

NPSA re-launches its ‘Being Open’ approach

In 2005, the National Patient Safety Agency (NPSA) issued guidance on communicating effectively with patients when things go wrong. Following changes to the NHS since the launch, they have reviewed the guidance and developed a new Being open framework.

The new framework is a best practice guide for all healthcare staff, including boards, clinicians and PALS. It explains the principles behind Being open and outlines how to communicate with patients, their families and carers following harm.

According to the NPSA “Open and honest communication with patients is at the heart of health care. Research has shown that being open when things go wrong can help patients and staff to cope better with the after effects of a patient safety incident.

Healthcare staff may be fearful of upsetting the patient, saying the wrong or admitting liability. This guidance and the associated actions outlined in the Alert, provide reassurance that Being open is the right thing to do, and encourage NHS boards to make a public commitment to openness, honesty and transparency.”

Download the guidance and access an e-Learning programme based on the guidance here.

Notable quote: Making sense of NHS governance

"The ideas, principles and mechanisms constituting governance in the NHS derive from an amalgam drawn from corporate governance, public governance and a variety of other sources. The resulting miscellany presents directors, managers and senior clinicians with a considerable sense-making challenge."

Richard Holti and John Storey – Clinical and non-clinical executive directors’  Sense-making of the new governance arrangements in the NHS. Download here.

House of Commons Health Committee ‘Special Report’ on Patient Safety

The Health Committee has published a ‘special report’ on patient safety relating to the Committee’s patient safety report published in July 2009 (click here).

The Government responded to the patient safety report on 13 October (click here).

This special report sets out the responses to the patient safety report  by the Care Quality Commission and Monitor. It also contains a response by Professor Sir Ian Kennedy (formerly chair of the Healthcare Commission) and a reply to his response from the chairman of the Health Committee.

Of particular interest in the report is Monitor’s responses to various issues around boards highlighted in the original patient safety report.

Download the 27 page ‘special report’ Patient Safety: Care Quality Commission, Monitor, and Professor Sir Ian Kennedy’s Responses to the Committee’s Sixth Report of Session 2008-09 here.

Managing healthcare risk: Out with AS/NZS 4360 – In with ISO 31000

Few people concerned with managing ANY kind of risk in the NHS will not have heard of AS/NZS 4360 – the Australian/New Zealand risk management Standard. The Standard was licensed for the NHS in England in 1999 as part of the Department of Health’s NHS Controls Assurance Project. It introduced to the NHS the concept and practice of risk registers and risk matrices. AS/NZS was subsequently licensed by the rest of the UK NHS and also by the public healthcare system in Ireland.

AS/NZS 4360 is about to be consigned to risk management history. In December 2009 it will be replaced by ISO 31000 – a truly international risk management standard that, essentially, is the next revision of AS/NZS 4360.

Watch a presentation given by Kevin Knight, chair of the ISO working group on the ISO risk management standard, and the driving force behind AS/NZS 4360, on the new Standard and its links with AS/NZS 4360. 

Watch Kevin’s presentation here.

Monitor publishes new guidance for NHS foundation trust governors

Monitor, regulator of NHS foundation trusts, surveyed foundation trust governors in 2007 to find out how well they were performing in their new role; the findings of that study indicated governors would welcome further advice and support on discharging their statutory duties.

Governors are an essential part of the unique governance structure at NHS foundation trusts; as the elected and appointed representatives of staff, patients, and local stakeholders, they provide a tangible link between a foundation trust and the local community it serves. The board of governors has significant power at its disposal through the statutory duties that it is required to discharge. In the process of representing the interests of the trust’s members, governors have a statutory duty to:

• appoint and, if appropriate, remove the chair;
• appoint and, if appropriate, remove the other non-executive directors;
• decide the remuneration and allowances, and the other terms and conditions of office, of the chair and the other non-executive directors;
• approve the appointment of the chief executive;
• appoint and, if appropriate, remove the NHS foundation trust’s auditor; and
• receive the NHS foundation trust’s annual accounts, any report of the auditor on them and the annual report.

In addition:

• in preparing the NHS foundation trust’s forward plan, the board of directors must have regard to the views of the board of governors.

The new guidance addresses each of these statutory duties, describing the processes involved and suggesting points for consideration.

Download the new guidance Your Statutory Duties: A Reference Guide for NHS Foundation Trust Governors here.

Notable Quote: Sir Stuart Burgess on the board’s conundrum

“How do you equate the total accountability of the board for all that the organisation does with the practical impossibility of knowing everything that is being done in the board’s name?”

Sir Stuart Burgess, quoted in Corporate Governance Countdown