NPSA issues guidance on risk matrices

They say that ‘what goes around, comes around’. Back in 1999 the Department of Health, as part of its controls assurance project, issued guidance to the NHS in England on risk management, risk registers and risk matrices. The NPSA has recently issued guidance which appears to, essentially, ‘re-issue’ the original controls assurance guidance.

Readers should note that the latest version of the Australian/New Zealand risk management standard is the 2004 edition, and not 1999 as referred to in the NPSA guidance. Also, the original Health Service Circular that launched the use of the Australian/New Zealand risk management standard, and its associated exemplar risk matrix, across the NHS was HSC (1999)123 - Governance in the new NHS: Controls Assurance Statements 1999/2000: Risk management and organisational controls, and not what is referenced in the NPSA publication.

The NPSA risk matrix guidance can be accessed here.

NHSLA issues 2008 versions of risk management standards and handbooks

The NHS Litigation Authority (NHSLA) has issued 2008 versions of their risk management standards and risk management handbooks. These cover acute trusts, ambulance trusts, mental health & learning disability trusts and primary care trusts and can be downloaded here.

European Union consults on patient safety – deadline 20 May 2008

The European Commission (EC) launched, on 25 March 2008, an eight week public consultation on patient safety. The results of this will help in the development of the Commission’s proposal for on general patient safety issues planned for the end of 2008. That proposal will address the important issue of patient safety throughout the European Union (EU) and will include a detailed first pillar, addressing healthcare-associated infections (HCAI), on which separate public consultations have already been held.

The two primary objectives of the Commission’s general patient safety proposal will be:

i) to support Member States in their efforts to minimise harm to patients from adverse events in their health systems, through appropriate policies and actions to improve safety and, therefore, quality of care.

ii) to improve EU citizens’ confidence that they will receive sufficient and comprehensible information available on levels of safety and available redress in EU health systems, including healthcare providers in their own country and in other Member States.

According to the EC, “Patient safety issues can affect all EU citizens. The Commission would like to have the views of all those involved in this field from the patient and consumer to national competent authorities, from the health professional to the healthcare manager and anyone else who wishes to participate.”

Full details of the consultation can be accessed here.

ICSA Company Secretary qualification for NHS managers

The Health Service Journal (HSJ) has produced a brief article looking at the benefits of company secretary training from the Institute of Chartered Secretaries and Administrators (ICSA). To read the article, click here.

BBC Panorama survey into hospital infection control finds room for improvement

The BBC’s Panorama programme has carried out an infection control survey of UK hospital trusts for tonight’s – 27 April 2008 – program How Safe is Your Hospital? 170 hospital trusts responded to the survey, which asked 16 key questions, including:

- What is the average hospital bed occupancy rate for general and acute beds in your Trust for the last twelve months?

- What is the ratio of isolation beds to total beds within the Trust?

- What percentage of your isolation beds are used for the isolation of infected patients in order to prevent further infection?

- Do you routinely test your staff with diarrhoea for C-Diff?

- Do you have a publicly available policy on the isolation of infected patients?

Some hospitals are doing better than others in key areas known to have an impact on infection, such as bed occupancy, isolation of patients and hand hygiene.

Inevitably, perhaps, the Panorama programme uses, as it’s key focus, Maidstone and Tunbride Wells NHS Trust, where 90 patients died of C-Diff and 1100 other were affected, and which was subjected to an investigation report by the Healthcare Commission.

Healthcare Governance Review believes that much more could be done with Panorama’s survey results.

The full Panorama infection control survey questions and results, together with a letter from Rose Marie Gibb, former Chief Executive of Maidstone and Tunbridge Wells NHS Trust, can be downloaded here.

Department of Health issues 2007/08 guidance on Statement on Internal Control (SIC) requirements for NHS trusts, PCTs, SHAs and Heads of Internal Audit

With customary lateness, the Department of Health has finally issued, on 18 April 2008, guidance on Statement on Internal Control (SIC) requirements for the year ended 31 March 2008.

The SIC was introduced by the Department of Health’s Controls Assurance Team to replaced the original ’Controls Assurance Statements’. Some say that the SIC process appears to have become little more than a bureaucratic ‘tick box’ exercise. However, the real intent behind the process if for NHS organisations to ensure they have effective systems of internal control to help ensure achievement of organisational objectives. 

For NHS foundation trusts, the SIC requirements are set down by Monitor in line with HM Treasury guidance.

The SIC guidance for NHS trusts, PCTs, Strategic Health Authorities and Heads of Internal Audit, can be downloaded here.

Review of C.Diff at Ennis General Hospital, Ireland

The Health Service Executive in Ireland has released a report on key findings and recommendations relating to a “probable outbreak of Clostridium difficile at the Midwestern Regional Hospital Ennis (MWRHE) in March-April of 2007.”

Interestingly (and, perhaps, reassuringly?), there is little in the report that distinguishes it from a similar report that might be found in the NHS. In particular, there is the usual call for better infection control processes and procedures together with improved general management and, of course, governance over infection control.

The full report – Review of Increased Identification of Clostridium Difficile at Ennis General Hospital 2007 – can be downloaded here.

Monitor promotes board involvement in patient safety and quality

Dr William Moyes, Executive Chairman of Monitor- NHS Foundation Trust Regulator – has written to NHS foundation trusts (FTs) backing Lord Darzi’s views on the importance of making improving the quality of care for patients “theNHS’s main priority over the next few years.” 

In an e-mail sent to Chairs and CEOs of foundation trusts on 21 April, Dr Moyes is looking for volunteer FTs “to help develop and pilot good practce specifically for boards managing (sic) quality.”

Monitor envisages working with 3-4 FTs to:

- develop and pilot good practice for the board’s role in leading and managing quality improvement including: understanding the board role and collective responsibility for quality; board processes and management arrangements; setting quality objectives and assessing performance; and providing appropriate challenge to the medical director.

- consider how the board role translates in to action at service line level level using specific management tools: balanced scorecards from team to service line to board level; use of patient experience data to improve quality; and use of performance management arrangements to drive quality, including use of appropriate incentives.

Monitor aims to run an 8 week pilor across the volunteer sites to be completed by the end of July.

Healthcare Commission launches biggest ever NHS check on infection control

The Healthcare Commission has, today – 24 April 2008, launched a major programme of infection control inspection covering all 172 acute trusts annually as part of a drive to: reduce death and illness from healthcare-associated infections (HCAIs); improve the experience of patients in hospital; and increase public confidence in the NHS. The programme was established at the request of the Secretary of State for Health.

The Commission this week wrote to all acute trusts, calling on them to ensure that they have the necessary systems in place to minimise the risk to patients of catching a HCAI such as MRSA or Clostridium difficile.

In particular, trusts should check they are meeting the 11 mandatory duties outlined in the government’s hygiene code, which came into force as part of the Health Act 2006.

For further information on the Commission’s infection control inspection programme, click here.

 

US report on transforming hospitals into high reliability organisations

High reliability concepts are tools that a growing number of hospitals use to help achieve their safety, quality, and efficiency goals. Creating a culture and processes that radically reduce system failures, and effectively respond when failures do occur is the goal of high reliability thinking.

This report – Becoming a High Reliability Organization Operational Advice for Hospital Leaders – is written for hospital leaders interested in providing patients safer and higher quality care. It presents the thoughts, successes, and failures of hospital leaders who have used concepts of high reliability to make patient care better

The full report can be downloaded here.
 

Welsh patient safety campaign aims to save 1,000 lives

Modelled on the highly successful US Institute for Healthcare Improvement’s 100,000 lives campaign, NHS Wales has, today, launched its ‘1000 Lives Campaign’.

The ‘1000 Lives Campaign’ aims to reduce risks to patient safety by implementing life-saving interventions developed by clinicians in Wales.

Interventions include better management of medicines, reducing healthcare associated infections and surgical complications and improving general medical and surgical care.

Healthcare Governance Review spoke to Mary Burrows, Chief Executive of North and East Wales NHS Trust about the new initiative. She said “In Wales my Trust and now all NHS organisations in Wales are part of the Institute for Healthcare Improvement (IHI – Don Berwick et al) work on improving patient safety. Wales has launched its ‘1000 lives’ campaign today – 21 April 2008 - to run for 2 years and coinciding with the NHS 60th anniversary this year. My Trust has been part of the IHI Safer Patient Initiative for over a year now with demonstrable results using a simple yet effective methodology that engages clinicians from the start and is making a difference in our morbidity and mortality figures and infection rates as examples.

Our Trust has brought the 1000 lives (same methodology and with IHI and Health Foundation) and Safer Patient Initiative into ‘Making it safe’ adopting the methodology across all specialities. For those who don’t know, NHS Trusts in Wales run acute, community and mental health services.

For example whilst we are working on reducing ventilator acquired pneumonia in CCU as part of the ventilator care bundle, we will be using the methodology to improve handover of patients in general wards and as of yesterday will be using the methodology to introduce an evidence-based predictor tool for violence in our medical assessment unit that will allow clinicians to put in management plans to prevent violence in hospital, but in so doing will help to improve the outcome for the individual as well.

The methodology is simple and works on the basis of ’small test of change’ taking an idea, theory or concept and trying it on 1 patient or 1 ward and getting instant feedback, involvement of patient and then changing it, trying it again until it is reliable. Once it is reliable, it is spread to 3 patients then 5, etc. Reliability is strictly measured so you are able to see daily progress (or not) and then readjust what you are doing, checking for reliability again and then spreading.”

For further information about the 1000 lives campaign, click here.

Monitor updates NHS Foundation Trust Accounting Officer Memorandum

According to Monitor, this revised version of the NHS Foundation Trust Accounting Officer Memorandum includes updated citations in relation to the superceded sections of the Health and Social Care (Community Health and Standards) Act 2003; and correction of the reference to the Comptroller and Auditor General being the auditor of NHS foundation trusts.

It’s a strange quirk of NHS ‘governance’, put in place in the nineties, that accounting officers (i.e. Chief Executives of NHS organsiations) are accountable not only to their boards, but also, given their responsibilities for use of public resources, to Parliament.

Download the revised memorandum here.

HSJ offers ‘career coaching’ for NHS board members

Non-executive directors and chairs can now benefit from coaching by taking advantage of coaching sessions offered by the Health Service Journal (HSJ).

HSJ is putting NHS non-executive directors in touch with professional coaches for an opportunity to talk through their goals and work dilemmas. Participants will discuss their issue in a telephone coaching session with a professional coach. A summary of the session will appear in the Board Talk section of HSJ. If you would like to take part, email rebecca.allmark@emap.com with your name and contact details. Alternatively, for further information click here. Free registration may be required.

HSJ launces ‘Board Talk’ for NHS board members

The Health Service Journal (HSJ) has launced a new ’channel’ at www.hsj.co.uk that will give NHS trust board members a forum for sharing best practice and raising issues and concerns regarding clinical governance, financial management and communication. You can register for free and access news, features and opinion columns. The channel also includes:

- an online debate on corporate manslaughter that can be viewed on demand
- a forum led by Robina Shah, chair of Stockport trust, on health inequalities
- a column by Simon Jones, chair of the NHS Confederation Wales and former chair of Cardiff and Vale trust, giving a Welsh perspective on NHS board culture
- a feature by Andrea Sutcliffe, chief executive of the Appointments Commission, looking at the difference boards can make to patient safety
- the data burden - with an overwhelming amount of data and statistics, how can NEDs be sure they are getting the right information?

Through the channel, boards can keep up to date on the latest health topics.

If you would like to get involved in shaping this new resource, please email anamika.rath@emap.com.

Disclosing medical errors – ‘best practices’ from ‘leading edge’ USA medical institutions

Medical institutions around the World are seeking to turn the tide of medical errors by confronting and openly admitting their mistakes, disclosing them to patients and families and throughout their institutions, investigating their causes, and using what they learn to improve processes and systems so these errors do not recur. This paper from the USA (published on the Institute for Healthcare Improvement – IHI – website) highlights the work of seven organisations to prevent and disclose medical errors, including how they’re doing it and what they’re learning in the process.

For further information, click here.

Plan to cut Welsh NHS local health boards from 22 to 8 to “save millions of pounds in management costs”

In the NHS, management is so often treated as a cost, and not something that adds value to patient care. And when patient care goes wrong, the principal root causes usually relate to management (and governance) failings.

The NHS in Wales is cutting local health boards from 22 to 8 in an apparent bid to save money. Will this be good for patient care and safety?

Read the full story here.

Healthcare Governance in ’small countries’ – Spotlight on Wales

Wales is seeking to become an exemplar of excellence in small country governance. In part, this will be achieved through good governance of health services. Birmingham University’s Health Services Management Centre (HSMC) has undertaken a review of national healthcare governance arrangements in several small (sub-10 million population) countries – Scotland, New Zealand, Finland, Norway, Sweden, Denmark and the Republic of Ireland – to see what lessons can be learned.

The report on the review concludes that: “The governance of health services cannot be considered in isolation from the historical and cultural context in which governance arrangements have evolved. It follows that models of governance cannot easily be transferred between countries because history and culture will have a major impact on the extent to which arrangements that ‘work’ in one system can be applied or adapted in other systems. Not only this, but also in no country is the governance of health services an entirely settled matter. In all of the countries we have reviewed, reforms to governance are either being implemented or are under consideration, suggesting that dissatisfaction with the status quo and the search for improvements in health services’ governance are universal concerns.”

The report authors suggest that ”The value of this review for the NHS in Wales is therefore most likely to be in holding up a mirror that can be used to compare current arrangements with possible alternatives, and in providing ammunition for debate and discussion of options for change.”

The full report – ‘The Governance of Health Services in Small Countries: what are the lessons for Wales’ – can be downloaded here.

Little Blue Book of Governance Pitfalls

A London-based governance consultancy has produced an interesting ‘little blue book of governance pitfalls’ for boards. Independent Audit Limited says that “Sometimes getting it right is about not getting it wrong. Even good boards can get complacent about their own performance. So, from time to time, it pays to think about what might go wrong. What are the risks to effectiveness? Are we doing enough to avoid them? And how can we spot them if they’re creeping up on us? Here are a few things for you to think about. Some are old favourites, although you’ll be able to think of others. Some you’ll want to say don’t apply to you. But we hope they’ll get you thinking.”

Download the little blue book of governance pitfalls here.

Posted with kind permission from Independent Audit Limited.

Wales issues guidance on governance arrangements for visiting consultants

The Welsh Assesmbly has issued Welsh Health Circular (2008) 020 concerning governance arrangements for clinical sessions provided by visiting consultants. This circular makes the requirement to have a Service Level Agreement in place for all consultant led sessions provided in Wales by two or more separate organisations. It introduces a national model for Service Level Agreements (SLAs) for use in the accountability process between Local Health Boards (LHBs), Health Commission Wales (HCW) and NHS Trusts.

According to the circular, “The introduction of a national model SLA supports the development of a more comprehensive governance framework in Wales and improves the consistency and rigour attached to contractual agreements between organisations within the health community. The model SLA will clarify accountabilities and ensure that organisations deliver their commitments both in terms of contractual arrangements and the management of service delivery.”

Welsh Health Circular (2008) 020 can be downloaded here.

Department of Health sets bad example on Freedom of Information requests

According to the Health Service Journal (HSJ), the Department of Health (DH) has been “slated” over its freedom of information record. The DH has become the only government department to receive a formal practice recommendation from the Information Commissioner’s Office, which follows an audit of complaints that revealed the DH has repeatedly applied blanket exemptions to FOI requests, in some cases withholding entire documents from release.

This rebuke for the DH comes only 2 weeks after the Information Commissioner issued a warning to NHS and wider public service bodies following threatening High Court action against Hounslow PCT.

For further information, click here.