DH seeks ‘expressions of interest’ in the provision of PCT board development

The Department of Health in England (DH) is establishing a framework of organisations capable of providing development support to PCT boards, against a national standard specification.

PCTs will be responsible for determining their own local needs The DH intends to establish a framework of organisations capable of providing development support to PCT boards, against a national standard specification. The programme will be targeted at both executive and non-executive directors. Board development support packages are likely to include both diagnostic and developmental components, and will be tailored to meet specific PCT needs. The programme is likely to include a significant focus on the behaviours associated with high performing boards. Successful bidders will be required to start delivery of services from September 2008.

This is a major procurement which forms part of the Department of Health world class commissioning programme. We are seeking innovative solutions that will help ensure that PCT boards are able to take control of the commissioning agenda.

Further details about the services to be procured for the framework will be available in a Memorandum of Information (MOI), which together with a Pre-Qualification Questionnaire, will be issued to interested organisations after 2 June 2008. In addition, will host two market information days for potential providers. These will take place in Manchester on 4 June and in London on 9 June. Organisations can register for a market information day by emailing board.development@dh.gsi.gov.uk

Organisations wishing to express an interest should view the call for expressions of interest, listed on the Health Service Journal website here.

May 2006 issue of Health Care Risk Report

This issue of Health Care Risk Report (HCRR) moves the journal on from being a professional journal, into the realm of incorporating peer reviewed articles. The single peer reviewed  in the current issue describes How NHS trusts could use patient safety indicators to help improve care and is written by Dr Alex Bottle and Dr Paul Aylin from the Dr Foster Unit at Imperial College Faculty of Medicine. Their research has found that US patient safety indicators, when applied to Hospital Episode Statistics data, will be of value in directing clinical audit towards important areas of potential harm, and helping trusts assess performance over time.

Other articles in the May issue of HCRR include:

- A review, by John Tingle, of the Healthcare Commission’s 2008 report Learning from investigations.

- An article titled Teams, staffing, training and governance: the recipe for safer births, by Sarah Davies and Dr Brenda Ashcroft of University of Salford, outlining the findings of Safe Births, Everybdy’s Business, the report of an independent inquiry into safety in maternity care

- Learning from homicides committed by mental health users. A review, by Pat Anderson, editor of HCRR, of NHS London work looking at 26 mental health homicides and also NPSA work relating to investigation of serious patient safety incidents in mental health services.

- An article, by Stuart Emslie, editor of Healthcare Governance Review, looking at extracting the learning from large patient safety databases.

- A review, also by Stuart Emslie, of the latest version of the Department of Health’s Integrated Governance Handbook, published by the Healthcare Financial Management Association; and

- A look at abortion law developments and professional bodies’ advice by Claire Bentley, solicitor and professional support lawyer.

If your organisation does not currently subscribe to HCRR then please consider doing so. A subscription form can be downloaded here.

Declaration of interest: Stuart Emslie, editor of Healthcare Governance Review, is on the editorial advisory board of, and is a regular contributor to, Health Care Risk Report.

Prime Minister makes appearance at Patient Safety Congress 2008

The Prime Minister, Gordon Brown, made a surprise appearance at the 2008 Patient Safety Congress last week. His speech can be viewed here.

The congress was well attended with around 650 delegates, 90 speakers and 100 sponsors and exhibitors. The event represented a ‘call to action’ for everyone in the NHS to take work around patient safety to the next level. It also provided a unique forum to share the advances that have been made in patient safety both in the UK and overseas.

For further information on the congress, click here.

 

Deaths involving MRSA and Clostridium difficile – data reports for individual institutions from Office for National Statistics

The Office for National Statistics (ONS) has published its first report on deaths involving methicillin resistant staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile) by individual communal establishment (for example, hospitals, hospices, nursing homes) where the death took place.

The report contains data for establishments which had a total of more than 2,500 deaths from all causes in both periods 2001-05 and 2002-06. These institutions (217 hospitals and one hospice) account for more than 80 per cent of the total number of deaths involving MRSA and C. difficile in England and Wales.

The report, and additional information, can be freely downloaded here.

‘Private Eye’ makes a compelling case for ‘putting patient safety first’

An inspirational article in Private Eye tells the tragic story of the avoidable death of an airline pilot’s wife due to ‘human factors’. The airline pilot, Martin Bromily, is now temporary chair of the Clinical Human Factors Group (CHFG), a non-profit organisation dedicated to placing an understanding of human factors at the heart of improving patient safety.

According to the Private Eye article, “Martin Bromily was originally told his wife’s death [in a private unit adjacent to an NHS hospital] was extreme bad luck and that nothing more could be done.” However, an independent review concluded that her death was avoidable if only an established emergency protocol had been followed. The article goes on to say ”Put [doctors] in the extremely stressful situation of a very rare, rapidly deteriorating potential catastrophe and even the most senior clinicians can lose the plot.”

Martin Bromily is quoted in Private Eye as saying ”I want to help use [my wife's] death to bring cultural change to healthcare. I want to tell our two young children when they have grown up that Mummy’s death has made a big difference.” Private Eye says that “For the sake of Elaine Bromily, and the thousands of others who die each year from avoidable error, Lord Darzi’s review must rebuild the NHS around safety.”

Read the full Private Eye article on the CHFG website here. 

 

The real signs of a strong board – a USA perspective

In an article titled ‘Leading from the Boardroom’ in the April 2008 edition of Harvard Business Review the suggestion is made that many of the criteria used by corporate governance ratings agencies to assess board performance do not have much to do with board effectiveness.

Professors Jay Lorsch and Robert Clark, respectively of Harvard Business School and Harvard Law School, conducted a survey of Fortune 200 companies in 2005 and found that three of the most rated factors concerned the specific background, knowledge and abilities of directors. Also among the highest rated factors were specific governance activities or processes, such as manageable board agendas, appropriate allocation of meeting time and timely dissemination of information to directors before meetings. Less favoured factors included structural attributes favoured by governance ratings agencies such as size of board, mandatory retirement age for directors and separation of CEO and Chairman positions. According to Lorsch and Clark “the search for talismanic indicators of [board] quality continues.”

In their article, Professors Lorsch and Clark also contend that “directors must lead from the boardroom.” Thanks to Sarbanes-Oxley, they believe that directors have become “more hands-on with compliance [issues.....and] more hands-off with long-range planning.” They say that “Directors need to do a better job of balancing compliance with forward thinking” in an effort to reduce longer term risk to shareholders.

In the medical research world, “both researchers and journals are to blame for inconsistent disclosure of conflicts of interest”

A novel study suggests that medical researchers are inconsistent about disclosing financial conflicts of interest, and journals are inconsistent about how they use or publish disclosure information.

 
The investigators say that the findings call into question the whole purpose and efficacy of a process intended to preserve integrity and eliminate bias in medical literature.

For further information, click here.

  

 

eHealth for Safety – Impact of ICT on Patient Safety and Risk Management

It’s amazing what one can ’stumble’ across on the Internet. eHealth for Safety addresses the contributions which ICT applications make to patient safety and risk management in healthcare. An important focus is on tangible benefits for European citizens and healthcare providers.

This study looked at how ICT applications can improve patient safety and risk management in healthcare. Based on a review of tools currently in use and research on their use, the study team show that eHealth can help prevent medical errors, initiate rapid responses to any event, and track events, should they occur, as well as provide feedback to learn from them. The study concludes with recommendations for concrete steps in research and development to improve patient safety and risk management in healthcare, using ICT tools and services.

Download the final study report here.

In New Jersey, USA, all hospital trustees will receive mandatory ethics training in the delivery of health care services

A package of bills sponsored by members of the New Jersey Senate Health, Human Services and Senior Citizens Committee have been introduced “to address hospital governance in an attempt to keep hospitals competitive.”

Among the bills is a requirement that all trustees in a general hospital receive ethics training in the delivery of health care services. Given the fact that healthcare boards are responsible for setting the organisation’s ethical framework, Healthcare Governance Review believes that mandating ethics training for trustees has the potential to significantly improve the performance of healthcare boards. Will it catch on in the UK we wonder?

For further information, click here.

 

In Alberta, Canada, new “super health board” signs contract banning financial defecits

In Canada, Alberta’s health minister, Ron Liepert, is setting up the province’s multibillion-dollar health care delivery system to run like a corporation to cut waiting times and control spiralling costs.

According to Mr Liepert, “[Corporation is] not a dirty word. Three-and-a-half million Albertans are shareholders in this corporation and I want to ensure that they get the best return on their investment.”

Ken Hughes, the former insurance executive chosen as chairman, will be required to sign a performance contract that assures the new health board will keep spending within a limit set by the government

For further information, click here.

Update 21 May 2008 – Not everyone feels that a unitary ’super board’ is the way forward. Click here.

DH publishes feedback on consultation to remove or suspend chairs and non-executives from PCT boards

The Department of Health (DH) has published the results of its consultation to introduce powers of removal and suspension of chairs and non-executives from NHS primary care trust (PCT) boards in England.

The consultation results, together with the new legislation enacting the powers, can be found here.

 

IHI produces tool to calculate the cost of adverse events

The Institute for Healthcare Improvement (IHI) in the USA has, in response to widespread interest in making the “business case” for quality, unveiled a new practical tool that can be used to model the financial implications of reductions in adverse event rates.

This tool, the Events Prevented Calculator, allows one to track the change in rate of any one type of adverse event over time, and, when appropriate additional data are added, the consequent change in unnecessary deaths (“lives saved”), real and additional potential cost savings (“dark green dollar” savings and “light green dollar” savings, respectively), and the return on investment of quality improvement work targeting those adverse events.

According to the IHI, the primary purpose of the tool is allow clinical or quality staff to translate the results (or potential results, if hypothetical event data are used) of improvement work into terms and concepts that might be more accessible and relevant to leadership, board, and finance functions.  

The tool can be freely accessed here.

 

Healthcare Commission publishes 2007 national survey of adult inpatients

The Healthcare Commission has published the fifth survey of inpatients to be carried out since 2002. Just under 76,000 patients took part in the 2007 survey, which is a response rate of 56%. The results of the survey offer a valuable insight into the experiences of inpatients, and can be used to improve the quality of the care they receive in hospital.

In the biggest survey of patients staying overnight in English NHS hospitals, 42 percent of respondents gave their care the top possible rating, up from 38 percent in 2002 and an increase from 41 percent in the last survey.

The survey also shows that satisfaction with overall care remains high with the proportion of patients saying their care is “good”, “very good” or “excellent” at 92 percent.

But the Commission added that there were striking variations in the responses of patients at different NHS trusts, suggesting that some trusts must take more action if they are to achieve the standards of the best. For example, 77 percent of patients rated their care as “excellent” in the best performing trust, but only 24 percent in the lowest performing.

Full results of the 2007 national survey of inpatients, together with press release, supporting briefing and other relevant information can be accessed here.

NHS South Central seeks ‘Governance Performance Manager’

South Central Strategic Health Authority is looking for a qualified accountant or internal audit professional to lead on the performance management of the corporate governance agenda across the NHS South Central economy, and also provide support to the development and sharing of good governance practice.

The post-holder will work closely with the Boards, Audit Committees and senior managers of constituent Trusts and PCTs. Key tasks will include:

- developing a corporate governance performance management framework against which the post-holder will assess Trust and PCT performance
- attendance at public Board and Audit Committee meetings to assess board and governance performance,
- supporting Trusts and PCTs in the development of their risk management and board assurance arrangements,
- designing and delivering governance training for Senior Managers and Non-Executive Directors.

Potential candidates should have a sound knowledge of NHS governance issues, including effective Boards and Audit Committees, the Board Assurance Framework, risk management and integrated governance. They must also possess excellent communication and influencing skills, and be capable of working closely and credibly with the Directors, Non-Executive Directors and Senior Managers of a range of organisations.

For further information, click here.

 

Surgery death woman ‘failed by the system’

A woman who bled to death following surgery was ‘failed by the system’ according to a report in the Scotsman newspaper today.

According to the report, “Surgeon Michael Dixon said Marlene Wightman had been let down by the unit which cared for her at Edinburgh’s Western General Hospital in March 2006. But he said the failings were probably above any single person, pointing to inadequate training of nurses looking after cancer patients after surgery…………..He said that she was the only patient he had operated on who had died.”

“The inquiry heard that the surgeon could have saved Mrs Wightman’s life if he had been told about worrying levels of blood loss. Mr Dixon previously told the court that “alarm bells should have been ringing” after Mrs Wightman began losing blood in the hours after the mastectomy……..Mr Dixon said patients were being put in the hands of people who were “exposed” and did not have experience.”

At an earlier hearing, the nurse in charge of the hospital ward admitted it was short-staffed and that workers had been “stressed out”.

 

Audit Commission’s latest ‘Financial Health News’ announces forthcoming study on ‘board assurance’

The latest edition of the Audit Commission’s Financial Health News (FHN) – which provides health sector professionals with essential financial health management information, updates on the Audit Commisions’s current work and new national reports, together with editorials about the Commission’s audit work with NHS trusts and Foundation Trusts – contains a number of interesting articles, including:

- update on implementation of Payment by Results (PbR)
- a practical guide to improving medium-term financial planning for PCTs
- Emerging findings from the PbR assurance framework
- Notification of new health studies programme for 2008/09

The new health studies programme will include Board Assurance. According to the Audit Commission, “This study will assess the rigour with which NHS trust and NHS FT Boards assure themselves on the strength of the internal controls to support the accounting officer’s Statement of (sic) Internal Control and therefore the validity of the self assessment and self certifications for regulatory purposes. It will also review the steps Boards take to assure themselves about its quality and the data they receive.”

Current and past issues of FHN can be freely downloaded at the Audit Commissions’s website here.

Plug is pulled on premiere patient safety website

The Saferhealthcare website, a joint venture between BMJ Publishing, the National Patient Safety Agency, and the US Institute for Healthcare Improvement (IHI), is to “shortly go offline.” No reason has been given as to precisely why the parties involved have taken the decision to pull the plug on what appeared to be an informative and generally helpful site. Healthcare Governance Review notes, however, that the site does not appear to have been being properly maintained since October 2007.

NHS board member pay review published

Chief Executives of NHS Trusts now earn a median basic salary of £133,435, according to the latest NHS Salary Survey published by Capita Health Service Partners, and this is just over 5% higher than in the corresponding survey last year.

Finance Directors remain the next highest paid executive directors (excluding Medical Directors), with a median salary of £100,064 in trusts, the equivalent of around 75% of the median salary for Chief Executives.

The survey also shows median pay levels of £45,000 for Chairs and £12,150 for Non-Executive Directors in Foundation Trusts. These levels are higher than for other types of NHS organisations and reflect changes in the role and responsibilities for these posts within Foundation Trusts.

For further information, including how to obtain a copy of the Capita report, click here.

Dealing with ineffective governance in NHS Scotland – the case of Western Isles Health Board

An interesting case study involving the Western Isles Health Board - part of NHS Scotland – in what appears to be a classic case of ineffective NHS governance; and the mechanisms in place to hold senior figures to account.

In essence, the Auditor General (AG) for Scotland produced a Section 22 report on the Health Board following its failure to meet a financial target. This was the third consecutive year the AG had prepared a report on the accounts of the Board. His report points to “a number of serious weaknesses concerning the Board’s corporate governance arrangements.”

His report also states that “The Board has no comprehensive performance management framework in place and corporate objectives were not agreed during 2006/07. There is no committee to oversee performance and no system in place to record and report benefits from pay modernisation. Furthermore, a recent report by NHS Quality Improvement Scotland on clinical governance identified some significant failings, including a lack of clear strategic priorities and a lack of performance monitoring.”

Follow the inquiry into the Section 22 report on Western Isles Health Board here.

UPDATE – Western Isles Health Board has issued a statement saying that it has now achieved financial balance. Read the statement here.
 

MPs point to “inappropriate governance, management and communication by the Department of Health” as root causes of “inept” handling of junior doctors recruitment

According to a BBC report today, “The handling of the junior doctors recruitment crisis last year by the government was inept, MPs say.

The House of Commons’ health committee said the government had provided “inadequate leadership” amid the chaos which saw medics take to the streets.

The cross-party group of MPs said there had been inappropriate governance, management and communication by the Department of Health, while chief medical officer Sir Liam Donaldson had failed to take responsibility despite being the architect of the reforms.

But they also blamed doctors, saying they were more concerned with factional interests than the common good.

The government said it would consider the findings and pointed out it had already apologised for the problems.”