FREE Governance between Organisations conference on 18 November 2008 – first come first served!

East Midlands Ambulance Service (EMAS), in association with Dynamic Change Ltd., is hosting a free conference on 18 November from 10.30-14.30 at the Gateway Hotel in Nottingham.

The conference features Dr John Bullivant and Professor Michael Deighan who have developed the Governance between Organisations concept and Toolkit.

Places will be allocated on a first come first served basis.

To book your free place e-mail Karen Kanee, Governance Manager, on karen.kanee@emas.nhs.uk or call 0115 9296151.

You can download a flyer for the event here.

For further information on Governance between Organisations, click here.

Governance between Organisations conference, 4 December 2008, Manchester

Healthcare Events is running a conference on Governance between Organisations at Machester Conference Centre on Thursday 4 December.

According to Healthcare Events, “The conference provides a practical guide to implementing Governance Between Organisations (GBO) across health and social boundaries including lessons from outside the NHS, the role of the effective board, partnership governance with the voluntary sector and the role of standards and performance montioring.You will also have the opportunity to attend the interactive conference workshop: Implementing the Governance Between Organisations (GBO) Toolkit in your organisation.”

For further information on the conference, download the brochure here.

For further information on Governance between Organisations, click here.

DH issues new guidance on the duty to involve and consult service users

New guidance, published by the Department of Health yesterday, will help the public have more say in decisions made by their Primary Care Trust (PCT), enabling them to shape local health services. The Department of Health (DH) says that “NHS organisations should develop long-standing and inclusive relationships with users so that they have a clear and up-to-date understanding of the views, needs and preferences of the people for whom they commission and provide services.”

The strengthened ‘Duty to Involve’ guidance will also make feedback on public consultations more transparent and accessible.

This follows on from Lord Darzi’s review of the NHS earlier this year in which he recommended that any changes to NHS services should be transparent, locally-led and for the benefit of patients.

The new guidance ‘Real Involvement: Working with people to improve services’ is being issued to help PCTs and other NHS organisations understand changes to the Duty, and also to offer practical advice on how to put local people at the heart of service changes.

Increased patient involvement will, according to the Department of Health, enable local NHS organisations to put patients’ wishes first and give staff the freedom to respond and deliver safer, more personalised care. Developing NHS services in partnership with the public and staff plays an important role in creating a modern NHS which meets the changing needs of the population both nationally and locally.

The guidance is, at 148 pages, a weighty document which, according to Dr Andrew Craig of the MAC Partnership, “belies the fact that the duty to involve and consult ought to be simple.”

The guidance, Real Involvement: Working with people to improve services, together with an introductory leaflet on involving people and communities, can be downloaded here.

Launch of ACCA Corporate Governance and Risk Management Agenda and discussion paper ‘Corporate Governance and the Credit Crunch’

The Association of Certified Chartered Accountants (ACCA) will launch their ‘Corporate Governance and Risk Management Agenda’ at the House of Lords on 17 November 2008. Attendance at the event is by invitation only.

ACCA’s ‘Corporate Governance and Risk Management Agenda’ sets out ten principles for corporate governance and risk management which ACCA believes are fundamental to all systems of corporate governance that aspire to being the benchmark of good practice. They are intended to be relevant to all sectors, globally, including healthcare.

ACCA will also launch their discussion paper ‘Corporate Governance and the Credit Crunch’ at the 17 November House of Lords event.

Healthcare Governance Review readers can download a copy of the discussion paper ‘Corporate Governance and the Credit Crunch’ here. The paper contains, on pages 14 and 15, details of the principles of corporate governance and risk management contained in the forthcoming ACCA ‘Corporate Governance and Risk Management Agenda’.

The key principles are as follows (and further detail is provided in the above paper):

1. Boards, shareholders and stakeholders share a common understanding of the purpose and scope of corporate governance
2. Boards lead by example
3. Boards appropriately empower executive management and committees
4. Boards ensure their strategy actively considers both risk and reward over time
5. Boards are balanced
6. Executive remuneration promotes organisational performance and is transparent
7. The organisation’s risk management and control is objectively challenged, independently of line management
8. Boards account to shareholders and, where appropriate, other stakeholders for their stewardship
9. Shareholders and other significant stakeholders hold boards to account
10. Corporate governance evolves and improves over time

Following launch, the ‘Governance and Risk Management Agenda’ document will be available for download at http://www.accaglobal.com/governance

Patient Safety Congress 2009 launched

Patient Safety Congress 2009 will be held 30 April – 1 May 2009 at the ICC Birmingham.

Patient Safety Congress 2008 in London last May was a highly successful event with 800 delegates and over 100 speakers.

The Health Service Journal and Nursing Times have again teamed up with the NPSA, the NHS Institute for Innovation and Improvement and the Health Foundation, and also for 2009 the Department of Heath HCAI and Cleanliness Division and NHS Connecting for Health have joined the partnership.

Last year the Congress made the case for patient safety. 2009 is about “getting down to work, and providing the clear evidence and practical guidance you need to deliver real improvements. It is a unique opportunity to learn from the best examples in the UK, Europe and across the world, and to share their experiences of improving patient safety.”

The 2009 Programme can be downloaded here.

Speakers will be added over the next 2 months. To be the first to recieve speaker and programme updates sign up to the Patient Safety Congress E-Bulletin here.

The 2008 event sold out 2 months prior to the event. Ensure you do not miss out on the 2009 event by clicking here to book your place.

You can access the Patient Safety Congress 2009 website here.

Ombudsman publishes annual report on investigation of NHS complaints

The Parliamentary and Health Service Ombudsman has published her annual report for 2007-08.

During this period the Ombudsman received 4,011 enquiries related to 4,257 complaints against the National Health Service in England. She accepted 703 cases for investigation and reported on 636 investigations. Around half (49%) were fully or partly upheld.

The report highlights a number of case studies, which are useful for learning purposes.

The report also highlights the forthcoming changes to NHS complaints handling which take effect from 1 April 2009. From this date complaints that are not resolved locally by those who delivered the original service may be referred directly to the Ombudsman, so removing the current intermediate review by the Healthcare Commission.

Download the Ombudsman’s 2007/07 report here.

NHS providers to be ‘rated’ by patients

According to an article in The Independent (Monday 27 October 2008), “Ministers are planning the first “Zagat-style” user’s guide to the NHS, which will rate hospitals and GP practices on the basis of comments from patients.”

Zagat is a US-based organisation that provides ratings and reviews of restaurants, hotels, nightlife and attractions, which help consumers make better decisions. Zagat has teamed up with another US organisation to provide ratings and reviews of doctors in the USA.

In the NHS in England, over 6,000 comments from patients on individual NHS trusts have been recorded on the NHS Choices website. The “Zagat-style” scheme is due to go live next year with a TV campaign and dedicated website that patients will be encouraged to use to rate the service they received. This move is part of Lord Darzi’s drive to improve quality in the NHS, although he is apparently against the notion of rating individual doctors stating that “high quality medicine is a team effort now.”

Healthcare Governance Review welcomes any genuine attempt by the government to establish the bona-fide experiences of patients receiving NHS care and to ensure such experiences help drive up quality across the NHS, including GP practices. It remains to be seen how what the government is planning differs from the national inpatient surveys undertaken by the Healthcare Commission, which already provide an indication of patient reported quality across the NHS in England.

To read the full Independent article, click here.

Building effective NHS boards – UKPGA/Birkbeck ‘Policy Governance’ event a resounding success!

The joint UK Policy Governance Association (UKPGA) and London Centre for Corporate Governance and Ethics (LCCGE) at Birkbeck, University of London, event on 22 October 2008 appears to have been a resounding success.

Almost 40 people turned up at Birkbeck College in London to hear how Policy Governance can help NHS organisations build truly effective boards.

For an independent view of the event, please read the MAC Partnership blog here.

No Authority? Then No Accountability – the ‘Policy Governance’ view of the NHS Constitution

The consultation on the proposed NHS Constitution closed last week.  According to the MAC Partnership in London, “the UK Policy Governance Association (UKPGA) said it all……”

The UKPGA submission focused on two key aspects: accountability and local determination of needs. Those have to sorted out first before service users can be clear about what their entitlements to services are. But the NHS Constitution lacks a statement of accountability – ie there is no answer to the question “to whom is it accountable and for what and how is that accountability to be exercised?”

Read the MAC Partnership’s view on all of this here.

NHS board members “face sack” if their organisations fail to improve

According to an article in the Daily Telegraph (25 October 2008), “Ministers are drawing up a list of failing NHS organisations which will be handed to new management, including private sector firms, if they do not improve. Under the plans, chief executives and their whole board of directors would be sacked without pay-offs.”

The article goes on to say that “Between 30 and 40 hospital, primary care and ambulance trusts are expected to be labelled as “underperforming” in a Government list set to be published before Christmas.

About six of them will be classed as “seriously underperforming”. If they have not improved by April, they will be deemed to be “challenged” and their entire board could be sacked in a matter of months.

The remainder will face the same threat later next year if their performance does not improve, triggering a second round of takeovers in 2010.

The Royal National Orthopaedic Hospital, the Scarborough and North East Yorkshire Healthcare trust, the East of England Ambulance service, along with primary care trusts in Great Yarmouth and Waveney, North Yorkshire and York, and Brent are likely to be issued with the most urgent warning.”

Read the full Daily Telegraph article, and related content, here.

Update – Health Committee Patient Safety Inquiry: Evidence session arranged for 30 October 2008

The Health Committee has arranged an evidence session for its Patient Safety inquiry on Thursday 30 October 2008 at 11.00 am involving, as witnesses, Professor Sir Bruce Keogh, NHS Medical Director, and Professor Dame Christine Beasley, Chief Nursing Officer, Department of Health.

The session will take place in the Wilson Room, Portcullis House.

Further evidence sessions will be held and dates announced in due course.

The sessions will be open to the public on a first come, first served basis. There is no system for the prior reservation of seats in Committee Rooms. It is advisable to allow about 20 minutes to pass through security checks. Committee rooms and timings are subject to change.

Details of this inquiry were set out in Healthcare Governance Review. Click here for further information.

Stuart Emslie, editor of Healthcare Governance Review, and John Step, former National Audit Office senior value for money auditor, have submitted evidence to the patient safety inquiry which has been accepted by the Health Committee. Download their submission here. Please note that this submission is now the intellectual copyright of the House of Commons Health Committee.

US Center for Healthcare Governance introduces its “Quality Curriculum for Trustees” (Non-executives)

According to the US Center for Healthcare Governance, “Since quality of care is central to the mission of every hospital and health system, there is an increasing demand for the Board’s active role in inspiring even greater quality performance. This imperative has taken on a new urgency as quality is increasingly recognized as fundamental to a hospital’s mission of providing safe, cost-effective and affordable health care.”

The Center for Healthcare Governance has produced a Quality Curriculum for Trustees, developed to increase hospital Board member knowledge of the quality imperative. The six-hour program includes interactive sessions, including video segments, case history discussions, and small group exercises facilitated by trained presenters who specialize in quality and patient safety issues.

Specifically, the Quality Curriculum for Trustees is designed:

- to enhance Board members’ abilities to make the clear connections between their work in the boardroom, the performance of their organization, and the well being of patients and the community;
- to provide the tools Board members need to effectively drive their hospitals’ quality and safety initiatives; and
- with the flexibility to be customized based on individual organizational strategy, mission, and vision.

The Curriculum is timely and relevant for any organization interested in improving quality performance, or more effectively driving quality and patient safety initiatives. As a governance resource, the Curriculum will offer value for boards, trustees and executives of hospitals and health care systems, as well as related organizations with responsibilities or oversight related to quality and patient safety.

Whilst the curriculum is obviously geared to a USA context, nevertheless there is much in the curriculum that can be applied to healthcare boards outside America.

Download the Quality Curriculum for Trustees here.

Download the Board Quality Education Program Self-Assessment Tool for Trustees here.

Health Care Risk Report Vol 14 Issue 10 October 2008

Patient safety and risk management are the key themes in this issue of Health Care Risk Report.

Professor Louise Wallace describes a survey of trusts’ patient safety newsletters which reveals room for improvement. She also describes “an effective system of feedback” from incident reporting systems using her Safety Action and Information feedback from Incident Reporting (SAFIR) model.

Stephen Ramsden OBE, campaign director of the Patient Safety First Campaign for England, and chief executive of Luton and Dunstable NHS foundation trust explains what’s in the English national patient safety campaign for managers, staff and patients. A key aspect of the campaign is “leadership for patient safety – getting boards on board with patient safety, with the aim of demonstrating that it is the highest priority.”

Dr Jeff McIlwain takes a look at the consent process and argues that trusts need to rewrite consent forms if they are to elicit true consent and fit in with latest General Medical Council guidance.

Charles Hancock and Janette Midda offer some topics for debate on the ethical aspects of fire safety in the NHS. Meanwhile, Simon Greenfield explains why NHS trusts in London are getting tougher to improve fire safety including compliance with new legislation.

In the first of a two-part series, Dr Jiju Anthony explains the benefits that combining Lean and Six Sigma techniques in healthcare can have for organisations and their patients. While this, the first article gives a broad overview of Lean and Six Sigma, the second article will describe research carried out in NHS Scotland showing how the “use of Lean and/or Six Sigma was associated with a reduction in operational costs, reduction in patient waiting times, reduction in waste in processes, improved patient service delivery and improved understanding of the patient’s voice.”

The final article, and, again, the first of a two-part series, by Andrew Alonzi, a senior law lecturer, looks at the implications for practitioners of the Mental Capacity Act Deprivation of Liberty Safeguards (formerly known as the ‘Bournewoord’ safeguards) to be introduced in April 2009

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.

Personal budgets “could give the NHS the shake-up it needs”

As reported in the Times Online (19 October 2008) John Spiers, health policy fellow at the Institute of Economic Affairs, argues that what the NHS need to make real improvements for patients is for patients to be in control of the money. This is the essence of his message in his new Institute of Economic Affairs book - Who Decides Who Decides? Enabling Choice, Equity, Access, Improved Performance and Patient Guaranteed Care.

“What a shock to the complacent NHS if every service-user could say: “Thanks, but no thanks, I think I’ll go round the corner to the other provider.” And take their tax-based fund with them. This change would let loose at last the real power of direct economic incentives. It would make a reality of choice. It would impact on quality – especially attitudes to patients. It would bear down on costs. It would prompt new suppliers to come into the picture. It would say to the NHS: “Get going on change and improvement. There is no way back.”

Personal budgets could give the NHS the shake-up it needs. This has not been achieved by pouring more billions into it. Personal budgets are the most radical social reform we have seen. Their wider implications for the NHS are revolutionary.”

Healthcare Governance Review believes that the pursuit of optimal patient quality and experience can only be fully realised if patients become customers and are treated as such. The implications for healthcare governance of a customer driven healthcare delivery approach will be significant. 

Read the full Times Online article here.

Announcing the sad death of Professor Ellie Scrivens

Ellie Scrivens died peacefully at home early this morning (19 October 2008) following a relatively short illness. Her death is a great tragedy both for the field of healthcare governance and for her loving husband and two children.

Ellie built an international reputation in the field of healthcare standards and, subsequently, governance. She was an inspiration to me in my work on developing healthcare standards in the early nineties. When I joined the Department of Health as head of controls assurance for the NHS in England in 1998, Ellie provided invaluable assistance with the design and development of the NHS controls assurance standards. She subsequently became director of our NHS Controls Assurance Support Unit (CASU) at Keele University where she was an established professor of health policy.

When the controls assurance project came to it’s natural end in 2004 and the controls assurance standards were replaced by the Standards for Better Health, Ellie successfully transformed CASU into the Health Care Standards Unit (HCSU). HCSU helped many NHS organisations with the challenges of compliance with the Standards for Better Health.

Further information on Ellie’s professional career and achievements can be found here.

An obituary in The Guardian newspaper can be found here.

Ellie’s death is both untimely and unfair. Healthcare Governance Review extends its deepest sympathy to her family.

Stuart Emslie, Editor, Healthcare Governance Review

Health Committee reckons ‘FTs have some proven strengths, but much is unknown’

The House of Commons Health Committee has published a short report on Foundation Trusts (FTs) and Monitor.

The report finds that FTs have some proven strengths. They have performed well financially and generated surpluses. They have been high performers in routine NHS process quality measures. However, much is unknown. With a lack of objective evidence, it is not clear whether their high-performance is the result of their changed status, or simply a continuation of long term trends, since the best trusts have become FTs.

Key aims of FTs were the promotion of innovation and greater public involvement. While the Committee was provided with examples of good practice in both of these areas, again there was a lack of
objective evidence. 

In relation to public involvement, while the Committee saw some examples of good practice in FTs’ new governance arrangements, in general they seem to be slow to deliver benefits and despite numerous small studies, there remains a lack of robust evidence of their effectiveness. The governance process currently costs circa £200,000 per trust, giving a total of around £20 million per annum. We recommend that the Department of Health make it a priority to evaluate rigorously the FT governance system and to give guidance on best practice so that public money as well as members’ and governors’ time can be used as effectively as possible to improve services.

The Committee also found that while FTs do not appear to have yet exploited the full potential of their autonomy, witnesses from FTs told them that the ability of boards to make decisions more quickly was important and made a ‘tangible’ difference to the dynamic of their organisations. Unfortunately, concerns persist about what level of Government intervention in FTs’ affairs is legitimate, and the Government must clarify what the appropriate levels of intervention are.

Finally, the Committee found that Monitor’s application process and regulatory regime seems to be well regarded. However, a complex regulatory environment of other organisations also surrounds FTs, and in particular there is potential duplication between the Healthcare Commission and Monitor both of which evaluate the quality of FTs’ services.

Download the Health Committee report Foundation trusts and Monitor here.

Healthcare Commission ratings show ‘major improvement’ in NHS performance

The performance of the NHS in England appears to have significantly improved since publication of last year’s Healthcare Commission ratings.

Figures published on Thursday 16 October 2008 show that “trusts are improving the quality of services and managing money more effectively.”

Interestingly, Foundation trusts continue to outperform non-foundation trusts. Thirty-eight out of the 42 trusts rated “excellent-excellent” have foundation trust status. Eight foundation trusts were “fair”, while just one was “weak” for quality of services.

For further information click here.

‘Pioneering’ surgical safety hospital removes woman’s gall bladder ‘by mistake’

According to an article in the Daily Telegraph (Tuesday 14 October 2008), “Managers at St Mary’s Hospital in London, where the junior health minister Lord Darzi is Professor of Surgery, have apologised to [a] woman for the “regrettable error” involving what it described as a “minor surgical procedure”.

“An investigation has been launched into measures to identify patients at the Imperial College Healthcare NHS Trust, which includes St Mary’s, after the blunder.

But the hospital claimed that the error was fortuitous: that when the gall bladder was examined it was discovered that it needed to be removed anyway.”

The Daily Telegraph says the incident is “an embarrassment for the trust, which was recently chosen to pioneer a new World Health Organisation initiative to promote surgical safety, and for Lord Darzi, who is an honorary consultant there.”

Read the full article here.

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NHS publishes guidance on handover of patient care between ambulance and hospital

With the current interest in Governance between Organisations (e.g. click here), it is, perhaps, timely that NHS South West should publish detailed guidance for the NHS to assist in the timely handover of patient care from the ambulance to accident and emergency, or other hospital ward or department.

In his Foreword to the guidance, Sir Ian Carruthers, CEO of South West Strategic Health Authority, says that “Patient delays and ambulance handover waits have the potential to impact on patient care as well as wasting valuable NHS resources. Throughout the year, delays can be experienced by both patients and ambulance crews but historically, these delays increase during the winter months as pressure builds in acute settings.” He goes on to say that “it is vital that NHS organisations work together to develop systems and processes that manages patient care in an effective systematic way.”

Whilst there is no mention of Governance between Organisations in the document, the terms ‘appropriate governance’, ‘integrated governance’ and ‘clinical governance’ are (perhaps confusingly?) referred to.

All Acute Trusts and Ambulance Trusts as well as Primary Care Trust commissioners are invited to consider this guide and to decide locally, in light of it, if there are any steps they could take to help improve patient handovers.

Download the guidance, Ensuring timely handover of patient care – ambulance to hospital, here.

Department of Health updates guidance on human rights for NHS organisations

The Department of Health (DH) in association with the British Institute of Human Rights (BIHR) and 5 NHS Trusts have worked in conjunction to produce a framework to assist NHS organisations to develop and use human rights based approaches (HRBAs) to support their core business of planning and delivering high quality and accessible health services for all.

According to the Health Secretary, Alan Johnston, “healthcare and human rights are dependent upon each other………we cannot provide good care without respect for human rights…….It is essential that, as we move forward, we have these values at the heart of everything we do.”

The new framework document issued on 7 October 2008 “is a starting point for NHS organisations seeking to:
- put NHS values such as dignity, respect and equality into practice;
- shape services and procedures that put the human at the heart of healthcare;
- effectively support their staff and commissioned providers to fulfil their specific duties under the Human Rights Act 1998, as well as progressing Care Quality Commission standards on human rights and patient treatment;
- support and add value to their work on related duties and priorities such as: Next Stage Review; Commissioning a Patient-Led NHS; ensuring equality; Dignity in Care; delivering patient choice; providing more personalised services and ensuring that people have a stronger voice; and protecting the most vulnerable people.

 

The document states that ”the key benefits of an HRBA include:
- It helps improve experience and outcomes for patients, service users and staff by approaching services and decisions in a person centred way
- It supports delivery of wider priorities such as the ‘Next Stage Review’ and commissioning
- It improves compliance with the Human Rights Act and reduces complaints/litigation.

The publication Human Rights in Healthcare – A Framework for Local Action (2nd Edition, October 2008), together with additional resources can be downloaded here.