In Ireland, HIQA publishes final standards for infection prevention and control

The Health Information and Quality Authority in the Republic of Ireland (HIQA) has published its final version of its standards for infection prevention and control.

There are twelve standards underpinned by some 72 criteria. The Standards provide direction for health and social care providers on how to minimise and prevent Healthcare Associated Infections. They are designed to promote an environment that maximises patient safety, quality and accountability in health and social care services.

The standards are:

1. Governance and Management
2. Structures, Systems and Processes
3. Environment and Facilities Management
4. Human Resource Management
5. Communication Management
6. Hand Hygiene
7. Communicable /Transmissable Disease Control
8. Device Related Infections
9. Microbiological Services
10. Outbreak Management
11. Surveillance Programme
12. Antimicrobial Resistance

Download the full standards and associated guidance here.

Health Care Risk report Vol.15, Issue 6, May 2009

Patient safety continues to be a focus at the highest level, with Parliament’s health committee grilling the great and good over care failings at the Mid Staffordshire Foundation NHS Trust. The Healthcare Commission’s report on this trust – one of the last that it produced before becoming part of the Care Quality Commission – shows that the NHS still far to go to achieve a true patient safety culture.

Clinicians and managers throughout the NHS are putting a lot of hard work into patient safety and it is to be hoped that as time goes on this work will bring results. However, improved safety has been hard to demonstrate in the USA, as John Tingle points out in this issue, in spite of their having started work on this issue earlier than us.

Also in this issue of Health Care Risk Report (HCRR), investigation expert Maria Dineen provides some useful pointers on report writing while Josephine Ocloo talks about the expertise and knowledge that patients and relatives have to offer patient safety work in the NHS.

Also in the May issue of Health Care Risk Report :

- An analysis of the Healthcare Commission’s report on NHS boards and patient safety, by Stuart Emslie, editor of Healthcare Governance Review

- The success of the Speedy Resolution Pilot in Wales

- Professional evidence to the health committee

- Medication safety and pharmacists’ new professional body

- Expert comment on “failure to refer” in general practice, the care and treatment of mental health service user Daniel Gonzales, and a fatal fall from a hoist in a care home.

If your organisation does not currently subscribe to HCRR then please consider doing so. A subscription form can be downloaded here. You can also subscribe to the free ‘Health Care Risk Report e-zine’ newsletter.

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.

Boards going further faster – DH guidance on MRSA targets and productivity

The Department of Health (DH) has issued a pocket guide “for chief executives and boards” on “meeting the MRSA target and increasing productivity.”

The guide states that “Sustainable improvement in HCAI requires board-level support and endorsement, with every trust having a prioritised action plan that is integral to its overall strategic direction. Achievement of the target will require the engagement and active involvement of all staff working at every level of the organisation, supported by the infection control team and identified ‘champions’.”

The guide does recognise that meeting the MRSA target is fundamentally a management (i.e. chief executive) issue and, refreshingly, does not seek to attempt to get the board to micromanage the issue. That said, the guide does include the usual DH pre-occupation with having a “non-executive champion” for reducing MRSA!

Download the pocket guide  here.

IoD seminar and guidance: The Governance of NHS Foundation Trusts: Making it Work

The Institute of Directors (IoD) Policy Unit will be hosting a half-day seminar on the subject of governance of National Health Service (NHS) Foundation Trusts on Monday 29 June 2009 at 2pm in London.

According to the IoD, “The NHS employs something like 1.3 million people to deliver health and social care. Ensuring that the NHS delivers effective and efficient care means that good leadership is required.

The NHS is not a single entity. It is delivered by a variety of boards, trusts, authorities and other organisations. Although structures may differ across the UK, all of these have boards of directors.

The Institute of Directors – whose membership includes directors in the health sector, both executive and non-executive – takes a keen interest in having the best leadership in place at board level in all organisations.

The seminar will bring together directors from the NHS, policy-makers and others to discuss some of the existing experiences in the NHS. This will include the pioneering NHS trust model in England. The scope for more autonomy and accountability and extension of good leadership practices will also be on the agenda.”

The programme is currently being finalised and will be available at www.iod.com in due course. To register your interest, email policyevents@iod.com

Stafford: “…the only way to explain it is the complete dysfunctionality of the board”

In a thought-provoking article in the Health Service Journal, Michael White (assistant editor – politics – of the Guardian) says that:

At Stafford – to quote one Whitehall chum – “everything that could have gone wrong went wrong… the only way to explain it is the complete dysfunctionality of the board.”

Read Michael White’s article here.

NHS has a poor understanding of boards……latest example

A letter of 7 May 2009 from NHS East of England Chairman Keith Pearson JP to chairs throughout the region encourages them to “identify one of your non executive directors to act as a Board level champion for sustainable development and to work with your executive lead.”

As regular readers of this blog site will know, it is not the job of non-executives to ‘mimic’ their executive board member colleagues.

The challenge has to be persuading the BOARD to champion whatever it needs to champion. The board would then require its chief executive to act in line with its own requirements (i.e. that which is important to the board).

Whilst Mr Pearson’s ‘request’ is undoubtedly well meaning, no non-executive director should undertake managerial work – it compromises the independence of the role.

New of the World – amazingly ill informed about NHS management

Healthcare Governance Review usually prefers to ignore the sensationalist, ill-informed and grossly unjust and unhelpful remarks about NHS managers made by the media (and Vince Cable of the Liberal Democrats!).

But today’s headline-grabbing, newspaper-selling manager-bashing by the News of the World simply cannot go without comment.

The News of the World states that “PENPUSHERS in the National Health Service cost a sickening £2.6 BILLION last year – with managers OUTNUMBERING frontline consultants.”

They say that ”The NHS has lost sight of what it’s supposed to be providing – good quality healthcare that’s value for money” and they attribute this to the amount of money spent on management. They have produced a “table of shame” showing management costs in a range of NHS organisations.  “Top of our table,” says the News of the World, ”spending £7 million – 8.5 per cent of its total budget-on desk-jockeys is the Bedford and Luton Mental Health Trust, where chief executive Paul Mullen is on a handsome £115,000 a year.”

Now, those of us ‘in the know’ are fully aware that the NHS is a high risk industry that is overly-bureaucratic but heavily under-managed. Many patients die uneccesarily or suffer needless harm every year simply because of management failings – in short, the NHS does not spend nearly enough on good management and management systems to protect and support doctors and other clinicians in providing safe, high quality care. By other high risk industry standards, what is really ”sickening” about the NHS is that it ONLY spends, at most, 8.5% of revenue managing itself. Other high risk organisations would be at least double this figure.

Read the News of the World article here and, if you feel strongly about their ill informed portrayal of management in the NHS, leave a comment on their website.

Being an NHS board member means thriving under pressure……

Healthcare Governance Review editor Stuart Emslie has published the second of two articles in Health Management, the journal of the Institue of Healthcare Management.

The article – Tough at the top - acknowledges that veryone in healthcare is under pressure. Boards are under particular pressure because they are ultimately accountable for the success and safety of an organisation. They have a huge amount of responsibility and when things go wrong, the buck stops with them. This can have serious implications for boards and board members.

Download a copy of Stuart’s article Tough at the top (PDF)

The first article looks at how board performance relates to organisational performance. Download this article Boards and performance (PDF)

Thome report on Mid Staffordshire looks to ensure governance and clarity of accountability

Dr David Colin Thome, National Director for Primary Care at Department of Health, has published his report on Mid Staffordshire NHS foundation trust alongside Professor Sir George Alberti’s report (click here).

Dr Thome makes recommendations in four key areas:

1. Involving patients and the public
2. Commissioning for outcomes supported by excellent use of appropriate data and information
3. Ensuring governance and clarity of accountability of all the different organisations in the system
4. Clinical leadership

It is refreshing to note that Dr Thome does not fall into the usual trap of confusing governance with management. There is no mention of boards managing the organisation and there is no reference to ‘Governance between organisations.’

His recommendation relating to ‘ensuring governance and clarity of accountability of all the different organisations in the system’ appear balanced and cover:

1. PCTs as local leaders of the NHS must assume ultimate responsibility for commissioning safe services and improving the health of their patients and populations.
2. All hospital providers including foundation trusts must allow PCTs ready access to review their services.
3. SHAs are the regional headquarters of the NHS, and in that role must ensure that the whole healthcare system discharges its responsibilities, with a particular emphasis on the performance management of PCTs to ensure that they are taking forward their leadership role. The Commissioning Assurance System for world class commissioning provides a framework for taking this forward.
4. PCTs and SHAs must be more proactive in informing Monitor of any concerns prior to foundation trust application and not assume that the regulators will take responsibility for ensuring quality of care. The regulators must share data and early concerns to allow PCTs and SHAs to take action.
5. The Department of Health should describe how the roles of PCTs, SHAs and the regulators are different and how they interrelate.
6. The Department of Health should set out clear expectations on all health organisations that effective ‘business continuity planning’ is the norm, and work in co-production with the NHS to develop guidance for organisational transition, including effective formal record keeping.
7. The NHS Confederation should consider how it can support PCTs through its network to develop their capacity and capability to respond to their role as local leaders of the NHS following lessons to be learnt from this review.

The Department of Health has published its response to the Alberti and Thome reports and this report, together with copies of the Alberti and Thome reports can be downloaded here.

Notable quotes – corporate governance

Readers are encouraged to reflect on the following quotes in the context of the governance of public sector healthcare organisations.

“People get religion of sorts about ethics and corporate governance in down markets. When things are going well, they tend to forget about it.” James A Allen. 

“With the trillions of dollars that have been wiped out of pension plans and other savings, investors have come to understand they need to pay attention to the governance of corporations — from compensation to board structures. If they don’t, the cost is going to come out of their pockets. They’ve got to be engaged.” Stephen M Davis.

These quotes were taken from a USA article on executive pay. Read full article here.

Research finds higher NHS patient safety reporting rates associated with a more positive safety culture?

An interesting paper published in Quality and Safety in Health Care concludes that “Incident reporting rates from acute hospitals increase with time from connection to the national reporting system, and are positively correlated with independently defined measures of safety culture, higher reporting rates being associated with a more positive safety culture.”

The paper is based on information reported to the National Patient safety Agency’s National Reporting and Learning System (NRLS).

The strength of the ’statistically significant’ regression coefficients presented in the paper at Table 3 are in the range 0.03-0.05, equivalent to correlation coefficients between 0.17 and 0.22, which brings into question the validity of the findings. According to Cohen J. In: Statistical power analysis for the behavioral sciences. 2. Erlbaum L, editor. New Jersey; 1988, correlation coefficients values between 0.1 and 0.3 are regarded as weak correlation, those between 0.3 and 0.5 as moderate, and those equal to or higher than 0.5 as strong. Values below 0.1 are regarded as having no correlation. On this basis, the presented coefficients could be said to demonstrate only a weak correlation.

Interestingly, the study was funded by the NPSA and two of the paper’s seven authors are affiliated to the NPSA.

The NPSA has previously been criticised by the Public Accounts Committee for its non-delivery of a fully functional NRLS. The system, even today, is still not delivering the learning information originally envisaged in 2001 by the Department of Health (click here) and produced by other patient safety reporting systems around the world. In addition, Healthcare Governance Review was recently critical about the information supplied to trusts by the NPSA from its NRLS (click here).

Readers might be interested in drawing their own conclusions from this research by freely downloading the full paper Trends in healthcare incident reporting and relationship to safety and quality data in acute hospitals: results from the National Reporting and Learning System here.

New NHS Evidence site caters for governance

The new NHS Evidence site launched yesterday (30 April 2009) by NICE will, according to NICE, “ allow people working across health and social care – including social workers, commissioners, clinicians, academics and researchers – to access a comprehensive range of sources of clinical and non-clinical evidence to help them make informed decisions about treatments and resources.

“Until now,” says NICE ”evidence of what works to prevent and treat many conditions has been generated, analysed and interpreted by different unaccredited sources. Announced as part of Lord Darzi’s report ‘High Quality Care for All’ (June 2008), NHS Evidence will help users identify the best evidence by sorting, sifting and prioritising a range of information and awarding an accreditation mark to the most reliable and trustworthy sources of guidance. All information submitted for accreditation will be assessed by an independent advisory committee and guidance producers must show they meet a pre-defined set of criteria indicating that their product has been developed using rigorous processes.”

Healthcare Governance Review did a short ‘test drive’ of NHS Evidence searching for all information that contained the word “governance.” A total of 3,804 entries were found.

The new NHS Evidence service can be accessed here.