NHS boards – preparing for Quality Accounts

The Department of Health (DH) along with the Care Quality Commission, Monitor and NHS East of England, has written to all trusts to update them on overall progress on Quality Accounts to date; and to encourage them to make their local preparations needed before publishing their first statutory Quality Accounts in (subject to the legislative process) June 2010. The DH says they ”will write again in the autumn with our consultation on the final shape of Quality Accounts.”

Annex A to the letter sets out a summary of the engagement process DH has undertaken to date. In addition, NHS foundation trusts and NHS organisations in NHS East of England have produced Quality Reports for 2008-09 which have provided “a valuable foundation for our [DH] thinking on Quality Accounts.” There is a link in Annex A to some examples that Foundation Trusts have put together. These – and other examples – will, according to DH, be evaluated, and the findings published later this year, as part of a “best practice toolkit” they are developing. This will also, apparently, include guidance on issues such as stakeholder engagement, audit, and board assurance, details of which are set out in Annex A.

From the findings so far, the broad content of Quality Accounts is, according to the DH,  likely to contain the following:

• a statement setting out how the Board has assured itself about the quality of the services offered by the organisation;

• an outline of your organisation’s Quality improvement priorities;

• information relating to locally chosen and relevant indicators on the quality of services provided in your organisation;

• a small amount of nationally determined content – this is likely to include for example, evidence of your current CQC registration status, and relevant findings from CQC’s periodic and special reviews;

• a description of how you decided what to include in your Quality Account, including who has been involved in its design, and how you took account of the views of the views of patients, the wider public and the regulators.

There was, according to the DH, also a very strong feeling that Quality Accounts would have greatest impact if they were readily accessible to the public.

Download the letter and associated annex here.

NHS Governance 2009 conference a success

The Health Service Journal’s (HSJ) annual NHS governance conference held over 3-days at Earls Court in London this week attracted over 300 delegates across the different days, with some attending two or all three days.

The conference was a great success with a host of excellent speakers plus good audience participation during panel sessions, etc.

The general state of chaos and confusion around governance and management was a key issue to come out of the event. The speaker from the new Care Quality Commission added to the confusion by saying that “governance relates to consistent management, cohesive policies, processes and decision rights for a given area of responsibility.” This is a new definition that does not align with the myriad definitions already in place in various NHS guidance documents, and does not conform to key thinking about governance. Interestingly, another speaker coined a ‘new’ governance term at the event. Professor Paul Stanton spoke about “intelligent governance.” Healthcare Governance Review looks forward to the day that the subject of governance in the NHS will be addressed ‘intelligently’ by the Department of Health and associated agencies and bodies, including the new Care Quality Commission!

The presentations from the event should be posted on the web for free download by 3 July. When available, download the presentations by clicking here.

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.

Alberti report on Mid Staffordshire fails to understand the role of boards

Professor Sir George Alberti may be a respected clinician, but his report on Mid Staffs, described by Monitor, regulator of NHS foundations trusts as “robust”, demonstrates a clear lack of understanding of the role of boards and the fundamental differences between governance and management.

Of particular note are his recommendations that:

- A member of the Board should be given responsibility as patients’ champion and (s)he or another Board member should have the same role specifically for older people; and
- Patient/public representatives should be included on all Board committees and sub-committees.

On a positive note, however, the report does recommend  that “Clinical governance arrangements should be enhanced with strong Board level support.”

Read the report MID STAFFORDSHIRE NHS FOUNDATION TRUST:
A review of the procedures for emergency admissions and treatment, and progress against the recommendation of the March Healthcare Commission report together with Monitor’s response to the report here.

Healthcare Commission reports on patient and public involvement in service planning and improvement

The Healthcare Commission has produced a report on a national study of how well healthcare organisations engage local people in planning and improving their services. Key findings are:

- Patients and service users involved in the study generally felt they did not have enough say in their health services. They wanted more information about how to give their views and what changes are made as a result of their contributions. The report recommends trusts should strengthen the culture of being open and responsive with local people and give feedback on how their contribution has improved services.

- Problems were experienced when patients and service users are trying to make their views heard. Key themes included: poor communication; lack of openness; poorly designed local surveys and questionnaires; not enough opportunities to discuss views in an environment where they felt comfortable; no sense of NHS trusts building a relationship with them over time.

- One in four comments from patient groups on NHS trusts’ performance against the relevant core standard in the annual health check were negative. Most of these (80%) were about trusts failing to seek the views of patients and the public. About 50% were about how far, if at all, their views were taken into account.

- People’s views were not used routinely in planning and improving health services. Most trusts could provide some examples of using people’s views, but few demonstrated they routinely took account of them when planning and improving services. In addition, few organisations described any evaluation of their work with patients to find out whether it made a difference to people or services. The report recommends trusts should be able to demonstrate that people are influencing their major service and commissioning decisions.

- Some communities and groups are still ‘not heard’. Most trusts recognised they did not do enough to use the views of those in the poorest health or most in need of their services, and identified specific groups. Groups least likely to be heard include: black and minority ethnic communities, older people, people with learning disabilities, disabled people, children and young people. Healthcare organisations should increase efforts to reach these groups.

- Organisations should undertake checks on whether they, and their local patient and community groups, have the staff, skills and resources in place to involve people effectively in decisions about services.

The full report Listening, Learning, Working Together can be downloaded here.

Sir Michael Parkinson appointed NHS dignity ambassador

The Government has asked Sir Michael Parkinson, the chat-show host, to act as an ambassador for its “dignity in care” campaign to establish how well hospitals throughout England look after patients, in particular elderly people.

Ministers say they want to know if patients were treated with dignity and respect, about cleanliness and the nature of staff teamwork.

Comments should be posted on the NHS Choices website at www.nhs.uk

Source: Times Online

Joseph Rowntree Foundation report on community involvement in the governance of local services

With increasing emphasis placed on the engagement of service users, citizens and communities in government policy, the Joseph Rowntree Foundation (JRF) has published a 70 page report that examines community involvement in the governance of local services, with an emphasis on the role of public officials. Community involvement in governance is defined as “community involvement in shaping local services and policies.”

According to the report, “The role played by public officials in community engagement has important effects on the extent to which community views can influence local services”

The report studies the experiences and views of public officials, comparing a local authority, a police service and a Primary Care Trust in Haringey, North London.

Specifically, the research examines:

- public officials’ perspectives on the purposes of community engagement, the different types of engagement mechanisms used, and the role played by community participants;

- organisational constraints and enablers of community engagement, including senior management support, resources, performance management systems, time frames and organisational culture;

- the informal practices and processes used by public officials to engage with the community and their attitudes and feelings towards it; and

- officials’ views about the extent of community influence and the factors which affected this.

 Download the report, Public officials and community involvement in local services, 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.

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.

Patient and public involvement: the challenges facing NHS boards

In an article in the Health Service Journal (HSJ – 26 September 2008), Robina Shah, chair of Stockport NHS foundation trust, talks to Joan Saddler, the national director of patient and public affairs, who appears very clear about the role of boards in enhancing the visibility of patients and the public.

“Many boards believe in the concept of patient and public involvement and engagement,” says Ms Saddler in the article,  ”but they struggle with implementation. Successful boards will eventually find solutions to critical and complex problems, therefore ensuring the organisation has the skills, as well as the will, to embed patient and public engagement.”

She goes on to say that “Patient and public involvement is not difficult, but it requires complex planning. Boards currently have a range of important drivers that the system has previously lacked. These include an emphasis on patient experience in the key operating framework targets, an emphasis on quality and personalisation of care in Lord Darzi’s report, and the real operational levers the world class commissioning framework can facilitate.”

Read the full article here.