CQC CEO wants to “ring alarm bells in the boardrooms” of poorly performing organisations

The Care Quality Commission (CQC) has published performance ratings for 2008/09 all 392 NHS trusts in England. Their assessment, also known as the ‘annual health check,’ shows big improvements for patients. According to the CQC, there is a reduction in MRSA and Clostridium difficile, and more people are:

- seen in A&E within four hours;
- receiving treatment within eighteen weeks of referral; and
- screened for Chlamydia.

Overall, the CQC says that the NHS is performing well on quality and has significantly improved its financial management.

However, the Commission is concerned about the 20 trusts rated weak on quality, particularly those rated weak over a number of years, and trusts rated fair for too long without improving.

Cynthia Bower, CQC Chief Executive, says:

“I want to ring the alarm bell in the boardrooms of these organisations. Next year, all trusts must register with us to legally function. It is clear that many have significant work to do to and a short time in which to do it. They should be in no doubt that we will take firm action if we deem it necessary.”

Of particular interest is the self-reported state of compliance with the Core standards for better health. The standards with highest rate of compliance are:

C08a (100% compliance) – support for staff to raise concerns about services
C10b (100%) – professionals abide by relevant codes of professional practice
C14a (99.8%) – providing information about how to complain
C22a&c (99.8%) – organisations cooperate to improve health of the community
C06 (99.6%) – health and social care organisations cooperate
C07b (99.6%) – promote openness, honesty, probity, and accountability

Core standards with lowest rate of compliance are:

C11b (87.6%) – participation in mandatory training
C09 (88.3%) – systematic and planned approach to records management
C04c (88.3%) – reusable medical devices are properly decontaminated
C04b (89.6%) – minimise risks of medical devices
C07e (90.5%) – challenge discrimination, promote equality and respect human rights
C02 (90.7%) – protect children by following national child protection guidelines

Full information on the 2008/09 annual health check can be found here.

South Tees FT needs Deputy Director of Healthcare Governance and Quality: Closing date 23 Oct 2009

Following a major Trust-wide review of their Governance structures, South Tees are looking for someone to provide the strategic leadership and corporate management of Clinical Governance within the Healthcare Governance Directorate. This will involve working closely with the Medical Director and Director of Nursing and Patient Safety. It will also involve working with the Head of Corporate Affairs and the Head of Financial Governance and Control to ensure that the Trust achieves integrated governance. The successful candidate will deputise for the Executive Directors on Governance issues and be part of the Trust’s senior management team. He/she will lead a team covering a comprehensive range of associated functions: NICE and NPSA guidance, Clinical Audit, NHSLA and CQC compliance.

Educated to Masters Degree level the successful candidate will need to have significant experience of working in a senior management position in a complex organisation. He/she will possess a comprehensive understanding of clinical governance and the requirements of the External Regulators and will need to be a dynamic and transformational leader with experience of developing corporate policy, strategy and preparing and presenting Board papers.

Successful candidates will be required to attend the selection process on Monday 16 November 2009.

The post is advertised as 37.5 Hours Per Week and Agenda for Change terms and conditions Band 8D with Salary Range: £63,833 – £79,031 pa plus Pension and Staff Benefits

For informal enquiries, or to arrange a visit, please contact Sue Wooding on (01642) 854697 or email Sue.wooding@stees.nhs.uk

Closing Date: 23 October 2009

Audit Commission ‘High Performing Board’ events for existing and aspirant foundation trusts

Following the success of their high performing board seminars in 2007 and 2008, the Audit Commission is holding a series of seminars between 22 October and 26 November dedicated to foundation trusts and aspiring foundation trusts across England.

Continuing the theme of the high performing board while focusing upon quality, the seminar will support executive and non-executive directors to enhance their understanding of the right level of information required to discharge their duties.

The seminar will focus on three themes:

Quality Improvement

This presentation will enable you to learn from others by sharing the experience of delivering quality improvements in patient care and re-shaping local health services to respond to the needs of the local community.

Quality and Costs

This presentation will explore how boards ensure that they can safely reduce costs and advance quality at the same time. It will also explore successful NHS productivity and efficiency schemes.

Quality NHS leadership

This presentation will discuss and explore the benefits of creating and embedding a quality leadership culture. The seminar will allow for presentations, time for discussion and reflection. It will enable you to meet and network with colleagues working in diverse roles across the health economy.

For further information, including dates, venues, speakers and booking form, click here.

Governing trainee doctors – what boards should know

There is a commonly held assumption that early August is an unsafe period to be admitted to hospital in England, as newly qualified doctors start work in NHS hospitals on the first Wednesday of August.

The figure below, for example, depicts real data for the whole of 1996 for a major acute hospital that was a key pilot site in the development of the NHS’s Incident Recording and Information System (IRIS) – part of the NHS’s Safecode project in the nineties. The trend, produced by the IRIS software, clearly shows a significant rise in reported harm to patients during August. Root cause analysis found that the major underlying cause related to lack of effective trainee doctor supervision whilst more senior doctors were on holiday.

This issue has now been subjected to a fairly rigorous scientific analysis and is the subject of a recently published paper by researchers at Imperial College London. The researchers  investigated whether in-hospital mortality in hospitals in England is higher in the week following the first Wednesday in August than in the previous week 

They found that “the odds of death for patients admitted on the first Wednesday in August was 6% higher after controlling for year, gender, age, socio-economic deprivation and co-morbidity. When subdivided into medical, surgical and neoplasm admissions, medical admissions admitted on the first Wednesday in August had an 8%  higher odds of death.” In each case the results were statistically significant.

The researchers state that if this is due to the changeover of junior hospital staff, then this has potential implications not only for patient care, but for NHS management approaches to delivering safe care. They suggest further work to look at other measures such as patient safety, quality of care, process measures or medical chart review to identify preventable deaths rather than overall early mortality to further evaluate the effect of junior doctor changeover.

In their efforts to govern patient safety, Healthcare Governance Review believes that boards of hospitals with trainee doctors should be challenging executive directors on the safeguards (controls) in place to manage the potential risks.

Read the full research article Early In-Hospital Mortality following Trainee Doctors’ First Day at Work here.

Notable quote: A doctor’s view on patient quality and outcomes

 

“In the twenty first century most doctors and nurses still haven’t got much of a clue about the quality of care we’re providing, the effect we have on you, what happens to you after you’re discharged, whether we’ve made your life better or worse or even if we’ve killed or cured you. We operate and consult in a vacuum, with virtually no feedback, just muddling through and hoping for the best.”

Dr Phil Hammond, 2002. Trust me, I’m a doctor. Metro Publishing, London

Does improving quality save money?

A new report published by the Health Foundation ‘Does improving quality save money?’ provides evidence that suggests quality improvement could make an important contribution to addressing financial pressures but only if there is careful planning, leadership, expertise, perseverance, and not a little healthy scepticism. It also requires a sustained and relentless focus on high quality implementation.

The Health Foundation believes that managers and clinicians in the health service should be asking themselves the important question of how they can continue to improve quality while also cutting costs.

The research, carried out by a leading academic, shows that poor quality services are common and costly. It has been estimated that the costs to the NHS of hospital acquired infections are £1bn a year and adverse drug events are estimated to be between £0.5bn.

There is evidence that some solutions for poor quality are effective. There is strong evidence that simple clinical-level changes are effective in reducing adverse events, such as prophylaxis before surgery, but there is less evidence of the effectiveness of other proposed solutions.

When looking at organisational changes, the potential is greater for reducing waste and poor quality and making savings but so are the risks. This is probably due to the number of professions and organisational units that need to change.

The report’s author John Overtveit says, ‘To make it more financially advantageous for providers to increase quality, changes are needed in routine financing systems, in how performance is measured to include quality measures, and in expert support and information on how to make successful improvements’.

Research shows that improving quality can save money, though the current evidence is limited. The review found that many studies which reported savings did not assess the cost of the intervention, left out some costs, or did not use actual cost data from the service.

‘The report suggests that although the available evidence isn’t strong, improvement initiatives can reduce costs to service providers and improve quality. There is evidence that adapting patient safety practices and proven treatments have the potential to improve outcomes and save money. This requires careful planning, leadership, expertise, perseverance and a sustained and relentless focus on high quality skilful implementation.

At a local level, the evidence in the report suggests that clinicians and managers can increase their likelihood of success by: working together to meet the challenge, using tested improvements that are adapted to local circumstances, using reported experiential evidence; measuring and monitoring the improvement, including how much it has cost and how much it has saved; and above all by managing implementation skilfully.

At a national level, the evidence suggests that the Department of Health and Strategic Health Authorities could improve chances of success by providing NHS organisations with expert support, supporting the development of skills and addressing the barriers created by the financial and performance management systems.

Download the report Does improving quality save money? here.

New book – Enhancing Patient Care: A practical guide to improving quality and safety in hospitals

This is, perhaps, THE most practical and useful book on patient safety and quality of care available today. Every hospital and anyone involved in patient care, clinical governance, quality, safety and/or risk management should have a copy. And any educational programme covering the subjects mentioned should commend this book as a key text.

Written by Australian clinicians, Associate Professor Alan Wolff, Director of Medical Services, and Sally Taylor, Clinical Risk Manager and former midwife (see photo), and formally launched by the Victoria Health Minister on 31 August 2009 (click here), this is a commonsense guide to quality improvement and risk management in hospitals. The book is based on their work, over many years, in the Wimmera Health Care Group in Victoria, Australia. Their experience at a regional hospital has led to a pragmatic framework that guides other health services through the relevant evidence and theory, down to finest details on practical quality, safety and risk management. 

Whilst the book has been described in terms of “help[ing] improve practices and patient outcomes in hospitals throughout Australia” there is little, if anything, in the book that cannot be applied internationally. Enhancing Patient Care will be of particular use to anyone who wants to set up or improve a quality improvement and risk management program, regardless of size and budget.

  

Assoc. Prof. Alan Wolff and Sally Taylor

The book contents include:

- Explanations of clinical governance, quality improvement and risk management
- How to detect adverse events and risks to patient safety
- A practical framework to prevent adverse events and reduce risks
- How to develop a quality improvement and patient safety culture
- A step-by-step guide to implementing a clinical risk management program in your health service
- How to develop a clinical risk management program in a small hospital

Interested readers can download a PDF preview of the book, which includes the detailed contents pages, a diagrammatic description of the Wimmera quality improvement and risk management model, and a Foreword by Profesor Bruce Barraclough, Chairman of the International Society of Quality in Healthcare (ISQua), here.

The book costs 50 Australian dollars (approx. 30 British pounds) and can be purchased from the bookshop of the Medical Journal of Australia, here.

What patients want to know in deciding where to go for hospital treatment

According to the Patient Association, patients have been telling them for years just what sort of information they want so that they can decide where to go for treatment. They need to know essential facts like:

• Clinical outcomes of individual consultants
• Ward infection rate – not just the overall hospital’s statistics
• Nurse:patient ratio – because too few nurses endangers their care
• Mixed sex accommodation – patients should not have to share toilets and wards with members of the opposite sex
• Hospital parking charges

The Patients Association says that patients need to be satisfied that information provided is totally accurate and up to date, so that they can give proper consent and do away with the postcode lottery.

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.

“Efficient use of resources and good quality services go hand in hand” – new finance guide for doctors

The Audit Commission and Academy of Medical Royal Colleges have published A guide to finance for hospital doctors.

In the publication, they state that ”there are many examples where clinicians have led change and improved services, through taking greater responsibility for managing the money available to them. This is not about focusing on cost and cost alone, but how best money can be used to improve the quality of care, combining operational and clinical effectiveness. Efficient use of resources and good quality services go hand in hand.”

Healthcare Governance Review believes that the guide, whilst written for doctors, may be of interest to board members and managers.

Download A guide to finance for hospital doctors here.

NAO publishes latest NHS infection control report

The National Audit Office (NAO) has published its latest report – Reducing Healthcare Associated Infections in Hospitals in England. This report builds on earlier NAO reports into healthcare associated infection published in 2000 and 2004.

The report points to real progress in dealing with infection control issues in hospitals. But there are still problems to address, including the finding that doctors are less likely to comply with good infection control practice.

According to the NAO “There has been a perceptible change in leadership, performance management and clinical practice in most trusts. The impact has not, however, been the same for all trusts. A quarter of hospital trusts have reduced MRSA bloodstream infection rates by over 80 per cent, but 12 per cent had an increase in MRSA bloodstream infections. Twenty nine per cent of hospital trusts have reduced C. difficile infections by over 29 per cent, but 19 per cent have had an increase in C. difficile infection. Moreover there has not been the same impact on other avoidable infections, where there is still a lack of robust and comparable surveillance information. The information that is available suggests that other healthcare associated bloodstream infections, including ones due to other antibiotic resistant organisms, may have increased. Most staff and patients are less aware of the risks of acquiring these other infections. There is scope therefore for hospitals to improve infection prevention and control further and make savings by tackling other healthcare associated infections.”

Key recommendations for trusts and trust boards set down in the NAO report include:

- Hospital trusts should extend root cause analysis to all serious infection incidents. The Department, Health Protection Agency and National Patient Safety Agency should implement a system for collating and sharing the key lessons from trusts’ analyses in the same way as for other serious patient safety incidents.

- Primary care trusts should require all providers to put in place assurance systems which demonstrate how they are complying with good infection control practice, for example, clinical audit compliance and root cause analysis.

- Hospital trusts should require staff to report healthcare associated infections which contribute to death, significant disability or injury, for one or more patients to the trust’s patient safety incident reporting system.

- Hospital trusts should have processes to provide their board with assurance that infection, prevention and control is the responsibility of everyone in the trust. For example as required by the Code of Practice, all staff should have performance objectives for complying with good infection control practice.

- Hospital trusts should have processes in place to assure their boards that there is effective control over the appropriateness of the antibiotics being prescribed.

- Primary care trusts should monitor hospital trusts’ and other healthcare providers’ antibiotic prescribing and take action to address inappropriate use.

- Primary care trust commissioners’ contracts with healthcare providers should explicitly state expectations of quality and safety with respect to reducing the risk of all healthcare associated infections.

Download the NAO report Reducing Healthcare Associated Infections in Hospitals in England plus associated survey, research and other materials here.

Delivering and demonstrating quality in the NHS – Free HSJ online seminar

The Health Service Journal (HSJ) has produced a free to view 45 minute debate and discussion to help NHS organisations gain the information they need to measure, performance manage and assure quality. The HSJ says it is an opportunity to get to grips with the challenges ahead and help you lead the way in delivering high quality care for all.

The seminar tackles the following issues:

- Establishing appropriate quality metrics

- Securing resources and developing skills to deliver quality accounts

- Embedding quality into contracts through the use of CQUIN

- Determining the reality of reliable information available and steps to improve this

- Ensuring information governance, compliance and risk procedures are robust and fit for the future

Watch the seminar on your computer by clicking here.

Kings Fund report – From board to ward

The Kings Fund has published From board to ward – identifying good practice in the business fo caring. Essentially, the report focuses on the role of executive nursing directors on boards.

According to the Kings Fund, “Failure to deliver the fundamentals of care can bring down an NHS board faster than failures of either finance or performance, and there have been recent examples of this. Despite this, there are still serious concerns about the lack of attention some NHS boards pay to the quality of clinical care. However, there have been considerable changes to the external environment over the past year, culminating in the NHS Next Stage Review, led by Lord Darzi………This gives support to the improvement of the quality of care being a business imperative. Such emphasis poses particular challenges for nurse executives. On the one hand, they are well placed to help boards assure themselves about the quality of clinical care. Yet when there are high-profile failings in patient care, it is often nurse executives who are blamed for failing to champion quality and patient safety at board level.”

The King’s Fund, in partnership with the Burdett Trust for Nursing (a charity that offers grants to support the nursing contribution to health care), has developed a programme of work to support nurse executives and NHS trust boards to ‘bring the ward to the board’. It is about turning the spotlight firmly on to reviewing clinical quality, and putting patients and how they experience health care at the heart of an organisation’s work. It set out to explore the role of nurses on the board and how far they were able to influence boards to increase the level of engagement with clinical quality.

This report presents the findings from the first phase of the programme, which was based on seven pilot sites across the UK. The sites included two foundation trusts, a partnership trust, and a primary care trust in England, as well as one site in Northern Ireland, one in Wales and one in Scotland. These pilot sites were chosen for the learning they could contribute about the role of the nurse executive in relation to high-quality, board-level clinical engagement, as well as how to manage patient care and improve the quality of the patient experience. The next phase of the programme, working in another six sites, is already under way and its findings will be reported later in 2009.

Download From board to ward – identifying good practice in the business fo caring here.

New reporting requirements put quality at top of Board agenda

New reporting requirements announced on 23 April 2009 will see NHS foundation trusts across England and all NHS organisations in the East of England report on the quality of care their organisations deliver – and how they plan to improve it – as part of their 2008-09 Annual Reports.

The introduction of quality reporting follows a joint consultation by Monitor, NHS East of England, the Care Quality Commission (CQC) and the Department of Health.

According to Monitor, regulator of NHS foundation trusts, “Quality reports will help to develop more transparent and accountable public reporting, ensure that Boards have clear priorities and achievable plans in place for driving improvement, and help to inform the development of Quality Accounts, a legal requirement for all NHS organisations from 2010 as set out in High Quality Care for All.

All NHS foundation trusts in England, and NHS organisations in the East of England, will be asked to:

Produce a quality narrative which provides an overview of the quality of care the organisation offers, its priorities for improvement and how these improvements will be achieved. Patients and the public can use this information to hold Boards to account on the commitments they make;

Respond to any concerns raised about their trust by regulators or representatives of the public (i.e. LINks) and the actions taken to address these concerns; and

Report on their performance in 2008/09 on the basis of indicators chosen by the trust for patient safety, clinical effectiveness and patient experience. In addition to local indicators, the organisation must also report on its performance against national priorities and core standards.”

Further information can be found here.

USA report – A Board of Directors Dashboard for Driving Quality in Acute Care

On November 10, 2008, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services and the U.S. Health Care Compliance Association (HCCA) co-sponsored a government- industry roundtable called Driving for Quality in Acute Care: A Board of Directors Dashboard.

This roundtable focused on how a hospital’s board of directors can use performance scorecards, or dashboards as a tool to promote quality of care in its institution. Dashboard reports use graphics to concisely present critical data in summary form.

Many questions were asked about the creation and use of the dashboard. For example, how do hospitals determine the quality measures to be used? Should the board’s quality committee or medical staff be involved with the creation of the measures? Who, in addition to the board, should be given the dashboard? How frequently should the dashboard be updated? What actions should the board take in response to the information presented in the dashboard? How
can the dashboard be linked to the organization’s strategic plans or objectives? These questions formed the basis of the roundtable presentations and discussions.

Download the roundtable report  Driving for Quality in Acute Care: A Board of Directors Dashboard here.

Looking at the problems at Mid Staffordshire NHS foundation trust through a Policy Governance lens

Caroline Oliver, a World authority on building high performing boards using the Carver Policy Governance model, has responded to the situation at Mid Staffordshire NHS foundation trust (see below) with a short article titled ‘Danger – Targets at Work’.

According to Caroline, the main problem in the NHS currently is that  ”assurance systems are often assuring the wrong things, by which I mean that they are assuring compliance with matters of means rather than ends.”  

Healthcare Governance Review believes that had the Mid Staffordshire board been focused on ends (i.e. organisational purpose) rather than fixated on various means issues, the outcome for many patients who allegedly died unnecessarily might have been very different.

Caroline states that “the work of boards in healthcare really matters.” Further, she believes that “the immediate hope for progress in terms of distinguishing ends from means lies with NHS boards who are the only people at local level who have the authority to require an ends focus and to hold themselves and their organisations accountable for the fulfillment of same. When boards define ends they are defining their organisation’s real bottom line – the criteria against which everything they do should ultimately be judged. When boards define ends they are providing meaningful leadership. Yes they need to ensure that everything about the organisation is legal, prudent and ethical, but without ever losing sight of the organisation’s purpose.”

You can read Caroline’s full article, Danger – Targets at Work, on her website here.

Stafford Hospital ’scandal’: board members and managers who have not already left should “examine their consciences.”

Following on from the recent report into ‘appalling’ emergency care conditions (click here), Sir Ian Kennedy, Chair of the Healthcare Commission, is reported in the Sunday Telegraph today (Sunday 22 March, 2009) as saying that board members and managers who had not already left [Mid Staffordshire NHS foundation trust] should “examine their consciences”.

“Anybody who had any responsibility for leadership and management must ask how they allowed this place to get into the state where patients were dying,” he is quoted as saying in an interview with the newspaper.

Sir Ian Kennedy said it was clear that serious problems at the hospital were evident as far back as 2002, yet no action was taken by managers. He also criticised ‘bosses’ at the strategic health authority for failing to act.

The Sunday Telegraph has launched a campaign today for a series of measures to ensure that the crisis in Staffordshire is never repeated in the NHS. The Heal Our Hospitals campaign demands the establishment of an independent inquiry into the regulation and supervision of NHS hospitals.

The newspaper is also calling for:

- A review of hospital targets to ensure that they work to improve quality of care.
- Nurses to focus on patient care – not form-filling – as their central duty.
- Routine publication of comprehensive death rates for hospitals.
- Patients to be given a stronger voice in the running of hospitals.
- Assurance that senior hospital staff will not be rewarded for failure.

 Read the full Sunday Telegraph article here.

Participate in ISQua 2009 quality conference, October, Dublin – Governance & Leadership track

Are you and/or your organisation interested in speaking or presenting a poster at one of the world’s biggest annual healthcare quality conferences 11-14 October this year in Dublin?

The 2009 annual conference of the International Society for Quality in Healthcare (ISQua) is focusing on the highly topical issue of designing quality into healthcare organisations. This is a major annual event attracting up to 1000 delegates and speakers from all over the world.

One of the tracks for the conference is ‘Governance and Leadership’ and Stuart Emslie, editor of Healthcare Governance Review, is assisting ISQua with this aspect. The key question being addressed by this track is “How is the quality and safety function best designed into the organisation construct of our Health Systems at National, Regional and Local levels?”

Possible areas of focus include:

· Where does the quality (including safety and risk management) function fit into Health Organisations at Corporate level and what is its role?
· How does the delivery system organise for quality?
· How does the Corporate quality function relate to the delivery system i.e. National, Regional and Local level inter-relationships
· How do we design the system such that roles, authority, responsibility and accountability for quality is clear and unambiguous?
· Within this framework, how are standards and quality, as well as safety and risk management, assured?

For further information or to submit an abstract (deadline 20 March 2009) click here or, alternatively, contact Stuart Emslie directly on svemslie@aol.co.uk or by telephone on +44(0)7932376562.

Spotlight on learning from complaints

The Healthcare Commission has released a report about its experiences dealing with complaints in the NHS, and recommends that trust boards oversee the complaints system in their organisations.

According to the Commission, “Complaints are…..inherently negative feedback for organisations. However, the process of dealing with them should be viewed as a valuable and positive opportunity for the NHS to learn from mistakes and bring about real improvements in services.”

The report, titled Spotlight on complaints, makes 12 key recommendations to the NHS:

1. Acknowledge the person’s right to complain.
2. Ensure that the complaint is assessed upon receipt, so that any concerns about a risk to the safe care of other patients can be identified promptly.
3. Clarify what the person’s concerns are and manage expectations about possible outcomes to the investigation of the complaint.
4. Consider the various options for resolving the complaint – for example, a meeting or reimbursement of costs.
5. Ensure that the person is kept informed of progress throughout the life of the complaint.
6. Confirm to the person what support is available to assist in making a complaint – for example, the Independent Complaints Advocacy Service (ICAS).
7. Take statements from, and interview if necessary, those staff involved in the events leading up to the complaint. This should be done as soon as possible, so that events are still fresh in the memory.
8. Where necessary, obtain clinical advice on the matters raised. This advice must have a high degree of independence – for example, by obtaining advice from the trust’s medical director or from a clinician at another trust.
9. Ensure that any letters to the person making the complaint are written in plain English and are as free as possible of clinical or other technical terminology.
10. Offer an apology if appropriate.
11. Ensure that general learning is taken from specific complaints and is embedded into the system of care for the future.
12. Ensure that the boards of trusts are satisfying themselves that all the above are happening.

Download the full report, Spotlight on complaints, here.

Guidance issued on Patient Reported Outcome Measures (PROMS)

The Department of Health in England (DH) has issued finalised guidance on the national standards for Patient Reported Outcome Measures (PROMS). PROMs are measures of a patient’s health status or health related quality of life. They are typically short, self completed questionnaires, which measure the patients’ health status or health related quality of life at a single point in time.

Healthcare Governance Review believes that the NHS exists, fundamentally, so that people receiving NHS-funded care realise the best possible health outcomes within available resources. Thus, actively seeking the views of patients who experience the care is critical in any governance-level evaluation by providers, commissioners and the Department of Health of they extent to which the NHS is properly managed and governed.

The improvement of clinical quality and outcomes for patients is at the heart of recent NHS reforms. For example, the Patient Choice reforms envisage patients making informed decisions over their healthcare based on quality information.

Data collected routinely by way of PROMs will, according to the DH, improve the available information on clinical quality. A Hip replacement questionnaire, for example, compares patients’ own assessments of their mobility and pain before and after a hip operation, creating a measure of clinical success.

The DH sees other beneficial application of PROMS data, including its use to:

• evaluate the relative clinical quality of Providers of elective procedures. PROMs data can be used by clinicians, managers, regulators and PCT Commissioners to benchmark Providers’ performance. It can be used for clinical audit and it can be used by patients and GPs exercising choice,
• research what works. Efficacy and cost-effectiveness of different technical approaches to care can be evaluated using PROMs in association with other measures,
• assess the appropriateness of referrals to secondary care. PROMs data can be used to establish whether referrals for elective procedures are appropriate by examining variation in baseline PROMs scores across the country,
• support the reduction of inequalities, and
• empower commissioners. PCT Commissioners can use the data to establish the quality of services, which they are contracting with Providers for.

Furthermore, the DH intends to link payments to PROMs data by making payments to hospitals conditional on the quality of care given to patients as well as the volume of care delivered. The DH has previously stated that a range of quality measures covering safety (including cleanliness and infection rates), clinical outcomes, patient experience and patient’s views about the success of their treatment (i.e. PROMS) will be used for this purpose

Download the latest DH PROMS guidance here.