‘The fun theory’ – could it work for healthcare governance?

According to an initiative by Volkswagen, “…something as simple as fun is the easiest way to change people’s behaviour for the better. Be it for yourself, for the environment, or something entirely different, the only thing that matters is that it’s change for the better.”

As an example, check out this 2 minute video.

Convinced? If so, then how could we make healthcare governance or, indeed, healthcare generally, fun in a way that could change people’s behaviour and create change for the better? Answers in the Comments section below please.

Click here for Volkswagen’s website ‘Thefuntheory.com’.

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.

Human tissue governance?

The latest in a long line of ‘governances’ in healthcare appears to be ‘human tissue governance.’

The Royal Brompton & Harefield NHS Trust, the largest heart and lung centre in the UK, currently has a vacancy for a Human Tissue Governance Manager.

According to the advert posted in www.jobs.nhs.uk the trust is looking for “a suitably qualified person to promote and ensure compliance with the Human Tissue Act and the Trust’s licensing arrangements with the HTA [Human Tissue Authority].”

Further, the advert mentions that “The post holder should have a scientific or clinical research background and be fully conversant with the provisions of the Human Tissue Act in particular with regard to the use of human samples for research and education. The post holder will also be familiar with audit processes to monitor compliance. With proven interpersonal and communication skills you must be used to working in a busy office and be adaptable to a changing environment.”

The full advert can be found here.

Healthcare Governance Review invites readers to answer the following poll question.

Disclosing medical errors – ‘best practices’ from ‘leading edge’ USA medical institutions

Medical institutions around the World are seeking to turn the tide of medical errors by confronting and openly admitting their mistakes, disclosing them to patients and families and throughout their institutions, investigating their causes, and using what they learn to improve processes and systems so these errors do not recur. This paper from the USA (published on the Institute for Healthcare Improvement – IHI – website) highlights the work of seven organisations to prevent and disclose medical errors, including how they’re doing it and what they’re learning in the process.

For further information, click here.

Plan to cut Welsh NHS local health boards from 22 to 8 to “save millions of pounds in management costs”

In the NHS, management is so often treated as a cost, and not something that adds value to patient care. And when patient care goes wrong, the principal root causes usually relate to management (and governance) failings.

The NHS in Wales is cutting local health boards from 22 to 8 in an apparent bid to save money. Will this be good for patient care and safety?

Read the full story here.

Department of Health sets bad example on Freedom of Information requests

According to the Health Service Journal (HSJ), the Department of Health (DH) has been “slated” over its freedom of information record. The DH has become the only government department to receive a formal practice recommendation from the Information Commissioner’s Office, which follows an audit of complaints that revealed the DH has repeatedly applied blanket exemptions to FOI requests, in some cases withholding entire documents from release.

This rebuke for the DH comes only 2 weeks after the Information Commissioner issued a warning to NHS and wider public service bodies following threatening High Court action against Hounslow PCT.

For further information, click here.

Governance is a “black box” says US non-profit hospital article

According to one expert consulted for this article on non-profit hospital governance in the USA, “There isn’t a very good empirical understanding of how to make boards work and work well. A lot of it is based on anecdotes………Finance and quality of care are systematically laid out. Governance is a black box.”

Read the full article here.

Public Interest Report raises serious financial concerns at Hinchingbrooke Health Care NHS Trust

The appointed external auditor has issued a report under Section 8 of the Audit Commission Act (commonly known as a public interest report). The report sets out the appointed auditor’s serious concerns about the financial position of the Trust.

Rob Bennett, on behalf of the appointed auditor, PricewaterhouseCoopers LLP, said:

“The Trust, which has an accumulated deficit of £22.9m at 31 March 2007, does not have a plan to recover this deficit by 31 March 2009 in order to meet its statutory breakeven duty. The deficit is expected to be £38.7m at 31 March 2008. The Trust needs, as a matter of urgency, to work with the Department of Health, the East of England Strategic Health Authority and its commissioners to identify and implement a solution which will enable it to achieve its statutory duty”.

The report shows that:

- The financial position of the Trust has deteriorated significantly over the last three years. The reported deficit has increased from £1.8m in 2004/05 to £22.9m in 2006/07.

- Whilst the Trust initiated its own financial turnaround process in the summer of 2006 and this delivered cost improvements of £4.2m in 2006/07, these savings were not sufficient to enable the Trust to break even in 2006/07.

- In early 2007, Cambridgeshire Primary care Trust (PCT) started a consultation exercise in respect of the future services at Hinchingbrooke. The results of the exercise were reported in July 2007 and the preferred option was for redesign of the hospital’s services based on reduced levels of activity.

- During and following the consultation, the Trust has been working with Cambridgeshire PCT to enable planning to take place to show the future shape of services, use of the current site and workload and financial estimates. This work represents the “Sustainable Hospital Project”.

- The Trust has also updated its financial recovery plan with the primary objective of stopping any further deterioration in its in-year financial position. The Trust does not currently have a plan to address its cumulative deficit which at the time of preparing the public interest report is estimated to be £38.7m at 31 March 2008. The Trust has a statutory duty to break even, taking one year with another and recoup the cumulative deficit by 31 March 2009.

- The Trust received temporary Public Dividend Capital of £27.3m in 2006/07 in order to strengthen its cash position. At the time of writing the report, the latest cash flow forecast showed that the Trust will need further significant cash support at 31 March 2008.

The report notes that whilst the Trust Board has been taking appropriate action to improve the financial position, given the scale of the projected cumulative deficit at 31 March 2008 and the absence of a plan to recover it, the Trust will be unable to achieve this element of its statutory breakeven duty by 31 March 2009 without external support. The Trust, working with the Department of Health, East of England Strategic Health Authority and its commissioners, needs to identify and implement a solution that will enable it to achieve its statutory breakeven duty by 31 March 2009.

- The report, also recommends that the Trust should:

- Deliver savings in line with plans and timetable.

- Continue to monitor all categories of income and expenditure and where necessary, reduce them in line with anticipated reductions in activity.

- Determine the shape of future hospital services and their related budgets by finalising work on the Sustainable Hospital Project.

- Update the existing Financial Recovery Plan in the light of the above and any of the detailed recommendations that remain to be addressed to ensure that it satisfactorily addresses the need to recover the Trust’s cumulative deficit.

In the event that a significant deficit remains at 31 March 2009, the Strategic Health Authority will need to find a resolution for this deficit or address the impact on any successor body.

The full Pulic Interest Report for Hinchingbrooke can be downloaded here.

Freedom of Information Act Commissioner gives warning to the NHS

The Health Service Journal (HSJ) has reported that Hounslow primary care trust’s failure to meet its obligations under the Freedom of Information Act was so severe that the information commissioner Richard Thomas served draft High Court papers to force it to reveal information – the first time this has happened under the act.

Mr Thomas said: “The FOI Act must be properly implemented by public bodies – it is not a voluntary scheme that organisations can dip in and out of. I consider that other health trusts and public authorities could usefully learn lessons from this case.”

According to the HSJ, “The central lesson here is that trusts must ensure their procedures for dealing with FOI requests and their records management systems are up to scratch – a lesson Hounslow has learned the hard way.”

For further information, click here.

ACCA reports on a survey aimed at ‘Understanding governance in the NHS’

The Association of Certified Chartered Accountants (ACCA) has made public the results of a survey, undertaken with the support of the Department of Health, looking at governance in the NHS in England.

For a summary of the survey results, provided by ePolitix.com, click here.

Click here for a more detailed commentary of the survey provided on the ACCA website.          

Heathcare Governance Review is awaiting a copy of the full report and will provide a summary analysis of the findings on this site in due course.

Welcome to Healthcare Governance Review!

Healthcare Governance Review (HGR) is a free public blog site and e-mail newsletter for anyone concerned with governance issues in healthcare, including board members, senior managers, clinicians, assurance providers, policy makers and regulators. HGR is published by Healthcare Governance Limited and kindly supported by ECRI Institute (Europe). The site is edited by Stuart Emslie, Director of Healthcare Governance Limited.  Stuart is internationally known for his work in healthcare governance and healthcare risk management, including patient safety, having lectured and/or consulted in several countries, including Australia, China, Hong Kong, Ireland, Malaysia, Singapore and the USA, in addition to the UK. He is visiting fellow in healthcare governance and risk at Loughborough University Business School (where he developed and currently leads a ‘World-first’ postgraduate programme on healthcare governance – see the Education page), is visiting lecturer in risk management and clinical governance at Flinders University Medical School in South Australia, and is formerly Department of Health head of controls assurance for the NHS in England. Stuart holds a masters degree, with distinction, in corporate governance and ethics from the University of London and a bachelors degree, with honours, in mechanical engineering from the University of Strathclyde. He is a chartered mechanical engineer and a member of the Institute of Healthcare Management (IHM).