Strategic partners programme February 2013 update

Wed,27 March 2013
News

This month’s update includes news and insights on the final Francis report on the massive failings at Mid Staffordshire NHS Trust, resources for Healthwatch, regulations for Health and Wellbeing Boards and Health Scrutiny Relations, the role of quality ratings, an Office for Disability Issues’ report on ‘building a deeper understanding of disability’ and the NHS Commissioning Board’s planning guidance and online tools

Francis’ final report on the Mid Staffordshire NHS Foundation Trust Public Inquiry – what are our conclusions?

This long awaited report from Robert Francis about the failings at Mid Staffordshire does not fall short of describing the most appalling conditions – see http://www.midstaffsinquiry.com/index.html Calls for help to use the bathroom were ignored. Patients were left lying in soiled sheeting and sitting on commodes for hours, often feeling ashamed and afraid. Patients were left unwashed, at times for up to a month. Food and drinks were left out of their reach and many were forced to rely on family members for help with feeding. Staff failed to make basic observations, and pain relief was provided late or in some cases not at all. Patients were often discharged before it was appropriate, only to have to be re-admitted shortly afterwards. “Many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives."

The Inquiry found that a chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care. Morale at the Trust was low, and while many staff did their best in difficult circumstances, others showed a disturbing lack of compassion towards their patients. In the absence of direct accountability of the NHS to patients, staff are probably the most essential safeguard for minimum standards. However, staff who spoke out or considered this felt ignored, and there is strong evidence that many (potential) whistleblowers were deterred from doing so through fear and bullying or for not wanting to foul their own nest.

This is a strong reminder that the current whistleblowing protections under the Public Interest Disclosure Act 1999 do not deliver in practice. When weighing up whether or not to speak out, staff are reminded of former whistleblowers. Those colleagues have often been accused of ‘bad faith’, that is their own interest would have driven them to speak out rather than concerns about the quality of NHS care. After all, whistleblowers need to be swift in escalating the formal procedure (against their line management). If they don’t act swiftly, then they risk becoming associated with the reported dangers and offences, in which case they can be seen to act in ‘bad faith’.

In Mid Staffordshire, the Trust's board was found to be disconnected from what was actually happening in the hospital and chose to rely on apparently favourable performance reports by outside bodies such as the Healthcare Commission. The Inquiry concluded that it would be unsafe to put a figure on the number of avoidable or unnecessary deaths at the Trust. Interestingly, Robert Francis QC has recommended, given the lack of understanding surrounding mortality statistics and their use, that the Department of Health set up an independent working group to urgently review the gathering and use of mortality data in the NHS.

It is clear that – as in the unrelated yet similar abuse incidents suffered by people with learning disabilities at Winterbourne View – there was a clear division between them (patients) and us (staff). This division is at the core of the problem rather than a shortage of staff per se or financial pressures more generally. Francis’ report calls for developing the right culture of care within the NHS, through better leadership, training, information and transparency as part of its 290 recommendations. However, of those recommendations, there are only a handful (eg number 62 on ‘patient focus) which make the case for directly investing in and building up patient and public voice. This is in itself symptomatic: the findings concerning professionals have apparently been so alarming that patients, friends and families can (again) not be supported to regain and take over control within the NHS. This is despite the slogan ‘The NHS belongs to all of us’.

We can all take action to bring this slogan to life. Positive health outcomes go back to lots of variables that are in the control of the person and are not just determined by social work and/or clinical procedures. The Francis report on the failings at Mid Staffordshire and the Winterbourne View reports have drawn our attention to the absence of people’s voice, of their lived experience and of the benefits of peer support. Improving patients' lives means empowering us to build up and use our own insights in everything we do in the context of our whole life domains. If we can make informed and fully supported choices, we can bring about integrated and coordinated care that is both effective and efficient. So how can we bring on a hands-on devolution of power to people and stop all rhetoric? We have put some proposals to the NHS Commissioning Board (and an initiative on people-powered commissioning), Health & Social Care Information Centre, Monitor’s ‘Fair Playing Field Review’, NHS EXPO and the National Stakeholders Forum:

  • We need parity of medical and non-medical aspects of care. This means there needs to be widespread recognition in all NHS systems and processes that the ability of staff to engage with patients is as important as the ability to administer medication for example. With their lived experience, patients should be routinely offered the opportunity to become part of the workforce.
  • Could there be a ‘right to peer support’ at the stage of diagnosis within GP practices as well as nationally via Choose & Book e-referral systems – so that we can bring the different (treatment or support) options to life by hearing from a peer who has walked a similar path in the past?
  • It has been shown that if provision is directly driven by patients and users of care and support then quality will be improved and unnecessary referrals and clinical procedures reduced. We would like to see personal health budgets – which empower people to make their own arrangements and to micro-commission services – expanded beyond Continuing Care from April 2014. 
  • Could there be payment profiles related to minimum scorings which providers would have to achieve on Patient Reported Experience / Outcome Measures?
  • Can we establish a true power shift to train more and more people up to become experts by experience and peer supporters while quality checking, non-complex reviews and contract monitoring are increasingly carried out by User-Led Organisations and patient groups?
  • Starting at a local level, how can we connect up with Healthwatch and Healthwatch England to kick off a social movement so that we combat the ‘white coat syndrome’ and foster self care and user-driven approaches to commissioning (eg pooling personal budgets) wherever this is appropriate?

Even if all of Francis’ 290 recommendations were implemented now, the fundamental shift in culture can only be achieved if patient voice is put top of the agenda for boards and is the first responsibility of professionals to act on. That will take time and commitment over many years. Clinical Commissioning Groups and councils’ adult social care departments – the ball is in your corner.

Disability Rights UK continues project on supporting LINks in the transition to Healthwatch 

In January 2012 Disability Rights UK started – in a consortium with Race Equality Foundation, NAVCA and Regional Voices – with delivering action learning sets to existing Local Involvement Networks (LINks). The Department of Health-funded project has been extended to include research on the four key areas (leadership & governance; engagement; representation; influence) and produce comprehensive resources for forthcoming Healthwatch organisations. Local Healthwatch organisations are intended to become important influential players with a seat on Health and Wellbeing Boards. Once finalised in April 2013, these toolkits will be accessible from the Disability Rights UK website and hence of use to all members who are active in their local communities.

Local Authorities – Health and Wellbeing Boards and Health Scrutiny Relations

The Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 have now been published http://healthandcare.dh.gov.uk/hwbs-health-scrutiny-regulations-2013/  . The publication of these regulations provides a step forward in enabling local authorities to finalise local preparations for health and wellbeing boards and health scrutiny arrangements.

The Local Government Association (LGA) and Association of Democratic Services Officers (ADSO) are jointly publishing a practical guide to support local authorities in interpreting and implementing constitutional and governance aspects of the legislation. 

'Fulfilling Potential: Building a deeper understanding of disability in the UK today'

A new document from the Office for Disability Issues summarises the analytical evidence on disability. It looks at the number of disabled people in the UK, as well as looking at the way disability develops over the life course and at the fluctuating nature of disability. It also looks at the trends in outcomes and the barriers to participation in different areas of disabled people's lives.

The aims of this publication are:

  • to provide an analysis of the current evidence on disability in the UK to inform the development of the next stage of work on Fulfilling Potential - the development of actions, outcomes and indicators;
  • to inform public understanding and prompt debate about disability and the issues faced by disabled people; and
  • to raise awareness, drive a change in attitudes and support an increase in commitment to improving the lives of disabled people in the UK today.

'Fulfilling Potential: Building a deeper understanding of disability in the UK today' is published on the ODI website http://odi.dwp.gov.uk/fulfilling-potential/index.php

Information is Power, Why Ratings of Care Services need to return - VODG report

Published, independent, ratings of the quality of care services would be a great help to consumers, providers and commissioners in distinguishing between services in the adult social care marketplace – and in driving improvement. This has been reported by the Voluntary Organisations Disability Group (VODG).

It is more straightforward to (re)introduce ratings in social care than in health. Progress in adult social care does not need to wait for the development of an NHS system. Most current or planned initiatives provide useful public information but operate on a voluntary - and therefore patchy - basis.

The most cost-effective, logical and consistent solution is for the Care Quality Commission (CQC) to award ratings for social care quality, and this would reduce the current confusion around the different rating systems. Trip Advisor-type rating systems that are directly informed by users of care and support services could sit alongside the CQC star ratings. CQC will need to attend to a number of operational and methodological issues in order for the sector - and the public - to have confidence in such ratings.

The full report can be accessed here http://www.vodg.org.uk/news/227/111/Information-is-power-arguing-for-a-return-to-care-ratings.html

Topics for new NICE quality standards and guidance in social care

The National Institute for Health and Clinical Excellence (NICE) has taken forward their initiative on quality standards and other guidance for social care in England as set out in the Health and Social Care Act (2012). Previous pilots focused on dementia and looked after children, and corresponding finalised quality standards will be published in April 2013. Social care guidance topics for 2012-14 have already been identified. The Department of Health is now consulting on topics for new NICE quality standards and guidance on social care from 2015. Closing date is 26 April 2013. See

http://consultations.dh.gov.uk/quality-and-safety/nice-future-quality-standards-2/consult_view

NHS Friends and Family Test: publication guidance

Some members of Disability Rights UK will have heard of the Friends & Family test which will be introduced in the NHS. It has been found a valid measure to ask patients whether they would recommend the service they are currently or have just been using to their friends & family. The measure can be seen as too crude, and to capture real patient satisfaction the exact time points for the question will be crucial. The Department has published guidance for providers of NHS funded services on calculating and publishing the NHS Friends and Family Test results. Seehttp://www.dh.gov.uk/health/2013/02/nhs-fft-guidance/ 

New tools and resources to support NHS reconfiguration

There are great expectations for local citizens, Healthwatch and also user-led organisations to play a role in local discussions and decisions on the reconfiguration of services and support. The NHS Confederation has developed a range of tools and resources to help NHS leaders effectively communicate and engage with staff, patients, the public and stakeholders about changes to local services. See www.nhsconfed.org/reconfiguration  

NHS Commissioning Board sets out planning guidance for first year

The NHS Commissioning Board has published its planning guidance for NHS commissioners, called ‘Everyone Counts: Planning for Patients 2013/14’. The guidance covers a set of outcomes against which to measure improvements. It outlines five offers – moves toward seven-day a week working for routine NHS services, greater transparency and choice for patients, more patient participation, better data to support the drive to improve services, and higher standards and safer care.

Also published are financial allocations to CCGs, and advice for every CCG and local authority on measuring outcomes, which are intended to support and inform their planning and strategy development.

You can read more on the NHS Commissioning Board website:
http://www.commissioningboard.nhs.uk/2012/12/17/everyonecounts/ 

NHS Commissioning Board Online Tool Directory – your views sought

From this April the NHS Commissioning Board will have responsibility for the budget of the NHS in England, using this and working through local clinical commissioning groups it will work to improve health and care for everyone and help people get the outcomes they really want. As part of this, the NHS Commissioning Board are working with the Department of Health, Public Health England and Social Care to scope out what people really want from a single website covering all aspects of health and care. You may be aware of NHS Choices, which gets 20 million unique visits a month and has become a valued website for lots of people.

The NHS Commissioning Board want to build on this and transform the current internet offer to give people a trusted site for everyone who wants good information about any aspect of health and care that can be accessed across different channels.

One of the things the NHS Commissioning Board are doing is developing an online tools directory. The directory will provide a trusted listing of online health tools for people and care professionals that help improve health and care outcomes. The NHS Commissioning Board would like to invite you to take a look at the online tools directory that can be found here athttp://toolsdirectory.nhs.uk/. Please be aware that this is an alpha site only. The layout and functionality will continue to be improved and updated.

The NHS Commissioning Board would appreciate your help to develop this online tools directory by completing two easy steps.

1. Visiting the directory and downloading an app or tool (athttp://toolsdirectory.nhs.uk/)
2. Trial the app(s) or tool(s) and then rate them on the site
This will benefit the development of the site in light of the launch at the Healthcare Innovation Expo show in March 2013.

You can also give your feedback on the site as a whole. There is a feedback button available on the alpha site (you will find it when you scroll to the bottom of each page). You can also email the team at: tools.feedback@nhs.net

Note: for pdf files you will need to download adobe acrobat reader. To convert the pdf to alternative formats or for more information on accessibility go to adobe accessibility.