A report examined the state of cancer services in England, in the context of recent and ongoing changes within the National Health Service. It said that recent change, combined with a lack of spare capacity, was seen as holding back the development of cancer services. The report said that the research had highlighted a number of perceived challenges, including: increasing demand for services and insufficient capacity to respond; a loss of national and local leadership and infrastructure; fragmentation of commissioning across services; and variation in the roles and responsibilities of new organizations, as well as a need to rebuild relationships and expertise across the new structures. The report made recommendations, including a call for increased investment.
Source: Hilary Brown, Jo Ellins, James Kearney, Kelly Singh, Oliver Jackson, Holly Krelle, and Iain Snelling, Measuring Up? The health of NHS cancer services, Health Services Management Centre, University of Birmingham/ICF GHK Consulting
A report examined what was known about the extent and quality of care and services delivered by allied health professionals (AHPs – including such services as chiropodists/podiatrists, dieticians, occupational therapists, paramedics, physiotherapists, and radiographers). It said that AHPs made up 6 per cent of the National Health Service workforce in 2013, but the numbers varied across areas of care and geographical areas. The report said that there was very little systematic information at a national level about the quality of care delivered by AHPs, and discussed the importance of developing information systems that would collect consistent and comparable data.
Source: Holly Dorning and Martin Bardsley, Focus On: Allied health professionals – can we measure quality of care?, Health Foundation/Nuffield Trust
An article examined the impact on patient outcomes (mortality and length of hospital stay) of the centralization of acute stroke services, drawing on a study in two metropolitan areas of England (London in the south east and Manchester in the north). It concluded that a centralized model of care, in which hyperacute care was provided to all patients with stroke across an entire metropolitan area, could reduce mortality and length of hospital stay.
Source: Stephen Morris, Rachael Hunter, Angus Ramsay, Ruth Boaden, Christopher McKevitt, Catherine Perry, Nanik Pursani, Anthony Rudd, Lee Schwamm, Simon Turner, Pippa Tyrrell, Charles Wolfe, and Naomi Fulop, 'Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis', British Medical Journal, 5 August 2014
The government began consultation on proposals to make it a legal requirement for health and social care providers to display the performance rating given to them by the Care Quality Commission. The consultation document included draft regulations to show how the changes would work in practice. The consultation would close on 13 October 2014.
Source: Display of Performance Assessments: Placing a legal requirement on registered providers to display the rating published by the Care Quality Commission, Department of Health
Links: Consultation document
An article examined concerns that might affect the willingness of National Health Service staff in England to recommend their own organizations. It said that asking study participants whether they would recommend their organization if family or friends needed treatment offered important insights into the quality and safety of care. It said that use of this device might detect signs of organizational decline and avert healthcare scandals, but that its use outside of a research context required further evaluation.
Source: Mary Dixon-Woods, Joel Minion, Lorna McKee, Janet Willars, and Graham Martin, 'The friends and family test: a qualitative study of concerns that influence the willingness of English National Health Service staff to recommend their organisation', Journal of the Royal Society of Medicine, Volume 107 Issue 8
A report said that patients undergoing operations in private hospitals might be put at risk from issues such as inadequate equipment, lack of intensive care beds, unsafe staffing arrangements, and poor medical record-keeping. It said that around 6,000 patients a year were transferred to National Health Service hospitals from the private sector and, between October 2010 and April 2014, 802 patients died unexpectedly in private hospitals. The report made a range of recommendations to increase available information (including information for patients), and to improve governance, formal reporting, and regulation requirements in the private hospital sector. It also recommended that the Department for Health should review the nature and cost of the transfers from private to National Health Service hospitals each year.
Source: Colin Leys and Brian Toft, Patient Safety in Private Hospitals ï¿½ the Known and the Unknown Risks, Centre for Health and the Public Interest
A report examined the standard of patient nutrition and hydration in hospitals in the United Kingdom. It recommended that the government should develop and maintain a food and drink strategy, and introduce a set of standards across National Health Service hospitals.
Source: The Hospital Food Standards Panel's Report on Standards for Food and Drink in NHS Hospitals, Department of Health/Age UK
A think-tank report said that using surplus National Health Service land for supported housing offered better value for money than selling it for private development. It said that the National Health Service could make indicative savings of around £6 billion (over a 25 year period) by using surplus land in this way, and that increasing supported housing offered scope to reduce delayed hospital discharges which currently cost around £200 million per year.
Source: NHS Surplus Land for Supported Housing: Why now and what are the possible cost savings?, Smith Institute
A think-tank report examined the purpose and scope of the General Medical Council, the organization that oversaw the medical practice of doctors in the United Kingdom, and questioned whether the existing arrangements for fitness to practice issues could reasonably be described as 'self-regulation'. The report said that the existing system had encouraged excessive complaint at zero cost for complainants, and had failed to follow due processes in many cases, causing potential damage to doctors and with a potential knock-on effect on patients, as well as imposing further costs on the National Health Service. The report called for a range of changes, including for the Council to audit its practice, for the development of a culture of apology, and for the National Health Service to support doctors through the complaints process.
Source: Hilarie Williams, Christoph Lees, and Magnus Boyd, The General Medical Council: Fit to practise?, Civitas
A paper examined the issue of missing data in the English Patient-Reported Outcome Measures survey, and proposed a strategy for addressing this, using multiple imputation techniques. The paper also discussed its impact on assessing provider performance.
Source: Manuel Gomes, Nils Gutacker, Chris Bojke, and Andrew Street, Addressing Missing Data in Patient-Reported Outcome Measures (PROMs): Implications for comparing provider performance, Centre for Health Economics (University of York)
A report examined recent evidence about how the workplace experience of healthcare staff was associated with the quality of care and patient satisfaction. It said that there were clear links between improved staff experience and better care for patients, and that good human resources practice and staff engagement should be seen as integral to overall objectives for the National Health Service.
Source: Jeremy Dawson, Staff Experience and Patient Outcomes: What do we know?, NHS Employers
An audit report said that out of hours family doctor services were variable and although some parts of the National Health Service in England were achieving value for money for their spending on out of hours services, this was not the case across the board and NHS England did little to monitor quality where family doctors retained responsibility for the services. The report said that most patients were positive about their experience of out of hours services, but around one-quarter of people were not aware of their availability.
Source: Out-of-Hours GP Services in England, HC 439 (Session 201415), National Audit Office, TSO
The mental health watchdog for Scotland said that there had been some improvements made to National Health Service continuing care settings for people with dementia since 2007, but there were still wide variations in the quality of care and treatment, particularly concerning the use of psychotropic medication, the quality of the environment, and the availability of meaningful activity. The report made a series of recommendations to NHS Boards and the Scottish Government.
Source: Dignity and Respect: Dementia continuing care visits, Mental Welfare Commission for Scotland
An article examined the evidence on the efficacy of the 'quality and outcomes framework' for family doctors in improving health outcomes, its impact on non-incentivized activities, and the robustness of the clinical targets adopted in the scheme. There was 'strong evidence' that the framework had initially improved health outcomes for a limited number of conditions, but subsequently outcomes had fallen to the pre-existing trend. There had been limited impact on non-incentivized activities, with adverse effects for some sub-population groups.
Source: Carwyn Langdown and Stephen Peckham, 'The use of financial incentives to help improve health outcomes: is the quality and outcomes framework fit for purpose? A systematic review', Journal of Public Health, Volume 36 Number 2
A range of reports provided findings from the reviews of the association of the late entertainer Jimmy Savile with 28 National Health institutions, in the context of the allegations of sexual abuse made against him. In addition to individual reports for the affected organizations, an overarching assurance report was published. A further report on lessons to be learnt by the NHS was to be published in due course.
Source: Department of Health
A report said that a recent audit of end of life care had found significant variations in standards across hospitals in England. It said that major improvements were needed to ensure better care for dying people, and better support for family, carers, and friends. Recommendations included: for the provision of a face-to-face specialist palliative care service, 7 days per week; for mandatory training for all staff caring for dying patients; for regular pain monitoring; and for the decision that the patient was in the last hours or days of life to be made by a multidisciplinary team, discussed with the patient where possible, and documented by the senior responsible doctor.
Source: National Care of the Dying Audit for Hospitals, England, Royal College of Physicians
The Care Act 2014 was given Royal assent. The Act provided for a range of measures regarding health and social care, including: a cap on the cost of social care in England; the legal right of carers to support from their local council; provision for local authorities to assess the care and support needs of children, and young carers, who might need support after they reach the age of 18, to facilitate the transition to adult social care; entitlements to personal care budgets and provisions for deferred payments for care; a rating system for hospitals and care homes, and new powers of intervention to the chief inspector of hospitals; and the creation of two new public bodies, Health Education England and the Health Research Authority, designed to provide additional training and support for health professionals.
Source: Care Act 2014, Department of Health, TSO
A report examined productivity improvements in the National Health Service, and considered ways in which to avoid an anticipated 'major crisis' in NHS and social care. It said that: the existing productivity challenge was uniquely different, and difficult, because of the severity and duration of funding restraints that had coincided with major reorganization; that NHS spending would fall from its peak level in 2009 to just over 6 per cent of gross domestic product by 2021; and that some providers now planned to cut emergency and elective work as a result of funding being diverted from NHS allocations to consolidate the Better Care Fund. The report discussed policy implications and areas for further efficiency savings. It called for funding to cover the costs of change and to provide temporary support for otherwise sound organizations that were experiencing budget difficulties.
Source: John Appleby, Amy Galea, and Richard Murray, The NHS Productivity Challenge: Experience from the front line, King's Fund
A report said that deficiencies had been found in routine asthma care that sometimes led to preventable deaths. The report called for: every hospital and family doctor practice to have a designated, named clinician for asthma services; better monitoring of asthma control, and immediate action on loss of control; better education on risk awareness for doctors, nurses, patients, and carers; and all patients to be provided with a personal asthma action plan.
Source: Mark Levy, Rachael Andrews, Rhona Buckingham, Hannah Evans, Caia Francis, Rosie Houston, Derek Lowe, Shuaib Nasser, James Paton, Navin Puri, Kevin Stewart, and Mike Thomas, Why Asthma Still Kills: The National Review of Asthma Deaths (NRAD) – Confidential Enquiry report, Royal College of Physicians
A report discussed the health and social care system in England and said that it was no longer fit for purpose in the context of an ageing demography and the current funding environment. It called for health and social care provision to be integrated into a single system, with a ring-fenced, singly commissioned budget, and more closely aligned entitlements. The work of the Commission would continue, and a further call for evidence was issued alongside this interim report.
Source: Commission on the Future of Health and Social Care in England, A New Settlement for Health and Social Care: Interim report, King's Fund
Links: Report | Summary and backgound papers | Call for evidence | Kings Fund press release | Age UK press release | Care and Support Alliance press release | CSP press release | BBC report | Guardian report
An article examined the views of users of the NHS 111 telephone triage service. The service was piloted in England in 2010 and used non-clinical staff to triage telephone calls from users, with the aim of improving their access to urgent healthcare. It said that the pilot services appeared to be acceptable to the majority of users, but made recommendations for improvements in questioning and in auditing the accuracy and appropriateness of advice. The paper said that the views of service users should be considered in the context of the wider evaluation outcomes.
Source: Alicia Oï¿½Cathain, Emma Knowles, Janette Turner, and Jon Nicholl, 'Acceptability of NHS 111 the telephone service for urgent health care: cross sectional postal survey of usersï¿½ views', Family Practice, Volume 31 Number 2
The government began consultation on proposals to change the legislation that governed the Nursing and Midwifery Council, the United Kingdom regulator for the two professions. The changes included proposals that would: change the handling of fitness-to-practice (FtP) cases; introduce power to review certain FtP decisions; allow registrants who were not fit to practice to be removed from the register; change who sat on registration appeal panels; and change insurance requirements. The consultation would close on 12 June 2014.
Source: The Nursing and Midwifery Council ï¿½ Proposed Changes to the Governing Legislation: A paper for consultation, Department of Health
An article examined factors influencing the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service hospitals in England. It said that strategies that supported the implementation of reasonable adjustments did not reliably translate into consistent provision, and concluded that ward culture, staff attitudes, and staff knowledge were crucial to accessible provision. The authors recommended further research.
Source: Irene Tuffrey-Wijne, Lucy Goulding, Nikoletta Giatras, Elisabeth Abraham, Steve Gillard, Sarah White, Christine Edwards, and Sheila Hollins, 'The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study', BMJ Open, Volume 4 Issue 4
A report examined the quality of National Health Service patient care in the four United Kingdom countries since devolution, based on analysis of around 20 indicators from the 1990s onwards. It said that there had been significant improvements across all four countries, with the performance gap between England and the rest having narrowed in spite of policy differences between the four countries. The report said there had been particular progress in Scotland, but that waiting times in Wales had risen since 2010. All countries had increased the amount spent on healthcare, but spending had slowed in response to austerity. The report compared results with an earlier study in 2010 and also analyzed the north east of England as a comparator to the devolved countries.
Source: Gwyn Bevan, Marina Karanikolos, Jo Exley, Ellen Nolte, Sheelah Connolly, and Nicholas Mays, The Four Health Systems of the United Kingdom: How do they compare?, Health Foundation/Nuffield Trust
A report (by an official advisory body) provided the outcome of a review of the United Kingdom law relating to the regulation of healthcare professionals and, in England only, the regulation of social workers. It set out a new single legal framework with new powers and duties for regulators, and included a draft Bill.
Source: Regulation of Health Care Professionals Regulation of Social Care Professionals in England, Cm 8839, Law Commission
A report by a committee of MPs said that many hospitals found it difficult to cope with increasing levels of demand for accident and emergency services. It said that financial incentives were not aligned across the system, which meant that attempts to ensure patients were treated at the primary care level were not yet working. It noted the lack of specialist emergency care consultants, the slow introduction of round-the-clock consultant cover in hospitals, and a lack of quality performance data, and said that accountability and responsibility for introducing the required change remained unclear. The report made recommendations, including the consideration of better pay and conditions for consultants in more challenging hospitals, and to review the funding system.
Source: Emergency Admissions to Hospital, Forty-sixth Report (Session 201314), HC 885, House of Commons Public Accounts Select Committee, TSO
The government began consultation on proposals to impose a duty of candour on all providers registered with the Care Quality Commission. The duty would require organizations to be open with service users if they were harmed (above a certain 'harm threshold') as a result of their care or treatment. The document included draft regulations and asked about the anticipated impact on providers. The consultation would close on 25 April 2014.
Source: Introducing the Statutory Duty of Candour: A consultation on proposals to introduce a new CQC registration regulation, Department of Health
A report provided findings from an enquiry into how health and healthcare might be improved in London. Suggestions included: the use of unused or run down National Health Service land and buildings to help address the housing crisis or to house modern health and care services; taking a more regulatory approach to addressing obesity; and addressing the perceived need for stronger strategic leadership of health and care services.
Source: London Health Commission: Summary of call for evidence, London Health Commission
An article examined findings from the Confidential Inquiry into premature deaths of people with intellectual disabilities in England. It said that there were health disparities between people with and without intellectual disabilities, and that the research had evidenced the contribution to those disparities of factors related to care and health service provision.
Source: Pauline Heslop, Peter Blair, Peter Fleming, Matthew Hoghton, Anna Marriott, and Lesley Russ, 'The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study', The Lancet Volume 383, Number 9920
A paper examined how to identify indicators of high-quality mental health services and how the presence of those indicators would lead to key recovery outcomes. It said that it was important to distinguish between quality indicators at an individual level and those at an organizational level, and made a number of recommendations for local providers, health and social care commissioners, and government.
Source: Geoff Shepherd, Jed Boardman, Miles Rinaldi, and Glenn Roberts, Supporting Recovery in Mental Health Services: Quality and outcomes, Implementing Recovery Through Organisational Change Programme (ImROC), Centre for Mental Health/Mental Health Network, NHS Confederation
An article examined the value of qualitative research to a positivist framework for evaluating policy, presenting results from a study of the impact of two key National Health Service reforms, the 18 Week Patient Pathway and Payment by Results, on four English hospitals. It said that the study demonstrated the capacity of qualitative work to improve understandings of cause and effect, as well as to inform the development of better quantitative measures and data sets.
Source: John Wright, Paul Dempster, Justin Keen, Pauline Allen, and Andrew Hutchings, 'How should we evaluate the impacts of policy? The case of Payment by Results and the 18 Week Patient Pathway in English hospitals', Policy Studies, Volume 35 Number 1
An article examined how the final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry and the Law Commissions' review of health and social care professional regulation would impact on the professional regulation bodies.
Source: Tim Spencer-Lane, 'Safeguarding the public by regulating health and social care professionals: lessons from Mid-Staffordshire and the Law Commission review', Journal of Adult Protection, Volume 16 Number 1
A study examined the response of acute hospital trusts in England to the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis Report), published in 2013. The research asked how hospital trusts had responded to the key themes in the report, and about the challenges of changing the quality and culture of care. The report said that there were 'profound tensions' between the need to meet financial performance requirements and the prioritization of quality of care. Trusts had reported greater pressures from regulators and commissioners and the requirements for data provision were onerous for some.
Source: Ruth Thorlby, Judith Smith, Sally Williams, and Mark Dayan, The Francis Report: One year on – the response of acute trusts in England, Nuffield Trust
A report by a committee of MPs said that while the majority of women had good outcomes from National Health Service maternity services in England, performance and outcomes could be much better. It had found that the rate of stillbirths and babies dying within seven days of birth was higher in England than in the other United Kingdom nations, the quality of care varied between trusts, and there were persistent inequalities in the experiences of different groups of women. The report made a number of recommendations.
Source: Maternity Services in England, Fortieth Report (Session 201314), HC 776, House of Commons Public Accounts Select Committee, TSO
An article examined the effect of withdrawing incentives on recorded quality of care, in the context of the United Kingdom Quality and Outcomes Framework pay for performance scheme. It suggested that, after removal of incentives across a range of activities, performance remained stable, although all of the investigated activities had remained indirectly or partly incentivized in other indicators, such that further work would be needed to establish whether the findings held when incentives were fully withdrawn.
Source: Evangelos Kontopantelis, David Springate, David Reeves, Darren Ashcroft, Jose Valderas, and Tim Doran, 'Withdrawing performance indicators: retrospective analysis of general practice performance under UK Quality and Outcomes Framework', British Medical Journal, 348 January 2014
The government began consultation on proposals to change the system of regulation for health and social care organizations in England, including the introduction of legally mandated minimum standards, backed by enforcement options for the regulator. The consultation would close on 4 April 2014.
Source: Introducing Fundamental Standards: Consultation on proposals to change CQC registration regulations, Department of Health
An audit report said that the National Health Service waiting time standards for elective care in England had mostly been met nationally, although the picture was varied for individual trusts and the published waiting time figures were subject to recording inconsistencies and data coding errors. The report recommended actions for NHS England and commissioners, to improve data quality.
Source: NHS Waiting Times for Elective Care in England, HC 964 (Session 201314), National Audit Office, TSO
A report evaluated the early operation of the Rotherham Social Prescribing Model, a health and social care commissioning model piloted in Rotherham, a town in the north of England. The pilot project aimed to prevent worsening health and reduce specialist interventions for people with existing long-term conditions, through linking patients in primary care and their carers with non-medical sources of support within the community. The report outlined progress to date and made immediate and longer term recommendations.
Source: Chris Dayson, Nadia Bashir, and Sarah Pearson, From Dependence to Independence: Emerging lessons from the Rotherham Social Prescribing pilot – summary report, Centre for Regional, Economic and Social Research (Sheffield Hallam University)
A paper examined productivity levels in the National Health Service in England for 2011-12, over a range of measures. It said that productivity had grown between 2010-11 and 2011-12, despite a potential underreporting in some activities. The paper discussed fluctuations in productivity over time.
Source: Chris Bojke, Adriana Castelli, Katja Grasic, and Andrew Street, Productivity of the English National Health Service from 2004/5: Updated to 2011/12, Centre for Health Economics (University of York)