Weekly political news round up – 17th October 2014

October 17, 2014 in News by Whitehouse

Around the sector

Health Service Journal has reported that the leader of the Welsh Conservatives, Andrew Davies AM, has called for directly elected health commissioners to replace local health boards as those responsible for commissioning services. Davies said that: “Directly elected health commissioners, with a mandate from the communities they serve, will be able to reflect local priorities when bringing about the transformation our NHS needs to be fit for the 21st century.”

Writing in Health Service Journal, Labour MP Debbie Abrahams, Parliamentary Private Secretary to Shadow Health Secretary Andy Burnham, has said that Labour’s proposed changes to the commissioning roles of clinical commissioning groups (CCGs) and health and wellbeing boards (HWBs) would be an “evolutionary process, not a big bang”. She added that rather than HWBs assuming commissioning responsibilities immediately, they will only be able to do so once they are assessed as competent.

Health Service Journal has reported that Judith Ellis, the new chief executive of the Royal College of Paediatrics and Child Health (RCPCH) has said that hospital trusts should ensure adequate children’s community services are in place before closing in-patient units, in light of fears that there will be a wave of further consolidations in services as trusts struggle to recruit consultants.

The Department for Education has published statistics showing the levels of development that children aged 0-5 have achieved as part of the Early Years Foundation Stage. It found that in 2014, 94% of all children achieved at least an expected level of development for health and self-care (including toilet training), with 23% exceeding expectations, 71% meeting the expected standard and 6% falling short. This compares with 92%, 20%, 72% and 6% in 2013.

The Scottish Government has announced that spending on Scotland’s health service will increase in real terms by £288 million – taking Scottish health spending above £12 billion for the first time.

Childcare Minister Sam Gyimah has announced that the Government intends to improve access to high-quality early education, particularly for two-year-olds from poor backgrounds.

Care Quality Commission publishes State of Care report 2013-2014

The Care Quality Commission (CQC) has published its latest State of Care report, which examines the state of health care and adult social care in England in 2013-14.

The report found many examples of good and outstanding care, but also found a wide variation in the quality of care that people receive from different providers, in different places and sometimes at different times of the day or week.

Since September 2013, the CQC has been inspecting services based on the five following criteria:

  1. Are they safe?
  2. Are they effective?
  3. Are they caring?
  4. Are they responsive to people’s needs?
  5. Are they well-led?

The report found that whilst most NHS trusts provided services which were largely both caring and effective, there was a high degree of variation and room for improvement in the other areas.

In particular, the CQC identified that variation in basic safety was a “serious problem”, identifying a lack of effective safety processes and a lack of a culture and that learns from mistakes and near misses. It found that “far too many hospitals” had safety standards and the majority required improvement to be considered safe. Of the overall key questions rating for acute hospitals that the CQC published up to the end of August 2014, 8 of 82 safety ratings were inadequate, with 57 requiring improvements. The CQC labelled this level of poor performance as “shocking”.

One case study used to highlight poor case involved a woman who was not prompted or helped to the toilet and was left wet every night, which resulted in two urinary tract infections and subsequent confusion.

Also identified was a variation in the quality of leadership, which it believed was vital at all levels in ensuring better quality and safety overall. It was determined that 60% of hospitals needed to improve on leadership.

The report outlines suggestions for what providers should do and what the public should do. It is suggested that providers should be proactive in analysing what good care looks like, rather than waiting for a CQC inspection, and that they should act swiftly as one system to protect people from poor care. On the other hand, the report said that the public should actively use CQC’s ratings and reports to make choices about their care, whilst also using their voice to give feedback on both good and poor care.

Health Secretary Jeremy Hunt calls for investment in safer care

Health Secretary Jeremy Hunt has called for hospital managers to invest in safer care. The announcement comes following both the CQC State of Care report 2013-14, and a report published by Frontier Economics, commissioned by the Department of Health, which found that the cost of preventable poor care ranged from £1 billon to £2.5 billion annually. It also found that 800,000 patients – one in 20 of all admitted to hospital – suffered harm that could have been avoided.

According to the study, urinary tract infections caused by catheters resulted in an average of 10 extra days in bed, at a cost of £2,523 per patient. This amounts of a total cost to the NHS of £67m a year – or the equivalent of pay for 1,300 nurses.

Speaking at Birmingham Children’s Hospital, Hunt said that “if you’re short on money, poor care is about the most wasteful and expensive thing you can do”, adding that he wanted “every director of every hospital Trust to understand the impact this harm is having not just on their patients, but also on their finances”. He stated that patient experience/safety and finances were “two sides of the same coin”.

Unannounced spot checks in Welsh hospitals did not reveal systemic concerns about patient care

The Welsh Government has published a report which outlines the findings of unannounced spot checks to test standards of care, including continence care, in district general hospitals across Wales. The new report, which found “no systemic issues of concern”, follows on from the Trusted to Care report which highlighted poor quality of care in two health boards in Wales.

Specifically regarding continence care, the report found that patients’ fundamental toileting needs were being met, stating that inspectors “witnessed a breadth of practice positively supporting patients’ toileting needs”, but that there were areas which needed improvement.

With regards to product provision, whilst there was high and “mainly appropriate” use of continence pads, including a good selection, these were not always stored discreetly. For catheter usage, the report found that use was “appropriate for the needs of patients”.

The report suggested that there were two key challenges for staff in their efforts to promote good toileting and continence care. Firstly, the layout of wards was problematic and encouraged reliance on bed pans rather than access to toilets. Secondly, there were wards where the dependency of patients was particularly high and where nursing staffing levels made it difficult to respond to all patients in a timely manner.

It was also identified that the ‘All Wales Continence Bundle’ was not used in many areas, with some citing the amount of paperwork and duplication as reasons for non-use.

National Institute for Health and Care Excellence launches consultation on updating the Public Health Quality Improvement Guide for prevention and control of healthcare-associated infections

The National Institute for Health and Care Excellence (NICE) has launched a consultation on the outcome of a review to determine whether the Public Health Quality Improvement Guide for the prevention and control of healthcare-associated infections (PH36) should be updated.

The draft review proposal recommended that the Quality Improvement Guide should only undergo a terminology and indicator refresh, as no new policies or guidance had been identified that invalidated the existing quality improvement statements, and that intelligence gathered suggested that the content is still relevant and useful.

The review itself focused largely on a policy search to identify any new key documents that are aimed at organisational and management factors impacting on healthcare-associated infections, as well as a search of new NICE guidance and existing publications. No relevant documents were identified, and no mention was made in the review to catheters or other relevant medical devices.

The deadline for comments is Thursday 30th October 2014. Please do let us know if you have any comments by Thursday 23rd October so we can incorporate these into a response.

It is expected that the final decision date for the review will be in December 2014.

Ofsted launches consultation on overhaul of school inspections

Ofsted has announced that it is has launched a consultation on a new common inspection framework for the inspection of maintained schools, academies, further education and skills providers, non-association independent schools and registered early years settings. The proposals are designed to streamline the transition that children make between settings as they grow up.

Whilst it is proposed that there should be a broad uniformity in inspection criteria for all settings, specific additional judgements will be made for specific types of settings (early years, six form and further education). The proposals state that schools with nursery settings will continue to receive a separate grade for that provision. Separately from this consultation, the Small Business, Enterprise and Employment Bill states that schools’ provisions for two-year-olds on the Early Years Register will now be inspected as part of a school inspection using the new common inspection framework.

The framework states that inspectors must consider how educational settings will meet the need of disabled children and learners and those with special educational needs. Despite this, no specific grade will be given.

The deadline for responses to the consultation is Friday 5th December 2014.

Commenting on the proposals, Purnima Tanuku, Chief Executive of the National Day Nursery Association (NDNA), warned that the move by Ofsted to standardise inspections across school-based nurseries, schools and further education colleges could lead to further “schoolification” of the early years.