Weekly political news round up – Friday 22nd November 2013

November 22, 2013 in News by Whitehouse

Update on Children and Families Bill

The Children and Families Bill completed its Grand Committee stage in the House of Lords this week, and the first two days of the Bill’s Report Stage have been confirmed for December 9th and 11th. However, with many issues still unresolved, particularly to Parts 1 and 2 of the Bill on family law, we have learned that the Government do not expect the SEN clauses in Part 3 to begin debate until the second day of Report and not to conclude the debate until a third or fourth day expected in the New Year.

Government publishes further response to report on Mid Staffordshire NHS Foundation Trust inquiry

The Government has published its further response to Robert Francis QC’s report on the Mid Staffordshire NHS Foundation Trust public inquiry. The response, titled Hard Truths: The Journey to Putting Patients First, explains the changes that have been put in place since the initial response was published, and sets out how the whole health and care system will prioritise and build on this. There are also detailed responses to the 290 recommendations made by the inquiry. The Government accepted all but nine of the 290 recommendations. The recommendations which the Government did not accept relate to a statutory duty of candour, regulation of healthcare assistants, and making it a criminal office to obstruct healthcare professionals from exercising a duty of candour.

The Francis Report was published in February 2013, and called for a ‘fundamental culture change’ across the health and social care system to put patients first. There were six core themes that were highlighted for action: culture, compassionate care, leadership standards, information, and openness, transparency and candour.

The Government’s initial response, Patients First and Foremost, published one month later in March 2013, set out a plan to prioritise care, improve transparency and ensure that where poor care is detected, there is clear action and accountability. Since the report was published, the Government and the health service have made initial changes aimed at ensuring better and more frequent inspections, greater independence for the Care Quality Commission (CQC), better standards and more involvement with patients and the public.

This second response includes some improvements designed specifically to reduce catheter-associated infection, as well as general improvements to patient involvement. There was, however, no direct reference to paediatric continence or continence more generally in either volume of the response, though the report did note the review of the Children and Young People’s Health Outcomes Forum, one of several reports commissioned to look at some of the key issues emerging from the Inquiry.

The first section of the report outlines changes that have, or will be made, to prevent problems from arising, while the second section contains the detailed response to each recommendation.

The most relevant changes that are planned by the Government include:

  • The establishment of a new Patient Safety Collaborative Programme by NHS England to spread best practice on patient safety.
  • The encouragement of the use of NHS Safety Thermometer data collection to help inform improvements in some key patient safety areas, including catheter-associated infection.
  • The strengthening of the professional duty of candour to ensure that doctors and nurses and open with patients when mistakes occur, and for professionals to report errors that could have led to harm.
  • Listening to more to patients, including plans to, by December 2013, have 80% of clinical commissioning groups (CCG) commissioning support for patients’ participation and decision in relation to their own care.
  • The promotion a culture of openness by making it clear to patients how they can complaint or get support on making complaints.
  • The development by the Department of Health and Care Quality Commission fundamental standards recommended by the inquiry, in clear language for what it means to patients and service users, for public consultation.
  • For Health Education England (HEE) to lead on ensuring improvements in continuous professional development and appraisals.

Action has already been taken by Healthwatch England and the Local Government Association to launch a tool to help local areas identify what outcomes and impacts a good local Healthwatch could achieve, as well as by the CQC to involve patients in its inspections of hospital ratings.

Various organisations have responded to the Government’s response, including NHS England; the CQC; Health Education England; Healthwatch England; the Royal College of Physicians; and the Royal College of Nursing. In general, these organisations welcomed the Government response and identified some of the work they will take forward over the coming months.

NICE launches consultation on draft quality standard for infection control

The National Institute of Health and Care Excellence has published a draft quality standard on infection control for children and adults receiving healthcare in primary, community and secondary care settings. NICE quality standards are designed to drive measurable quality improvements within a particular area of health or care.

This particular quality standard is aimed at contributing to certain improvements outlined in the NHS Outcomes Framework 2013/14. It seeks firstly to contribute to prevent people from dying prematurely by reducing the amount of lives lost from causes amenable to healthcare in adults and children, and secondly to treat people in a safe environment and protect them from avoidable harm by reducing incidences of healthcare associated infection.

The draft quality standard contains six quality statements about infection control, including two that specifically involve urinary catheters. On this issue, the quality standard seeks to ensure that:

  • People needing a long-term urinary catheter have their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of their catheter (statement 4);
  • People with long-term urinary catheters, vascular access devices or enteral feeds are educated about the safe management of their device or equipment, including techniques to prevent infection (statement 6).

NICE is consulting on the draft quality standard. The consultation asks if the draft quality standard accurately reflects the key areas for quality improvement, and also asks a specific question about draft quality statement 4:

  • What are the specific components of the procedures defined that are the main areas for quality improvement?

Commons Health Committee hears oral evidence on the management of long-term conditions

As part of the Commons Health Committee’s ongoing inquiry into the management of long-term conditions, the Committee heard oral evidence from Care and Support Minister Norman Lamb, and Dr Martin McShane, Director of Improving the quality of life for people with long-term conditions, NHS England. There was no explicit mention of paediatric continence, or continence care in general, during the session.

McShane said that he would be working with Health Secretary Jeremy Hunt on long term conditions next year. He criticised the current system saying that while it was successful on health and planned care, the failure to address long-term conditions had resulted in long-term conditions being a significant drain on the health service’s resources.

In response to questioning about the strategy of NHS England in supporting people with long-term conditions, McShane noted that there were three teams in the Department of Health working on long-term conditions, but NHS England’s model under the five domains of care was to use crosscutting programmes where appropriate. He said that the “traditional” approach of publishing a single strategy was not their preferred approach. McShane instead said the approach would be about “how we move the whole system to ensure that people with long term conditions get high-quality care as well as delivering changes to premature mortality and hospital care”.

Royal College of Nursing and the Infection Prevention Society highlight infection control concerns

The Royal College of Nursing (RCN) and the Infection Prevention Society (IPS), a membership organisation of health professionals working in infection prevention and control, have published a joint briefing paper highlighting concerns over ongoing infection prevention and control arrangements in England.

The briefing states that following the structural changes to the health service in April 2013, infection and protection specialists who had been commissioned by primary care trusts to support commissioners were now commissioned by a variety of organisations including the Department of Health, the Care Quality Commission, NHS England (including its area teams), as well as clinical commissioning groups and local authorities, rather than a single body.

This, in combination with the increase in number of NHS commissioning organisations, has raised concerns over a significant variation and a lack of consistency in approach and management. As a result, there are now concerns that infection control could be overlooked or insufficiently supported. Urinary tract infections are briefly mentioned in a section outlining NHS England’s work on infection prevention, where the report notes that UTIs in patients with an indwelling urethral catheter are part of national commissioning for quality and innovation (CQUIN) guidance, using the NHS safety thermometer methodology.

The report includes three recommendations including that commissioning organisations should have in place a formal process to provide assurance to their respective boards of the level of infection prevention support available to them, and to what extent this meets the organisation’s needs.

Tabled written questions on continence care

Labour MP Rosie Cooper, secretary of the continence care APPG, has tabled three written questions on continence care and continence related problems, asking the Health Secretary:

  • How many hospital admissions there were for urinary tract infections in 2012; and what the estimated cost to the NHS was of treating such admissions.
  • What steps he is taking to improve the training of doctors, nurses and healthcare assistants in continence care.
  • Whether NHS England is responsible for provision of guidance on continence care to clinical commissioning groups.