A Year in Review

Ben O’SullivanDaniel Komrower

Junior Doctor Advisory Team

• Provide independent advice to trainees and trusts in NW and Mersey on rotas, monitoring and contractual issues

• Visit trusts as part of quality assurance functions of HENW

• Dragons Den – think about submitting!!

Content

• Department of Health full response to Francis

• Berwick Patient Safety Review

• Keogh review into 14 hospital trusts

• Greenaway Shape of Training report

DoH response to Francis

Hard Truths: Journey to putting patients first

January 2014

‘Francis Report’• Robert Francis QC• Barrister with a background in the NHS: involved in the

inquiries into the Bristol Royal Infirmary and Alder Hey

• Commissioned by Labour government to chair an inquiry ‘giving a voice to those who suffered at Stafford’

• Delivered February 2010• Commissioned by Coalition government to chair a second

inquiry into the wider systemic failures of the NHS, investigating how this suffering had been allowed to occur without detection

• Delivered February 2013

Francis Report - recommendations• Gross failings in the wider regulatory and

commissioning systems to reveal problems in safety and quality of care

• 290 recommendations• Focus on organisations and 5 general themes:– Values and standards– Openness, transparency and candour– Compassion and care– Information– Leadership

‘The one thing that doesn't abide by majority rule is a person's conscience’

Atticus Finch, To Kill A Mockingbird

Government response• Initial response: Patients first and foremost• March 2013• Laid out actions to prevent, detect, take action, provide

accountability and ensure training and motivation• Broadly, focussed on changes to existing system

• Full government response: Hard Truths• January 2014• Responds also to 6 further independent reviews: Keogh,

Cavendish, Berwick, Hart, NHS confederation, Lewis

‘First, we need to hear the patient, seeing everything from their perspective, not the system’s

interests’

DoH actions• Clear navigation for patients’ complaints and concerns• Duty of candour among all professionals• Quarterly reports by trusts on complaints and concerns• Legislation on ‘wilful neglect’• Care certificate for HCAs and social support workers• Increased power to patients through local Healthwatch ALB• Extension of Friends and Family test to mental health• Involvement in commissioning• Patient involvement in CQC rating system• Values-based recruitment

Improving the Safety of Patients in England

A promise to learn – a commitment to act

August 2013

Berwick report

• Consultant paediatrician• Former President and CEO of IHI• Administrator for centres of Medicare and

Medicaid services (CMS)

• Asked by PM as an independent perspective, how ‘to make zero harm a reality in our NHS’

• Delivered August 2013

Berwick report - recommendations

1. Embrace ethic of learning2. Quality of care, in particular patient safety, a top

priority3. Patients and their carers should be present, powerful

and involved at all levels of HCOs4. Sufficient staff5. Quality and patient safety science and practice part of

lifelong education of all HCPs

Berwick report - recommendations

6. NHS as a learning organisation with support for change7. Transparency should be complete, timely and

unequivocally shared with the public8. All organisations should seek out patient and carer

voice9. Regulatory systems should be simple and clear,

avoiding diffusion of responsibility10. Responsive regulation of organisations

What does this actually mean for me?

• What was the last audit/project you did?

• Why did you do it?

• Who benefitted most – the patient…the department…you? How do you know this?

• If you had asked the patients on your ward what you should do as a project – what might they have said? If you had done this, would have made things better for your patients?

Keogh Review

• Feb 2013 -> July 2013• Review hospitals with persistently high

mortality rates post Francis Report• 14 trust reviewed– Hard data and soft intelligence– MDT planned and unannounced visits– Listening – focus group/community– Risk summit – coordinated plan of action

Mortality rate• Is it of any use?• What is the correct measurement?

– HSMR – Hospital Standardised Mortality Ratio• Hospital deaths• 56 diagnosis groups (80% of deaths)• Allowances for palliative care• If observed = (standardised) expected deaths = 100

– SHMI – Summary Hospital-level Mortality Indicator• 30 days of discharge• All diagnosis groups (100% deaths)• No allowance for palliative care• Ratio of observed death compared to expected (risk-adjusted model)

deaths. Expected deaths = 1

8 Key Ambitions

1. Reduce mortality not debate statistics2. Better data availability for QI and public3. Patient/carers/public equal partners 4. Patient and clinicians have confidence CQC 5. Isolated hospitals will be a thing of the past6. Appropriate nursing staffing levels and skill mix7. Junior doctors clinical leaders – TODAY8. Happy engaged staff vital for patient care

Securing the future of excellent patient care

• Prof David Greenaway• 29th October 2013• All UK

Key Messages• General care in broad specialities -

generalists• Still need Specialist • Sustainable career – opportunity to change• Opportunities driven by local patients need• Academic training pathways• Full registration to point of graduation

No clinical supervision

Rest of career

MDT

CPD

Credentialing

Professional practice

Broad-based Specialty Training

4-6 years

Generic and transferable competencies

OOP year

Postgraduate

Foundation Year Training

2 years

Postgraduate

Medical School

Undergraduate

Registration CertificateOf

SpecialityTraining

Controversies

• Moving registration• Training– Shorter– Less trained consultants– Sub consultant grade (? CST less than CCT)

The Keogh Report