Public perceptions of privacy and dignity in hospitals is research, conducted by Ipsos MORI, involved 2,000 interviews with members of the public across the country. It was designed to explore perceptions towards privacy and dignity in hospitals, with particular emphasis on the importance of single-sex accommodation. Key findings are that cleanliness and staff attitudes are the most important factors for patients to feel they are treated with privacy and dignity in hospital.

Five years on - are we half way there? from Diabetes UK suggests that half way through the ten-year plan, the NHS’s progress in achieving person-centred, co-ordinated care that aims to ensure fewer people develop diabetes and better care for those who have the condition will fail to deliver on the standards it set itself five years ago if it doesn’t refocus NHS efforts.

It finds that while some people with diabetes in some parts of the country receive excellent care, many are still not benefiting from the effective delivery of diabetes services that the NSF set out to achieve.  This puts almost 1.9 million people with diabetes in England at increased risk of serious complications including heart disease, stroke and blindness.

The House of Commons Health Committee: Modernising Medical Careers: Third Report of Session 2007–08: Volume I Report, together with formal minutes states the government had provided “inadequate leadership” however it also idenitfies that doctors were more concerned with factional interests than the common good.

This follows publication of the Tooke Report Aspiring to Excellence: Final report of the Independent Inquiry into Modernising Medical Careers which we posted about earlier in the year with the final report, the draft report and the government response.

Patient Experience Scores for the PSA target – April 2008 updates the patient experience scores published on 29 January 2007. They include scores derived from survey results published by the Healthcare Commission for 2006/07. There are new data points for ‘adult inpatients’ and ‘community mental health’ in 2006/07. These figures report on progress against the PSA target for sustained improvement in patient experience.

• The overall patient experience score for adult inpatients in 2006/07 has increased slightly to 76.4 from the score of 76.2 in 2005/06. The score is 0.7 points higher than in the earliest fully comparable year of 2003/04 (75.7).
• The overall patient experience score for community mental health services in 2006/07 has increased to 75.2, up 0.7 points from the score of 74.5 in 2005/06. 
• Scores for ‘involvement in decisions about healthcare’ cannot be compared across sectors.  The baseline scores for emergency services (2004/05) is 77.1.  The baseline score for outpatients (2004/05) is 81.7.  For adult inpatients, the latest score of 70.9 is unchanged from 2003/04.  Results for community mental health services show a slight increase to 63.7 in 2006/07 (from 63.3 in 2003/04) whilst primary care results are slightly lower at 81.9 in 2005/06, compared to 82.1 in 2003/04
• The baseline score for ‘choice of provider’ is 27.3 from the 2005/06 DH survey of PCTs.  This score represents the baseline position in the last year before the choice of provider policy was introduced. 

This is the third quarterly practice survey (National summary of results), covering a sample of practices from each primary care trust (PCT). The aims of the survey are to get feedback from practices on their perception of the support offered by their PCT and on the clinical and financial engagement of practices with PBC.  The survey is part of a group of indicators that will be assessed together to give a picture of PBC implementation.

Key findings:

• There has been a rise in the number of practices commissioning new services through PBC (+8 percentage points since Wave 1 and +5 percentage points since Wave 2). 41 percent have commissioned new services through PBC.
• The percentage of practices who have agreed a commissioning plan with their PCT has continued to increase (+11 points since Wave 1 and +3 points since Wave 2). 57 per cent of practices have now agreed a commissioning plan.
• 62 percent of practices support the policy of PBC (a rise of 5 percentage points since Wave 1, and 3 percentage points since Wave 2).
• The percentage of practices agreeing that PBC has improved patient care has marginally increased from 12 percent in Wave 2 to 16 percent in Wave 3. The proportion who disagree that PBC has improved patient care is in line with that of the previous two waves (31% in Wave 3, 30% in Wave 2, and 31% in Wave 1).
• 71 percent of practices claim to have a good relationship with their PCT, a decline of 3 percentage points on Wave 2.
• The proportion of practices who have received a financial incentive scheme has marginally declined since Wave 2 to the levels recorded in Wave 1 (down 4 percentage points since Wave 2 - now 62 percent).
• There has been a rise in the proportion of practices who engage with their local population from 61 per cent in wave 2 to 70 per cent in Wave 3 (an increase of nine percentage points).
• Around 4 in ten practices continue to rate their PCT’s managerial support for PBC as good (40 per cent in Wave 3, 42 per cent in Wave 2 and 37 per cent in Wave 1), however, half continue to rate managerial support for PBC as poor (49 per cent in Wave 3).
• As in previous waves, around a third of practices continue to rate the quality, format and frequency of information provided by their PCT as being good

Monitor’s Third quarter report on NHS foundation trusts’ performance for 2007-8, identifies good overall performance, with no NHS foundation trust currently at risk from intervention for financial reasons. Some NHS foundation trusts are failing to meet the target to reduce rates of MRSA, and seven NHS foundation trust have been required to attend meetings to explain their plans to improve performance in this area.

Patients will be able to choose where they are treated from any provider meeting Healthcare Commission standards from 1 April, but Free Choice at the Point of Referral a King’s Fund’s briefing on the latest official data finds the policy has some way to go before it is likely to drive improvements in the quality of hospital services.

One of the ambitions of free choice is to create incentives for hospitals to drive up quality standards as they compete for patients, but official data shows that:

• use of ‘Choose and Book’ — the computer system designed to facilitate choice — whilst increasing still falls short of the government’s target, with only 50 per cent of referrals from GP to hospital being made using the system
• although increasing numbers of patients say they remember being offered a choice of hospital by their GP since the policy began in 2006, the proportion is still only 45 per cent
• of those 45 per cent, only 27 per cent said their GP gave them a booklet containing comparative information on hospital performance to help them make a decision.

The Commissioner Volume 3 Issue 3 from the North West Primary Care Librarian’s Group was published today with its podcast ( Standard Podcasts [6:22m]) contents are:

• PBC: Personalise your Improvement with the No Delays Achiever

• Dental Commissioning and Contract Monitoring - Tendering, Procurement & Contracting

• Evaluation of One-Stop Shop (Oss) Models of Sexual Health Provision

• Improving Access to Psychological Therapies implementation plan

• National Infarct Angioplasty Project (NIAP) interim report

• Practice-based commissioning : tips for preparing and pitching a proposal

• Strategic commissioning for older people

• Apply for Beacon Status

• Other documents and conferences

Feed for Podcast

Standard Podcasts [6:22m]

The Government’s Response to the Health Select Committee’s First Report of Session 2007-08 on the National Institute for Health and Clinical Excellence sets out the Government’s response to the Health Select Committee’s report on the National Institute for Health and Clinical Excellence (NICE). It welcomes and endorses the Committee’s expression of support for and confidence in NICE. Separate reports by the World Health Organisation on NICE’s technology appraisal and clinical guidelines programmes have commended the way in which it discharges its vital responsibilities.

The new issue of the He@lth Information on the Internet is now available online. If you want to access the full text of the journal you’ll need your Athens password from the Liverpoo PCT. (If you don’t have an Athens password and are eligible you can get one here).

Articles

Bookmarks

Articles

Current literature

What’s new?

In the Know  (Executive Summary) from the Audit Commision aims to encourage people to think about the information they use whenever they make decisions. It has examples, drawn from many different sources, of how information has been used in improving public services. It notes:

When decision makers use information well, local public services improve.

• The quality and cost of our local public services depend upon the decisions that many people make: users make choices; professionals exercise judgement; managers prioritise; and politicians allocate resources.
• Using information well in decision making leads to better local public services. Examples vary from reducing the number of young people not in education, employment or training to increasing the number of ambulances reaching incidents quickly; improvements include reducing fly-posting by 90 per cent, and increasing library membership by 58 per cent.
• Two-thirds of 3 and 4 star councils use information well, but only a tenth of 1 and 2 star councils do.

Information needs to be relevant for the decision at hand.

• Different decisions require different information, and judging what information is relevant for a decision is not easy.
• Performance indicators alone will not be adequate for important decisions.
• Aggregating information (for example over geography or time), using a range of information from different sources, and sharing information, will generate a fuller picture.

Good quality data are the foundation of good quality information.

• Data should be captured once and used numerous times.
• Data should be sufficiently accurate for the intended purpose. Highly accurate data are often neither cost-effective nor possible for many decisions.
• Decision makers need to judge how quickly and frequently they need information. Some information may need to be updated and available immediately, in real-time, but for many political, financial and strategic issues, understanding trends over time is more important than immediacy.

The way information is presented is important for accurate interpretation.

• Relevant, good quality, information will not help decision makers if they cannot understand it.
• How information is presented, and what story it helps to tell, can affect the decisions based upon it.
• The way information is presented, therefore, needs to be tailored for both the audience and the decision at hand.

Using information well requires decision makers and analysts to have particular skills.

• Decision makers need to be able to identify the information they need and to interpret it accurately.
• Those providing information need strong analytical and presentation skills.
• Evidence suggests that these skills are in short supply.

People need to think carefully about the information they use whenever they make decisions.

• Those who make important decisions about local public services should demand better and clearer information.
• Public bodies need to evaluate whether their information is fit for purpose and used to best effect.
• Relevance, quality and presentation, summarised as RQP, are the key characteristics for useful information.

Medical care for the Armed Forces: Seventh Report of Session 2007–08: Report, together with formal minutes, oral and written evidence identifies that clinical care for servicemen and women injured on military operations is now “world-class” but the government needs to do more to look after families and veterans, especially in providing mental health care.  Emphasise support had to go beyond the period of an individual’s service, and should form part of the compact between the services and society.

Mental Health Act Commission Twelfth Biennial Report - Risk, Rights, Recovery finds that there are severe funding issues faced by providers of mental health services in that:

• Patients deemed to be a threat to themselves or others are being denied hospital beds while commissioners disagree with regard to funding.

• The Mental Health Act Commission has found practitioners are being told to delay sectioning people with urgent mental health needs until primary care trusts ascertain who should pay for their treatment.

• The problem is caused by high bed occupancy levels and the need for PCTs to balance budgets.

• This has encouraged PCTs not to detain patients who have travelled from other areas until the home PCT has agreed to pay.

Thse practices are unsuprisingly condemned in this report.

To use this journal you’ll need your NHS Athens password from Liverpool PCT (You can register here to get one if you work for the PCT.  If you need any training for this or any other electronic resources and you work for the PCT use the contact form at the bottom of this post to request it.

Quality Lines
David P Stevens
Qual Saf Health Care 2008; 17: 1. [Extract] [Full text] [PDF]

Handovers and Debussy
D P Stevens
Qual Saf Health Care 2008; 17: 2-3. doi:10.1136/qshc.2007.025916 [Extract] [Full text] [PDF]

Structuring flexibility: the potential good, bad and ugly in standardisation of handovers
E S Patterson
Qual Saf Health Care 2008; 17: 4-5. doi:10.1136/qshc.2007.022772 [Extract] [Full text] [PDF]

Patient race/ethnicity, age, gender and education are not related to preference for or response to disclosure
C Hobgood, J H Tamayo-Sarver, and B Weiner
Qual Saf Health Care 2008; 17: 65-70. doi:10.1136/qshc.2006.021758 [Abstract] [Full text] [PDF]

Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study
E M A Witherington, O M Pirzada, and A J Avery
Qual Saf Health Care 2008; 17: 71-75. doi:10.1136/qshc.2006.020842 [Abstract] [Full text] [PDF]

Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system
P D Mills, J Neily, L M Kinney, J Bagian, and W B Weeks
Qual Saf Health Care 2008; 17: 37-46. doi:10.1136/qshc.2006.021816 [Abstract] [Full text] [PDF]

Adverse outcomes after discharge: occurrence, treatment and determinants
P J Marang-van de Mheen, N van Duijn-Bakker, and J Kievit
Qual Saf Health Care 2008; 17: 47-52. doi:10.1136/qshc.2007.023309 [Abstract] [Full text] [PDF]

Patient safety events reported in general practice: a taxonomy
M A B Makeham, S Stromer, C Bridges-Webb, M Mira, D C Saltman, C Cooper, and M R Kidd
Qual Saf Health Care 2008; 17: 53-57. doi:10.1136/qshc.2007.022491 [Abstract] [Full text] [PDF]

Comparing measures of patient safety for inpatient care provided to veterans within and outside the VA system in New York
W B Weeks, A N West, A K Rosen, and J P Bagian
Qual Saf Health Care 2008; 17: 58-64. doi:10.1136/qshc.2006.020735 [Abstract] [Full text] [PDF]

Intensive care unit nurses’ perceptions of safety after a highly specific safety intervention
N C Elder, S M Brungs, M Nagy, I Kudel, and M L Render
Qual Saf Health Care 2008; 17: 25-30. doi:10.1136/qshc.2006.021949 [Abstract] [Full text] [PDF]

What is quality and how is it achieved? Practitioners’ views versus quality models
P Hudelson, A Cléopas, V Kolly, P Chopard, and T Perneger
Qual Saf Health Care 2008; 17: 31-36. doi:10.1136/qshc.2006.021311 [Abstract] [Full text] [PDF]

Adequacy of information transferred at resident sign-out (inhospital handover of care): a prospective survey
S M Borowitz, L A Waggoner-Fountain, E J Bass, and R M Sledd
Qual Saf Health Care 2008; 17: 6-10. doi:10.1136/qshc.2006.019273 [Abstract] [Full text] [PDF]

A theoretical framework and competency-based approach to improving handoffs
V M Arora, J K Johnson, D O Meltzer, and H J Humphrey
Qual Saf Health Care 2008; 17: 11-14. doi:10.1136/qshc.2006.018952 [Abstract] [Full text] [PDF]

Integrating the chronic-care model and the ACGME competencies: using shared medical appointments to focus on systems-based practice
S R Kirsh and D C Aron
Qual Saf Health Care 2008; 17: 15-19. doi:10.1136/qshc.2006.020925 [Extract] [Full text] [PDF]

Patient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors
J F Crofts, C Bartlett, D Ellis, C Winter, F Donald, L P Hunt, and T J Draycott
Qual Saf Health Care 2008; 17: 20-24. doi:10.1136/qshc.2006.021873 [Abstract] [Full text] [PDF]

Homeopathy or regular medicine? Cook County Hospital, Chicago, Illinois, 1882–1887: evidence, politics, customer choice and provider perceptions at work
D Neuhauser and M Diaz
Qual Saf Health Care 2008; 17: 76-78. doi:10.1136/qshc.2007.023705 [Extract] [Full text] [PDF]

Practice guidelines for haemodialysis in Egypt
Qual Saf Health Care 2008; 17: 79. doi:10.1136/qshc.2007.023325 [Extract] [Full text] [PDF]

Impact of the European Working Time Directive on specialty training
Qual Saf Health Care 2008; 17: 79-80. doi:10.1136/qshc.2007.023234 [Extract] [Full text] [PDF]

Learning from investigations from the Healthcare Commisson highlights the following issues that have been consistently highlighted as a result of their investigations.

• Leadership and management: Poor leadership was a problem in nearly all of the investigations carried out by the Commission.

  Some boards had been focused on mergers or targets at the expense of their broader activities.

  Lack of continuity in leadership was a problem in some trusts, where frequent changes in management were a factor in poor care. Bullying and harassment by managers was a factor in two cases investigated. The Commission found there was a fine line between promoting change vigorously and bullying.

  Investigations often uncovered a breakdown in leadership and management, with a lack of clarity on responsibilities from board to ward. Poor teamwork, either between management and clinicians or between clinicians themselves was another common factor in failings.

• Use of information: The Commission was surprised that most of the trusts investigated did not have adequate systems in place to routinely inform the board of trends or potential problems. Board members must assure themselves about the quality of services for which they are responsible and need data to do this professionally.
• Mergers and restructures: Seven of the trusts investigated had recently undergone mergers or significant organisational change. The message from the Commission’s investigations is that where significant change is taking place, the management task should not be underestimated.
• Safeguarding vulnerable adults: Poor understanding of adult protection procedures and responsibilities was a serious problem in the two investigations into learning disability services and also a number of interventions in trusts. The Commission said staff need good training to understand their crucial role in protecting vulnerable adults.
• Poor care on general wards: When its investigations looked at acute hospital care, the Commission noted that care on general wards fell well below the care provided on specialist wards. Older patients were most at risk as they were often most dependent on good nursing care. The Commission will monitor this aspect in future investigations to identify whether this is an emerging common theme.

Mental Health Act Commission Eleventh Biennial Report (In Place Of Fear) questions whether all inpatient mental health services provide their patients with acceptable levels of security, care, or a sense of being treated as  someone who matters. It welcome the Government’s announced refocus on inpatient services and call for it to concentrate on building up these aspects, in place of the fear that many patients have of services and that many people have of mentally disordered people.  The importance of breaking such ‘circles of fear’ for Black and minority ethnic patients are particularly welcomed.

There is evidence that inpatient services are losing staff and resources to community
services, but that pressures on inpatient beds remain high. Over half of all wards are full or have more patients than beds, with staffing shortages and unpleasant ward environments undermining the therapeutic purpose of inpatient admission.

The report highlights the dangers inherent in devolved service commissioning for ensuring adequate levels of specialist provision, and note the vulnerability of mental health services as Trusts face financial crises.

The extension of patient ‘choice’ across health service provision should not be allowed further to disadvantage or ostracise patients who are unable to exercise choice because of their mental incapacity or because of legal powers of compulsion held over
their treatment.

Boundaries of current mental health law under stress, with discussion of about forty cases
in court, and a more general observation of legal powers being used in ways that may not have been intended by Parliament, often for pragmatic reasons where professionals are keen to intervene in what they perceive to be a person’s best interest or as measures of social order.

It also discusses aspects of the use of present mental health powers in relation to civil detention and police powers, including an extended discussion on the detention of mentally disordered offenders.We provide analysis of deaths of detained patients; seclusion incidents notified to the Commission; and Second Opinion activity during this period.

The report has a strong focus on measures to encourage and support the empowerment of all patients, including those without mental capacity to make certain decisions about their care.

It finally reviews the proposed future arrangements for monitoring detention of mentally disordered persons and suggest ways in which the forthcoming Mental Health Bill might be improved to ensure acceptability to mentally disordered persons and the effective protection of their rights.

Mental Health Act Commission Eleventh Biennial Report - Errata and Addendum

Many maternity units in England are failing to provide top quality care, an independent review suggests. The Healthcare Commission found huge variation in quality of care across England with women in London receiving the worst service.

The Commission has published three investigations into maternity units and this area of care makes up one in 14 of referrals to its investigation unit on safety grounds.

In the absence of formal standards, the review set performance benchmarks for maternity for the first time, taking into account guidance from the National Institute for Health and Clinical Excellence (NICE) and the National Service Framework for Maternity Services. Trusts can use these to measure improvement and the Commission will conduct a follow-up review to check on progress.

• Briefing Note
• Individual Trust Results
• Maternity service review final results spreadsheet

More than 17,000 people receiving treatment in the UK have died unnecessarily because of the inadequacies of the NHS, it is claimed today. The figure, in Wasting Lives: A statistical analysis of NHS performance in a European context since 1981 published by the Taxpayers’ Alliance, is calculated using data given to the World Health Organisation. It compares the number of people who died prematurely, even though their illness was treatable in the UK to that of Germany, France, the Netherlands and Spain.

A New Health Service for Liverpool Strategic Plan 2008 – 11: A Discussion Document(Summary) is the developing strategic business plan that sets out Liverpool PCT’s top priorities for the next three years and the thinking behind them. It has 8 priorities:

1. Delivering the things that make a big difference

• Cut deaths from cardiovascular disease by half in under-75-year-olds, compared with 2004
• Cut deaths from accidents by 20% in under-75-year-olds, compared with 2004
• Cut deaths from cancer by 20% in under-75-year-olds, compared with 2004
• Improve the health and well being of children and young people through the initiative - ‘Young Healthy Liverpool’
• Everyone living in Liverpool will know more about how to look after their own health and that of their family
• Everyone living in Liverpool with a health problem will know the right place to go to receive help
• A NHS dentist will be available for anyone within a maximum 15-minute, public transport ride of their home
• Reduce admissions to hospital due to alcohol misuse and work with Liverpool people to encourage a more sensible approach to alcohol consumption

2. A better understanding of self-care and how health services can support it

3. Gold standard primary care and community services

4. Gold standard hospitals

5. End of life services

6. Personalised care

7. An end to waiting

8. Joined-up services

To underpin these and enable NHS Liverpool to improve continuously the strategy recognises and values:

1. Developing a NHS Liverpool workforce

2. Research and Development

3. Managing the Resources

4. Making decisions

5. Making it all happen

National Care of the Dying Audit generic report 2006/2007 considers the care of the dying in five key areas and finds that:

Physical Comfort of the Patient 

• Medication was assessed and non-essential medication was stopped in 93% of patients.

• Anticipatory prescribing was undertaken for pain relief in 91% of cases, for agitation in 84% of cases, for the prevention of respiratory tract secretions in 80% of cases, for nausea in 80% of cases and for breathlessness in 67% of cases.

• Inappropriate blood tests and antibiotics were discontinued in 87% and 91% respectively, and recording of ‘not for Cardio Pulmonary Resuscitation’ (where appropriate) documented in 93% of patients.

• In regard to ongoing care the presence or absence of symptoms could be recorded for patients during the last 24 hours of life. The status was not recorded for 18% - 19% of those assessments. Where the status was recorded patients were assessed as being symptom controlled in 95% for pain; 94% for agitation; 91% for respiratory tract secretions and 99% for nausea and vomiting of occasions.

Psychological and Spiritual Aspects of Care

On commencement of the LCP (Initial Assessment)

• Patient awareness of diagnosis and recognition of the dying phase was recorded as having been achieved in 57% and 45% of patients respectively. In one third of cases there was no documentation on the LCP suggesting a need for further education and training for healthcare staff.  Some hospitals, however, did achieve 100%.
• In over 80% of cases, carers were recorded as being aware of the diagnosis and dying phase, suggesting that healthcare staff find it easier to talk to carers
• The spiritual needs of patients and carers were recorded as being assessed in 34% and 53% (respectively) of appropriate cases

Communication with Patient,Carer and Healthcare Professionals

This is variable but carers were more likely to have had the care plan explained to them than the patient:

• At Initial Assessment, documentation confirmed that patients had the care plan communicated to them in over one third of cases, compared with 78% of carers.  It was recorded that 90% of those carers understood the care plan after it was explained to them.

• Communication with primary care (both on commencement of the LCP and after the death of the patient) was documented as having taken place in only about a third of cases, although there were pockets of good practice

Information Giving and Receiving

• Contact information about the most important person to contact in case the patient’s condition deteriorates was achieved at Initial Assessment in 79% of cases and Hospital information leaflets regarding facilities and access were given out in 59% of cases at that time
• Around the time of death or deteriorating condition of the patient (Initial Assessment), only half of families were recorded as having been given appropriate information about local and national procedures that may need to be followed.

Following Appropriate Procedures

• Following death, appropriate hospital procedures for laying out of bodies, storing of patient’s belongings and other activities were documented as having been followed in around half of cases.  However, the high level of care after death goals that are left blank at the point of delivery of care requires more investigation before firm conclusions can be made.