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Billy Boland on quality improvement at the NHS Leadership Academy

5 Feb, 14 | by BMJ

billy_bolandThe first residential for the NHS Leadership Academy felt barely five minutes ago, so I balked as I realised how much there was to do for the next. The reading list and exercises laid out for me on the online campus disappeared off the bottom of my computer screen. An unwelcome yet horribly familiar feeling of having too much to do in too little time swept over me with an intensity I’d not felt since medical school. Early learned coping skills of playing cards or going to the pub sprang to mind. But having long since proven their ineffectiveness in getting things done, I began mirthlessly plugging through the content, determined not to enjoy myself. more…

David Lock: Should accident victims who get a payout be entitled to free NHS care?

3 Feb, 14 | by BMJ

At a time when NHS bodies are under more financial pressure than ever before there is one anomaly which is worth highlighting. Personal injury victims can be paid damages on the basis that they will claim the cost of private medical care, but then such a person is entitled to keep the damages and demand free NHS care.

This anomaly arises because patients who are injured in a road traffic accident, an accident at work, or as a result of negligent hospital treatment (or any other personal injury claim) are entitled to seek the future costs of their medical care as part of a damages claim. As a result of an act of Parliament passed in 1948 when the NHS was created, a defendant (whether the NHS litigation authority [NHSLA] or an insurer) is not allowed to insist that the tort victim uses NHS services instead of seeking private care. The NHSLA or insurer has to pay the cost of future medical bills on a private basis. Hence an NHS Trust can be forced to pay damages for a clinical negligence victim to be provided with future care funded by BUPA. more…

Richard Barker: How can academic health science networks (AHSNs) influence GPs to spread innovation?

28 Jan, 14 | by BMJ

As independent contractors, GPs cannot be instructed to take up innovation. They will adopt innovations that they can see will benefit their patients and also their practices in terms of finance or efficiency. They can be given financial incentives, but there is a limit to the funds available and Quality Outcome Frameworks (QOFs) have historically been used to ensure that current good practice is as universal as possible. Today’s report from Nesta and CASMI has confirmed that in considering adopting an innovation, GPs have very limited time and resources. However, some practices are ahead of the curve at adopting certain types of innovation (our report looked at drugs, technologies, and practices). While our research didn’t uncover any “serial adopters” who take up all innovations rapidly, it did reveal “technophilic” practices that tend to adopt a cluster of IT innovations more readily than others. more…

David Wrigley: How to fast track hospital closures—use clause 118

23 Jan, 14 | by BMJ

david_wrigleyLike a baby throwing their toys out of a pram, Jeremy Hunt is using the blunt instrument of legislation to hit back at patients and campaigners who beat him in the High Courts over his attempt to close Lewisham Hospital.

Lewisham was a successful, popular, high quality, and solvent London hospital. A neighbouring hospital was in dire straits owing to crippling politically engineered PFI debts, so Jeremy Hunt sent in his officials who decided the answer was to close Lewisham Hospital. No one could understand the logic. This decision immediately angered local clinicians, commissioners, and residents, and a huge and ultimately successful campaign stopped the closure process. It was ruled unlawful by the judge. Mr Hunt subsequently decided to spend thousands of pounds of tax payers money to appeal against this High Court decision—but again he lost. To waste a huge amount of tax payers money on these legal bills does make one question his judgment. more…

Richard Vize: Are clinical commissioners improving patient services?

21 Jan, 14 | by BMJ

Richard VizeClinical commissioners are beginning to demonstrate how they are improving patient services, countering the lack of attention they are getting from politicians.

The health reforms were intended to put clinical commissioners at the heart of the drive to improve quality and reconfigure services. But since they took over from primary care trusts in April, clinical commissioners have not fitted in with the political direction being pursued either by health secretary Jeremy Hunt, or the shadow health secretary, Andy Burnham.

Hunt’s determination not to mention the health reforms means clinical commissioners have rarely been part of his narrative about improving the NHS. Crucially, his response to the Mid Staffordshire scandal has been to focus on regulation rather than commissioning as the way to avoid future crises. Indeed, commissioners often feel disconnected from the work of the Care Quality Commission in their area. more…

Marc Wittenberg on taking part in a CQC inspection

16 Jan, 14 | by BMJ

marc_wittenbergIn September 2013, shortly after starting in post as a national medical director’s clinical fellow at the BMJ and NHS England, I received an email inviting applicants to join “Mike’s army” as a junior doctor on a CQC (Care Quality Commission) inspection. My application was duly accepted and I was signed up to inspect one of the first wave of hospitals under a new model of inspection developed following the widely acclaimed methodology of the “Keogh reviews” earlier in the year.

The new inspections, developed by a team led by the first chief inspector of hospitals, Mike Richards, were initiated in part in response to the Francis reports, and aim to fundamentally improve the quality of the inspections that the CQC carry out. Having been on the receiving end of a number of inspections, I was intrigued to gain an insight into this. more…

Sean Roche: In order for patients to be valued, we must begin by valuing staff

15 Jan, 14 | by BMJ

sean_rocheSince the Francis report there has been much discussion about the need to disseminate “compassion” in the NHS. While there has been a great deal of moralistic rhetoric extolling the virtues of this noble and uniquely human quality, and its indispensible role in a caring health system, there is relatively little analysis of those organisational factors that might lead either to its flourishing or to its withering away.

I believe that the most effective measure to increase the degree of compassionate care towards patients would be for NHS staff themselves to feel more valued and nurtured by their organisations. The trouble is that the wider NHS culture has undergone a steady transformation in proportion to the extent of marketisation. There is a shift from a sense of belonging to part of a broader family in a cherished public service in which we take pride, to feeling more like disposable, anonymous employees of an indifferent corporate behemoth. There are various dimensions to this shift in culture. Firstly, NHS staff feel precarious in a way that was previously unheard of. Many are familiar with service reorganisations in which staff must “reapply” for their jobs. What is the underlying message? That your job is far from secure. Of course this feeling of potential job insecurity contributes to a pervasive free-floating anxiety. Secondly, the need for continual training, appraisal, performance management, revalidation, personal development, audit, targets, etc. creates an anxious atmosphere of always feeling that one is lagging behind and trying to catch up—that the goal of being designated “competent” is forever receding away on the horizon. Staff live with an apprehension that at any moment the hand of institutional authority might clap you on the shoulder and condemn your lack of up-to-date equality and diversity training, or woeful ignorance of your nearest fire exit. more…

David Zigmond: We need an appointment with Dr Finlay

11 Dec, 13 | by BMJ

david_zigmond2A recent article by Stephen Moss (“Pills, bills and bellyaches: a peek behind the scenes at a GP surgery,” Guardian.) is a vivid Hogarthian portrait of a frontline of our current NHS.

As a long serving inner city GP there is much I can endorse, amplify, or dispute. One strand is of interest and illuminates much else. Health secretary Jeremy Hunt is reported as pressuring simultaneously for a return to a traditional “family doctor” ethos (which I strongly support) and an instant, skyping, emailing, extended hours service (which I find inimical). It seems clear to me that one service cannot do both, and that an emphasis on the latter will destroy the former. Personally sensitive and imaginative care requires certain kinds of understanding, and these can come only from attentive human contacts and bonds. more…

Billy Boland: Live at the NHS Leadership Academy

10 Dec, 13 | by BMJ

billy_bolandIt’s taken me a while to write about my first residential for the NHS Leadership Academy Bevan Programme. So much went on there, I’ve needed a bit of time to come down from the whole thing. It was a dark day in November that found me racing through the English countryside to get to Leeds, and the hotel that I was to call home for the week. Until then, all I’d known about the course was via emails and the website, other than a phone call discussing my 360 degree feedback. Though there was plenty of material to get stuck into and mull over, in my mind the course wouldn’t properly start until I met the other members in my group. more…

Katherine Sleeman: Dying people need care, not just care plans

13 Nov, 13 | by BMJ

Exactly three months after Julia Neuberger recommended that the Liverpool Care Pathway (LCP) should be phased out in the UK, the first randomised controlled trial (RCT) of the LCP was published in the Lancet. [1] The cluster randomised trial, carried out in Italy among patients with cancer, showed little benefit of the LCP in improving the overall quality of end of life care. Some secondary endpoints—such as breathlessness, and feeling treated with kindness, dignity, and respect—did improve, while coordination of care, family emotional support, and control of pain and nausea and vomiting did not. more…

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