Mid-Staffordshire : Response of Royal College of Physicians Edinburgh

February 25, 2013

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Time to refocus the NHS on quality and dignity of patient care: RCPE response to Mid
Staffordshire

SENIOR CARE AND REVIEW

Many of the detailed recommendations also offer potential for improving standards, including the recommendation that ‘hospitals should review whether to reinstate the practice of identifying a senior clinician who is in charge of a patient’s case’. However, we believe this should not be a matter for local hospitals to consider and discount; instead this should be enshrined in national standards. The benefits of early senior review in reducing mortality, and of consultant-delivered care are clear and the requirement to have a named senior clinical lead responsible for individual patients could greatly assist efforts to improve continuity of care in increasingly fragmented clinical environments. Clearly, this will require moving towards a consultant presence seven days per week, over an extended working day, and this will have to be taken into account by workforce planners. The recent report from the Academy of Medical Royal Colleges and Faculties provides related standards which require to be implemented in the NHS.

Historically, the NHS has relied heavily on the goodwill and commitment of consultants to work well beyond their contracted hours. However, there is evidence that this ‘goodwill model’ is not sustainable.4 Doctors cannot be expected to absorb additional commitments ad infinitum while continuing to provide high quality patient care. This reality and the changing mood within the workforce, in which young doctors are increasingly choosing alternative career paths away from the medical specialties, must also be taken into account when planning what level of workforce will be required to provide high quality, safe patient care. In parallel, we must work to ensure that future generations of doctors are supported, do not become disengaged and less committed to delivering care and are prepared to work beyond hours as patients’ needs require.

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Lost in Care : The Waterhouse Report

November 3, 2012

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LOST IN CARE

The general background to the Inquiry
“When announcing the Government’s decision to appoint this Tribunal, the Secretary of State for Wales referred to the fact that it had been known for several years that serious sexual and physical abuse of children had taken place in homes managed by the former Clwyd County Council in the 1970s and 1980s. The Secretary of State mentioned, in particular, an intensive investigation by North Wales Police begun in 1991, in which about 2,600 statements had been obtained from individuals and which had resulted in eight prosecutions and seven convictions of former care workers, but he said that, nevertheless, speculation had continued in North Wales that the actual abuse was on a much greater scale than the convictions themselves suggested.”

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House of Lords : HSCB – Hansard

October 12, 2011

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HEALTH AND SOCIAL CARE BILL : TUESDAY 11 OCTOBER 2011

“Moved By Earl Howe

That the Bill be read a second time.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, this is a Bill of profound importance for the quality and delivery of health and care in England, for patients and for all those who care for them. As such it has been, quite rightly, the subject of intense scrutiny, not only in another place, but also more widely. Indeed, the intensity of the spotlight directed at its content over the last few months is borne out by the number of your Lordships who wish to speak today and tomorrow. I look forward to the debate ahead of us.

In approaching this Bill, I believe it is instructive to look backwards to its roots as well as forward to what it seeks to achieve. In opposition, the two coalition parties asked themselves the same simple question: “How can we make the NHS better?”. In asking that question we were clear about several things. We were clear that the founding principles of the NHS-that it should be a comprehensive service, free at the point of use, regardless of ability to pay, and funded from general taxation-should remain sacrosanct. We were also clear that we should reject any system that discriminated between rich and poor. The NHS should aspire to the highest standards of service for all our citizens, but in seeking ways to make the health service better, it was necessary to identify the challenges that it faces. What are they?

The first, and most obvious, is rising demand for healthcare from a growing and ageing population and the increase in long-term conditions. The second is the rising expectations of patients about what should be on offer to them from a health service in the 21st century, including new drugs and technologies. The third is the financial challenge-the inexorably rising costs of providing services against an increasingly constrained budget.

Two key principles emerge from this analysis: the need for maximum efficiency in the way the health budget is spent; and the need to make the service patient-centred. For many years, politicians have spoken of the NHS as a patient-centred service, but how can a service be truly patient-centred if decisions about the treatments and pathways of care that are available to patients are taken at several removes from those who know best what the needs of patients are-namely, the patients themselves and the healthcare professionals who look after them?….”

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Future Forum : Response of RCOG to David Cameron

June 17, 2011

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RCOG STATEMENT ON THE PM’s SPEECH ON THE LISTENING EXERCISE

“However, several key issues still remain.

These are:

In order for GP Commissioning Consortia to work, there needs to be a process involving service providers in the decision-making process since they have the front-line experience and knowledge of what services are needed in their respective specialties

There needs to be clearer explanation of the way in which competition in the NHS will work. While competition can be a spur to drive up quality and drive out inefficiencies, the extent of the private and charity sectors’ roles in the NHS need to be far better defined and delimited

There is real anxiety over workforce planning and the training and education of doctors in training, a critical factor in the future development of high-quality specialists. To be involved, ‘any qualified providers’ must provide training, subject to the same standards and conditions as NHS providers. These developments will have serious consequences on our medical workforce in the future.”

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GOVERNMENT RESPONSE TO NHS FUTURE

My Black Cat is SCREECHING! Wonder why?

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Government Response to NHS Future Forum

June 15, 2011

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GOVERNMENT RESPONSE TO NHS FUTURE FORUM

“The Government has announced that it accepts the core recommendations of the NHS Future Forum report and will make changes to its plans for modernisation of health and social care.

The key changes include:

Reaffirming that Ministers are accountable overall.

The original duty to promote a comprehensive health service will remain.”

My Black Cat is SCREECHING! Wonder why?

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Big Data : The next frontier

May 14, 2011

witchround

BIG DATA :THE NEXT FRONTIER FOR INNOVATION, COMPETITION AND PRODUCTIVITY

Health Care Reforms : In the Witch Doctor’s opinion this document is very relevant to some of the thinking behind the proposed UK Health and Social Care Reforms. It was released this month by McKinsey Global Institute but it won’t let me cut and paste an extract. However, part of it covers US and global healthcare, and the perceived importance of data-mining of healthcare information to the economy. It makes an interesting read and illustrates one of the reasons why the WD does not think the “listening period” or Professor Steve Field’s comments in yesterday’s Guardian will result in an about turn.

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LINK TO MY BLACK CAT’S INTERTWINGLEMENT BLOG (Updated 13 March 2011)

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Letter from RCGP to David Cameron and response to proposed health reforms

May 9, 2011

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LETTER FROM DR CLARE GERADA, CHAIR OF COUNCIL, RCGP TO DAVID CAMERON”

“However we have a number of serious concerns and suggest the following recommendations:

1: COMPREHENSIVE HEALTH CARE
That the Bill should make it clear that the Secretary of State has a duty to provide, or secure provision, of a comprehensive health service throughout England.

2: CHARGING FOR HEALTH CARE
That commissioners or providers should not be able charge patients for health care services that are currently provided free by the NHS or are recommended by NICE.

3: ISSUES RELATING TO MARKET FORCES IN HEALTH CARE
That the Bill should place a duty on Monitor, the National Commissioning Board and GP Commissioning Consortia (GPCC) to enable collaboration to provide integrated services to meet patients needs without fear of a competition referral.

4: ISSUES RELATING TO EU COMPETITION
There needs to be clarity as to the legal implications of EU competition law (particularly when, and in what circumstances, it is enforceable) and other contractual and regulatory details.

5: ACCOUNTABILITY AND CONFLICTS OF INTEREST
Consortia must remain publicly accountable for all commissioning decisions, so that Board minutes and financial decisions are open to public scrutiny, including details of payments made to GPs or Practices for non-general medical services, including payments to private companies in which GPs have a financial interest.

6: RESOURCE ALLOCATION AND RISK POOLING
That there is clarity as soon as possible as to which allocation formula will be used for allocation to GP consortia for commissioning hospital care.

7: PRACTICE BOUNDARIES
The proposal to undermine the relationship between a local GP and local patients by abolishing practice boundaries is revised.

8: WORKFORCE AND TRAINING ISSUES
Given that the education and training proposals mark a revolution in medical education and could be harmful in primary care, we urge a careful and detailed reconsideration ahead of any implementation.

9: CONFIDENTIALITY
That there is as an absolute assurance that the Bill will not force doctors to breach their duty of confidentiality.”

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THE GOVERNMENT’S HEALTH REFORMS : AN ANALYSIS OF THE NEED FOR CLARIFICATION AND CHANGE BY THE ROYAL COLLEGE OF GENERAL PRACTITIONERS

CONCLUSION

81. The future NHS must build on the strengths and values of today’s health service, in particular building on the strengths of general practice. The benefits of modern general practice are well documented, with significant evidence that a good relationship with a GP, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs.45

82. Irrespective of the outcome of these current reforms, the RCGP will continue to promote the development of high-quality, effective patient-centred care, with GPs at the heart of NHS service delivery.46

83. The RCGP recognises that the NHS needs reform and we would welcome the opportunity to work with the Government to further develop proposals to maximise benefits for patients

84. In the meantime we shall continue to offer leadership and guidance to members as they seek to deal with the consequences of the NHS reforms. We are engaging with our members to provide input to the Prime Minister’s Listening Exercise and will continue to develop further proposals for reforms of the NHS which place patients at the centre and promote family medicine. We shall also provide guidance, education and training opportunities, and through the RCGP Centre for Commissioning, shall ensure the sharing of good practice to assist GPs to develop the necessary skills to lead effective clinical primary care within the context of GP commissioning consortia.”

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LINK TO MY BLACK CAT’S INTERTWINGLEMENT BLOG (Updated 13 March 2011)

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