Mid-Staffordshire : Response of Royal College of Physicians Edinburgh

February 25, 2013

witchround

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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Mid Staffordshire – Review by Sir George Alberti

May 1, 2009

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MID STAFFORDSHIRE NHS FOUNDATION TRUST – PROFESSOR SIR GEORGE ALBERTI

A review of the procedures for emergency admissions and treatment, and progress against the recommendations of the March Healthcare Commission report.

EXECUTIVE SUMMARY

“This review of Mid Staffordshire NHS Foundation Trust was undertaken at the request of the Secretary of State for Health and Monitor following a critical report published by the Healthcare Commission on 19th March 2009. The following were the key observations:

1. There have been major improvements in the A&E department with 4 new consultants, improved nursing skills and prompt, efficient handling of emergency cases, and, improved training of junior doctors. The A&E department is now providing safe, good quality care.

2. There remain problems with the flow of patients through the hospital. Suggestions have been made about improvements in bed management and patient discharge.

3. The principles underlying the operation of the Emergency Assessment Unit are correct but cannot be fully implemented until patient flows improve.

4. There are now 3 acute physicians who have improved greatly the timeliness of care of medical emergencies. The other physicians have agreed to implement a new way of working which will accelerate care and provide early consultant-delivered decisions.

5. There are highly committed, acute surgeons working at the Trust but too few in each of the surgical specialties. A system of networking with neighbouring Trusts is required.

6. Equipment deficiencies were identified by the Healthcare Commission and are still to be rectified by the Trust.

7. The medical wards have too few qualified nurses and every effort should be made to rectify this and to increase numbers beyond those agreed to date. Efforts are also needed to improve nurse training and morale and to refocus attention on the needs of each patient.

8. Care of the elderly should be enhanced at all stages of the patient pathway and a collaborative network should be established with primary and community services with more focus on care of patients closer to home.

9. A similar network or board should be established for urgent and emergency care including all partners, such as the Primary Care Trust (PCT), the ambulance trust, social services, the voluntary sector, pharmacies, patients and the public as well as Mid-Staffordshire Foundation Trust. This could and should greatly facilitate
delivery of care by the most appropriate person in the most appropriate setting in timely fashion.

10. Patients and the public have not been included sufficiently in discussions and decision-making. They should be involved at all levels and more real-time patient and family views should be sought and used to help shape service delivery.

11. The PCT should ensure that quality and safety indicators are built into all commissioning and performance management arrangements.

12. There is an urgent need for a coherent 5-year plan for the Trust with a timed action plan taking into account the changing nature of medicine as outlined in Professor Lord Darzi’s report last year. The Trust needs to see clearly where it fits into the overall health economy and should be clear about what it can do well and safely and what should be networked with others e.g. hyper-acute stroke care and some branches of surgery. The plan should be developed together with the PCT and other partners including the public. This will give the public and the staff a clear indication of how the Trust is developing and at what speed and remove much of the current uncertainty and unhappiness.

13. The Trust’s staff need to change from a “make-do” culture to a “can-do” culture. There were encouraging signs both at Board level and amongst the staff that this is indeed taking place.”

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