Performance data for 5,000 individual consultant surgeons have today been published by NHS England, plus the rest of today’s news and comment
3.59pm There are some interesting reader comments regarding the main findings of the HSJ/SercoCommission on Hospital Care for Frail Older People.
One reader said the Commission “backs up the sideline discussions in the CCG”.
“Integration needs to overcome two separate systems, both financially challenged, to actually and wholeheartedly invest their share and time. In reality, local authorities and CCG’s see it as an opportunity to offload liabilities into the BCF and onto the other party.”
“True integration will only be achieved when social care and healthcare are one system.”
Another reader suggested: “Surely whatever is done should be for the good of the patients, and not always be about saving money, just better use of the resources available.”
One reader commented: “Some sense being articulated at last! Integration may bring with it many benefits and it may, therefore, be the right thing to do but, please, let’s not make unrealistic assumptions about reducing costs.
“One of the founding assumptions for the NHS was that free access to high quality care would improve the health of the population such that the cost of the service would actually fall over time.
“The evidence is quite the opposite, that improving health and extending life all adds to the overall care burden and costs more money - end of life crises, which consume the vast bulk of health spend in any individual’s life, still happen - just later.
“Add to this the inflationary costs of new technology, drugs, and heightened quality standards (do we really need all those O&G consultants for 168 hours labour ward presence in every hospital?) and you have the perfect storm.
“Politicians will argue that hospital reconfigurations are required to raise standards and reduce waste/costs but, for many, the balance between local access and so-called quality is shifting in the wrong direction.”
2.58pm Specialists can provide support and training to help GPs and nurses diagnose and treat complex patients, write Ruth Robertson and Matthew Honeyman from the King’s Fund.
2.42pm Publishing outcomes based information can help trusts to nip problems in the bud before they escalate into a crisis, argues Jeanette Whyman, partner and head of medicalnegligence at Wright Hassall.
2.28pm The Care Quality Commission has agreed in principle to publish information about the use of covert or overt surveillance to monitor care to providers, service users and their relatives.
The decision was made during the regulatory body’s board meeting this morning.
CQC board members have approved the information to be included in the final documents, but have asked that the information for the public be written in a more accessible way.
The CQC is due to publish the information shortly.
Chief Inspector of adult social care Andrea Sutcliffe, said: “We know that exploring the potential use of hidden and public cameras in care homes and other care settings is a really sensitive issue – and one that provokes a huge range of debate and opinion.
“We have spent the past year really listening to people who are using health and social care services, their families, providers and partners on their experiences, anxieties and concerns that matter to them.
“The information we will publish for providers makes clear the issues we expect them to take into account – for example, consulting with people using the services and staff – if they are considering installing hidden or public cameras.
“I hope the information we will publish for the public will help them make the right decisions in difficult circumstances and I look forward to making sure that this information is written in a way that is most useful for them.
“I am clear that any form of surveillance cannot be seen as the only way to ensure people are receiving safe, high-quality and compassionate care. We need enough staff, properly trained and supported who really care to ensure people get the services they have every right to expect.”
Care services minister Norman Lamb, said:“Cameras have helped to expose terrible cruelty and neglectful care and I welcome this new information.
“Decisions about using surveillance are extremely difficult – there is always a balance to be struck between protecting people and respecting their right to privacy – but this information will help families to make the right choice for them.
“We are committed to preventing poor care from happening in the first place and have introduced tougher standards for inspecting care services as well as measures to shut down those that aren’t up to scratch.”
2.10pm Want to read further on the HSJ/Serco Commission on Hospital Care for Frail Older People?
2.08pm Read the detailed evidence for the major findings from the HSJ/Serco Commission on Hospital Care for Frail Older People.
2.00pm The chief inspector of GPs’ most instructive contribution to the debate on primary care this week was not the data dump of risk ratings for England’s 8,000-odd practices, but the one surgery he singled out as providing “outstanding” services across the board, writes HSJ senior bureau chef Dave West.
1.56pm The findings of the HSJ/Serco Commission on Hospital Care for Frail Older People has been widely covered in the national press.
The Guardian reports that plans by the Westminster parties and the NHS leadership to safeguard the health service’s future constitute “magical thinking” that will not ensure its survival.
Politicians of all parties have fallen for a myth that integrating health and social care services and moving many medical services out of hospitals represent the best way of keeping the NHS sustainable, they say.
The Guardian also refers to the Commission in its leader column on NHS funding. It argues that the integration of hospital and community care is right, but it won’t save money.
“Imagine a commercial enterprise that regarded its principal customers as an awkward inconvenience. Instead – as the report, commissioned by the Health Service Journal, argues – hospitals should recognise that the best community and intermediate care in the world can never keep elderly people out of hospital all the time.
“The kind of indifferent care that too many patients’ families report is the direct result of hospitals treating their relatives as a problem rather than trying to make that unavoidable stay as good as possible.
“Hospital care that fails to recognise the specific needs of geriatric patients causes more long-term problems, strikingly illustrated by the statistic that 10 days in a hospital bed leads to 10% loss of muscle mass.”
Meanwhile The Independent writes that NHS plans to take the pressure off hospitals and save billions of pounds by providing better care for the elderly in the community are based on “wishful thinking”, a group of leading health experts have warned.
The “integration” of NHS and council social care services is a key policy goal of both the Government and the Labour Party, the paper points out.
1.30pm The main report of the HSJ/Serco Commission on Hospital Care for Frail Older People is officially launching now at the Foundation Trust Network exhibition theatre.
The CSUs will become a single organisation from 1 April 2015, having previously pledged to work in partnership with each other.
1.10pm The foundation trust model must be updated to prevent a hospital centred approach which could “perpetuates silos”, shadow health secretary Andy Burnham has said.
At the Foundation Trust Network’s annual conference Mr Burnham said that while the FT model was the “perfect vehicle” for driving change, there were problems with it which “must be acknowledged and addressed”.
1.06pm Multinational companies including G4S and arms manufacturer Lockheed Martin are among those that have expressed interest in a £1bn contract to run GP support services outsourced by NHS England, HSJ has learned.
NHS England issued a contract tender notice last week appealing for bidders to run primary care support services. The authority decided to outsource the functions last summer.
With a contract value of £1bn over 10 years, the tender is one of the highest value single deals ever offered by the NHS.
12.51pm Don Redding, director of policy at the charity coalition National Voices said the charity coalition “welcomes the Health Service Journal Commission and in particular its emphasis on better relational care, involvement in decisions as the core of good patient experience, and focusing on the person not just the illness.
“It is not helpful to polarise this debate by pitting ‘integrated care’, which is often seen as ‘community-based’, against acute care. Coordinated care is coordinated care, whatever array of services a person may need at a given time. Person centred coordinated care should include people’s use of hospital services, and transitions across settings.
“People should have a care plan that they have drawn up, and which anticipates emergencies. The care plan should go with them into the hospital, and be reviewed and used throughout their care journey, including their move home or to residential care.
“Key to progress on this issue is responding to the views of older people themselves, more of which can be seen in I’m Still Me, a Narrative for Coordinated Support for Older People, developed by people who use services working with National Voices, UCL Partners and Age UK which will be released later this month. It includes calls for a national debate on the use of the word ‘frailty’ which is emphatically rejected by many older people, whether or not others would view them as frail or vulnerable to a health emergency.”
12.49pm In response to the HSJ Commission on Hospital Care for Frail Older People, Professor Karen Middleton, chief executive of the Chartered Society of Physiotherapy, said: “The Commission is right to highlight the need to tackle delayed discharge, particularly in the week when it was revealed it had reached its highest level.
“As the case studies attached to the report show, this must be delivered by a range of professionals including physiotherapists, with each bringing their own area of expertise to meet all of a patient’s needs.
“The recommendation to improve community services so that care can be continued after discharge – or to reduce the chances of an admission in the first place – is also welcome.
“But while the report suggests that community services may only delay a subsequent hospital admission, it is important to remember that the NHS should not only add years to the life, but also life to the years.
“That is what can be achieved through keeping people out of hospitals and it is essential now that the necessary decisions to deliver that are taken.”
12.10pm Commenting on the formal launch of MyNHS, health secretary Jeremy Hunt said: “Targets matter - and the key A&E and 18 week targets have driven huge improvement over the last 15 years.
“But perhaps because of that success, we have allowed a conventional wisdom to develop that the best way to change anything is through yet another target and a bit more money.
“Ten years ago, Sir Bruce Keogh and heart surgery colleagues showed the world that there is a different way. They achieved dramatic improvements in performance, not through new targets, but by publishing results for individual cardiac surgeons for the first time.
“Transparency is about patient outcomes not process targets. It uses the power of a learning culture and of peer review, not blame.
“Healthcare globally has been slow to develop the kind of safety culture based on openness and transparency that has become normal in the airline, oil and nuclear industries.
“The NHS is now blazing a trail across the world as the first major health economy to adopt this kind of culture.”
Professor Norman Williams, former president of the Royal College of Surgeons, said: “The NHS is world leading in publishing surgical outcomes – it is one of the first to embark on this and covers the highest number of specialities.
“More generally, the NHS has shown leadership and ambition in its approach to transparency by publishing such a wide range of information on quality and performance.
“This kind of breadth of information will help to continually drive up standards.”
12.06pm The NHS must adopt a different approach to performance management that focuses on the transparent provision of information rather than chasing targets or extra resource, the health secretary said.
Such an approach could also be enforced, Jeremy Hunt announced at the Foundation Trust Network conference today, with new rights grafted into the NHS constitution.
10.58am Performance data for 5,000 individual consultant surgeons have today been published by NHS England, which the commissioning body has described as a major “major step forward on the transparency journey”.
The data appears on the MyNHS area of the NHS Choices website, officially launched today by the health secretary.
The data will show whether there clinical outcomes for each consultant are within their expected limits.
The data includes data for three new speciality areas - lung cancer, neurosurgery and urogynaecology – as well as the 10 specialities which published in 2013.
The data for 10 of the 13 specialities will be published in full with three more specialities being published in the coming weeks.
Results included in the Consultant Outcomes Publication (COP) are based on National Clinical Audit data.
The publication of outcomes data began in 2006 with publication of the mortality rates of cardiac surgeons, led by Professor Sir Bruce Keogh, NHS England’s national medical director.
Professor Sir Bruce Keogh said: “This represents another major step forward on the transparency journey. It will help drive up standards, and we are committed to expanding publication into other areas.
“The results demonstrate that surgery in this country is as good as anywhere in the western world and, in some specialities, it is better. The surgical community in this country deserves a great deal of credit for being a world leader in this area.”
Work to compile the data has again been led by the Healthcare Quality Improvement Partnership (HQIP), which manages the National Clinical Audit programme on behalf of NHS England.
HQIP outcomes publication director, Professor Ben Bridgewater, said: “By adding more specialties, more indicators and much greater functionality on NHS Choices, we are providing patients and relatives with a much fuller picture and greater reassurance about the care they are likely to receive.
“This is just one part of a broader information landscape, but a vital one.”
Next year NHS England will publish the one-year and five-year survival rates for individual hospitals for the four commonest cancers – lung, breast, bowel and prostate. These account for 50 per cent of all cancers in England.
10.27am The HSJ/Serco Commission on Hospital Care for Frail Older People sought out examples of good practice from around the NHS. Read about them here.
10.22am In May, HSJ told the story of Mrs Andrews, who, after falling at home, spent seven weeks in hospital and never made it back home.
In latest HSJ video, Professor David Oliver discusses what went wrong with Mrs Andrews’ care, and how it should have been different.
10.11am Health leaders and patient advocates have welcomed the findings of the HSJ/Serco commission while warning that frail older people were not well managed by “fragmented” healthcare regimes.
10.05am A lack of leadership is limiting the ability of hospitals to provide “best in class care” to elderly patients, with too much variation across providers according to the HSJ Commission on Hospital Care for Frail Older People.
There is a more than threefold variation between areas in rates of emergency admission and occupied bed days for people aged over 65, while eighty per cent of those who stay in hospital longer than 14 days are over 65, according to the commission.
The commission notes that older people are admitted to all clinical areas within a hospital and therefore all doctors need to “acquire the right skills and values”.
9.57am Political leaders’ belief that health and social care integration is the “silver bullet” for the NHS’s financial difficulties is a “myth” and “Messiah concept” that has no realistic prospect of success.
This is the chief conclusion of the HSJ/Serco Commission on Hospital Care for Frail Older People, which also criticises the coalition’s flagship integration project, the better care fund, as having been planned in a “hokey cokey” fashion.
6.30am Good morning and welcome to HSJ Live. The HSJ/Serco Commission on Hospital Care for Frail Older People has published its report.
The commission addressed the problem of how the NHS should care for the country’s increasing number of frail older people. Its central conclusion is that hospital providers and commissioners should not rely on government plans for greater integration between health and social care as a solution – they must and can take action now themselves to tackle the problem.