Charity calls on health service to better engage with staff in order to improve care and perforamance, plus the the rest of the day’s news and comment

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4.20pm Commenting on the NHS Support Federation’s research about the independent sector, David Hare, chief executive of NHS Partners Network, said:

“The figures quoted by the NHS Support Federation are based on a very small sample of contracts and are not representative of the wider NHS. Overall the independent sector currently provides around 6% of NHS clinical care and this figures has only increased by 1% since 2010.

“Involvement of the independent sector in the NHS is not new. For many years independent providers have supported the NHS and this has benefitted patients and delivered real value for the NHS.

“Open competition for NHS contracts allows commissioners to choose the best available provider for services regardless of whether public, private or voluntary sector. But this is not privatisation of the NHS. Services delivered by independent sector providers under the NHS banner have always been free at the point of delivery and we know that the vast majority of people do not mind who delivers their care as long it is free.”

4.10pm Sir Kevin Barron MP, Chair of the All-Party Pharmacy group today responded to a new campaign to raise awareness of the pharmacy service.

Speaking about the Pharmacy Voice-backed Dispensing Health campaign he said: “Community pharmacies are the ideal first port of call for people with minor ailments, coughs and simple aches and pains. Yet too few people know about the support that’s on offer and so go to their GP or, worse, A&E instead.

“The Dispensing Health campaign makes absolutely clear the important role that pharmacy can play in easing the burden on primary and emergency care services.  It chimes with what I and my colleagues on the All-Party Pharmacy group have been saying consistently to ministers, parliamentary colleagues and the NHS. I’m delighted that this is now being recognised by the national media. I hope that we will see far more people making the most of the expert help available from their local pharmacies rather than heading straight to their GP or hospital for minor ailments.”

2.30pm Sean Duggan, chief executive of Centre for Mental Health has responded to HSJ’s exclusive story revealing that Monitor and NHS England have been accused of “institutional bias” against mental health and community services.

He said: “It is extremely worrying to see the existing disparity in NHS spending between mental and physical health care being widened.”

“Reinvesting scarce resources in effective mental health interventions like liaison psychiatry and psychological therapies can help to make the NHS more efficient and improve people’s lives. Mental health services have as much need to act on the Francis Report’s recommendations as acute hospitals. We hope this decision will be reconsidered with evidence of the pressing need to reinvest in mental health support and reverse the institutional bias in NHS funds.”

2.00pm A report published today by The Point of Care Foundation shows that the way healthcare staff feel about their work has a direct impact on the quality of patient care as well as on an organisation’s efficiency and financial performance.

The report, Staff Care: how to engage staff in the NHS and why it matters, argues that it is not only necessary for healthcare providers to encourage staff engagement (the process by which staff come to have a positive attitude towards the organisation and its values) but to accelerate it. 

The report, which reviewed evidence from a wide range of sources, highlights that:

  • Patient satisfaction is consistently higher in trusts with better rates of staff health and wellbeing
  • There is a link between higher staff satisfaction and lower rates of mortality and hospital-acquired infection
  • The NHS could save £555 million a year if it reduced sickness absence by a third.
  • Stress and burnout are more frequent in the NHS than in other sectors. Approximately 30 per cent of sickness absence in the NHS is due to stress.

It points out that NHS staff engagement fell for three consecutive years from 2009 before rising very slightly in 2012. Only 55 per cent of staff would recommend their organisation as a place to work.

The Foundation calls on healthcare organisations to increase staff engagement at both a strategic and operational level by making support for staff central to their strategies to improve patient care, productivity and financial performance. It also sets out simple steps being used in parts of the NHS to improve staff engagement.

However, the report demonstrates there are discrepancies between what senior managers and staff think and say when it comes to how effectively their organisation supports staff and promotes high quality patient care:

  • Putting patients first: While 62 per cent of NHS staff agree the care of patients and service users is their organisation’s top priority, over a third either disagree (17 percent) or neither agree or disagree (21 percent). In contrast, 95 percent of chief executives who responded to a survey for the Foundation reported that a focus on the quality of patient care was either fully in place or mostly in place within their organisation.
  • Solving problems: While 74 percent of staff say are able to make improvement suggestions, only one in four (26 percent) say senior managers act on them.  CEOs, however, report that staff engagement is one of their top three priorities. Worryingly, while 86 percent of CEOs surveyed by the Foundation are confident staff are able to raise concerns, the Chartered Institute of Personnel Development found that fewer than six in ten staff (58 percent) felt confident about doing so.
  • Listening to and involving staff: only one in three NHS staff (35 percent) say communication between senior managers and staff is effective. Yet despite CEOs reporting that they prioritise staff engagement, nearly half (46 percent) of foundation trusts rely solely on the annual staff survey to formally canvas staff opinions.  

Steps that board members and managers can take to increase staff engagement are set out in the report, including:

  • articulating values in plain English and showing how they translate into behaviours
  • giving staff responsibility and authority to solve the problems they think affect patient care
  • creating space for staff to reflect on the emotional challenges of caring for patients
  • training line managers in people management skills – including the large number of clinicians who lead and supervise other staff but who  don’t think of themselves as managers.

Director Jocelyn Cornwell, commenting on the report, said: “It’s the experiences of staff that shape patients’ experiences of care, for good or ill, not the other way around. Working in healthcare ought to rank amongst the best jobs in the world, but far too many healthcare professionals feel over-worked, disempowered and unappreciated.

 “Caring for patients is very hard and challenging. Boards need to support managers at every level so that they in turn support staff to deliver the best possible patient care.

“We want the NHS to be notable for being not only the largest employer in the country, but also the best. There is much good practice in the NHS, but for it to become the norm we need to close the gap between rhetoric and reality.”

Staff care includes eight case studies of good practice in supporting and engaging staff working in healthcare. The aim of the case studies, and the report overall, is to inspire senior managers and everyone responsible for leading healthcare staff to take action and support staff to deliver patient-centred care.

The report itself is viewable by clicking the link below.

1.50pm Dr Maureen Baker, Chair of the Royal College of GPs has said that GPs should make youth mental health a priority.

“The majority of GPs are skilled at supporting young people and families in their generalist role but fewer than half of GPs are given the opportunity to undertake a paediatric or psychiatry training placement during their training,” she said today.

“The vast majority of NHS care for children and young people is delivered by general practice teams and so GPs have a crucial role to play in improving the mental health of younger people. It is also important that children and young patients feel comfortable approaching their GP and that their GP is sufficiently prepared to discuss what are often sensitive issues with confidence.

“Youth mental health is a clinical priority for the RCGP and we are embarking on a number of important projects to raise awareness of youth mental health and simple things that GPs can do to give our younger patients a more positive experience.

“The RCGP is proposing that there should be increased focus on equipping GPs to deal with the common mental health problems faced by younger people – this includes improving mental resilience, managing anxiety, depression and self-harm, identifying suicide risk and in the early recognition of psychosis.

“The College is therefore recommending that in future, as part of an enhanced four-year training programme, all GP trainees should receive specialist-led training in both child health and mental health. The RCGP is also working with the Royal College of Paediatrics and Child Health, the Royal College of Psychiatrists, and Young Minds to develop ways that GPs and specialists might train together and so work more effectively when caring for young people with mental health problems and has set up a series of meetings to take this forward.

“Children and young peoples’ mental health and wellbeing is fundamental to their physical health. Statistics show that 75% of adults with mental health problems will have presented symptoms by the age of 18 – and 50 per cent by the age of 15 - and so it makes sense that we do more to tackle mental health problems as early as possible.”

1.35pm A campaign group has claimed that almost 70 per cent of contracts for NHS services in England between April-December 2013 were won by private firms.

The NHS Support Federation, a group which opposes private sector involvement in the NHS, said that, of a sample of 57 contracts they analysed, 39 of those went to private firms.

The federation said 15 of the 57 contracts they have sampled went to the NHS, two went to charities and one was shared between the NHS and a non-NHS supplier.

According to the group’s website, 400 contract opportunities have been advertised over the same period.

1.00pm HSJ can exclusively reveal healthcare leaders from across the community and mental health sectors have united against plans to cut the tariff price for their services by a fifth more than the reduction proposed for acute providers.

Monitor and NHS England have been accused of “institutional bias” against mental health and community services. For full details on Shaun Lintern’s story, click here.

12.55pm Emily Wooster, policy manager at The Mental Health Foundation comments on the first report of statistics for the Improving Access to Psychological Therapies programme carried out by the Health and Social Care Information Centre.

“We welcome the first report of statistics for the IAPT programme which gives us an indication, amongst other things, of who is accessing IAPT services, as well as waiting times and recovery rates.

“These statistics indicate that referral to IAPT services is still currently focussed on those of working age and more needs to be done to improve access rates for older people and children and young people – as almost 3 in 4 people being referred were aged between 20 and 49.  

“The IAPT programme has made real progress in treating and supporting those with depression and anxiety since its inception– we hope that next year’s report will show that progress has been made in referrals and treatment for these groups.”     

12.15pm The health service is the second most gay friendly employment sector, according to Stonewall’s Workplace Equality Index.

Nine NHS organisations were listed among the top 100 employers for 2014, an increase from six last year by the charity that fights discrimination against gay people. To find out who they are click here.

12.00pm A new campaign to increase awareness of the pharmacy service aims to take pressure off GPs and A&E departments

The launch of Dispensing Health follows a poll showing that less than half of adults (48 per cent) know pharmacists can advise on minor ailments, treatment for which reportedly costs the NHS £2bn annually.

11.55am The Daily Telegraph reports this morning that the NHS is set to recruit ‘scores’ of doctors from India in order to deal with staffing shortages in accident and emergency departments across the UK.

The paper’s health correspondent, Laura Donnelly, writes that rescue plans have been drawn up to tackle widespread shortages in casualty units, which have seen a 60 per cent rise in spending on agency ‘locum’ doctors.

Dr Clifford Mann, president of the College of Emergency Medicine told the paper the move “smacks of desperation”.

The paper also reports that a knighted nurse faces being banned from his profession after having an affair with an 83-year-old widow he was counselling after the death of her husband.

Sir George Castledine, 67, started a relationship with the woman through regular visits to her home. A conduct and competence committee in central London found Sir George guilty of several charges.

11.45am In The Times: millions of patients should see a high street pharmacist for minor ailments rather than visiting their GP, according to health leaders.

Pharmacists should be the first port of call for coughs, flu, aches, pains and common childhood sickness to ease the pressure on the NHS, say the heads of 23 key health groups, including the Royal College of GPs, the Royal College of Nursing and the College of Emergency Medicine.

11.43am Turning to this morning’s newspapers, The Daily Mail writes that older women are putting their lives at risk by failing to go for regular smear tests.

The latest figures from the NHS Information Centre show that in 2013 82 per cent of women aged 50 to 54 had been recently tested. This dropped to 76 per cent among 55 to 59 year olds and to 73 per cent among 60 to 64 year olds.

Women who do not get regularly checked are up to six times more likely to develop the disease than those who attend all their appointments, Cancer Research UK said yesterday.

Elsewhere in the paper, Lord Tebbit has said that people’s “stupid actions” in eating “rubbish” foods is behind the rise in obesity, reports The Daily Mail.

He said in the House of Lords that ministers should tell people to take individual responsibility for their weight rather than the government setting up initiatives to promote healthy eating.

11.30am More patients should be treated in the back of ambulances rather than taken to hospital, MPs have heard.

Conservative backbencher Andrew Percy (Brigg and Goole) said the approach would benefit people requiring emergency treatment in hospital as it would make better use of ambulance services. Read more here.

11.15am Lee Feander and Imran Dassu argue this week that the sheer scale of procurement in the NHS should be used to its advantage, rather than acting as a barrier to efficiency.

They provide five lessons from global procurement best practice which would benefit the health service. Find out what they are here.

11.05am Watch HSJ reporter James Illman’s latest video, in which he analyses the results of our first technology survey. Find out why healthcare leaders believe the sector will struggle to achieve Jeremy Hunt’s target of a completely digital health service by 2018.

10.55am In this week’s issue of HSJ, Michael White writes from the trenches of the political battleground that is A&E staffing figures. Figures collected by the Labour party on the amounts spent on locum staff seems the latest weapon in this battle.

White argues that both parties enjoy engaging in the blame game over manpower shortages in emergency departments and that, as ever, the origins of the problem have much deeper roots. Read his full column here.

10.43am Continuing on the Care Quality Commission theme, the regulator’s chief inspector of hospitals for England, Professor Sir Mike Richards, has seperately published his first report on the quality of care provided by University College London Hospitals NHS Foundation Trust at University College Hospital.

CQC inspected the hospital, which primarily provides services to people living in Camden, Islington, Barnet, Haringey and Westminster, in November. This inspection focused on services provided by the trust in accident and emergency (A&E), medical care (including older people’s care), surgery, intensive/critical care, maternity, children’s care, end of life care and outpatients. 

Overall, the team of inspectors, including doctors, nurses and specialists, found that services run by University College London Hospitals NHS Foundation Trust were safe, effective, caring, responsive to patients’ needs and well-led. The inspection team saw many examples of good care, and were impressed by the dedication shown by staff and the emphasis at all levels of the trust on putting patients first. The vast majority of patients were very positive about the care they received.

However, the inspection team also noted areas of the hospital where staff were delivering care under pressure and where the environment was not at an appropriate standard.

Following the inspection, four compliance actions were issued to the trust, relating to the lack of full completion of the World Health Organisation (WHO) checklist, the safety and suitability of premises in A&E, and recording of care assessments and records management on the acute medical wards.

The WHO checklist, designed to ensure safer surgery, was not always being fully completed. This led to a risk that surgery could be unsafe.

A full report from the inspection has been published on the CQC website:

10.00am The Care Quality Commission has appointed its four deputy chief inspectors of hospitals, who will support the chief inspector of hospitals, Professor Sir Mike Richards, in working for the interests of patients and ensuring that health services are safe and responsive to people’s needs.

The Deputy Chief Inspectors will lead multidisciplinary teams that carry out scheduled and responsive inspections across acute, community health, mental health and ambulance services in England.

CQC’s Deputy Chief Inspectors of Hospitals are:

  • Ellen Armistead – currently chief executive of Lincolnshire Community Health Services NHS Trust and a qualified nurse;
  • Professor Edward Baker – currently medical director and deputy chief executive of Oxford University Hospitals NHS Trust;
  • Dr Andrea Gordon – currently regional director (central region) at CQC
  • Dr Paul Lelliott – former consultant psychiatrist at Oxleas NHS Foundation and director of the Royal College of Psychiatrists’ Centre for Quality Improvement. Dr Lelliott will have a particular responsibility for CQC’s regulatory activities across mental health services.

Professor Sir Mike Richards, CQC’s Chief Inspector of Hospitals said: “I am delighted to have appointed the Deputy Chief Inspectors of Hospitals, who will support me in leading the monitoring, inspection and regulation of health services across England. They each bring with them a wealth of experience across regulation, leadership and frontline practice.

“The Deputy Chief Inspectors will share responsibility for assessing and judging how well providers put the quality of care at the heart of everything that they do and ensuring that the interests of those who use their services are protected. Each Deputy Chief Inspector will lead multidisciplinary inspection teams, including clinicians and trained members of the public. They will provide assurance that health services are meeting the fundamental standards of safety and quality and will take action against those that are not. With the new approach to hospital inspection in full swing, I am looking forward to working with the Deputy Chief Inspectors in their new roles.”

Dr Paul Lelliot will take up his position next week. The start dates for the other Deputy Chief Inspectors of Hospitals are to be confirmed.

7.00am Good morning and welcome to HSJ Live.

There are calls to make clinicians and leaders accountable, but David Oliver, visiting professor of medicine for older people at City University, London, and a commissioner on HSJ’s Commission on the Hospital Care of the Frail Elderly, asks whether we can really regulate and punish quality in the NHS when there’s little differentiation between “wilful neglect” and those who sometimes get it wrong?

“I don’t deny for one moment that patients’ relatives, campaigning groups or the press have a legitimate desire to see frontline staff who have abused or neglected people in their care brought to book,” he writes.

“Nor that organisational leaders who have fiddled data, gagged staff who raised concerns, sacrificed safe nursing numbers for cost savings, ignored coalface operational issues to focus on “strategy”, should face consequences including possible “negative registration”.

“There are, however, a range of sanctions that exist already. We have criminal, negligence and human rights law including “criminal negligence”. We have professional accreditation, registration and regulation for clinicians, regulation and inspection for organisations. Although NHS managers have resisted similar arrangements, their role is no picnic and as a medic, I wouldn’t trade places.”