Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern
Welcome to Lintern’s Risk Register
It’s a new financial year but history is weighing heavily on the NHS. Past idiocy on workforce planning and the dangerous drive to foundation trust status at the expense of patient care continue to haunt the service.
As ever, please let me know if you have a patient safety story that needs telling. You can contact me in confidence here.
Shaun Lintern, patient safety correspondent
The disaster of workforce planning exposed (again)
The NHS ignored obvious warning signs and failed to properly ensure a sufficient supply of nurses to meet demand almost entirely because of the desire to save money. This was the central finding of the independent Migration Advisory Committee report. It pulled no punches and was brutal in its assessment of how the coalition government, strategic health authorities (nostalgia!) and NHS trusts themselves created the current nursing shortage affecting the UK.
As well as setting out in detail the years of failure to ensure the NHS has enough nurses to care for patients (how do we continue to be so bad at this?) the report worryingly suggests the same pattern is being repeated right now on Health Education England’s watch. The MAC said it had been told that HEE would have commissioned 3,000 extra nurse training places in 2016-17 were it not for cuts imposed in George Osborne’s spending review that led to it opting for just a tenth of that figure.
Now HEE was not happy about this and told me it didn’t recognise that figure… but amusingly it wouldn’t tell me what the correct number was. Either way, we are repeating mistakes of the past.
And it’s not like the Department of Health was not warned. Back in 2012 I analysed the cuts to nurse training places by SHAs since 2010-11 which showed a drop of 12 per cent.
In that article David Green, vice chancellor of the University of Worcester and former chair of the West Midlands group of universities, said: “We are heading straight for a national disaster in two to three years’ time.”
I take no pleasure in saying “We told you so.”
Lessons from Mid Staffs still need learning
“Inappropriate and unsafe care was not addressed, even where that was clearly set out in internal or external reports, and the response to adverse incidents was grossly deficient, with a failure to investigate properly and learn lessons.”
The trust’s culture was seen as “oppressive” with staff “driven to the brink.”
“For many of these concerns, it is hard to come to any other conclusion than that they were managed in the way they were in order to ensure the trust application for NHS foundation trust status remained on track.”
You’d be entirely forgiven for thinking the above extract was from the Francis report into the scandal at Mid Staffordshire Foundation Trust. Sadly it comes from a governance review by Capsticks into worryingly bad management of Liverpool Community Health Trust which was published this month.
The report and the scale of the failures are frighteningly similar to those found at the infamous Stafford Hospital and the author of the Capsticks review points this out several times.
While the rush to achieve foundation trust status has now largely passed into history, there is a risk that the sustainability and transformation planning process and the pursuit of new care models - both being driven from the centre as financially and politically necessary - will prove similarly distracting for trust boards. Coupled with the current NHS deficit, the whole situation feels very similar to where we were in 2006, the same year that Mid Staffordshire Foundation Trust decided to make £10m cuts on the orders of the West Midlands SHA in order to break even.
The immaculate conception of maternity personal budgets
The president of the Royal College of Obstetricians and Gynaecologists has shed some light on how it came to be that the national maternity review recommended personal budgets for maternity care.
It appears this particular recommendation, which dominated the headlines about the supposedly independent review when it was published in February, was inserted into its work before the review panel ever really got going by NHS England and chair Baroness Cumberlege.
Writing on the college’s website Dr David Richmond said: “You won’t have failed to notice that one particular recommendation – the proposal for NHS Personal Maternity Care Budgets to give women more control over their care – received the most media prominence. It’s worth being aware that, although this received a lot of professional reticence, from both obstetric and midwifery colleagues, this was an area that NHS England and the Chair wished to consider piloting.”
Former panel member James Titcombe has similarly said this was pre-determined and vice-chair Sir Cyril Chantler told me this was an idea that “was suggested” to the review.
This adds further weight to the view that the national maternity review functioned in some respects as a convenient way for NHS England to ensure its policies received the touch of independent credibility. But Dr Bill Kirkup couldn’t have been clearer that he is still waiting for a national review that actually addresses the recommendations he made following his investigation of failures at Morecambe Bay.
NHS Improvement and HSIB will have to grow up fast
On 1 April NHS Improvement was born – a Frankenstein creation by the government mashing together Monitor and the NHS Trust Development Authority in a desperate bid to avoid primary health legislation for a new arm’s length body. Improvement aside, the new body and its chief executive Jim Mackey will have a lot to do just keeping the show on the road.
But it will also have new responsibilities to attend to, after the patient safety directorate was lifted and shifted from NHS England (which concluded that this most important area of work was outside its remit) and the birth of the Healthcare Safety Investigation Branch.
HSIB – the no-blame clinical incident investigation service – has the potential to be a major improvement for safety in the NHS. Regulations on how it will operate as part of NHS Improvement, including its independence, finances and how investigations will work, have been published here.
I understand the chief investigator is unlikely to be appointed before the end of the summer.
- Board Talk/governance/assurance
- British Medical Association (BMA)
- Department of Health and Social Care (DHSC)
- Five year forward view
- Health Education England
- Lord Carter
- NHS England (Commissioning Board)
- Parliamentary and Health Service Ombudsman
- Patient safety
- Quality and performance