11th September 2015

• RCS calls for focus on urgent and emergency care in seven-day services debate
• NHS England publishes new safety standards for invasive procedures
• Monthly stats show most surgical specialties miss targets
• MPs debate Healthier Together deal in Greater Manchester
• Jeremy Hunt announces a new single definition of success for trusts
• Assisted Dying Bill defeated in the House of Commons

RCS calls for focus on urgent and emergency care in seven-day services debate

The Royal College of Surgeons has published a policy paper on the introduction of seven-day services in the NHS, reviewing evidence around differences in patient outcomes at the weekend compared with during the week. The College strongly supports the move towards seven-day services, and believes the focus should be on urgent and emergency services. The RCS acknowledges the evidence that mortality is higher for weekend admissions than for weekday admissions in England. Evidence shows that this is partly caused by patients being sicker when admitted at the weekend than on other days, but also by lower standards of care in hospitals at the weekend. However, as it stands, there is a lack of evidence for specific causes having a large effect on mortality on their own.

RCS President, Clare Marx, was quoted in the press over the weekend, including in the Observer, The Sunday Telegraph, and the Mail on Sunday, in stories responding to a report published in the British Medical Journal concluding that mortality risk is higher at weekends despite adjusting the data for sicker patients being admitted at weekends. In a statement, Miss Marx said: “Given finite NHS resources, the focus should be on reducing mortality and therefore improving urgent and emergency care and services for those patients already in hospital at the weekend. It must be stressed that this is not about making NHS staff work longer hours, but enabling a sufficient presence of appropriate staff across the entirety of the week.”
 

NHS England publishes new safety standards for invasive procedures

NHS England has published National Safety Standards for Invasive Procedures (NatSSIPs) which aim to reduce the number of patient safety incidents related to invasive procedures where surgical never events could occur.

The standards provide clinicians with broad principles for safe practice and advice on how to implement best practice, as well as supporting NHS providers to develop their own local standards, working with staff and surgeons. The NatSSIPs build on the World Health Organisation (WHO) Surgical Checklist, and follow the Surgical Never Events Taskforce Report published in 2014 which includes recommendations on reducing the incidence of never events.

RCS President, Clare Marx, commented: “The Royal College of Surgeons fully endorses these standards. We need to ensure that an understanding of causes and impact of Never Events is an integral part of the training for all medical and non-medical staff involved in caring for patients undergoing invasive procedures.”
 

Monthly stats show most surgical specialties miss targets

Statistics on key care areas for July 2015 have been released by NHS England. They illustrate a long-term trend of increasing volumes of both urgent and emergency care and elective activity, and show that most surgical specialties are missing referral to treatment targets.

The number of A&E attendances for July 2015 was 2.2 per cent lower than that for July 2014, but over the last 12 months the number of attendances has increased by 0.9 per cent, with emergency admissions up by 2.5 per cent. A&E waiting time targets were narrowly missed, with 94.996 per cent of patients admitted, transferred or discharged from A&E within four hours.

The number of patients starting consultant-led treatment over the last 12 months was 4.9 per cent greater than in the preceding 12 months. Standards for referral to consultant-led treatment within 18 weeks were met, with 92.9 per cent of patients on the waiting list at the end of July waiting less than 18 weeks (the target is 92 per cent). However, the majority of surgical specialties missed this target, with the exception of ENT and oral surgery. Figures for the other specialties (neurosurgery, cardiothoracic surgery, general surgery, plastic surgery, urology, and trauma and orthopaedics) were between 90 and 92 per cent.

Six of the eight cancer standards were met, but only 81.9 per cent of patients were treated within 62 days of urgent GP referral (the target is 85 per cent). Delayed transfers of care were up 9.8 per cent compared to July 2014, with 147,000 delayed days during July 2015.
 

MPs debate Healthier Together deal in Greater Manchester

MP for Wythenshawe and Sale East, Mike Kane, tabled a debate in the House of Commons on the Healthier Together programme, and the decision taken against assigning University Hospital South Manchester (UHSM) at Wythenshawe as one of the four single service hospitals in Greater Manchester. Mr Kane and other local MPs raised concerns voiced by clinicians that tertiary services and specialist surgery at Wythenshawe would suffer without the maintenance of a high level of general surgery support at the hospital, potentially leading to procedures becoming unsafe for patients. 

With the risk of Wythenshawe being downgraded, MPs highlighted concerns that UHSM could struggle to recruit specialists, and that patient safety and public support had not been fully considered when making the decision on allocation of single service hospitals across the city region. MPs called for a pause on the programme, and a chance to re-open the consultation to clinicians who felt their views had not been considered.

Care Quality Minister, Ben Gummer MP, responded that he believed the balance between patient safety and access considerations had been struck across most of Manchester under the Healthier Together proposals, but that he will impress on local commissioners the importance of continuing to consult with clinicians.

Jeremy Hunt announces a new single definition of success for trusts

In an interview with the Health Service Journal (HSJ), the Health Secretary said that he wants the measure of success for NHS trusts to be defined by their rating given by the Care Quality Commission (CQC). This would move to a situation where trusts are measured by a ‘single definition of success’, where patients can easily assess a single set of quality distinctions. This comes with a suggestion that the distinctions between foundation trusts and other NHS trusts could be broken down in future, with the possibility of freedoms previously exclusive to foundation trusts being extended to other trust that have been rated good or outstanding by the CQC.

Mr Hunt’s announcement in July to merge foundation trust regulator Monitor with the NHS Trust Development Authority into the new NHS Improvement already paves the way for a weaker distinction between foundation trusts and NHS trusts. Foundation trust status has previously been used as an indicator of quality, but CQC inspections have found disparities between foundation trusts and NHS trusts, rating 11 non-foundation trusts as ‘good’, and 35 foundation trusts as ‘requires improvement’ or ‘inadequate’.

Mr Hunt highlighted that former NHS England Chief Executive, Sir David Nicholson, said: “You have to have a single definition of success in a large complex organisation like the NHS. You have to make sure trusts don’t feel there’s Monitor’s definition of success, and the CQC’s definition of success, and then the Department of Health’s definition of success.”

Assisted Dying Bill defeated in the House of Commons

The Assisted Dying Bill was voted down by MPs today at its Second Reading by 330 to 118 votes. The RCS published a position statement on the Bill ahead of its Second Reading, which states the College's concerns with the Bill.