13th February 2015

• Freedom to speak up review published
• "Expert patients" could save the NHS £2bn
• College concerns raised as Lords debate Health and Social Care (Safety and Quality) Bill
• A&E performance improves despite increase in attendances
• Department of Health releases plans for greater transparency in health and care

Freedom to speak up review published

This week saw the publication of Sir Robert Francis’ “Freedom to Speak Up” review. The review, to which the College submitted evidence, was set up in response to anxieties about the way in which the NHS deals with concerns raised by staff. The report makes a number of recommendations aimed at ensuring NHS staff feel safe in raising concerns and confident those concerns will be acted upon.

The report concludes that although many cases are handled well, too many are not. It therefore recommends a number of “principles and actions” to redress this and encourage a culture whereby people feel comfortable in speaking up. The recommendations are made under five key themes: initiatives to engender culture change; ways of improving the handling of cases; measures to support good practice; measures to support vulnerable groups; and prospects for extending legal protection.

Culture change is seen as the most important aspect of improving the way concerns are raised and dealt with in the NHS. The primary need, according to the review, is to move away from a culture where we seek “who is to blame” to where the focus is instead on “has the safety issue been addressed?” The report says that speaking up should be a shared commitment and staff at all levels should welcome and encourage raising concerns.

To improve the handling of cases all NHS organisations should ensure they have the proper structures to facilitate both the informal and formal raising of concerns. While to support good practice these organisations should have a range of persons to whom complaints can be raised with easily and without formality. These provisions should also be extended to vulnerable groups, such as students or trainees, and the report recommends that the Royal Colleges work in conjunction with HEE to make sure the principles of the report are applied in education settings too.

“Expert patients” could save the NHS £2bn

A new report from the think tank Reform has suggested that the NHS could save £2bn by 2020 by getting patients more involved in their own healthcare. The analysis finds that greater engagement by patients could reduce unnecessary visits to A&Es while novel technologies are increasingly enabling patients to do jobs previously carried out by clinicians, such as measuring their own blood sugar levels.

The report highlights four case studies from the UK and abroad that demonstrate the efficacy of successful patient engagement schemes. These include an online health portal, Health Connect, developed by the US health insurer Kaiser Permanente, which allows patients to take online health assessments and email clinicians. Patients using the service report much greater confidence and success in self-managing their conditions. Closer to home, the report says that the use of personal health budgets has reduced hospital demand and proved value for money while financial incentives for enrolling in smoking cessation and gym programmes have also been of benefit to both patients and the health system in general.

College concerns raised as Lords debate Health and Social Care (Safety and Quality) Bill

The Health and Social Care (Safety and Quality) Bill has had its first outing in the House of Lords after successfully passing through the Commons. The Bill, which aims to strengthen the safety and quality of health and social care services by improving communication and information sharing and reforming some aspects of professional regulation, had its Second Reading last Friday, a stage at which Peers can discuss the general principles of the legislation.

The College has lobbied for the Bill to be amended to include provisions set out in the Law Commission’s draft Bill on professional regulation, namely around protecting the title “surgeon” and enabling the GMC register to be annotated to allow for credentialing. Lord Ribeiro, the peer responsible for taking the Bill through the Lords, highlighted the College’s wish for further amendments and sought clarification from the Government on whether it was still committed to bringing forward the Law Commission’s proposals. This sentiment was echoed by other peers who wanted broader changes to professional regulation.

In response the Minister, Earl Howe, acknowledged that the disappointment as to the lack of reforms to professional regulation is widely shared and said that the Government would legislate “when parliamentary time allows”.

A&E performance improves despite increase in attendances

The latest figures published today by NHS England show that the percentage of patients seen within the four hour target frame has improved slightly on last week, up from 92.3% to 92.9%. This is despite the fact that attendances are up by nearly 7,000 to their highest level since the beginning of January.

Meanwhile, the latest statistics show that since the first Monday in November until last Sunday, there have been 21,142 elective and 1034 urgent operations cancelled. Respectively, this is a 37.9% and 27.2% increase on last year.

Department of Health releases plans for greater transparency in health and care

The Department of Health has released a two-year plan (2015-17) summarising how MyNHS information will be expanded and improved. My NHS is a website that displays NHS performance information, to support transparency and drive quality. The document released covers plans for use of data related to CCGs, GP practices, hospitals, consultants and other areas.

The plans include an expansion of consultant outcomes publication, to include consultant-team or unit-level data, metrics meaningful to patients, and new specialties. The overall five-year plan (2015-2020) for outcomes publication will be published by September 2015. Publication of team or unit-level data will be tested through at least three audits by summer 2015, with official publication by 2016.