16th October 2015

• Over half of hospitals and trusts require improvement, finds CQC state of care report
• Monitor recommends improving elective care productivity to reduce NHS costs
• Medical negligence case reaffirms a patient's right to choose their surgeon
• Access to Medical Treatments (Innovation) BIll debated in the House of Commons
• Scottish Government proposes new limits on working time for junior doctors
• Aligned framework needed to assess local health systems, finds King's Fund
• Government announces further cap on agency staffing costs
• Stephen Dorrell appointed as Chair of NHS Confederation

Over half of hospitals and trusts require improvement, finds CQC state of care report 

The CQC has published its annual analysis of the quality of health and adult social care in England (2014/15) for the first time since its new ratings system was introduced.

Across health and social care most services are rated as good, but safety continues to be the biggest concern, with 13% of hospitals rated inadequate for safety. 62% of hospitals and trusts require improvement or are inadequate, and surgical services at over half (56%) of acute hospitals require improvement (50%) or are inadequate (6%). 43% were rated good, and 1% outstanding.

For urgent and emergency services, 58% of acute hospitals require improvement (49%) or are inadequate (9%), while 38% were rated good and 4% outstanding. By contrast 80% of GP practices and 60% of adult social care providers were rated good or outstanding.

Strong leadership is crucial to delivering good care – 94% of services rated good or outstanding overall are also rated good or outstanding for their leadership; conversely 84% of those rated inadequate overall were rated inadequate for leadership. Other factors crucial to delivering excellent care include: having the right numbers and mix of staff; robust workforce planning informed by excellent data; and willingness to collaborate with partners across the local health economy.

Half of providers have been able to improve their ratings within six months of inspection in at least one of the five key CQC questions (is the service 1. safe, 2. effective, 3. caring, 4. responsive, 5. well-led).

The report concludes that the sector needs to build a collaborative culture and engage with all staff to ensure they own the quality of care they deliver. This will require being open and transparent and learning from mistakes; ensuring accurate information is available to understand what works and make good decisions; learning from the best; and working with local and national partners.

Monitor recommends improving elective care productivity to reduce NHS costs

In new research by Monitor, the regulator has found that productivity reforms in elective care could cut costs and reduce the length of stay for patients. The recommendations focus on the two largest areas of elective procedures: orthopaedics and ophthalmology. Monitor estimates that such reforms could reduce the cost of these services by between 13% and 20%.

Monitor worked closely with the British Orthopaedic Association (BOA) and the Royal College of Ophthalmologists, as well as NHS providers, in conducting the research. Recommendations include rating patients by risk and simplifying pathways for low-risk patients, extending clinical roles for routine tasks in theatre, and better measuring, communicating and managing the number of procedures per theatre session. 

Dr David Bennett, Chief Executive of Monitor, said: “The financial challenge facing the NHS is growing and hospitals up and down the country are being asked to do more to make sure they live within their means. We are seeking to play our part by offering practical support to the clinicians, managers and frontline.”

Medical negligence case reaffirms a patient’s right to choose their surgeon

A medical negligence case, Kathleen Jones v Royal Devon and Exeter NHS Foundation Trust, has clarified the right of a patient to choose their surgeon. The claimant, Ms Jones, took legal action against the Trust where she was treated by a surgeon other than who she had thought would operate on her, and the judge found in favour of the patient.

Ms Jones had been put on the waiting list to undergo surgery on her back with a consultant orthopaedic spinal surgeon of her choice at the Royal Devon and Exeter Hospital. However, on the morning of her operation, Ms Jones realised that a more junior and less experienced surgeon would be leading it. Unfortunately, she suffered nerve damage during the operation. Ms Jones’s case for medical negligence was ruled on in September 2015. 

The judge ruled that this was not evidence of negligence, however, he accepted her claim, as the judge found that if the original consultant had performed the surgery, there would have been a lower risk of damage, and therefore there had been an infringement of the patient’s right to choose her surgeon. The Court found that the Trust was liable for not providing the surgeon chosen by the claimant as there was strong evidence that the choice of surgeon was important to the claimant.

Access to Medical Treatments (Innovation) Bill debated in the House of Commons

The Access to Medical Treatments (Innovation) Bill received Second Reading in the House of Commons today, marking the first debate on the Bill in Parliament. The Bill has been introduced by Conservative MP Chris Heaton-Harris as a Private Member’s Bill. Having similarities with Lord Saatchi’s Medical Innovation Bill from the last Parliament, the new Bill sets out provisions for ‘responsible innovation’ by clinicians. At Second Reading, the Bill passed by 32 votes to 19, taking it to Committee Stage, where amendments can be tabled to the Bill.

The RCS opposes this Bill, and we circulated a briefing to MPs outlining the College’s position ahead of today’s debate. 

Scottish Government proposes new limits on working time for junior doctors

Scottish Health Secretary, Shona Robinson MSP, has provided an assurance that the Scottish Government intends to revise the working time rules for junior doctors so that they work to 48 hours each week. Currently, interpretation of the European Working Time Directive (EWTD) means that working 48 hours per week can be averaged across six months. The Health Secretary’s intention was expressed in a letter to Brian Connelly, who has led a campaign on lowering the number of hours worked by junior doctors following the death of his daughter, 23-year-old junior doctor, Lauren Connelly, in a car crash in 2011. The accident occurred after Dr Connelly had completed a night shift at Inverclyde Hospital. 

As part of the ongoing dispute between the BMA Junior Doctors’ Committee (JDC) and the UK Government on the proposed new junior doctors’ contracts, the JDC have asked for assurance from the Health Secretary, Jeremy Hunt MP, to provide contractual safeguards on the number of hours worked by junior doctors.;

Aligned framework needed to assess local health systems, finds King’s Fund

The King’s Fund has published a review, commissioned by the Department of Health, on how to measure the performance of local health systems through a scorecard. The aim is to allow providers, commissioners and the public to assess and compare local health services. 

The report recommends that performance assessment in the NHS is simplified and aligned to remove duplication. This would include consolidating the three national outcomes frameworks into a single framework covering the NHS, public health and social care. This simplification and alignment of performance measures would deliver a ‘single definition of success’. NHS England’s CCG Assurance Framework would be the principal means for managing CCG performance, and would incorporate indicators from the CCG Outcomes Indicator Set. However the review does not recommend an aggregate score for the local health system in CCG area using performance indicators alone, as this could mask good or poor performance on individual indicators.

The scorecard information would be split into indicators of local health system performance at three levels of detail. The report recommends that such information is made widely available to the public and NHS organisations. This could involve producing a single public-facing website housing all relevant information.

Government announces further cap on agency staffing costs

Further to the cap on costs for agency nurses in NHS trusts announced in June, the Government has announced the extension of the cap to all agency staff, including doctors. The new hourly price cap will be introduced on 23rd November 2015, and will be originally set at a rate slightly higher than that paid to permanent staff, and will be gradually reduced to the same level as substantive staff by April 2016. The Department of Health has said that Trusts will be able to override the cap when ‘absolutely necessary to protect patient safety’.

Health Secretary Jeremy Hunt MP said: “The tough new controls on spending that we’re putting in place will help the NHS improve continuity of care for patients and invest in the frontline - while putting an end to the days of unscrupulous companies charging up to £3,500 a shift for a doctor.”

Stephen Dorrell appointed as Chair of NHS Confederation

NHS Confederation this week announced the appointment of Stephen Dorrell as their new Chair. The former Conservative MP was Health Secretary between 1995 and 1997, and Chair of the Health Select Committee from 2010-14. Mr Dorrell served as MP for Loughborough from 1979-97, and for Charnwood from 1997-2015. Since stepping down from Parliament, Mr Dorrell has been an adviser on healthcare and the public sector for KPMG.