The NHS needs to be an organization in which an open dialogue about care quality is part of the natural culture of the organization, not a duty which only arises in cases of service failure. Robert Francis made 290 recommendations in his report, but in truth they boil down to just one - that the culture of 'doing the system's business' is pervasive in parts of the NHS and has to change. Many who raise their concerns in the NHS at present risk serious consequences for their employment and professional status. But disciplinary procedures, professional conduct hearings and employment tribunals are not the proper place for honestly-held concerns about patient safety and care quality to be aired constructively. The NHS standard contract imposes a duty of candour on all NHS providers. This is an essential principle, but it is not adequately understood or applied. It should mean that all providers create a culture which is routinely open both with their patients and their commissioners. The same principle should apply to commissioners so that they are routinely open and accountable to local communities. The Health Committee recommended this approach in 2011 and repeats that now. It should be a prime role of the CQC to encourage the development of this culture within care providers, and of NHS England to develop the same culture within commissioners. The Health Committee will in future work closely with the Professional Standards Authority to develop the accountability process for professional regulators in healthcare
In April 2010 Dr David Bennett was appointed as interim Chief Executive of Monitor and then as Chair in March 2011. He was appointed permanent Chief Executive of Monitor with effect from 1 November 2012, while remaining as Chair pending a new appointment. On 10 October 2013, the Secretary of State proposed to appoint Dominic Dodd as Chair of Monitor. Dr Bennett has filled the roles of both Chair and Chief Executive - effectively Executive Chair - and has led Monitor through the whole process of change brought about by the Health and Social Care Act 2012. He has both shaped and interpreted the role that Monitor now plays in the system which makes the transition to another individual taking on the Chair an especially difficult one. On this basis the Committee did not endorse Mr Dodd's appointment
This year's inquiry into the work of Monitor concludes that the model of care provided by the health and care system is not changing quickly enough with the result that pressures continue to build, threatening the financial stability of individual providers, and therefore the quality of care provided The pressures are likely to be particularly marked in the acute sector as plans are prepared and implemented to achieve the resource transfer required by the introduction of the Better Care Fund from April 2015. Continuing this theme, the Committee argues that as the NHS financial situation tightens, the challenge for Monitor in supporting trusts in financial difficulty is likely to increase. The MPs emphasise the importance of addressing pressures within individual providers in the context of the local health economy. The requirement for major change in the care model can only be delivered if individual providers, and Monitor as their regulator, look beyond preserving existing structures and address the need to develop different structures to meet changing needs. The Committee also expresses concern that Monitor has not done enough to reform the system of tariff payments for providers, arguing that the current tariff arrangements often create perverse incentives for providers and inhibit necessary service change. It recommends that Monitor and NHS England should initiate a formal joint process for a prioritised review of the NHS tariff arrangements with the objective of identifying and eliminating perverse incentives and introducing new tariff structures which incentivise necessary service change
According to the Health Committee, more needs to be done to protect the interests of patients who rely on mental health services. The Committee has undertaken a review of the 2007 Mental Health Act (ISBN 9780105412076). Many psychiatric wards are over capacity and there is huge pressure on beds, nevertheless, the Committee was shocked to learn that there is evidence that patients who need hospital treatment are being sectioned unnecessarily in order to access a bed. This represents a serious violation of patient's basic rights and it is never acceptable for patients to be subjected to compulsory detention unless it is clinically necessary. The 2007 Act contained important provisions which introduced Community Treatment Orders (CTOs). These orders allow for patients to be treated in the community whilst still being subject to recall to hospital if their condition deteriorates. The Committee is also concerned that pressure on hospital beds may be driving increased use of CTOs. MPs also examined the function of Independent Mental Health Advocates who help patients take advantage of their rights whilst in hospital. The Committee is in no doubt that a patient's primary advocate should be their clinician and independent advocates, ultimately, provide an important, but supplementary, service
In this report the Health Committee welcomes improvements in the performance of the Nursing and Midwifery Council (NMC) over the last year, but expresses continuing concern that the progress made so far remains fragile. The Committee emphasises that it is important to ensure that the new challenges facing the NMC do not become a distraction from the continuing requirement to improve its performance of its core functions. The report is the first example of a Health Committee review of a professional regulator which builds on the work of the Professional Standards Authority (PSA). The length of time the NMC takes to conclude its fitness to practise cases has been an enduring concern for the Committee. From 2015, the NMC proposes to toughen the target period for resolving fitness to practise cases to 15 months (eventually to 12 months). The NMC has announced plans to introduce a system of revalidation by the end of 2015 which is welcomed. The Francis Report into the failings at Mid Staffs examined the role of regulators, including the NMC, in detail. The report stresses the importance of ensuring firstly that registrants understand their professional obligation to raise concerns when they see evidence of poor patient care, and secondly that patients and public are made more aware of the role of the NMC as the regulator of professional and clinical standards. The NMC should take urgent steps to raise the profile of the NMC both among its registrants and among patients and public.
This report calls for a radical change in the Government's approach to the health and social problems caused by the rising consumption of alcohol in England. Consumption per head has nearly tripled since 1947, and 31 per cent of men and 21 per cent of women are drinking hazardously (more than 21 units per week) or harmfully (more than 50 units per week). It is estimated alcohol abuse in England and Wales kills 30-40,000 people a year and costs the economy £55bn. Excessive consumption also leads to serious accidents, disorder, violence and crime. In the report, chapter two looks at the history of alcohol consumption. Chapter three considers the impact of alcohol on health, the NHS and society as a whole, including the costs of crime and loss of work. Chapter four analyses the Government's alcohol strategy. Chapters five to nine consider respectively NHS policies on prevention and treatment; education and information policies, the marketing of alcohol, pubs and licensing; and off-licence sales, particularly in supermarkets. Chapter ten looks at the key issue of the price of alcohol. The Committee calls for minimum pricing for units of alcohol. Evidence shows that a rise in the price of alcohol is the most effective way to reduce consumption. It would affect most of all those who drink cheap alcohol, save up to 3000 lives a year with a price of 50p per unit, would benefit traditional pubs and encourage a switch to weaker wines and spirits. Minimum pricing should be accompanied by an increase in duty. Finally, in chapter eleven, the Committee puts forward a new alcohol strategy.
The Government plans major changes to the public health system in England. These will affect all three domains of public health: health protection (addressing environmental threats to population health); health improvement (tackling health inequalities and lifestyle issues impacting on health and wellbeing); and healthcare public health (applying public health expertise to the provision of healthcare services). A new dedicated public health service, Public Health England (PHE), will become operative from April 2013. The Committee believes the PHE must be visibly and operationally independent of Ministers. Major new responsibilities for public health will also be assumed by local authorities, but the Committee finds that the lack of a statutory duty on local authorities to address health inequalities in discharging their public health functions is a serious omission in the Government's plans. The Committee also call for: the Secretary of State for Health to be given an explicit statutory duty to reduce inequalities in public health as well as to protect the public from dangers to health; the DH to set public health budgets, both nationally and locally, that take account of objective measures of need; the Chief Medical Officer to give professional leadership in respect of both the medical and public health professions; the Government to review its opposition to proposals on regulation of health professions; the role of the Public Health Interventions Advisory Committee of the National Institute for Health and Clinical Excellence to be clarified.
There are serious and deeply ingrained problems with the commissioning and provision of Children's and adolescents' mental health services. These run through the whole system from prevention and early intervention through to inpatient services for the most vulnerable young people. The Committee draws conclusions and makes recommendations for action in the following areas: (i) Information; (ii) Early intervention; (iii) Outpatient specialist CAMHS services (Tier 3); (iv) Tier 4 inpatient services; (v) Bridging the gap between inpatient and community services; (vi) Education and digital culture; (vii) GPs; (viii) National priority and scrutiny
A draft Law Commission Bill on the regulation of health and social care professions sets out the framework for a negative register, but it was not included in the Queens' Speech either as a draft or a substantive Bill. The Government needs to set out what changes to the powers of regulators it is planning to make through secondary legislation instead. Following up themes in the Francis report, regulators need to be visible and accessible to registrants, and also to patients and members of the public who wish to raise concerns about patient safety. Since 2003, the HCPC has recommended that statutory regulation be extended to a further eleven professions from the current sixteen. Of these, the only groups to receive statutory regulation to date are operating department practitioners and practitioner psychologists [the other groups are Clinical Perfusion Scientists, Clinical Physiologists, Dance Movement Therapists, Clinical Technologists, Medical Illustrators, Maxillofacial Prosthetists & Technologists, Sports Therapists, Sonographers and Genetic Counsellors]. The HCPC should list any professional groups for which they feel there is a compelling patient safety case for statutory regulation so that this can be pursued with the Department of Health as a matter of urgency. There is also concern at the length of time it can take for professional groups to gain statutory regulation. Given that new groups can be added to the HCPC's register by means of secondary legislation, there should be no undue delay in extending statutory regulation to professional groups where there is a compelling patient safety case for doing so
This report states that the values of the NHS will only be reflected in practice if NHS and social care services are 're-imagined'. The care provided by the health and social care system will break down if quicker progress is not made to develop more integrated health and social care services which focus on meeting the needs of individual patients. It is unlikely that public expenditure on health and social care services will increase significantly in the foreseeable future. This means that the only way to sustain or improve present service levels in the NHS will be to focus on a transformation of care through genuine and sustained service integration. There must be a much more joined up approach to commissioning health and care services. On other issues the Health Committee also concludes: measures currently being used to respond to the Nicholson Challenge too often represent short-term fixes rather than the sustainable long-term service transformations; changes in tariff payments within the NHS do not constitute ’efficiency savings' - they are simply internal transfers; under-spending against budget of money allocated to the NHS has attracted adverse comment and the MPs call for a general review of the operation of Treasury rules; the NHS will not be able to rely on the present rate of paybill savings once the present restraints on public sector pay are relaxed in April 2013
The Health Committee is highly critical of the delay in setting out precisely what a value-based pricing system for drugs entails. There is also uncertainty about the implications of the changes proposed for the Cancer Drugs Fund which was introduced in 2011 to allow clinicians to use drugs that had not been approved by NICE, and which will be superseded by the value-based pricing system. The Committee calls for: an assessment of the outcomes for those patients whose treatment has been paid for by the Cancer Drugs Fund; evidence of beneficial outcomes which should inform the new value-based pricing scheme and applied to treatments of conditions other than cancer; and clarity about how drugs which have been paid for by the Fund will continue to be available to individual patients. There is also concern about the implications for the effectiveness of NICE of recent evidence about access to information from clinical drug trials. There should be both a professional and legal obligation to ensure that all regulators, including NICE, have access to all available research data about the efficacy and safety of pharmaceutical products which are in use in the UK. The pharmaceutical industry should introduce a new code of practice to make this commitment effective and the GMC should reiterate its guidance to doctors on the conduct of drug trials. Is important for the credibility of NICE that Patient voice is effectively and openly represented in all its work; and that NICE guidance should continue to be guidance rather than an instruction and that the NHS should continue to allow local discretion, but variations from NICE guidance should be open, transparent and accountable
This report from the House of Commons Health Committee shows that whilst the health of all groups in England is improving, over the last ten years health inequalities between the social classes have widened with the health of the rich improving more quickly than that of the poor. Health inequalities are not only apparent between people of different socio-economic groups - they exist between different genders, different ethnic groups, and the elderly and people suffering from mental health problems or learning disabilities also have worse health than the rest of the population. The causes of health inequalities are complex, and include lifestyle factors - smoking, nutrition, exercise to name only a few - and also wider determinants such as poverty, housing and education. Access to healthcare may play a role, and there are particular concerns about 'institutional ageism', but this appears to be less significant than other determinants. [Ed.].
This memorandum contains the replies received from the Department of Health to a series of questions tabled by the Select Committee, on a wide range of issues grouped under the headings of: current issues including NHS staffing; salaries and wages of non-NHS staff; retirement projections, dental and medical staff payscales; also included are; general expenditure issues; NHS resources and activity; personal social services resources and activity; capital expenditure and investment and questions on the departmental annual report
This memorandum contains the replies received from the Department of Health to a series of questions tabled by the Select Committee, on a wide range of issues grouped under the headings of: expenditure; investment, including the private finance initiative (PFI); NHS Plan and reforms, including staffing, pay and contracts, treatment outside the NHS, and the National Institute for Health and Clinical Excellence (NICE); breakdown of spending programme; activity, performance and efficiency; and departmental annual report.
Public expenditure on health and personal social Services 2007 : Memorandum received from the Department of Health containing replies to a written questionnaire from the Committee, written Evidence
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