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Almost 6,000 fewer nurses in NHS since election: figures

Patient safety has been 'profoundly' put at risk by cuts to nurses and midwives with seven a day axed since the last General Election in a move that has seen 6,000 posts lost.

Since April 2010 the number of qualified nursing, midwifery and health visiting staff has fallen by 5,748, according to data from the Health And Social Care Information Centre (HSCIC).

Coroners make record number of recommendations to NHS

Coroners have issued a record numbers of recommendations to hospitals in order to prevent future patient deaths.

NHS trusts were warned that they must put more staff on duty outside of office hours to ensure safety on the wards, as well as improving communication and note-taking.

Our View:

A couple of articles in The Telegraph over the past week. Anyone else see a correlation between these items? It seems clear that reductions in front-line staffing in key areas is going to reduce the quality of care and increase avoidable deaths. Not hard to predict you wouldn't think but in another article, The Telegraph quotes Nursing Times magazine reporting that In two years the number of nurses being trained annually has dropped by an eighth, from 20,092 in 2010-11 to 17,546 in 2012-13. There is the usual platitudinous statement from a DoH spokesperson but really...Nuts!!

It's all about Visibility - How long has this been going on?

The fallout from the Winterbourne View scandal continues: The Public Health Minister Anne Milton said the report from the serious case review showed that there were failures "at every level". Further, she expresses shock at - ".....the healthcare commissioners not having any sort of monitoring in place."

The report from the operator of the hospital says "Following the events at Winterbourne View Hospital the findings from the 150 CQC inspections of NHS and Independent care providers found a real gap between policy and practice in learning disability services across the country. Serious doubt has been cast on the sector’s ability to provide the right care and support for people with learning disabilities, autism and behaviours that may be described as challenging." Castlebeck emphasises that issues are being actively addressed and that they have made significant improvements but in the broader context Mencap chief executive Mark Goldring said: "We fear that unless the government commits to a strong action plan to close large institutions and develop appropriate local services for people with a learning disability, there is a very real risk that another Winterbourne View will come to light."

Our View: The visibility and transparency of information is crucial to an effective quality management process. At a corporate or group level management needs to have immediate visibility of issues. You need to be able to ensure that managers are accountable and that policies are not just in place but that they are understood at all levels and are being consistently applied. With the right tools at your disposal you will be able to identify points of risk and manage improvements in a targeted and proactive way. If you think spreadsheets are the answer then I wish you well. Version management, auditability, efficiency of scale just don't come included.

What does Quality mean?

You decide!! Actually your customers decide. If you don't think you have customers then by all means call them your Service Users - but also their families, advocates, carers. Are your commissioners customers? If we take Anne Milton's suggestion they don't behave like customers, just buyers, not the same thing but this might change. How often do you ask about levels of satisfaction and do you track trends against that? The best organisations with a reputation for excellent customer service - think Virgin Group, First Direct, Hiscox, BMW - measure their customer satisfaction and quality metrics at Board level and act on trends and even specific comments. But if you don't have the information, or it takes weeks to compile, then you're always behind the curve.

With the football season now in full swing, I'll leave you with one thought: nil satis nisi optimum (nothing but the best is good enough). Do give it some thought.

Have a good week!!

Rob Anderson
This email address is being protected from spambots. You need JavaScript enabled to view it.

The Daily Mail reports this week on a dramatic rise in complaints about healthcare provision through the local authority Ombudsman:

Complaints about care service up 22% in a year: Ombudsman's damning verdict on help for elderly and vulnerable

Says the Mail

"Complaints over care provision have risen by nearly a quarter in a year, a report said yesterday.

The Ombudsman said it had received more than 1,000 complaints about adult social care in the 2011/12 financial year – a 22 per cent rise on the previous year. The increase is partly explained by a widening of its remit to include private contractors used by councils to provide care.

The main difficulties related to the standard of care provided. Patients and relatives complained of poorly trained staff with bad attitudes who sometimes failed to turn up or made only very short calls."

Our View: Our customers and other contacts in the industry tell us that the CQC inspectors are becoming much more proactive and are particularly focused on safeguarding but also issues such as medicines control and care standards in general. This is not surprising given the criticism CQC has received in the past year or so. As the Mail reports, the profile of elderly care has been raised by a number of recent scandals, well reported in the media, which have affected the reputation of some specific providers and the industry in general. What the article doesn't discuss, at all, is the squeeze on funding from all commissioning bodies which is bound to affect some aspects of care.

Notwithstanding all of the above; with many people funding their own care they have choices. Reputations can be fragile - ask G4S!! The industry and individual corporations have to mind their reputation in order to attract the discretionary customer. If the first you hear about quality issues is one of your locations getting a bad mark from a CQC inspection then maybe now is the time to plan on improving your QM systems.

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Making technology your slave  -  the Human Factor

The success criteria for any systems implementation is whether people use it or not. DOH!! This might sound obvious but it's rare to see it on a project plan. If your system is simple to use and your people can see that they get value from it then they will give you the information you need through it - "what's in it for me?". You want accountability, your people want to focus on care. Our Assured Compliance solution is used by many organisations to ensure all their locations operate to the highest standards and continue to improve quality standards. If you are looking for improved record keeping, better quality information and consistent quality with reduced cost of compliance, do get in touch.

Have a good week!!

Rob Anderson
This email address is being protected from spambots. You need JavaScript enabled to view it.

Dilnott - a red herring?

In July last year, the Health Secretary said: "We knew last year when we came into office that the system of supporting people with care at home and in residential homes was in great difficulty. With the Dilnott report proposing a way forward is something really going to happen in this Parliament?

The BBC also reports on the question of how this will be funded:

Longer term - how does this work?.

In its annual look at the government's finances, the Office of Budgetary Responsibility (OBR) says in 2017-18 public spending needs to be cut by another £17bn or the same amount raised in taxes to stop debt ballooning. The OBR says this change would bring total debt back to 40% of GDP by 2061.Without the move it says debt would reach 89% of annual income by 2061.

It says the main reason more cuts are needed, on top of the £123bn already going through, is the rising healthcare costs caused by more people living longer. In an interview with BBC radio the chairman of the OBR Robert Chote says that an ageing population will lead to increases in government spending on healthcare, long-term care and state pensions.

Our View: You can't separate health and social care. There will need to be a massive transfer of resources into health and social care. From where? Can the NHS in particular continue to offer free service at the point of use as a general position. We already pay for prescriptions and dental care. Almost certainly, we can expect to pay for other aspects - GP visits, discretionary procedures, "hotel" costs in hospitals? In the short term the Dilnott proposals look unfundable and we are all going to have to get used to the State taking a smaller role in providing for our retirement.

Making technology your slave  -  Spreadsheet solutions?

Bottom line is that spreadsheets are a great tool - for individuals. The problem is how many have you got? Can you validate and ensure consistency across different versions? If you need a comprehensive reporting mechanism that enables you to get an overall management view and ensures consistency then you need some kind of database application. If you are looking for improved record keeping, better quality information and consistent quality with reduced cost of compliance, do get in touch.

Have a good week!!

Rob Anderson
This email address is being protected from spambots. You need JavaScript enabled to view it.