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Has Wales found the winning formula for healthcare?

In the Guardian last week, the question is asked whether the model in Wales to integrate Health and Social care is the right formula. The sub-header states that "All indicators show that the country's approach to the integration of health and social care services is working". This week the story is somewhat different - the BBC reports the Welsh First Minister Carwyn Jones saying that  health services in Wales will "collapse" unless hospitals are reorganised. The Guardian report says "Wales is struggling with cuts in common with the rest of the UK. But the Labour-led Welsh government has not protected the country's £6bn annual NHS budget as the coalition has protected the NHS budget in England, and consequently the pain is spread more evenly across health and social care."

"If not now, when? If not us, who?"

The Winterbourne View scandal continues to reverberate across the Health and Social Care industry. In an opinion piece in The Nursing Times, Bob Gates demands to ‘Address the appalling lack of direction for learning disability nurses’. He makes the point that "What is problematic and worrying is that the latest BBC Panorama investigation into the abuse inflicted upon residents of Winterbourne View Hospital now appears not to be isolated." As if to emphasise this, The Daily Mail this week quotes a report that of the 51 patients transferred to new homes from Winterbourne View, 19 have been the subject of safeguarding alerts subsequently, asking if any lessons have been learned after the shocking revelations from Winterbourne View, and whether anything has actually changed in the way residential care homes are run.

The Mail quotes Norman Lamb, minister of state for care services, as saying: "I want this case to reinforce to everyone, from frontline workers to regulators, service commissioners, managers and board members, that they have a responsibility in preventing abuse of vulnerable people." No reasonable person could disagree, but how does this situation make sense? What is the context and how should the sector respond?

Mr Gates carries through his analysis: "... such appalling atrocities can and must never be excused but they should be understood within the context in which some of the qualified nurses now work within the independent sector. .......a context characterised by them working in isolated settings, with little peer support, little or no clinical supervision, and very often no access to continuing professional development and no clear career structure. It is not uncommon in such settings to find nurses overseeing large numbers of unqualified support workers who have little or no formal training."

The Independent reported earlier this month on the larger end of the Care Home provision in the UK:  "The size, ownership and residents of elderly care homes have changed during the past 30 years. Around 430,000 elderly and disabled people live in long-term residential care in the UK, but only one in 10 are now in council or NHS-run institutions. Voluntary and for-profit companies account for 57 per cent of the independent sector compared with only 5 per cent in 1989." The world has indeed changed.

These issues of appropriate care are not confined to the UK. In another recent piece in The Guardian entitled "Let my mother go" the journalist Michael Wolff discusses a personal view on dementia and end of life care in agonising candour. Here, in this provocative and heartbreaking plea, he reveals why our obsession with longevity is making old age a living hell for some. It's a tough read emotionally but I would urge anyone working in the sector or with an elderly relative, or if you expect to be elderly someday, to read right to the end.

Our View:

Care is becoming more complex and demanding of organisations delivering care services, and of the people delivering the service at the sharp end. However, as the piece in Nursing Times suggests, the staff in those areas can feel isolated and starved of resource. The private sector is certainly a cash-generative business but in some areas is heavily burdened with debt, as the Independent article highlights. This overhang can be a severe constraint on operational effectiveness. Often costs are constrained at the point of service provision but the perceptive Board will be looking at what is available to enhance the quality of service delivery and understand where the cost balance should be. As the motor industry discovered long ago, quality saves money and is a must have to ensure survival.

In our last newsletter we quoted the Health Secretary as demanding more accountability across the sector. With accountability the quid pro quo must be empowerment. Give people the right tools and they can do the job, knowledge indeed can be a powerful thing.

Have a good week!!
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Health Secretary calls for more accountability

The Nursing Times reports new health secretary Jeremy Hunt urging better care for older people and more accountability among care home managers. In another initiative, "Harm Free Care" will certainly drive NHS clinical commissioning groups in their aim to eliminate harm in patients from four common conditions, with some payments tied to quality metrics:
  • pressure ulcers
  • falls
  • urinary tract infections in patients with a catheter
  • new venous thromboembolism (VTE).
This, along with the publishing of the Government's White Paper on open data, promising unfettered access to anonymised data, highlights the importance of a cost-effective means to collect, report and publish data reliably. The cost of reporting and data quality are major issues for the healthcare industry. Use of IT for operational and compliance reporting is generally not well served and not helped by the development of systems which simply don't have usability built into them. From the well-publicised disasters in the NHS to shelf-ware in the private sector the industry needs effective means to capture and use information.

In another article, the debate is opened "Should a nurse always be present on a doctors' ward round?". Can they be serious? Thankfully, common sense seems to prevail - Ward rounds should not be neglected, warn colleges, saying "Ward rounds should be the “cornerstone” of care but pressures on staffing and capacity have led to them often being “neglected”, according to the Royal College of Nursing and the Royal College of Physicians."

Our View:

Information management is a critical issue for public and private health providers. However, piling on more pressure to report statistics on the Ward or in the Care Home can take people away from the key aspects of providing care. This can become systemic as we can see from the ward round scenario. The tail eventually wags the dog. Back to fundamentals: the industry needs simple means to collect information which people can actually use, the ability to collect a piece of information once only, and for it to be available on demand for operational support, compliance and audit.

MHA implements Assured Compliance solution for Service Quality Management

Implementation enables Continuous Performance and Quality Improvement, reducing administrative burden and the cost of compliance

Guildford and Derby – August 29 2012 – IPROS CUBE and MHA announced today that MHA has successfully implemented the Assured Compliance solution from IPROS, enabling a clear view of all compliance metrics across the organisation and supporting the culture of excellence within MHA.

"Prior to implementing this system, producing a clear view of quality of delivery across all homes was a complex and labour-intensive task, taking several days." said Amanda Griffiths, Director of Service Improvement at MHA, "With this solution I can get an up to date view across all our homes whenever I need it." Adding that “This has enabled us to highlight potential issues in our processes and address them in order to improve the quality of outcomes for our residents. The implementation process was simple and effective, enabling us to deploy the best of our quality management processes within the system in less than a month and allowing us to adapt the system as and when we need to. ”

"We have been delighted to work with Amanda’s team at MHA," said Rob Anderson, Managing Director of IPROS CUBE.  "Our approach of deploying the Assured Compliance solution with the customer processes driving the system is quite unique. Very often software systems require major changes in an organisation to fit the system constraints. We take the view that adapting the best of the customer’s quality systems into the software is the right approach. That we have been able to do this in a few weeks, with minimal disruption to MHA operations proves the method."

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