The recent Hospital Directions Conference covered the big issues affecting the future of the NHS. Here is a round up of key stories from the event:
Living up to the demands of the Francis Report
Nearly one in three (27%) consultant posts at Stafford Hospital is filled by locums because of the reputational damage caused by the care failings scandal investigated by the Francis Inquiry, according to a West Midlands trust chief executive.
“There are times when there are very, very high levels of agency staff at the hospital,” David Loughton, chief executive of the Royal Wolverhampton Hospitals NHS Trust, told the Hospital Directions conference.
Mr Loughton, who has been a chief executive in the West Midlands for 27 years and has played a role in supporting the Mid Staffordshire NHS Foundation Trust since 2007, said they were currently working to reconfigure services at the trust.
But he warned that a number of other trusts around the country were also in “serious trouble” with their clinical viability and their services too would need to be reconfigured.
“The one thing that has got in the way of sorting some of these problems out is because everyone wants to keep going until they absolutely finally fall over and that is a big issue.”
Following a recent inspection by the Care Quality Commission Mr Loughton said they were now looking for £3.6m extra funding because they needed to improve nurse staffing levels. “One extra nurse per shift on each ward adds up to £3.6m. If you repeat that across the piece it’s a lot of money.”
Cathy Winfield, director of patient experience and chief nurse at Derby Hospitals NHS Foundation Trust, said that following the Francis investigation they were aware that they needed to help their professionals to put patients at the centre of care. “We are starting to see our lead consultants deal with those professional and performance issues which is really encouraging and a step forward.”
When asked whether she thought the Mid Staffs scandal could occur again in another trust, she agreed it could. She said anybody who thought they didn’t have a ward or a department in their own organisation that wasn’t delivering care of the highest standard was naïve.
“That is why you have to be vigilant and make sure you listen to patients and your staff and why it is absolutely critical to be out there feeling it and testing it for yourself. You cannot take your eye off the ball or become complacent for one second.”
Phil Willan, a member of the Royal College of Physician’s patient and carers network, agreed that some be elements of Mid Staffs could already be happening again in some trusts although hopefully not to same extent.
But he said: “We still have to acknowledge that the vast majority of hospitals do operate very well indeed and patients do appreciate the care they get. Let’s not beat ourselves up too much about this.”
Improving staff engagement
Taking action to improve staff engagement over the long term pays off, John Adler, chief executive of University Hospitals of Leicester NHS Trust, has shown.
He outlined the success he had achieved in a previous role as chief executive of Sandwell and West Birmingham Hospitals Trust implementing the Listening in Action programme over six years.
Listening in Action is a pioneering programme of engagement created by consultancy Optimise Limited. It is based on evidence that engaged staff deliver better care for patients. It mobilises people around a common mission that matters to them, builds pride and inspires spread.
Sandwell and West Birmingham was the first trust to pioneer adoption of this approach on a widespread basis as its core way of working and it has now been rolled out to a number of other trusts. Mr Adler is currently introducing the programme in Leicester.
At Sandwell and Birmingham thousands of staff across the whole trust were involved in the programme, from theatres to security, medical engineering to finance. Individual teams delivered specific changes in their areas which benefited patients − including improved ward environments, better food choices, more accessible services at times to suit patients and improved patient information. The staff survey showed an increase in staff satisfaction.
“If you take away one message please don’t toy with scale of this initiative, you need to go the distance over the long term. This is about a systematic approach to staff engagement, the way it works: commitment followed by engagement, followed by empowerment, then embedding. It’s important to follow the process because it is tried and tested its very much evidence based.
“Crucially if you don’t really understand the vital matrix of staff engagement and are not really prepared to put the long term effort into it and make sure there is action, or if you don’t think your chief executive is interested, it would be better not to start.
“In my experience, and that of a lot of other people now, is that the Listening in Action programme does work as a method of taking us forward to a situation where staff really do feel valued by the organisation,” said Mr Adler.
CQC’s new inspection regime
The Care Quality Commission (CQC) has radically changed the way it inspects the quality of health services this year, the Hospital Directions conference heard.
CQC chief executive David Behan explained that the inspection process has moved away from checking whether hospitals are complying with a set of regulatory requirements to asking five key questions about whether services are high quality and safe.
The questions are:
– Are services safe? Patients want to know, for example, that if they are admitted to hospital whether they are at risk of contracting a hospital acquired infection.
– Are services effective? If a patient has experienced a stroke for example they will want to know whether they will they be scanned within four hours according to the NICE guidance
– Do services treat patients with compassion and dignity? This is about how responsive are services to feedback and to people using services be they patients or carers and whether the complaints system is regarded as intelligence that helps an organisation to improve or is regarded as a threat and are whistleblowers listened to?
– Are services responsive? This question captures issues about whether targets such as four hour waits are being met but also checks on how responsive a service is to the community that it serves.
– How well led are services? Inspectors will want to know what the culture of the organisation is, what is considered to be important and what gets done.
The findings of each inspection will be instilled into a rating on each hospital trust on a four point scale which will identify services which are: outstanding, good, those which require improvement and those which are inadequate. In time individual services will be given ratings. All trusts will be inspected under this new regime by 2015.
“You cannot regulate quality into services – the only thing we can do is hold up a mirror that reflects whether services are of a high quality or not as the case may be.
“The responsibility for placing quality in service sits with those of you who provide services. It sits with those who have professional qualifications and are professionally registered and those of you that are commissioning services,” said Mr Behan.
Collaboration key to success
A collaborative approach which empowers doctors and other staff to test out innovations is one of a raft of measures that has helped to improve performance at Salford Royal NHS Foundation Trust.
The trust’s CEO David Dalton told the conference that when staff participated in the learning collaboratives they were able to experiment with their ideas which could be measured and tested before being rolled out across the whole trust.
One innovation that emerged from a learning collaborative reduced cardiac arrest calls outside critical care from 130 to less than 20 a year when new ways were introduced to respond quickly to the deteriorating patient. Other trusts were spend around £500,000 on rapid response outreach teams.
The first £1m surplus gained after Salford became a foundation trust has enabled 2840 members of staff to be involved in the collaborative approach.
To drive further quality improvements the trust has dispensed with the chief operating officer and director of operations posts and appointed new clinical directors who take responsibility for performance management.
Goals are critically important and staff must take a keen interest in quality improvement and patient safety, said Mr Dalton. To monitor staff engagement with the aims of the trust individuals are now assessed for the contribution they make to the organisation.
A positive approach is reflected in their pay. To pass the assessment staff have to demonstrate they have undertaken their mandatory training, have had a reasonable attendance record and also had a successful outcome from their appraisal. These criteria are reflected in consultants’ clinical excellence awards.
Leadership visibility and awareness is also key and Mr Dalton says he often spends half a day working alongside staff on the wards and in other areas of the hospital in order to find out what they are thinking and feeling and to hear any concerns they might have.
For three consecutive years Salford has been rated one of the highest by staff in the NHS staff satisfaction survey.
“If you want to know whether an organisation is focused on quality improvement then go and talk to the staff and they will tell you what it is like to work in that organisation,” said Mr Dalton.