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Health outcomes consultation launched

HSJ - 19th July 2010 5:23 pm

The government has launched a public consultation aimed at defining how the NHS should be judged over healthcare outcomes for patients.

Health secretary Andrew Lansley said the publication, Transparency in Outcomes - a framework for the NHS, would be the first of many in the coming weeks which will consult with healthcare professionals, patients, carers and the public on how to rebuild the NHS and refocus it on measurable clinical outcomes for patients rather than process targets of the past.

The publication aims to establish a new framework for the NHS and a set of national outcome goals which are defined by five separate outcome “domains” that will be used to measure the effectiveness of the new strategy and, where necessary, hold the health service and the government to account.

No evidence four-hour A&E target benefits care

By Mike Broad - 7th July 2010 9:14 am

There is no evidence that the four hour A&E target benefits clinical care, a group of senior doctors say.

The four-hour standard for processing patients attending emergency departments was introduced at 90% in 2004 and has sat at 98% since 2005.

But a group of doctors, writing in the BMJ, say it has encouraged target led rather than needs led care.

In 2005, the authors showed that patients admitted to hospital from the emergency department were affected most by a ‘spike’ in activity during the last 20 minutes of the four hours, which affected 12.3% of admitted patients and 3.6% of discharged patients in 2004.

They then analysed 12.2 million new patient episodes at English emergency departments in 2008-2009. The data show that the spike is still present and larger than in 2004, affecting 30.7% of admitted patients and 10.5% of discharged patients.

“Although many in the specialty of emergency medicine support the benefits that the four hour target has brought, these results suggest that they are not being experienced by all patients, and that processes throughout the hospital and wider healthcare system may not have improved to accommodate it,” they say.

“Good evidence based indicators of quality in emergency medicine need development,” they add. “We have no evidence that the 98% four hour target benefits clinical care, and our findings suggest that it has encouraged target led rather than needs led care.”

Last week, the coalition government relaxed the four-hour target to 95% of patients.

The letter’s authors include Prof Suzanne Mason, director of health services research, and Prof Jon Nicholl, professor of emergency medicine, both from Sheffield, and Dr Thomas Locker, consultant in emergency medicine in Barnsley.

Read the full letter.

Tags: A&E, Targets
Posted in Hospital Dr News | No Comments »

NHS waiting time targets are scrapped

The Guardian - 22nd June 2010 8:47 am

Andrew Lansley, the health secretary, has scrapped two key NHS waiting-time targets and called for management costs to be slashed by almost half, signalling a shake-up of the health service.

Lansley said he was ending the right of patients to see a family doctor within 48 hours and axing the 18-week target covering the period from hospital referral to start of treatment. Both were key planks of the Labour government’s health policy, which had used large cash injections and targets to improve the NHS.

Campaigners expressed concern that abolishing targets without a replacement system could lead to a “free-for-all” in which health providers were not held to account.

The coalition administration says allowing patients access to accurate information on the way a hospital performs will help it make judgments about the quality of services.

Surgery targets endanger patient safety, poll reveals

BBC Health - 17th June 2010 10:01 am

Pressures over hospital budgets and targets may be damaging safety in operating theatres, a survey suggests.

About one in five of the nearly 600 surgeons questioned by Bournemouth University reported being involved in incidents, during a two-week period, where patients were harmed.

Many complained of having to operate on patients they had not seen before, or a lack of time for complex operations.

The government says “a culture of micromanagement” has endangered safety.

A total of 549 general surgeons responded to the online questionnaire - about one in four members of the Association of Surgeons of Great Britain and Ireland.

Of these 40% said they had been involved in an untoward event where a patient was nearly harmed, and a further 19% where there was actual harm, during the two-week period covered by the survey.

Four hour A&E target to be scrapped, says Lansley

The Guardian - 10th June 2010 8:43 am

The government is to take the controversial and potentially unpopular step of scrapping four-hour waiting time targets in accident and emergency departments and instead focus on delivering the “best possible results for patients”, it said yesterday.

The coalition government had already announced widespread cuts to NHS targets that have “no clinical justification” without stipulating where the axe was likely to fall. But yesterday the health secretary, Andrew Lansley, revealed the plan as he took questions in the House of Commons following his announcement of a full public inquiry into failings at Mid-Staffordshire NHS Foundation Trust.

“We are going to look, and we will look constructively, at how we can scrap the four-hour target as it currently exists and work on the basis of what the clinical evidence makes clear directly contributes to delivering the best possible results for patients,” said Lansley.

Call for doubling of A&E consultant numbers

By Mike Broad - 30th April 2010 1:48 pm

The next government is being called on to more than double the number of consultants working in emergency departments.

The College of Emergency Medicine says every emergency department needs a minimum of ten dedicated consultants to deal with the growing number of patients presenting in A&E.

The current average is 4.2, while the number of patients averages 70,000 to 80,000 per year.

Increasing the number of consultants would guarantee their presence at evenings and weekends, and promote the highest standards of quality and safety.

The college claims that despite the increase in salaries the move would save money in the bigger picture. It would help reduce inappropriate investigations, unnecessary admissions and unsafe discharges.

Dr John Heyworth, president of the College of Emergency Medicine, said: “Emergency care is currently failing to deliver the service which the public expect and deserve. The single most important factor in providing a high quality, timely and clinically effective service to patients is care led by emergency medicine consultants.

“We are concerned that patient outcomes may suffer if this failure to invest in emergency medicine continues.”

The college has also called for a review of emergency care standards in its ‘manifesto’ A matter of emergency. The current target for all emergency care systems to achieve a target of 98% of patients being seen, treated and discharged within four hours is challenging due to understaffing and compromising patient care.

It also wants patients to have one-stop access to effective emergency care. The college supports co-location of the emergency department with other clinicians to provide unscheduled primary care, mental health and other key health services in one secondary care setting. It’s critical of walk-in or urgent care centres which are “largely unsupported by evidence regarding clinical and cost effectiveness. These initiatives have led to a fragmented system with duplication which evidence shows patients find confusing”.

Read the full manifesto.

Tags: A&E, Targets, Workforce
Posted in Hospital Dr News | 1 Comment »

Tories say hospitals are fiddling A&E waiting times

BBC Health - 23rd December 2009 10:46 pm

Hospitals are fiddling a four-hour A&E wait target by using other wards as dumping grounds, the Conservatives say.

Data from 114 NHS trusts in England found many patients faced long waits in assessment units which did not count towards the waiting time.

Over a fifth of units reported keeping patients longer than the recommended 24 hours with the average wait being 17.

Doctors agreed the system was being abused in places, but the government said the research was “misleading”.

The Conservatives asked hospitals to provide data on their use of these wards under the Freedom of Information Act.

Shadow health secretary Andrew Lansley said: “Labour complacently claim that they have abolished long waits for patients being admitted to hospitals, but these figures show that all they have really done is fiddle the figures.”

Andy Burnham defends NHS targets after failings

HSJ - 2nd December 2009 5:53 pm

The health secretary has defended the government’s targets for the NHS in the wake of failings at several hospitals.

Andy Burnham told the Commons the best hospitals were providing “high quality, safe care” as well as meeting performance targets, such as seeing accident and emergency patients within four hours.

He was responding to criticisms from the Tories that clinical priorities were being “distorted” by targets, with waiting times put above patient care.

Burnham said patient safety was his “highest priority” as he made a statement to MPs following revelations about high death rates at Colchester Hospital University Foundation Trust and poor hygiene and standards of care at Basildon and Thurrock University Hospitals Foundation Trust.

A report by Dr Foster Intelligence rated a dozen hospitals as “significantly underperforming”, despite nine of them being rated good or excellent by official regulator the Care Quality Commission.

Seven hospitals were also found to have considerably higher mortality rates for the past five years.

I’m one year wiser, while the NHS is none the wiser

By Stephen Campion - 25th November 2009 1:55 pm

I woke up on Tuesday morning with the realisation that a further year had been added to my age. The next form I fill in will no doubt make me say “no surely that can’t be right” as I begrudgingly supply the required details.

But as I drove to a meeting outside Northampton I had time to reflect on the ageing process and suddenly realised how lucky I am. Compared to the NHS whose age is marginally older than my own, I counted myself fortunate that I have not needed cosmetic surgery to keep going, whilst the NHS has endured countless operations under the guise of service reconfigurations, organisational restructuring, strategic re-alignment or indeed performance management.

But if human beings get wiser with age, I wondered whether that also applied to the NHS? By the time I arrived at my destination I had worked out that we, mere mortals, do get wiser because we learn from experience. I wish the same could be said of the NHS. The NHS is a modern marvel when it comes to technology and its ability to promote scientific advance. But has it matured with experience?

If anything, the NHS is becoming less experienced as it gets older. Medical training is a case in point. Trainees’ hours in the log book are considerably less than a few years ago - that is not because there is less to learn, far from it.

Consultants are spending less time working in the wider interest of the NHS because trusts are fixed on short-term targets, blind to the longer term benefits consultants can bring to the NHS by active participation with their royal colleges.

There are few chief executives who can claim to have been in post for more than five years; and when it comes to NHS monitoring and quality standards the goal posts seem to move every season.

Getting older is no bad thing if we learn from our experiences, use them to shape the future and share them with those following on behind. But, as the NHS gets older, I worry that those following on will have no-one to learn from.

Tags: Targets, Training
Posted in HCSA | 1 Comment »

Hospitals use ploys to beat 4-hour A&E target

The Times - 20th November 2009 9:42 am

Patients are being admitted to hospital to avoid breaching a government target on waiting times, NHS figures suggest.

More than one in twenty patients attending hospital in an emergency are being admitted to wards just minutes before the maximum four-hour wait.

Health unions have complained that staff are being “pressured” into manipulating data and admitting patients unnecessarily to meet the target, which aims to treat or discharge all accident and emergency patients within four hours.

Figures from the NHS Information Centre show that almost all patients in England are seen within the four-hour deadline, but there is a peak in the number of people admitted to a ward with just ten minutes to spare. Two-thirds of those treated as the deadline approaches are admitted to hospital, compared to just over one in five patients coming from A&E overall.

It is the first time such analysis has been done and the statistics are categorised as “experimental”.

The Royal College of Nursing warned last week that the four-hour target meant some nurses were “pushed into practices” that were risky for patients.

It said that there were “negative consequences” for patient care, especially those needing treatment in A&E wards, but not necessarily requiring an overnight stay.