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Transparency won't be enough to make hospitals safe and on its own can make matters worse
A recent YouGov poll showed that 48% of people think the NHS has got worse over the last five years. Just 8% thought it had got better.
With the scandal of Mid-Staffordshire, the 11 trusts placed into 'special measures' and the fact that a quarter of hospitals are currently described as 'high risk', perhaps this isn't surprising. There is a growing sense that we're not doing enough to get the highest standards in our hospitals.
In a climate like that, the first instinct of many politicians is to increase transparency. Laudable though that it is – on its own, it won't do enough to make our hospitals safe.
At Circle, we publish every item of patient feedback we get – good and bad – verbatim on our website. We are committed to giving patients as much information as possible so they can choose where and how they want to be treated and vote with their feet if standards fall below their expectations.
But there are two problems. Firstly, transparency alone is not a cure. Indeed, on its own, it can make matters worse. The Freedom of Information Act has revolutionised transparency, but we know all too well that some people go to great lengths to subvert the Act and ensure discussions aren't written down. Transparency, if poorly managed, can lead to more cover-ups.
Secondly, patients rarely act like the empowered consumers we need them to be. Too often they feel trapped into being grateful for the services they are given and have little knowledge of the power they have.
We run two state-of-the-art independent hospitals in Bath and Reading. Despite glowing CQC reports, some excellent clinicians, and a Michelin-trained head chef, 80-90% of our NHS patients come to us exclusively because of a GP recommendation.
So the question then becomes: how can increasing patient power help if they don't always choose to use it, and how can we improve transparency without people gaming the system? The answer lies in transforming culture.
When we first took over the management of Hinchingbrooke hospital, a severely distressed NHS trust facing closure, we would typically get 1,200 items of patient feedback per year. We introduced a shortened questionnaire and pursued patient feedback constantly. We now get 24,000 a year, and every return is published on our website.
Doctors, nurses and managers on the frontline go through the feedback together every month and take action to improve services. Far from this cycle being resented, feared or hushed up, it is celebrated. This is the culture of transparency that can too often be missed. And it didn't happen by accident.
At Circle, empowering our staff to take responsibility and ownership for their work is key to our success. All of our partners value transparency because it allows them to hold themselves, and each other, to account.
One of the first things we did in Hinchingbrooke was introduce an initiative called Stop the Line. We told every member of staff they had not only the right, but the duty, to stop any procedure if they thought a patient might be in danger. All senior staff then attend the scene of the incident and a decision is taken before an operation can resume.
The culture change we saw was overwhelming. Staff across our hospital aren't looking to cover up failure – they're looking to root it out. And since we introduced the initiative, we've seen a 50% drop in serious incidents.
Transparency does have a role in improving care. But it is naive at best to imagine that this alone will miraculously improve standards. Without the accompanying culture of openness and accountability, efforts to increase information about patient care will fall on deaf ears. We need a cultural revolution in the NHS – and we need the leadership to make it stick.
Steve Melton is chief executive of Circle Partnership
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers
Under-treatment of retirees identified as factor in why UK is doing relatively badly compared with other European countries
Public health chiefs have promised extra efforts to raise awareness of cancer symptoms among older people to help close the long established gap in survival rates between parts of the UK and some other European countries.
The "under-treatment" of the post-retirement age group has been increasingly recognised as an important factor of why the UK is doing relatively badly in some cancer league tables.
In England there have been national advertising campaigns under the Be Clear on Cancer masthead for nearly three years to help older people, among others, recognise symptoms and visit their GPs as part of a drive to bring about earlier diagnosis and treatment.
It is understood there will soon be a drive to raise awareness in England of extensions to routine breast cancer screening programmes beyond 50- to 70-year-old women.
The latest discrepancies have been revealed in a study covering survival from a range of cancers in more than 10 million people across 29 countries who were diagnosed between 2000 and 2007 and followed-up as far as 2008. The statistics from EUROCARE-5 are published in Lancet Oncology and suggest, for instance, that in all four UK countries survival from breast cancer five years after diagnosis was broadly comparable with the European mean of 81.8%, though only Northern Ireland was it above that. Cancers of the prostate, rectum and non-Hodgkin Lymphoma were similarly within range.
But for cancers of the kidney, ovary and colon, the gap was more marked. Survival among older patients is generally worse across the whole of Europe but in England, the worst cancers in this respect were those of the lung, rectum, melanoma, breast , stomach, prostate and kidney. About a quarter of all those with colorectal cancers in England present as emergencies, usually at a late stage in the disease meaning poor prognosis. This proportion rises to 43% in patients 85 and over.
Across the UK, breast cancer screening by mammography is routinely offered every three years to women between 50 and 70 and in England moves to extend that to younger women between 47 and 49 and older ones from 71-73 are nearing completion. The NHS operates separate bowel screening programmes in England, Scotland, Wales and Northern Ireland, covering differing age ranges among older people, with that in Scotland starting earlier than elsewhere at 50. Most use do-it-yourself stool testing kits which people back. In England, a programme has recently started to look at the inside of the rectum and lower bowel involving a thin, bendy tube being inserted into those 55 and over. Cancer Research UK. which helped develop this Bowel Scope programme , said it was likely to prevent thousands of deaths a year once rolled out nationally. It had also campaigned successfully for more patients to get state-of the-art radiotherapy.
Sean Duffy, national clinical director for cancer at Public Health England, said "real inroads" were being made into improving cancer survival. "For example, the improvement in survival in lung cancer has been dramatic over the last 20 years with almost twice as many patients alive a year after diagnosis now as was the case in 1990 and we can see that for melanoma (skin cancer) that the (five-year) survival for England (85.3 per cent) is better than the European average (83.2 per cent)."
Duffy thought this reflected a combination of the better organisation of cancer services, the availability of better treatments and earlier diagnosis. "Our one-year survival figures show that for both of these cancers we are now approaching the outcomes of other countries where survival has historically been significantly better than in England. However, we want the best outcomes for all cancer patients and we know that we need to build on the improvements that have been made and do much more."
Dyfed Huws, director of the Welsh cancer intelligence and surveillance unit, said Breast Test Wales had the highest rate of screen-detected cancers of all the breast screening programmes in the UK, and Wales also had the highest 15-year survival rate for women diagnosed with invasive breast cancer.James Meikle
Jackie Ashley (The reforms the NHS needs won't help to win an election, 2 December) is right to point out that the NHS and social care system is facing an unprecedented challenge of dealing with an older population.
We are already closing the traditional divide between the NHS and social care. We know people prefer to be supported to stay at home longer. It is also important for patients to be discharged quickly, rather than stuck in hospital.
That is why in this year's spending round we announced a £3.8bn better care fund to get local health and care services working together in the interests of the people they serve. Fourteen pioneering areas are showing the way to joined-up services so they better meet the needs of patients in the 21st century. They are leading a movement of change which is gathering momentum.
This will help the elderly woman live independently in her family home for longer by using healthcare technology. Or reduce the number of avoidable trips to A&E because a man with diabetes has the home support he needs to stop him ending up in hospital with complications.
Our plans will make this more than just an ambition. Local services know they need to act now because money will be released from the fund only once we are satisfied people are getting better care. This approach will protect our NHS and deliver the future of health and social care.
Norman Lamb MP
Care and support minister
Brandon Lewis MP
Local government minister
• Jackie Ashley praises Andy Burnham's commitment to whole-person care. She describes the process for achieving this as "horrendously complicated" and not an election-winning strategy. However, what Labour needs to articulate clearly is relatively simple and goes with the grain of public opinion, namely a plan for reversing the trend towards health service privatisation, which has accelerated since the implementation of the Health and Social Care Act 2012.
Above all, a commitment is required not simply to the repeal of the act, but to the maintenance of healthcare as a public service rather than a tradeable commodity. To this end, Labour must state its opposition to the outsourcing of commissioning support scheduled for 2016, which potentially hands control of £65bn for commissioning secondary and community healthcare to the for-profit sector; seek exemption of the NHS from the Transatlantic Trade and Investment Partnership; and most importantly, initiate a process to ensure that its policy proposals for replacing the act are drawn up in agreement with stakeholders, particularly health professionals who were sidelined by the coalition. With less than 18 months to the general election, the need for action is urgent.
Dr Anthony Isaacs
• I agree with the report, quoted by Jackie Ashley, that patients must own their own medical records. The best way to achieve this would be to create an electronic summary care record for every patient. This would also solve the lack of availability of patients' clinical details at any time in emergency departments across the country.
A model for this could be the private lifetime record created by Canada Health Infoway Inc. On a single computer screen are listed a patient's details, healthcare providers, medical history, allergies and other alerts, current and past treatment, laboratory and X-ray results and other useful details that would be vital in emergencies when no other records are available.
Dr Richard Taylor
Co-leader, National Health Action Party
• Does Andy Burnham really want to sweep away patients' confidentiality safeguards completely? Hippocrates didn't establish them under oath to prevent the co-ordination of medical care – he put them there to protect patients and prospective patients from being embarrassed by their conditions or even from being cast out from society. Just consider going along for a job interview today and being forced to admit openly to a history of depression or substance misuse or an adverse genetic susceptibility or whatever. I hope he thinks again about this one.
Dr Richard Turner
Harrogate, North Yorkshire
A new report shows that just 1% of NHS leaders believe there are no advantages to partnership working
The NHS is under pressure to come up with new ways of providing better and cheaper clinical and other services. This is not a question of policy or politics, it is the result of limited resources needing to meet increased demand, while maintaining quality.
As a consequence, partnership between NHS organisations and the private and voluntary sectors is an important strategy for making breakthroughs in service quality and productivity. The challenge is such that we must embrace the best skills, knowledge and capacity that are available whether within or beyond the NHS, particularly when it comes to complex, high spend and strategically important services.
Over the past year, I have been working with a group of leaders from across the NHS, private and voluntary sectors to explore how the sectors can work better together. Our resulting report, The power of partnership struck a chord – in our survey of over 280 industry leaders, only 1% of the NHS and 2% of private and third sector leaders believe there are no advantages to partnership working. And the majority of both NHS (54%) and private/third sector (64%) feel the greatest potential for partnership lies in delivering clinical services.
The real questions are: what is a partnership and how do you make it work?
Partnership is a term that is often used in a vague way, particularly in the public sector. What we have focused on is something much sharper and more purposeful. True partnerships are formal arrangements between equal partners, where common goals are defined, and both risks and rewards are shared. This marks them out from traditional outsourcing contracts, which are based on fixed specifications for delivery.
There was no room in any of our debates for lazy assumptions about which sector was better or for doubts about whether it was possible for the private sector and the NHS to work on the basis of shared values and a commitment to improving outcomes for patients. This is because we found impressive real life examples of successful collaboration. These include: an NHS trust and charity redesigning and integrating drug and alcohol services; a private company and two trusts forming a joint venture to reconfigure pathology services across a region; and a mental health trust and private provider coming together to design and build new services.
Procuring service delivery partnerships is far more complex than buying surgical gloves or drugs. It was disappointing that the long-awaited report on procurement from the Department of Health and NHS England focused almost exclusively on the procurement of products and largely ignored the more complex area of clinical and support services. This was a missed opportunity – but I'm pleased to say that the minister responsible for procurement reform has welcomed our report, and promised to and embed our advice into their plans.
The report sets out a lot of good practical advice but two important messages stand out. First, potential partners need to spend time talking to each other and seeing how they might collaborate before commitments are made or formal procurements get underway. Second, commercial skills must be instilled in NHS management – among executives, managers, procurement teams and non-executive directors. This will help NHS organisations to spot partnership opportunities and secure the best deal for the NHS and for its patients.
Sir William Wells is chair of the reference panel and former chair of the NHS Appointments Commission
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NHS statistics show 600,000 more people used emergency hospital services last winter, with a rise of 11% in four years
Attendances at A&E departments in England have risen significantly in recent years, with more than 600,000 more people using their services last winter than under the previous government, official NHS statistics have revealed. The figures show comprehensively for the first time the rise in numbers presided over by the coalition government, as fears mount of an impending "winter crisis", and prompted charities to warn that the situation could get worse.
Caroline Abrahams, charity director at Age UK, said: "The numbers could continue to increase since the social care system is being stripped to the bone, with access to high-quality social care becoming ever more difficult as vital services are withdrawn or reduced as a result of the current crisis in care. The NHS will struggle to cope with the increasing pressures brought on by lack of social care provision unless the system is radically reformed and given adequate funding."
The figures, published on Tuesday by the Health and Social Care Information Centre (HSCIC), show that the most deprived 10% of society are twice as likely to go to A&E as those in the least deprived 10%. They also reveal that the proportion of old people attending major A&E units has risen from 19% to 21% over the past four years, with nearly half of them being admitted to hospital, a situation Jane Harris, policy director at disability charity Leonard Cheshire, claimed was avoidable. She said the government "should be investing in a better care system. Disabled and older people and families shouldn't feel they have to go to A&E unless it really is an emergency".
Attendances at A&E departments were up 11%, to 21.7 million, over the past four years, compared with a 3.2% growth in the population during the same period, mainly due to a rise at minor injury units, the statistics showed. Almost half (47.2%) of people who attended A&E received only guidance or advice or no treatment, which will add to concerns that A&E services are seeing patients who could be treated more efficiently elsewhere.
Measures taken by Jeremy Hunt, the health secretary, to alleviate pressure on A&E include a named GP for elderly patients in their local surgery and making surgeries open for longer hours, although the HSCIC statistics show that attendances overnight are a small proportion of the total.
Dr Mark Porter, chair of the council of the British Medical Association, said patients needed to know how and where to access appropriate care. "Key to this is having an effective out-of-hours telephone service, yet the disastrous introduction of NHS111 replaced a clinician-led service with a call centre and was responsible for many people being wrongly directed to emergency departments," he said.
Last winter, 10.6 million people attended A&E, compared with 10 million in 2009-10. The number of people visiting A&E has been above 5 million in every quarter since the coalition government came to power, compared with exceeding 5 million in only three quarters (from April to December 2009) between April 2004 and March 2010. In the last full quarter (January to March 2010) of the previous government, attendances stood at 4.9 million, compared with 5.3 million in the same period this year.
Labour seized on the figures to accuse Hunt and David Cameron of ignoring the problem, but Hunt said there was "unprecedented demand" on services and blamed Labour's changes to the GP contract.
The shadow health secretary, Andy Burnham, said: "They prove that A&E has got steadily worse on their watch and blow apart repeated attempts to evade responsibility for the current crisis. They have diverted attention from the real causes of the pressure and allowed this crisis to deteriorate, putting spin before patient safety in an appalling abdication of responsibility."
But Hunt said: "We know demand for A&E services is increasing as the population ages, with more people needing more healthcare. That's why we are tackling both the short and long-term problems: transforming out-of-hospital care by reversing Labour's disastrous changes to the 2004 GP contract, joining up the health and social care system, and backing health systems with £400m to prepare for this winter."
The Tories said 1.6 million more patients are being seen in less than four hours since 2010, although the HSCIC figures showed that the chances of being admitted to hospital are significantly higher in the last 10 minutes before the key target period expires than in any other 10-minute period, suggesting staff could be rushing to allocate beds for fear of missing the four-hour target.