UK - Health watchdog calls for consistent action on safety and better services for people least able to care for themselves

Citation

(2007), "UK - Health watchdog calls for consistent action on safety and better services for people least able to care for themselves", International Journal of Health Care Quality Assurance, Vol. 20 No. 2. https://doi.org/10.1108/ijhcqa.2007.06220bab.006

UK - Health watchdog calls for consistent action on safety and better services for people least able to care for themselves

Keywords: Patient safety, Healthcare improvement, Healthcare equality

The Healthcare Commission has called for a drive to improve the safety of patients in both the NHS and the independent sector. It presses for more attention on services for people least able to look after themselves, including those with learning disabilities and mental health conditions.

And it says that more should be done to “put patients first” by ensuring that people are treated with dignity and respect and get better information about their care.

The Commission has published its annual State of Healthcare Report to Parliament, painting its most complete picture to date of healthcare in England and Wales.

The report includes, for the first time, a view of performance in meeting the minimum standards required by law of the independent healthcare sector in England. It makes clear that healthcare is improving. There are significant reductions in waiting times, including for care in A&E and for outpatient appointments. The quality of care is also getting better, helping to reduce deaths from heart disease and cancer.

The Commission highlights increases in the capacity of the NHS to serve patients, including a 24 per cent rise in the numbers of staff between 2000 and 2005. As a result, the NHS has been able to look after more patients more effectively.

But the watchdog sets out a four-pronged agenda for the next phase of improvements: delivering consistently safe care; providing services in a more patient-centered way; reducing inequalities in health; and tackling services for people with mental health problems, learning disabilities, older people and children.

Sir Ian Kennedy, the Commission’s Chairman, said:

There are real improvements to applaud and celebrate. These are having a genuine impact on people’s lives with many waiting less time for care and experiencing better treatment. The next step is to deal with the remaining ingrained problems, which are tougher nuts to crack.

We need to see a more consistent emphasis on safety. Of course most people experience safe care and where we find an urgent issue we have taken and will take action. But services could still be safer for patients. The NHS needs to take safety more seriously.

It is frustrating that in 2006 we do not have a clearer idea of how many people die or are harmed in hospitals when this could have been avoided. We should all be troubled when the National Audit Office states that “estimates of death as a result of patient safety incidents range from 840 to 34,000, but in reality the NHS simply does not know”. I recognize that it is not easy to get this information and that all major countries struggle with it. But without that knowledge, and the reasons behind it, improvement cannot take place. There is clearly room for improvement in compliance with standards on safety. And, this goes for independent sector, which needs to raise its game on this as well as the NHS.

It is also clear that services need genuinely to be built around patients’ needs and wishes. Finally, we must make sure that we give proper care to those least able to care for themselves, not least those with learning disabilities and mental health problems.

On putting patients first, the report says the majority of patients have a good experience of services, but many still say care is not organized in a way that meets their needs. They want better information about health and healthcare, plus more involvement in decisions. For example, 28 per cent of respondents to a survey of patients said doctors sometimes talk about them as if they are not there. One-third of people in hospital for a stroke report problems getting help to wash or go to the toilet, while two-fifths had problems getting help with meals.

On inequalities in health, the report says people are living longer. But life expectancy for men ranges from 72 to 81 depending on the local authority area they live in. Obesity among children between two and ten rose from 10 per cent to 14 per cent in nine years from 1995 – it is highest in deprived areas. Progress has been disappointing in meeting targets for narrowing inequalities, with gaps in life expectancy and infant mortality widening. In the past seven years, deaths from cancer and heart disease have fallen 14 per cent and 31 per cent respectively. Greater effort on health promotion and working in partnership with other agencies is needed to continue this.

On services for those least able to care for themselves, the report describes the Commission’s findings on services for people with mental health needs, learning disabilities, older people and children. It found, in some cases, a lack of attention to safety and services below acceptable standards. People with learning disabilities suffered neglect and physical abuse. One in three patients on mental health wards were affected by violence. Many elderly patients were not treated with dignity and respect. Services failed on occasions to meet the changing needs of children and young people, in particular those who were disabled, were leaving care or had mental health needs.

On safety, the report says that the majority of patients experience safe care, but standards are inconsistent. This was evidenced by the Commission’s work across standards, complaints and investigations. There are widely varying estimates on numbers of avoidable deaths and injuries. There are signs of improvement, with numbers of staff seeing an error that could cause harm falling to 40 per cent in 2005 from 47 per cent in 2003. But although 75 per cent of NHS employees say that their trust encourages reporting of incidents, only 50 per cent thought that their trust took action to prevent any recurrence of the incident reported. Each year, the Commission receives 8,000 complaints from patients that are unresolved by trusts, 22 per cent of which relate to safety. As regards safety across the NHS and independent sector, the Commission was concerned that some organizations did not meet core standards. In the NHS, one in ten trusts could not assure the Commission that they fully meet core standards on safety. In the independent sector, the Commission last year required one in ten providers to improve the management of risks.

The report includes an overview of standards in the independent sector for the first time. This adds to the assessment of compliance with core standards in the NHS, recently announced as with the NHS performance ratings. The assessments of the independent sector are not directly comparable, as different legislation applies, but there are common themes.

At the time of their annual inspection for 2005/2006, 50 per cent of establishments in the independent sector met all of the 32 minimum standards. A total of 85 per cent passed at least 29 standards while 10 per cent failed five or more.

As regards the assessment of the NHS, by reference to 24 core standards, 49 per cent of trusts “fully met” them and four per cent were categorized as “not met”. Overall, 81 per cent of trusts were meeting at least 90 per cent of the standards.

Looking at specific standards in the independent sector:

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  11 per cent of establishments (13 per cent of acute hospitals) failed the standard which requires them to have processes to ensure monitoring of treatment and care.

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  10 per cent (11 per cent of acute hospitals) failed on having processes to ensure that staff are appropriately recruited, trained and qualified.

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  7 per cent (8 per cent of acute hospitals, 14 per cent of pregnancy termination clinics) failed on having processes to minimize the risk of infection.

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  The Commission says that compliance was greatest among medium-size and larger independent establishments rather than smaller ones.

It was concerned about independent providers of mental healthcare where 8 per cent of standards were not met. The NHS pays for around 80 per cent of the patients using these services, including people detained under the Mental Health Act.

Of independent mental health establishments, 35 per cent failed three or more of the 32 standards, 12 per cent failed seven or more. Looking at specific standards:

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  23 per cent failed the standard which requires them to have processes for monitoring treatment and care;

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  19 per cent failed on having processes for recruiting trained and qualified staff; and

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  17 per cent failed on premises being appropriate for treatment.

On specific core standards for the NHS:

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  20 per cent of trusts could not assure the Commission that they ensured that healthcare staff attended compulsory training;

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  13 per cent could not assure the Commission that they have systems to ensure that all reusable medical devices are properly decontaminated; and

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  12 per cent could not assure the Commission that they have systems to minimize all risks associated with the acquisition and use of medical devices.

For further information: www.healthcarecommission.org.uk