A Year in Review

1. A Year in Review Ben O’Sullivan Daniel Komrower

2. Junior Doctor Advisory Team Provide independent advice to trainees and trusts in NW and Mersey on rotas, monitoring and contractual issues Visit trusts as part of quality assurance functions of HENW Dragons Den – think about submitting!!

3. Content • Department of Health full response to Francis • Berwick Patient Safety Review • Keogh review into 14 hospital trusts • Greenaway Shape of Training report

4. DoH response to Francis Hard Truths: Journey to putting patients first January 2014

5. ‘Francis Report’ • Robert Francis QC • Barrister with a background in the NHS: involved in the inquiries into the Bristol Royal Infirmary and Alder Hey • Commissioned by Labour government to chair an inquiry ‘giving a voice to those who suffered at Stafford’ • Delivered February 2010 • Commissioned by Coalition government to chair a second inquiry into the wider systemic failures of the NHS, investigating how this suffering had been allowed to occur without detection • Delivered February 2013

6. Francis Report - recommendations • Gross failings in the wider regulatory and commissioning systems to reveal problems in safety and quality of care • 290 recommendations • Focus on organisations and 5 general themes: • Values and standards • Openness, transparency and candour • Compassion and care • Information • Leadership

7. ‘The one thing that doesn't abide by majority rule is a person's conscience’ Atticus Finch, To Kill A Mockingbird

8. Government response • Initial response: Patients first and foremost • March 2013 • Laid out actions to prevent, detect, take action, provide accountability and ensure training and motivation • Broadly, focussed on changes to existing system • Full government response: Hard Truths • January 2014 • Responds also to 6 further independent reviews: Keogh, Cavendish, Berwick, Hart, NHS confederation, Lewis

9. ‘First, we need to hear the patient, seeing everything from their perspective, not the system’s interests’

10. DoH actions • Clear navigation for patients’ complaints and concerns • Duty of candour among all professionals • Quarterly reports by trusts on complaints and concerns • Legislation on ‘wilful neglect’ • Care certificate for HCAs and social support workers • Increased power to patients through local Healthwatch ALB • Extension of Friends and Family test to mental health • Involvement in commissioning • Patient involvement in CQC rating system • Values-based recruitment

11. Improving the Safety of Patients in England A promise to learn – a commitment to act August 2013

12. Berwick report • Consultant paediatrician • Former President and CEO of IHI • Administrator for centres of Medicare and Medicaid services (CMS) • Asked by PM as an independent perspective, how ‘to make zero harm a reality in our NHS’ • Delivered August 2013

13. Berwick report - recommendations • Embrace ethic of learning • Quality of care, in particular patient safety, a top priority • Patients and their carers should be present, powerful and involved at all levels of HCOs • Sufficient staff • Quality and patient safety science and practice part of lifelong education of all HCPs

14. Berwick report - recommendations • NHS as a learning organisation with support for change • Transparency should be complete, timely and unequivocally shared with the public • All organisations should seek out patient and carer voice • Regulatory systems should be simple and clear, avoiding diffusion of responsibility • Responsive regulation of organisations

15. What does this actually mean for me? • What was the last audit/project you did? • Why did you do it? • Who benefitted most – the patient…the department…you? How do you know this? • If you had asked the patients on your ward what you should do as a project – what might they have said? If you had done this, would have made things better for your patients?

16. Keogh Review • Feb 2013 -> July 2013 • Review hospitals with persistently high mortality rates post Francis Report • 14 trust reviewed • Hard data and soft intelligence • MDT planned and unannounced visits • Listening – focus group/community • Risk summit – coordinated plan of action

17. Mortality rate • Is it of any use? • What is the correct measurement? • HSMR – Hospital Standardised Mortality Ratio • Hospital deaths • 56 diagnosis groups (80% of deaths) • Allowances for palliative care • If observed = (standardised) expected deaths = 100 • SHMI – Summary Hospital-level Mortality Indicator • 30 days of discharge • All diagnosis groups (100% deaths) • No allowance for palliative care • Ratio of observed death compared to expected (risk-adjusted model) deaths. Expected deaths = 1

18. 8 Key Ambitions • Reduce mortality not debate statistics • Better data availability for QI and public • Patient/carers/public equal partners • Patient and clinicians have confidence CQC • Isolated hospitals will be a thing of the past • Appropriate nursing staffing levels and skill mix • Junior doctors clinical leaders – TODAY • Happy engaged staff vital for patient care

19. Securing the future of excellent patient care • Prof David Greenaway • 29th October 2013 • All UK

20. Key Messages • General care in broad specialities - generalists • Still need Specialist • Sustainable career – opportunity to change • Opportunities driven by local patients need • Academic training pathways • Full registration to point of graduation

21. Professional practice Postgraduate Postgraduate Undergraduate Medical School Foundation Year Training 2 years Broad-based Specialty Training 4-6 years Generic and transferable competencies OOP year No clinical supervision Rest of career MDT CPD Credentialing Certificate Of Speciality Training Registration

22. Controversies • Moving registration • Training • Shorter • Less trained consultants • Sub consultant grade (? CST less than CCT)

24. The Keogh Report