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Health Policy Intelligence Issue 52 – 21 December 2012

Francis is coming. Look busy!
Welcome to the latest edition of Health Policy Intelligence, the analysis and summary of the key events in policy by Health Policy Insight editor Andy Cowper
editorial@healthpolicyinsight.com / www.Twitter.com/HPIAndyCowper

One of the greatest adaptations of a sign is the classic Church noticeboard, where underneath the motivational slogan ‘Jesus is coming’, some wit has added the pay-off line ‘Look busy!’

So it has been with Robert Francis. This is not to cast the distinguished QC as a Messianic figure; rather because his delayed Mid-Staffordshire Public Inquiry report – which will now be delivered to the Secretary Of State For Health on 31 January 2013, and therefore published next February – has been making the system feel the need to look busy.

A keynote event was SOS Jeremy ‘Bellflinger’ Hunt’s speech at the Kings Fund’s annual conference on the quality of care and compassion. And he nailed some important points, speaking of “the normalisation of cruelty … perhaps the biggest problem of all facing the NHS. The crisis in standards of care that exist in parts of the health and social care system”.

Hunt is anticipating Francis hard with his solutions: “we urgently need to strengthen corporate and managerial accountability for the care provided. Yet too often managers have seen their priority as financial or clinical outputs. Incentives in the system have driven people to focus on quantitative input measures rather than the basic human right to be looked after with dignity and respect.

“We need to know much more quickly where the problems are … Next year we will roll out the “friends and family” test across the NHS. For the first time hospital users will be asked if they would recommend the care they received to a friend or close member of their family. NHS staff will also continue to be asked anonymously whether they would recommend their organisation to their own families … And we will publish the results”.

It was interesting to note that Andrew Lansley’s former special adviser Bill Morgan, now returned to his job at communications consultancy MHP Health Mandate, promptly blogged about the deficiencies of the friends and family tests.

Hunt continued, “it’s now clear we need to have a proper independent ratings system. It is not acceptable to deprive the public of the vital information they need, or remove the pressure for constant, relentless improvement in standards. I am not advocating a return to the old ‘star ratings’ but the principle that there should be an easy to understand, independent and expert assessment of how well somewhere is doing relative to its peers must be right. So this week I have asked for an independent study to be done as to how this might be achieved in a way that does not increase bureaucracy”.

Hmmm. Clearly, they should be based on extant data returns. But if these new ‘Hunt Quality Care’ ratings are to be meaningful, their production will have to involve no small amount of bureaucracy – in a system which is reducing its management spend to 45% of the 2008-9 level by 2014-15, lest we forget. The Christmas BMJ editorial by Professor Brian Jarman of the Dr Foster Unit at Imperial is also well worth reading on the subject of manager-led systems and cultures of blindness.

Hunt also picked up on the Kings Fund report on care quality, noting that “it is bad care that costs more – including the £1.4 billion spent on unnecessary emergency admissions. What about staffing levels and in particular the reduction in nursing numbers? if quality of care is really to be as important as quality of treatment we should be clear that changes to workforce numbers must not compromise the care provided”.

Given that nurses do much of the caring work, it’s striking that the Royal College of Nursing claims that 6,000 nursing jobs have already been lost since 2010, and that 61,000 posts have been lost or are at risk. Dr Daniel ‘Shirty’ Poulter was reported as having dismissed this as “scaremongering”.

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