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Flashcards in Chaos & Complexity in the NHS Deck (32):

Describe the Department of Health’s Business Plan 2014-15 for the NHS and what this involves.

Three goals for the future:
- LIVING AND AGEING WELL (preventing people from dying prematurely, transforming care outside hospital, focus on primary care, social care reforms, improving treatment/care for dementia)
- CARING BETTER (improve standard of care, change way technology and information is used, make progress towards achieving 'parity of esteem' between mental and physical health)
- PREPARING FOR THE FUTURE (improve productivity and sustainability, value for money for taxpayer, contribute to economic growth, develop capability and resilience, stewardship role of Department of Health).

Do this by:
- Leading confidently
- Building capability
- Improving policy making
- Increasing openness


Describe the NHS Outcomes Framework 2016-17.

Preventing people from dying prematurely - e.g. from major causes of death, in those with mental illness or learning disability

Enhancing quality of life for people with long-term conditions - ensure they feel supported, improving functional ability, reducing time spent in hospital, enhacing QOL for carers, enhacing QOL for those with mental illness or dementia or multiple LTCs

Helping people to recover from episodes of ill health or following injury - improving outcomes from planned treatments, preventing LRTIs in children from becoming serious, improving recovery from stroke, improving recovery from injuries/trauma, improving recovery from fragility fractures, helping older people to recover their independence after illness/injury, improving dental health

Ensuring that people have a positive experience of care - improving people's experience of outpatient care and A&E and end of life care, improving hospitals' responsiveness to personal needs, improving access to primary care services, improve experience of maternity services and of healthcare for mental illness and of young people's experiences, improving people's experience of integrated care

Treating and caring for people in a safe environment and protecting them from avoidable harm - reducing incidence of avoidable harm, improving culture of safety reporting, improving safety of maternity services


Define health literacy.

The individual’s cognitive and social skills that determine the ability to access, understand and use health information in a way that will promote their own health.


Define patient education.

Any set of planned educational activities/organised learning experiences that intend to improve (or enable change of) patient’s health behaviours and/or health status. It aims to slow deterioration of a disease, or to maintain/improve health outcomes.


Outline the following policy from the DOH “Liberating the NHS: No decision about me, without me. 2

This is to implement SHARED DECISION MAKING, so clinicians and patients work together, and make it become the norm in the NHS. This is important as it has been shown it leads to better outcomes and also patients want to be more involved in their care than they are at the moment. This is PATIENT-CENTRED CARE.

This would involve greater national provision of decision aids, including shared decision making in commissioning and contracts, including it in training, better provision of shared decision making, monitoring the quality of shared decision-making...


Outline the proposed junior doctors’ contract.

-Saturdays and Sundays will count as “plain time” (part of a junior doctor’s normal working week) and this now stretches to 10pm.
-Will receive extra money for working at least seven full weekends a year up to a maximum 10% increase in their pay.
-Pay is going down from 50% extra for a shift to 37% for working at least eight hours any time between 8pm and 10am.
-Increase in their basic pay of 10%-11%
-Separate 8% uplift so long as they do on-call work
-Pay premia for young doctors opting to specialise in A&E, psychiatry and oral and maxilo-facial medicine have been increased to £20,000
-Doctors doing locum shifts will have to first offer their services to the NHS, they will get a 22% bonus every time they do.
-Set up the new role of guardians of safe working to ensure doctors aren't working excessive hours
-Inequalities for part-time female junior doctors - unable to find childcare for extra weekend shifts, but now have mentor so they receive 'targeted accelerated learning'


What is meant by the inverse care law?

People who need the most care are least likely to receive it (the perverse relationship between the need for health care and its actual utilisation).
It essentially arises because of income inequalities.

In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support and inherit more clinically ineffective traditions of consultation than in the healthiest areas; and hospital doctors shoulder heavier case-loads with less staff and equipment, more obsolete buildings and suffer recurrent crises in the availability of beds and replacement staff.


Where does the inverse care law operate more completely?

Where medical care is most exposed to market forces, and less so where such exposure is reduced. 


When did privatisation of the NHS start?
Why is this problematic? (3)

1980's by Thatcher government

Increasing inequality in health
Enhancing private wealth
Reinforcing class-based health access


Average GP consultation with middle class patient took __ minutes; working class equivalent took __ minutes.

6.2 minutes
4.7 minutes


What is meant by the business rhetoric?
What is the main aim?
What was the problem and how was it corrected?

The GP contract of 2004
To reward those who work in deprived areas to try and reverse the inverse care law.
Created a two-tier system in which some practices found themselves with considerably fewer resources than they had under the old system, so a correction factor was introduced (Minimum Practice Income Guarantee). This is being phased out however.


What is the Social Value Act?

2013 legislation that places a legal obligation on all public sector commissioners to consider how they could improve the economic, environmental and social well-being of their population through their procurement activities.
This includes promoting good quality jobs, reducing social isolation, and improving health literacy.


What is patient centred care?

Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.


What are the four principles of person-centred care?

1. Affording people dignity, compassion and respect.
2. Offering coordinated care, support or treatment.
3. Offering personalised care, support or treatment.
4. Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.


What is health education?

Interventions that provide learning opportunities directed towards achieving change in health risk behaviours, or the maintenance of health enhancing behaviours.
Health education can include personal or mass media campaigns directed towards individuals or groups of individuals.


What are the three levels of health literacy?

Critical (more advanced than interactive)


What is health promotion?

Interventions which are designed to improve health status of individuals through the provision of screening or prophylactic services, environmental control, legislation and policy development within organisations.


What is public health?

Organized activities that address the health needs of populations as a whole including prevention of disease, health protection, improvement of health services and health promotion.
It is a social and political concept aimed at improving health, prolonging life and improving the quality of life among whole populations through health promotion, disease prevention and other forms of health intervention.


How can health professionals help mitigate the effect of lower levels of literacy? (4)

-When they assist the patient to navigate the health system
-Provide authentic choices for self-management of conditions
-Encourage patients to communicate
-By remaining aware of the relationship between levels of literacy and health outcomes


What is therapeutic patient education?

Designed to train patients in the skill of self-management, adapting treatment to their specific chronic disease as well as enabling coping processes and skills. It is managed by health professionals trained in the education of patients with the principle purpose of producing a therapeutic effect.


What thwarts the success of therapeutic patient education programmes?

Economical, psychological and cultural barriers e.g. low health literacy


What happened with the NHS in 1990-1997?

Financial pressure caused protest. This led to the ‘internal market’, and the NHS was split into purchasers (health authorities and some GPs) and providers (hospitals and community health services, GPs). The hospitals and community health services were organised into 400 Trusts. There were short-term funding increases.


Why was fragmentation and split negative?

Senior Consultants became employees of Trusts, subject to increasingly tight central management control, and they had less & less influence on policy. The duty of the doctor to the Trust came before duty to Patient. It destroyed capacity of NHS to plan & distribute resources based on health needs of population.


Explain what happened with the introduction of the private financial initiative.

This was to adopt unsustainable targets for reductions in bed capacity. It opened all public services to private sector provision, but it ending up being more expensive than public funding! This caused bed shortages to become more acute, waiting times didn’t get shorter, staff turnover increased, and it reduced bed numbers by 30%, budgets and clinical staff cut by 25%.


What is an integrated care team?

Comprises the professionals and roles of a range of services into one multi-disciplinary team. Introduced 'care coordinators' to help the patient and family navigate their way through the complex health system.


How does the NHS compare to other healthcare systems in the world?

Declared the best healthcare system, scoring highest on quality, access and efficiency.


Define improvement.
There is a culture of improvement in the NHS. What values underpin this?

“The combination of a ‘change’ combined with a ‘method’ to attain a superior outcome”.

Patients first
Working together


How do we improve? (3)

Audit against standards
Service improvement in the workplace


What is the role of the Care Quality Commission?

To carry out a mixture of announced and unannounced inspections.


What was the deficit in 2015?

£95.5 billion


What is the productive ward?

Using principles to deliver improved care through focusing on productivity and efficiency in an acute setting. It focuses on:
-releasing time to care for patients
-improved quality of care
-improved patient safety
-improved staff morale
-eliminating waste and making processes more efficient to make savings


Has the productive ward worked? (5)

40% increase in amount of time nurses spend on direct patient care
£30,000 savings
Handover time reduced by a third
Meal wastage rates reduced from 7% to 1%
30% reduction in falls rate