NHS wide issues Flashcards
(15 cards)
What are appraisals?
Formal structured process to reflect on work and consider effectiveness.
Not to look at poor practice but to strive for excellence
Takes into account
- research
- leadership
- work performance
- QI
It is ticking boxes you have set yourself where assessment is ticking boxes set by others
What is the benefit of revalidation?
Ensures a doctors fitness to practice
increases public confidence
identifies poor doctors and protects patients
Donaldson report - good doctors safer patients - wrote into contract what is expected of doctors
- led to devolution of GMC to local level
- renewed focus on rehab and improvement
Revaildation can in in 2012
- need a responsible officer
- need to maintain a portfolio
- annual appraisal
- recommendation to GMC every 5 yrs
NHS 10 year plan 2019-2029
Focus on
CVD increased detection and care
Maternity - decrease stillbirth and maternal fetal mortality
cancer care
SDEC
GP led urgent treatment centres
Integrated Care Systems (ICS)
Came in with Health and Care Act 2022
System/Place/Neighbourhood
Move from separation of commisioners and providers to a more integrated system and focus on local populations
aim to
- enhance value for money
- tackle inequalities
42 in England
IC Board - allocates budgets and is responsible for commisioning
IC Partnerships - planning and development of strategy
Locally is Wakefield ICS
Part of West Yorks Health and Care Partnership
Overall means trusts have to look beyond only hospital care and more community focus
Patient Reported Outcome Measures
Way of collecting information of quality of care as reported by patients
for example pre op and post op PROMS
CQUIN
Commissioning quality and innovation
Darzi report 2024
the NHS is in “critical condition, but its vital signs are strong
The report highlights issues with patient access, quality of care, and resource allocation, urging a systemic reformation plan to address these challenges
Anaes relevance - The report emphasizes the need for a more integrated approach to patient care, including pre-operative assessments and planning, which directly impacts anaesthetists’ work in preparing patients for surgery
Best Practice Tariffs
Best practice is defined as care that is both clinically effective and cost effective
BPT = conventional tariff plus additional payment
Can give penalties for non compliance
Eg
Hip fracture - time to surgery 36hrs
- involvement of orthogeriatrics
Mid Staffordshire Trust 2009
Findings
What enquiry did it lead to?
Local campaign group for enquiry
Led to Francis report
series of failures
-nursing
- poor management of emergencies
- high mortality rate
appalling care
1st enquiry
- bullying culture
target focussed
low staffing levels
constant management change
low morale
2nd enquiry
focus on finance and targets
lack of compassion
lack of accountability
Led to
New rating system for hospitals
chief inspector of hospitals created
minimum training standards for HCAs
How did mid staffs impact your practice?
Whistleblowing
Freedom to speak up guardian
CQC review
ICBs
- criminal responsibility for cover up
What is duty of candour?
- care organisations have a duty to act in a transparent way
- open and honest culture
- applies to organisations not individuals
- as soon as possible after a patient safety incident a patient must be told
- full explanation including what will happen next
Occurs for any incident involving
-death - sever harm - permanent injury
- moderate harm - led to a moderate increase in treatment requirement
What was the 2013 Keogh review?
Followed on from Francis enquiry
14 trusts with a higher than average death rate
- found that death rate is a complex figure and can be confounded eg coding
some immediate actions - mandate staff levels, close theatres
What was the Carter review?
Looked into productivity and performance
Expected savings
2bn from staff - better use decrease agency and attempts to reduce sickness
- culture of good morale leads to a more effective workforce
- idea of trust values
- need to better manage staff
- e-rostering of staff to increase efficiency
What was the Montgomery ruling
Shoulder dystocia - not properly counselled about the risks
doctors must provide all ingo about material risks that a reasonable person in the situation would attach significance to
- should tailor discussion to the patient
- bolam ruling counteracts
What is the role of the CQC?
Regulation of all of health and social care
- can give warning notices to make changes
- can limit a care providers registration
- can place in special measures
- administer fines/cautions/prosecutions
