Shape of Training - Health Education North West

Report
A Year in Review
Ben O’Sullivan
Daniel Komrower
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!!
Content
• Department of Health full response to Francis
• Berwick Patient Safety Review
• Keogh review into 14 hospital trusts
• Greenaway Shape of Training report
DoH response to Francis
Hard Truths: Journey to putting patients
first
January 2014
‘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
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
‘The one thing that doesn't abide by
majority rule is a person's conscience’
Atticus Finch, To Kill A Mockingbird
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
‘First, we need to hear the patient,
seeing everything from their
perspective, not the system’s
interests’
DoH actions
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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
Improving the Safety of
Patients in England
A promise to learn – a commitment to
act
August 2013
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
Berwick report - recommendations
1. Embrace ethic of learning
2. Quality of care, in particular patient safety, a top
priority
3. Patients and their carers should be present, powerful
and involved at all levels of HCOs
4. Sufficient staff
5. Quality and patient safety science and practice part of
lifelong education of all HCPs
Berwick report - recommendations
6. NHS as a learning organisation with support for change
7. Transparency should be complete, timely and
unequivocally shared with the public
8. All organisations should seek out patient and carer
voice
9. Regulatory systems should be simple and clear,
avoiding diffusion of responsibility
10. Responsive regulation of organisations
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?
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
Mortality rate
• Is it of any use?
• What is the correct measurement?
– HSMR – Hospital Standardised Mortality Ratio
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Hospital deaths
56 diagnosis groups (80% of deaths)
Allowances for palliative care
If observed = (standardised) expected deaths = 100
– SHMI – Summary Hospital-level Mortality Indicator
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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
8 Key Ambitions
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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
Securing the future of excellent patient care
• Prof David Greenaway
• 29th October 2013
• All UK
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
Undergraduate
Postgraduate
Medical School
Foundation
Year Training
Professional
practice
Postgraduate
Broad-based Specialty Training
No clinical
supervision
4-6 years
2 years
Rest of career
Generic and transferable
competencies
MDT
OOP year
CPD
Credentialing
Registration
Certificate
Of
Speciality
Training
Controversies
• Moving registration
• Training
– Shorter
– Less trained consultants
– Sub consultant grade (? CST less than CCT)
The Keogh Report

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