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NHS care overhaul: Jeremy Hunt's plan is ambitious but possibly unrealistic NHS care overhaul: Jeremy Hunt's plan is ambitious but possibly unrealistic
(6 months later)
Jeremy Hunt has outlined an initial package of measures that the NHS will have to implement in order to respond to Robert Francis QC's damning evidence of what the health secretary told MPs was the service's "darkest day" – the Mid Staffs scandal.Jeremy Hunt has outlined an initial package of measures that the NHS will have to implement in order to respond to Robert Francis QC's damning evidence of what the health secretary told MPs was the service's "darkest day" – the Mid Staffs scandal.
Each is vital to help change the NHS's culture by pursuing the hugely ambitious, but possibly unrealistic, twin goals of zero harm to patients and routinely excellent care for all patients at all times. For that to have a chance, all Hunt's plans need to work – and others too.Each is vital to help change the NHS's culture by pursuing the hugely ambitious, but possibly unrealistic, twin goals of zero harm to patients and routinely excellent care for all patients at all times. For that to have a chance, all Hunt's plans need to work – and others too.
The litmus test of all these new policies, initiatives and laws will be whether they, individually and collectively, provide an answer to the key question that underpinned Robert Francis QC's mammoth public inquiry: will they mean that the appalling care seen at Mid Staffs never happens again?The litmus test of all these new policies, initiatives and laws will be whether they, individually and collectively, provide an answer to the key question that underpinned Robert Francis QC's mammoth public inquiry: will they mean that the appalling care seen at Mid Staffs never happens again?
Only the most ardent optimist would answer unequivocally yes. But while they cannot realistically prevent any individual member of staff being cruel, callous or recklessly incompetent, they should greatly reduce the chances of Mid-Staffs-type failings recurring, given they were uniquely sustained and widespread.Only the most ardent optimist would answer unequivocally yes. But while they cannot realistically prevent any individual member of staff being cruel, callous or recklessly incompetent, they should greatly reduce the chances of Mid-Staffs-type failings recurring, given they were uniquely sustained and widespread.
A beefed-up inspection regime involving month-long poking around for the biggest trusts and inclusion of medical experts among the inspectors will help put hospitals under the sort of pressure that the unique responsibilities of publicly funded healthcare demand, and embrace the need for constant improvement, especially if Hunt's intention of the public being able to see ratings for individual departments proves viable.A beefed-up inspection regime involving month-long poking around for the biggest trusts and inclusion of medical experts among the inspectors will help put hospitals under the sort of pressure that the unique responsibilities of publicly funded healthcare demand, and embrace the need for constant improvement, especially if Hunt's intention of the public being able to see ratings for individual departments proves viable.
He wants something akin to Ofsted's simple, parent-friendly ratings – an at-a-glance signal that a hospital is "good", "outstanding" or something less. But, as the Nuffield Trust health thinktank told him just last week, the complexity and range of what hospitals do – providing many different types of care, potentially – makes one overall score, which he also wants, very hard to give.He wants something akin to Ofsted's simple, parent-friendly ratings – an at-a-glance signal that a hospital is "good", "outstanding" or something less. But, as the Nuffield Trust health thinktank told him just last week, the complexity and range of what hospitals do – providing many different types of care, potentially – makes one overall score, which he also wants, very hard to give.
The yet-to-be appointed first-ever chief inspector of hospitals will have to resolve this, and other tricky issues about how new key processes will actually work.The yet-to-be appointed first-ever chief inspector of hospitals will have to resolve this, and other tricky issues about how new key processes will actually work.
Hunt's ideas combine an admirable amount of practicality as well as pragmatism. He has wisely resisted pledging to implement all of Francis's 290 recommendations. Instead, he said, ministers are following the spirit of them.Hunt's ideas combine an admirable amount of practicality as well as pragmatism. He has wisely resisted pledging to implement all of Francis's 290 recommendations. Instead, he said, ministers are following the spirit of them.
Some of Francis's key recommendations are the subject of various ongoing reviews, such as whether individual NHS staff should become liable to prosecution if they harm or kill a patient. The American patient safety expert Prof Don Berwick is looking into that, though the Department of Health already has well-developed and well-grounded concerns about it, as do organisations representing doctors and other health professionals.Some of Francis's key recommendations are the subject of various ongoing reviews, such as whether individual NHS staff should become liable to prosecution if they harm or kill a patient. The American patient safety expert Prof Don Berwick is looking into that, though the Department of Health already has well-developed and well-grounded concerns about it, as do organisations representing doctors and other health professionals.
The fear is that such sanctions could deter staff from reporting that they have seen risky things being done by mistake to patients, and thus undermine the culture of openness which is central to the post-Francis-report NHS that ministers, NHS organisations and patients' representatives all want to see.The fear is that such sanctions could deter staff from reporting that they have seen risky things being done by mistake to patients, and thus undermine the culture of openness which is central to the post-Francis-report NHS that ministers, NHS organisations and patients' representatives all want to see.
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