28/09/2010 by Patrick Keady.

A new website featuring every UK law in full is now available for free.

Launched by The National Archives, you can now scrutinise 6.5 million laws documents in England, Scotland, Wales and Northern Ireland. They are stored as PDF files.

“This is the public’s statute book,” said Lord McNally, minister of state and deputy leader of House of Lords.

legislation.gov.uk presents complex information in a clear and intuitive way. Lord McNally continued that the website is groundbreaking and that it puts democracy at the heart of legislation. The website makes a major contribution to the government’s transparency agenda.

The website replaces The Office of Public Sector Information and Statute Law websites.

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14/09/2010 by Patrick Keady.

The success of healthcare systems is often measured
in terms of quality, activity and cost. Compared with the
US, Germany and France, the NHS performs well. In
terms of GDP, we spend less.

However, things are less clear when we compare NHS
quality and activity. Statistics come to the fore. We
compare the NHS with the EU, north America and
Australasia. And we might be missing a trick.

Could it be that there are better healthcare systems
elsewhere in the World? Healthcare systems that
deliver more at less cost.

Take Japan for example. It stands at or near the top in
every comparative ranking of healthcare quality, activity
and cost.

Not alone is their healthy life expectancy 6% higher
than in the UK, they also have the best recovery rates
from just about all of the major diseases. Japan
leads the World in curing the diseases that
can be cured. Impressive.

The percentage of people dying from circulatory
diseases per 100,000, is 75% less than here. The
proportion of cardiac death is four times less. The birth
rate is 30% less and the proportion of the Japanese
population that is obese, is one seventh. Although the
percentage of daily smokers in Japan is higher -
30.3%, compared to 26% in the UK.

Cost control is one of the key drivers of Japan’s
success. It’s savings in the high-tech realm can be
awesome. An MRI scan of the neck region in Japan
routinely costs 9% of one in the US.

All 125 million residents have access to healthcare
services. The Japanese see a Doctor about three times
as often as people here in the UK, or those with
healthcare insurance in the US. The number of Nurses
per 1,000 people in Japan is less than in the UK : 7.8,
compared with 8.8 in the UK.

And they have almost three times as many hospital
beds per 1,000 people. The average hospital stay is
four times the US average. The Japanese get twice as
many prescriptions and three times as many MRI
scans.

And the cost of caring for every person living in Japan
is less than half that of caring for the 80% of Americans
with health insurance. Total expenditure is less
than in the UK too - 7.8% GDP versus 8.1%.

So what do you think?

Post your thoughts below.

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29/07/2010 by Patrick Keady.

Published in July,  Equity and Excellence : liberating the NHS looks towards an NHS in England - that is slimmed down, smartened up and democratised to deliver better quality care.  Out goes what remains of Aneurin Bevan’s nationalised vision, and out too is the New Labour Government’s regime of process targets, replacing them with outcomes measures.

There will be a new role for Local Authorities to facilitate closer working between health and social care services, to support patient choice, to improve public health and enhance commissioning.

The White Paper spells out Government plans to make the NHS more competitive, with NHS Providers being more accountable and transparent.

England’s 35,000 GPs will have control of about £70bn. Clustered in GP Consortia, they are to be given freedom and responsibility for buying care from Providers, within and outside the NHS. GPs will be unable to generate a surplus. And should they fail, they will not be personally liable.

While Monitor superintends NHS Foundation Trusts at the moment,  the White Paper proposes to turn Monitor into a full-blown economic regulator to oversee a healthcare market in the same way that Ofcom and Ofgem oversee the markets in communications and energy.

Consideration will be given to abolishing the cap on private income that NHS Foundation Trusts can earn and whether any surplus can be re-invested in the organisation, although they will not be privatised.

While GPs may find sufficient power to shelter from the full impact of competition, Liberating the NHS challenges doctors too. Patients will get more choice and control. This will be backed by an information revolution to involve Patients in their care, designed around them and achieving, in Mr Lansley’s words, No decisions about me, without me.

March 2014 is an important milestone for NHS Trusts - they will be or have become part of, an NHS Foundation Trust. They will be subject to regulation from Monitor, and will be given new freedoms as part of the largest and most vibrant social enterprise sector in the world.

The Secretary for State will hold the NHS Commissioning Board to account for delivering better health outcomes through a national NHS Outcomes Framework.

Link to all of the Department of Health’s Liberating the NHS consultations at the ‘consultations’ pages at www.betteroutcomes.org

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15/04/2010 by Patrick Keady.

HSJ reported today that there is lack of information on the safety and effectiveness of much NHS care and that this has been spelled out in an interim report from members of the NHS National Quality Board.

One of the NHSs prevailing beliefs seems to be, that individuals will perform better and their organisations will flourish …. when we reward the behaviours that we seek … and punish the behaviours that we dislike. This approach works well for simple, routine, rule-based work.

But NHS workers undertake other types of work, where non-routine creative and conceptual capabilities are also required.

I believe that Quality in the NHS will improve significantly when PCTs and Trusts demonstrate to their staff, that they understand what it is that really motivates their employees - the motivation of making progress in their work, improving quality and the simple satisfaction of getting better at what matters.

We know that businesses with transcendent purposes survive and continue to deliver excellent services to their customers. Too bad that ICI, Boeing and some of the large banks focussed too much on targets, and too little on purpose.

NHS targets are good. They continue to challenge clinical teams and Trusts. They have played a key role in improving the NHS. But more and more we are seeing that targets, potent as they are, can be an insufficient impetus for NHS staff and organisations. They do not get everyone leaping out of bed in the morning and racing to the wards, patients homes, theatres and meetings …. to do deliver excellent patient care.

The BBC’s Panorama team discovered earlier this year, that Trusts were incorrectly assessing performance, potentially distorting their standing in the CQC’s Annual Health Check. 17 out of the 28 Trusts visited by the CQC in 2009, made incorrect assessments. Did Mid-Staffs and Maidstone & Tunbridge Wells focus too much on targets, and too little on purpose?

While much has been written on aspects of Quality in the NHS, I would like the outputs from the NHS Quality Board to be short and to the point. To focus on Quality outcomes from the perspectives of the Treasury/National Insurance contributors, patients and employees.

And while the NHS focuses on purpose, that its satisfied employees will be racing to the wards, peoples homes, theatres and meetings …. to continue doing what motivates them best - making progress in their work, improving quality and the simple satisfaction of getting better at what matters.

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org

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19/01/2010 by Patrick Keady.

HSJs Fundamentals of Governance took place in London, late last year.

Click here to see my review of the Conference. For a .pdf, contact me via www.betteroutcomes.org

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org

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21/12/2009 by Patrick Keady.

Every week, I receive two or three phonecalls about assignments in NHS risk management, governance and safety. However, many of the proposed assignments would be a waste of NHS time and NHS money.

Earlier this year, a PCT asked me to lead on corporate governance, health & safety, risk management, information management, health records, complaints, claims, moving and handling and commissioning strategy.

I challenged the potential client to describe in a few short sentences, what they wanted me to achieve, and by when. They were unable to see or tell me what success might look like.

So, I offered them telephone coaching, free-of-charge. The PCT soon saw that my input would be very worthwhile in one discreet project, where my independent insight and skill-set was just right.

The project is mission-critical to the PCT. They were happy with my daily rates too ! And during the course of the phone conversations, the potential client identified in-house people that could lead on many of the other pieces of work.

NHS organisations need to clearly think about what they want to achieve, before contacting independent consultants.

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org

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02/12/2009 by Patrick Keady.

Stephen Ramsden achieved so much at his NHS Foundation Trust. Just six weeks ago, the CQC rated Luton and Dunstable as the best acute trust in NHS East of England. HSJ reported today that he will be leaving the trust in the spring of 2010 after 12 years in the post.

And with 12 years as Chief Executive at his FT, he is a shining NHS example of what makes successful organisations …………successful.

Led by Jeff Immelt, CEO at General Electric, a study found one key trait that is common in all successful companies. Their managers stay in place for along time.

Staying in place for along time, gives them space to extend their abilities, to learn much more about their organisation, to develop the critical connections that make their organisations perform better.

This is what Stephen Ramsden did, as a Chief Executive at Luton and Dunstable. Medical staff become successful because they take similar speciality-specific steps to extend their abilities, to learn about their speciality and to develop critical connections.

Immelt also found the converse, asserting that ‘the places where we’ve churned people like reinsurance, are the places where you will find we’ve failed’. We’ve had examples in the NHS where people are ‘churned like reinsurance’.

We need more Stephen Ramsdens, not less!. And in turn, they need the support of their Boards, their employees, SHAs, Monitor, Governors and other key stakeholders.

Chief Executives need the time and space to get to know their organisations much better, to extent their personal abilities, to develop critical connections, to understand risks and how to manage them effectively.

And in return they will be better placed to ensure that their NHS organisations wrestle with the very real risks of escalating demand and constraining resources.

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org

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17/07/2009 by Patrick Keady.

Listening to Evan Davis on BBC Radio 4, I was particularly interested in the language of his guests.

James Dyson introduced himself as the founder of vacuum cleaners that work better.

Marta Lane Fox, recently appointed Champion of Digital Inclusion, is working to make life better for the six million economically and socially disadvantaged people in the UK that have no access to technology.

And Adrian Ringrose  the chief executive of a company that enables public sector organisations do what they do, by doing all the bits that these organisations don’t want to think about.

When introducing ourselves in the NHS, we tend to use different language. And this episode of BBC Radio 4’s The Bottom Line promised a lot. It was a discussion about creativity and innovation.

To be good at innovation and creativity, Martha Lane Fox said that boldness and self-confidence works for her. James Dyson added that innovation for him is caring about solving problems and taking little incremental steps to get there.

And Adrian Ringrose gave his insight into the public sector. He suggested that it is more important to do what we do in the public sector - by the rules, rather than focusing on the end game.

A generalisation perhaps, he reminded us that it is the end point that matters and we are more likely to get there by building on our mistakes.

And my guess is that this point resonates with you and many leaders in NHS risk management, governance and safety. I enjoyed this edition of BBC Radio 4’s The Bottom Line and I know that you will too.

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31/03/2009 by Patrick Keady.

The NHS Institute has been an exciting place to work. During my 18 months with them, I led the development of their intranet-based risk register and board assurance framework, standing orders, standing financial instructions and scheme of delegation.

As well as being a key link between the Institute and the Department of Health, I was actively involved in developing their balanced scorecard; sustainable development; reviewing the security of their people, buildings and information; the procurement of health and safety training and risk assessment services and lots more besides.

Working with the NHS Institute meant a lot me. Over the 18 months, it has transformed into an outward looking, customer-focussed organisation. Whenever I hear about NHS Live, Knowledge Management, World Class Commissioning, the Management Training Schemes, the Productives, Safer Care series … I’ll think of them.

And I’m looking forward to my next assignment at NHS Stoke on Trent.

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12/02/2009 by Patrick Keady.

‘Without a national study, politicians and health professionals go into denial ….. we don’t have a problem’. This was one of the comments for Sir Liam Donaldson when he opened the Patient Safety Research Portfolio Conference this morning at the Royal College of Physicians

Speaking to a selection of the researchers that participated in the 36 patient safety research projects undertaken over seven years, at a cost of about 70p per NHS England employee per annum. He outlined his vision of the ten contributions that patient safety research offers to improving healthcare, as follows:

•    increasing awareness of patient safety - with clinicians, provider organisations and commissioners
•    understanding the causes of patient (un)safe-ty – and in relation to sleep deprivation, Sir Liam reminded us of the importance of the 48 hour week - clinicians are more likely to kill patients when they are tired.
•    more research in the young discipline of patient safety will enhance safety and improve productivity
•    establishing conceptual concepts - to enhance the ‘poverty of concepts in patient safety’
•    developing solutions – including improved design in healthcare, a recurring theme throughout the day
•    setting standards for information – before and after studies, randomised control trials etc
•    informing evidence based care
•    evaluating progress including checklists - twice as effective as education
•    nurturing researchers
•    and promoting leaders in patient safety

Professor Richard Lilford oversaw the Patient Safety Research Portfolio from its inception and this morning, he highlighted some of the successes of the programme. These included Professor Nick Barber’s discovery that nursing homes openly welcomed the prospect of his team observing medication errors and recommending improvements – their willingness could be related to the significant amount of time that care home staff spend in medication-related activities.

The day was chaired by Professor Paul Barach, one of the best Chairs that I’ve seen at a healthcare seminar/conference. He has has a very rare ability. He keeps the audience interested, even during the ‘graveyard shift’.  And he ensured that all 17 leaders in patient safety research, delivered their presentations in less than 4 hours. Now that is a rare achievement.

Citing an (unnamed) study elsewhere in the world, we heard that 9% of clinicians wash their hands before they touch a patient in the operating room and 17% do so after they touch the patient. Enter Professor Sheldon Stone summarising the successes of the Clean Your Hands campaign – and reminding us of the rationale for the campaign - 8% of patients acquire healthcare associated infections and their mortality is six times higher. Direct contact by hand is the main route of infection and Sheldon delivered this very serious message, in an entertaining way.

Chris Fuller described HHOT – the hand hygiene observation tool and Professor George Hanna told us about the checking procedures developed by his team for naso-gastric tubes. Dr Rebecca Lawton highlighted the success and lessons learned in evaluating non-luer spinal connectors.

While risk metrices represent risk and are almost universal in healthcare, Professor John Clarkson highlighted their limitations - they lack a systematic approach. And this is why he and his team are developing a toolbox for healthcare, that will include risk assessment models and tools and a process for escalating the higher risks.

Dr Karin Lowson’s insight into single hospital rooms, was topical and revealing. Patients in single rooms are more satisfied. They are less likely to acquire infection experience medication errors during their hospital stay. That said, some patient in single rooms are more likely to die and experience depression. And the risk of an adverse event and length of stay are about the same for patients in wards and in single rooms.

Much has been said about enhancing the patient safety agenda on the curricula of healthcare professionals. And recommendations as to this an be achieved, were provided by Dr Pauline Pearson and Professor Amanda Howe.

Professor Ian Watt gave an overview of how patients can ensire that clinicians deliver safe patient care – by making sure that the treatment is appropriate for them, that the treatment is as planned and in accordance with the appropriate protocol, and identifying how the health system can be made safer.

Dr Ken Catchpole shared his line of enquiry in operating theatres and elsewhere in healthcare. And he has four key questions. Is the healthcare team’s approach consistent with achieving high standards of care. Is what they are doing acceptable for Ken and his family. Does what the team are doing have to be like this. Is this the best it can be? Simple questions, revealing answers.

And Professor Mary Dixon-Woods outlined six rules for governance in operating theatres. The organisation is geared to promote patient safety. Protocols are deployed appropriately and everyone serves their spirit. Optimum communication. Minimal distraction and interruption. Effective authority and accountability. Reporting patient safety incidents.

Professor Justin Waring is in the process of summarising the outputs from the PSRP under the broad headings of the nature of patient safety, sources of risk and safety, and identifying the future direction for research.

And Martin Fletcher was the final speaker, talking about the science of safety. The NPSA Chief Executive sees the patient safety research agenda developing by networking the researchers, funding more PhD students and running another UK patient safety research conference.
Some of the many highlights for me were hearing about the science of safety, Ken Catchpole’s approach to enquiry in patient safety, how patients can be more assertive, updating the curricula, design of hospitals and non-luer spinal connectors, prospective analysis, competency based training in naso-gastric tubes and handwashing, observing hand hygiene, the benefits and weaknesses of focusing on improving culture and CHUMS.

With many thanks to Sir Liam Donaldson, Professor Lilford, the PSRP team and all of the researchers for making this fantastic conference a reality.

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