Focus on… ensuring quality in acute trusts
This month we look at how clinical commissioners can reassure themselves about the quality of care their local hospital provides. Practical Commissioning editor Sue McNulty looks at the new role for GPs asquality overseers
There is probably at least one hospital in the NHS right now with standards akin to those uncovered in the Mid Staffs scandal. Or if not a whole acute trust, then at least an individual hospital department where patients are dying needlessly.
As Tom Kark QC said in his summing-up of the Mid Staffs public inquiry in December, it would be dangerous to think, as the Department of Health apparently does, that Mid Staffs was an isolated example.
A joint survey, published this week by Practical Commissioning and its sister magazine Pulse, shows a third of GPs have raised concerns about the standard of care in their local hospital in the last year. Some 9% of respondents in provisional results admit to a patient having died potentially as the result of sub-standard care from their hospital in the last year.
The most worrying finding, however, is that only 40% of GPs felt that if they raised concerns with a hospital, they would be properly investigated.
This question perhaps helps provide the answer to former health secretary Andy Burnham's cry when giving evidence to the latest inquiry of ‘puzzlement' at why GPs did not raise concerns. They were not part of the system, they probably didn't feel they would be listened to and they got on with doing the best for their patients within the GP consulting room. Even the consultants within the hospital were significantly disengaged from the trust management, so one has to ask – what chance did the GPs have of challenging inadequate care?
This lack of challenge in Mid Staffs is at the heart of what went wrong. Staff turnover, normally a sign of a high-quality organisation, was very low at Mid Staffs, and therein lay the problem – a culture of poor care went unchallenged.
In the future, GPs must not only move from gatekeeper to co-ordinators of care, they must become the eyes and ears of the care pathway their patients are sent on.
I have met GP commissioners who are seeking the information they need from their acute trust now to gain an accurate picture of quality, but are told it won't be ready for six months. In our first feature, we describe existing tools and sources that can help GP commissioners draw together their own picture of the quality being provided by their acute trust .
The lessons from Mid Staffs feature also highlights the importance of ‘soft' information – complaints, staff surveys, and what patients tell their GP about their hospital experience.
If true quality is to be achieved in the NHS, CCGs will need to move beyond the payroll/contract role PCTs attempted to occupy and move to a strategic level to raise quality.
Dr Judith Smith of the Nuffield Trust gives a overview of three areas that have attempted to make such a change.
Finally, one hopes GPs – even the ones not the keenest on commissioning – will now feel the vacuum of inaction on their quality concerns might be filled by the CCG.
And will CCGs pick up this baton? A letter GPs in the Great Yarmouth and Waveney area sent to their local MP recently gives hope: ‘Our new CCG will be depending on the trust to provide the acute care for most of our patients and we have lost confidence in the ability of its leadership to correct its current failings. Please act quickly before we have another Mid Staffs on our hands.'