“Recipe for chaos”: Will Lansley”s 60-step NHS plan save 10,000 lives a year
Sixty indicators to replace old target-led system
Focus will be on improving cancer survival with a zero-tolerance approach to hospital infections such as MRSA
Benchmarks: Andrew Lansley, the Health Secretary, wants NHS doctors and hospitals to be graded
Andrew Lansley was yesterday accused of creating a ‘recipe for chaos’ after introducing more than 60 performance goals despite a previous promise to scrap targets.
The Health Secretary unveiled a series of benchmarks – designed to save more than 10,000 lives, and that he claims will measure whether patient care is improving by covering a range of treatments across the NHS.
When Mr Lansley took over as health secretary last year he promised to ‘free’ the NHS from unnecessary targets to enable doctors to concentrate more on patient care.
He abolished a series of goals brought in by Labour, including the four-hour wait in A&E.
And he has insisted that his new measures are different as they focus on patient results.
In a speech at Guy’s hospital in Central London yesterday, Mr Lansley promised to ‘dispense with the jargon’, adding: ‘We make it clear that the NHS has one ambition and one ambition alone – improving results for patients.’
However Labour health spokesman Andy Burnham said: ‘Doctors and nurses will roll their eyes in sheer disbelief at this news. This is inept and no way to run the NHS. It’s a recipe for complexity and chaos when the NHS needs to be allowed to get on with the job.’
Figures on hospital death rates, the performances of GPs and surgeons and patients’ experiences will be published as part of the NHS Outcomes Framework.
REFORMS STILL CAUSING CHAOS, SAY DOCTORS
The Government”s reforms of the NHS “continue to cause chaos” on the ground, doctors leaders said today.
The British Medical Association (BMA), which opposes the Health and Social Care Bill in its entirety, said changes taking place now before legislation has even been passed are “chaotic and poorly co-ordinated”.
Groups of GPs have been told they must form groups to determine how the NHS budget is spent but, according to the BMA, they are being told they are too small.
Dr Hamish Meldrum, chairman of the BMA, said: “There has been a growing level of unease about how the reforms are panning out – we hear repeatedconcerns from doctors about mounting chaos on the ground.
“For example, clinical commissioning groups (CCGs), that had initially been told they”d have freedom to form to suit their local communities, are now being told they”re too small and have to re-form.
“People are still unclear how primary care will be managed as we don”t yet know where staff currently working in primary care trust “clusters” will eventually be based or if they”ll have jobs at all.
“Even at this stage, there are still unanswered questions about what statutory functions some bodies will have, making planning very difficult.
“Guidance is being issued that is overly restrictive and more and more bureaucracy is being created to try to deal with issues which should have been dealt with at the beginning.
“A huge amount of time, energy, money and commitment has been wasted because of a lack of a clear plan from the outset.”
The sixty indicators will replace the former target-led system and will include a focus on improving cancer survival and a zero-tolerance approach to hospital-acquired infections such as MRSA.
The plans are designed to ensure patients are treated with dignity by measuring the ‘responsiveness’ of staff to patient needs.
They aim to improve women’s and families’ experiences of maternity services, increase the number of people who can access an NHS dentist and help older people recover independence after illness.
Under the plans, fewer people with long-term conditions like asthma and diabetes will be treated in hospitals, and patients undergoing hip and knee operations will receive better care.
An indicator on carers who look after sick and elderly relatives is also included.
Mr Lansley said: ‘We have to clear the decks and be clear this is what we are focusing on.
‘People say in three and a half years’time, in 2015, at the next election, how will we know whether you’ve succeeded or not The answer is, “Have the outcomes improved”
‘It will be my failure if we haven’t improved them and the NHS should feel that it has not succeeded, that iswhat we are setting out to do.’
The Government will publish details ofthe current performance for each of the sixty benchmarks next week. National targets from improvement will then be set out by the time of the next election.
Today, the Government will publish forthe first time data comparing patients” experiences at individual GPs” surgeries, including recovery times.
It is hoped that revealing the information will force up standards by allowing patients to choose to avoid poorly performing doctors or institutions.
Where performance falls below minimum requirements the NHS Commissioning Board and Care Quality Commission will intervene to drive up quality, although how this will work in practice is unclear.
The aim of the plan is also to move away from a focus on targets, such as those for waiting times introduced under Labour.
However, patients will still have the right to prompt treatment within 18 weeks of referral by their GP as setout in the NHS Constitution.
Held to account: Nurses and other NHS staff will be judged against nearly 60 tough new goals designed to save more than 20,000 lives a year
Mr Lansley hopes the framework will also provide reassurance to parliamentarians about the accountability ofthe Health Secretary for the NHS.
There have been concerns that the Health and Social Care Bill, currently going through the Lords, dramatically weakens accountability of the secretary of state.
Mr Lansley also hopes the plan will provide a much greater level of NHS accountability by allowing better comparison with other health systems around the world.
The NHS has been criticised for lagging behind other countries in areas such as cancer survival.
Ministers will be expected hold the health service to account on delivering increasing improvements across all areas in the new framework.
Where performance falls below minimum requirements they will intervene to drive up quality, although how this will work in practice is as yet unclear.
The framework will also draw on existing information collected about the NHS to reduce the potential for”administrative burden”.
THE 60 INDICATORS FOR PATIENT OUTCOMES
1. Numbers of extra years that, on average, a person could have lived if given access to timely and effective health care.
2-3. Life expectancy at 75, for men and women.
4-7. Mortality rates in under-75s from cardiovascular disease, respiratory disease, liver disease and cancer.
8-13. One and five-year survival rates for colorectal (bowel), breast and lung cancer.
14. Mortality rate in under-75s, above the normal, in adults with serious mental illness.
15-17. Rates of infant mortality, neonatal mortality and stillbirths.
18. Mortality rate in under-75s, above the normal, in adults with learning disabilities.
QUALITY OF LIFE FOR PEOPLE WITH LONG-TERM CONDITIONS
19. Health-related quality of life for people with long-term conditions.
20. Proportion of people feeling supported to manage their condition.
21. Employment of people with long-term conditions.
22-26. Unplanned hospital admissionsin adults with conditions like asthma, diabetes, epilepsy, congestive heart failure and chronic obstructive pulmonary disease.
27-29. Unplanned hospitalisation for asthma, diabetes and epilepsy in under-19s.
30. The health-related quality of life for carers.
31. Employment of people with mental illness.
32. Quality of life for people with dementia.
HELPING PEOPLE RECOVER AFTER ILL HEALTH OR INJURY
33. Emergency hospital admissions for acute conditions (ie, injury or sudden onset of ill health) that should not usually require hospital admission.
34. Emergency readmissions to hospital within 30 days of discharge.
35-37. Health improvements following pre-planned operations for hip and knee replacements, groin hernia, and varicose veins.
38. Numbers of children who have to be admitted to hospital due to very bad chest (lower respiratory tract) infections.
39. Degree of recovery from injuries and trauma.
40 Degree of recovery six months after a stroke.
41. Degree of recovery after brittle-bone fractures, namely the proportion recovering previous levels of mobility after 30 days and 120 days.
42. Proportion of over-65s still at home 91 days after being discharged.
43. Proportion of over-65s offered rehabilitation after discharge from general or community hospital.
44. Patient experience of GP services; GP out-of-hours services; NHS dental services; hospital care (overarching indicators).
45. Patient experience of outpatient services.
46. How well hospitals respond to in-patients” personal needs (ie, basic care such as help with eating and going to the toilet).
47. Patient experience of A&E.
48. Ease of access to GP services and NHS dental services.
49. Women”s experience of maternity services.
50. A measure of the experience of end-of-life care (by asking bereaved carers).
51. Patient experience of community mental health services.
52. Children”s/young people”s experience of health care.
TREATING PEOPLE SAFELY
53. Reported patient safety incidents.
54. Safety incidents involving severe harm or death.
55. Incidence of hospital-related venous thromboembolism (VTE), a type of serious blood clot.
56. Incidence of health care-associated MRSA and Clostridium difficile infection.
57. Incidence of serious pressure ulcers, often acquired due to staying in hospital beds and not being moved often enough.
58. Incidence of medication errors causing serious harm.
59. Admission of full-term babies to neonatal care.
60. Incidence of harm to children due to “failure to monitor” their condition.