Moving beyond barriers

Monthly column for providers and professionals working in healthcare from Professor Ted Baker, chief inspector of hospitals.

The start of this month saw the publication of an important report looking at how local systems are working together. Beyond barriers, brings together our findings and key recommendations for change following the completion of 20 local authority area reviews exploring how older people move between health and adult social care services in England.

Reviewers found examples of health and care organisations working well together, and of individuals working across organisation to provide high quality care. However, they also found too much ineffective coordination of health and care services, leading to fragmented care and variation in people’s experiences.

The report sets out a number of recommendations designed to encourage improvement in the way organisations and professionals work to support older people to stay well, including:

• Reform of planning and commissioning of services. An agreed joint plan, funded I the right way, should support older people in their own homes, help them in an emergency, and then to return home safely.
• A new approach to system performance management. This would measure how organisations collectively deliver improved outcomes for older people.
• Joint workforce planning. This would allow flexible and collaborative approaches to staff skills and career paths.
• Better oversight of local system performance. New legislation so CQC could regulate how people and organisations work together to support people to stay well.

If you haven’t seen the report already, I would encourage you to take the time to read it and consider how the findings and recommendations could apply to the local system in which you operate. You can also find each of the 20 local system review reports on our website.

National review of radiology reporting

Our inspections help us make sure services are meeting fundamental standards of quality and safety, and we will take action where potential issues are brought to light through our regulatory activity. At the end of 2017, we initiated a national review of radiology reporting after inspections identified serious concerns in a small number of NHS trusts. The issues found resulted in CQC taking immediate action to protect patients, but also flagged wider concerns about delays in reporting across NHS trusts. We therefore requested data from all acute trusts in England about in order to develop a national picture about the timeliness and governance of radiology reporting.

The review found some examples of good practice; however it also identified some trusts that had a backlog of images and lengthy waiting times for patients awaiting their results. It also acknowledged that with demand for radiology services increasing, the shortage of radiologists is a contributing factor to delays and backlogs in reporting.

As a result of the review, we have made a number of recommendations aimed at reducing the risks to patients caused by increased demand and delays in reporting radiology examinations:

• NHS trust boards should ensure that they have effective oversight of radiology backlogs; risks to patients are fully assessed and managed; and staffing and other resources are used effectively to ensure examinations are reporting in an appropriate timeframe.
• The National Imaging Optimisation Delivery Board should establish national standards for report turnaround times, so that trusts can monitor and benchmark their performance.
• The Royal College of Radiologists and the Society and College of Radiographers should make sure that clear frameworks are developed to support trusts in managing turnaround times safely.

We need to act to address the challenges associated with radiology reporting and help minimise the potential risks so that patient examinations always receive a timely report by an appropriately trained healthcare professional. Those in acute trusts should read and share the report among your teams, and consider what action your organisation might need to take.

Safety — a top concern

I was pleased to speak at the national Patient Safety Conference this month in Manchester. Safety remains our top concern about services and this was an opportunity for me to highlight some of our key messages about the need to build a consistent safety culture in all services. Where we have seen this done well it has been by effective engagement and empowerment of frontline staff. Our Driving Improvement reports (acute and mental health) outline what successful organisations have told us was effective for them and I would encourage you to read them, if you have not already done so.

You may have seen that the Royal College of Physicians (RCP) has published guidance on safe medical staffing. I am supportive of this guidance as a first attempt to define what safe medical staffing looks like, and wait with interest to see how effective it is as the RCP look to pilot its use in a number of trusts.

We support the principle that staffing on hospital wards should be based on the needs of patients, which will vary according to the complexity of their conditions and support that they require. This guidance will be a useful resource to help trusts plan safe staffing requirements in a range of clinical situations.

Under the safe domain, we ask trusts to provide us with information on planned and actual staffing levels on each shift, so that we can assess any gaps. Also, we observe care delivery and look at reporting of incidents related to poor staffing. If we find that services are not as safe, caring or responsive as they should be, and if we find staffing levels are related to poor care, we will require improvements to be made in the best interests of patients.

Finally, I hope you had time to celebrate the NHS’s 70th anniversary. It was great to see so many people across the NHS and social care sharing their stories, and to see how much pride there is in the service and among those who work in it. As I mentioned last month, we have published a series of case studies celebrating the individuals who have gone over and above and made a significant impact on the care people receive. There are 70 in total, and I would encourage you to take a look if you haven’t already.

This blog is featured in the monthly bulletin for providers and professionals working in healthcare. You can sign up to receive our newsletters and bulletins on our website.