Policy Exchange has called for the adoption of hospital standardised mortality rates as an indicator of performance after a series of international reports slammed hospital regulation in the UK.
These reports, obtained by the think tank under the Freedom of Information Act, were prepared for the Department of Health in 2008 on the marriage of the health and social care regulators to create one regulatory entity, but they do not paint a pretty picture of the current system of National Health Service regulation and indicate that its failings have contributed to patient deaths.
According to Policy Exchange, all three are strongly critical of the “flawed system of self-reported hospital inspection and oversight”, and more than one reference is made to the “pervasive culture of fear in the NHS” as a barrier to improvement.
Furthermore, patient safety assessments are inadequate because of a lack of necessary clinical data, they warn, and according to one of the reports, in terms of patient safety and care “quality means meeting the targets”, the think tank said.
Quality Oversight in England, a report commissioned by world leaders in health care quality and patient safety the Joint Commission International (JCI), also noted that onsite evaluation of hospitals’ compliance with standards was “light-handed”, that there is no guidance from the DH to support performance improvement, and that two thirds of regulators’ assessments differed from the self assessments made by the hospitals themselves.
A report by not-for-profit group the Institute for Healthcare Improvement, Achieving the Vision of Excellence in Quality, claimed that the NHS “has developed a widespread culture more of fear and compliance, than of learning, innovation and enthusiastic participation in improvement”. Furthermore, it stressed: “Most targets and standards appear to be defined in professional, organisational and political terms, not in terms of patients’ experiences of care”.
And Developing, Disseminating and Assessing Standards in the National Health Service, the final report by RAND, also a not-for-profit organisation, pointed out that because the National Institute for Health and Clinical Excellence’s technology appraisals are part of core standards while clinical guidance is part of developmental standards, “these standards reinforced the concern that the DH is more interested in costs than clinical quality”.
In addition, with regards to the current method of hospital regulation, it noted that the declarations made by trusts on their performance against standards “were viewed with suspicion by outside observers”, placing a further question mark over the validity of self-assessment as a means of keeping check on performance.
According to Henry Featherstone, Head of the Health & Social Care Unit at Policy Exchange: “The reports detail a frightening catalogue of flaws in patient safety procedures – and government has dragged its feet over implementing a robust system of inspection and improvement, even after these flaws have been highlighted in the strongest possible terms”.
Thousands of lives could be saved
“Under a proper system of inspection and oversight, coupled with a continual process of performance improvement hundreds, if not thousands, of lives would be saved,” he said. “It has long been known that publishing patient outcome date can achieve this – as is borne out by experience around the world,” he argued, and called for the DH to “urgently move towards adopting hospital standardised mortality rates as a means of raising standards in patient safety”.
But spokesperson for the Department of Health told PharmaTimes UK News that England is one of the world leaders in the international drive to improve the safety of healthcare. “Adverse incidents are reported by trusts and analysed by the National Patient Safety Agency to ensure national learning. NPSA publishes summaries of the data on incidents every three months and this includes incidents that resulted in death”.
However, “it is sometimes difficult to identify which deaths are preventable when patients are already very ill,” she said, and stressed: “We encourage the reporting of all incidents to help improve our knowledge of all risks to patients that may be avoidable [and] work alongside the National Patient Safety Agency to encourage medical staff to report and learn from incidents even when no harm was caused to the patient”.
