Liberal Democrats' health policy

The Health Foundation’s response to the Liberal Democrats’ health policy consultation paper

Introduction

1.1. The Health Foundation is an independent charitable foundation working to improve the quality of healthcare across the UK. Our endowment enables us to spend at least £20 million each year to make UK healthcare the best it can be. Our programmes include leadership development, demonstration projects in healthcare organisations involving clinicians, managers and patients, commissioned research, and evaluation studies.

1.2. We welcome the opportunity to respond to the Liberal Democrats consultation on health policies. In particular, we welcome the commitment by the Liberal Democrats to :

• health services that are free at the point of delivery, funded through taxation and available to all regardless of age, disability, sex or ethnicity.
• improving the NHS by making it more responsive to the needs of patients.
• reform based on an informed vision of what changes the NHS should aim to achieve.

1.3. We have undertaken our own analysis of the challenges facing the delivery of healthcare in the 21st century. We have identified the following characteristics of healthcare delivery in developed countries:

• International research estimates that one in 10 patients in hospital experiences an incident that puts their safety at risk, and that around half of these could have been prevented.
  
• Not all patients receive the most effective and timely treatment. This causes waste in the system and leads to both the overuse and underuse of health services.
  
• There is growing evidence of poor patient experiences. Care is not always delivered in a way that is patient centred and patients are not as involved in their own health as they want to be.
  
• There is a lack of information available that can be used to identify when patients are and are not receiving high quality care. Without this information, it is difficult to know how to improve care.
  
• In addition, expenditure on healthcare continues to rise at a faster rate than growth in national income.

1.4. These problems are not inevitable and with the right skills, infrastructure and focus these issues can be addressed to improve the quality of healthcare. Furthermore, experience from other healthcare systems demonstrates that high quality healthcare is affordable (e.g. Jonkoping County, Sweden). Conversely, low quality, error-prone, less effective care is unnecessarily expensive.

2. Addressing the challenge

2.1. In addressing these problems, we think that staff locally should be given the freedom to decide how to deliver improvements to address the challenges we have identified above.

2.2. However, we think that improvements in the quality of healthcare across the UK will only be achieved if certain components are also in place nationally. This response urges the Liberal Democrats to ensure the following components are in place:

• An infrastructure to harness information about patient care
  
• Support to ensure healthcare professionals and managers have quality improvement skills
• National standards based on patient reported outcomes backed by regulation.

2.3. With these components in place we think that substantial improvements in patient care can be achieved in a way which galvanises patients, the public, healthcare professionals and managers without necessarily incurring additional cost.

3. An infrastructure to harness information about patient care

3.1. Better information about the care patients receive and the outcomes of that care is critical at a number of levels:

3.2. Nationally: Clinical outcome information is needed to provide an overview on healthcare quality, including issues relating to equity. It also allows for international comparisons. Data needs to be available by condition and risk adjusted where possible.

3.3. Commissioners: Commissioners already use activity profiling, conversion rates and data on lengths of stay to manage demand and financial pressures with providers. This should be matched with clinical outcome information about healthcare providers to support improvement and assess and manage provider quality.

3.4. Providers: Clinical outcome information is essential so clinicians and managers can take responsibility for their own services, make any necessary changes to improve them and for Boards to exercise their responsibilities.

3.5. Professional responsibility: Healthcare professionals need clinical outcome information so they can assess and improve their team’s and their own performance compared to peers and national best practice. Where outcome measures concern the actions of a single healthcare professional, they are also relevant to professional regulation and revalidation.

3.6. Patient decision-making: Patients and the public have a right to know about service quality. This information can help them make informed choices about where to go to meet their healthcare needs.

3.7. The aim should be to establish and maintain national systems for measuring clinical and patient reported outcomes for all treatments. Patient reported outcomes are already available for some surgical treatments. More work needs to be done in many areas of medicine and long term conditions. However, the experience of our ‘engaging clinicians’ programme demonstrates that healthcare professionals and patients have considerable interest in developing and using measures of clinical and patient reported outcomes for improvement.

3.8. There are a number of organisations funding national clinical quality measurement, including the Healthcare Commission, Royal Colleges and charities, though much of the funding tends to be short term, particularly from the charity sector. However, we understand that the Healthcare Commission’s support for national clinical measurement has significantly declined over the last two years, with almost no funds available for development in new areas. This is despite the significance of clinical measurement and plans in the White Paper, Trust Assurance and Safety - The Regulation of Health Professionals in the 21st Century, for clinical measurement to be a component of professional regulation.

3.9. We are therefore calling for sustainable funding mechanisms to be developed for nationally-accredited clinical measurement schemes. In our view these schemes should be governed by a partnership of the relevant stakeholders. Funding models, such as those developed in mental health, where national clinical quality measurement systems are funded by subscription, could be an option for acute and general services. These are under pressure in the current financial climate but if national standards require organisations to report on clinical outcomes this essential activity would be funded.

4. Support to ensure healthcare professionals and managers have quality improvement skills

4.1. Information about patient care needs to be coupled with support for healthcare managers and health professionals to have access to quality improvement methodologies. Our experience is that many healthcare managers and health professionals have inadequate skills and training in how to improve quality and safety and require support on how to improve. These skills include improvement methodology, systems thinking, leadership and implementation.

4.2. When clinicians and managers do have these skills we have seen significant improvements in healthcare quality, including improvements in safety, reorganisation of services to better reflect patients’ needs and more appropriate commissioning. At present there is no apparent national infrastructure for supporting providers to develop quality improvement skills. The NHS Institute of Innovation and Improvement does not have the remit to support organisations intensively in this way.

4.3. We also urge the Liberal Democrats to consider how clinicians will be engaged in improving healthcare services and how clinical leaders may be developed for the future. This is important because it is increasingly accepted that effective and engaged clinical leadership is vital if changes in clinical practice are to be systematic and sustained. We have also found that clinicians are most motivated to implement service change when they can see a direct impact on the quality of patient care.

4.4. The Government’s plans for the regulation of healthcare professionals, set out in the White Paper, Trust Assurance and Safety - The Regulation of Health Professionals in the 21st Century, contain some important developments which should also support clinical engagement in quality. For example, we are strongly supportive of the proposals to require healthcare professionals to revalidate their license to practice during their careers and for re-accreditation of specialists. We agree with the White Paper that revalidation should be formative as well as summative. This would ensure that revalidation is a vehicle for quality improvement rather than a burdensome bureaucratic exercise.

5. National standards supported by regulation

5.1. We think that it is important that minimum quality and safety standards are set at a national level. These are required to ensure equity of provision and access across the country. Currently, these standards are set by the Department of Health and are monitored by the Healthcare Commission. Patients and the public also should be assured that clinicians follow national best practice in treating and caring for patients. These standards include the National Service Frameworks, best practice established by NICE and standards of practice set out for professionals by the Royal Colleges and professional regulators like the GMC.

5.2. We think the role of the Healthcare Commission should be to assess whether healthcare providers have systems in place to monitor and act on key patient safety and quality indicators such as standardised mortality rates. Local healthcare providers would not be told how to achieve these standards, but be supported by access to tools and people who can help them improve. This would make nationally set standards meaningful and effective for improving quality.

6. Conclusion

6.1. With these national components in place we think that substantial improvements in healthcare quality can be achieved. For example, through our Safer Patients Initiative we are supporting 24 hospitals across the UK to reduce avoidable harm to patients. This initiative has an overarching objective to reduce hospital mortality rates by 50%. It then provides the hospitals with support and training for staff to develop skills in quality improvement. Within this supportive framework, frontline staff are liberated to work on their own ideas about how to change practice. The four hospitals involved in the first phase have halved their adverse event rate in just two years.

6.2. We therefore urge the Liberal Democrats to develop a national infrastructure to support quality improvement which includes:

• Clinical outcome measures at the centre of the healthcare system so patients, commissioners, providers and professionals have information that identifies when patients are and are not receiving high quality care.
• Support for people working in the healthcare system to develop skills to improve healthcare quality so that the gaps between best practice and current practice can be closed.
  
• Clear national standards and best practice to ensure equity of provision and access across the country.

7. Further information

7.1. If you would like to discuss any part of this response, please contact our Public Affairs team:

Julia Cream
Head of Public Affairs
020 7257 8029
Email Julia Cream

Zoe Ward
Public Affairs Adviser
020 7257 8051
Email Zoe Ward

James Adler
Communications Co-ordinator
020 7257 8067
Email James Adler

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