“Quality” is the latest buzzword in the National Health Service. Not content with all its existing performance measures showing how well – or not – the NHS is meeting various targets, the Department of Health has introduced “Quality Accounts”. Every trust, including hospital trusts and primary care trusts, has to produce its first Quality Account in June outlining what it has done to improve quality of care for patients.
To support this latest initiative, the DH insisted each strategic health authority had to set up a formal “Quality Observatory” to help trusts meet as many of the 200 indicators for quality improvement as they can.
No one can deny that quality and safety should be top of the NHS agenda. The Department of Health was rightly praised when it published its report High Quality Care for All in November 2008.
But does it really need all the overwhelming bureaucracy, red tape, paperwork and, of course, the accompanying extra staff and extra costs? Does the NHS really need
more performance indicators, priorities and frameworks?
Why can’t the DH simply rely on doctors, nurses and other healthcare staff to provide the best quality care and make the necessary improvements where and when necessary?
Its “vision” (a DH expression, not mine) of making quality improvement the organising principle of the NHS seemed a good one, especially as this was supported by the statement that: “Improvements in quality are led and delivered by teams of health professionals and supporting staff, working together as part of a whole system.”
It appeared that the doctors and clinical teams on the frontline would be able to show the way towards the provision of better quality care. They would be able to concentrate on doing their best for their patients rather than ticking boxes and meeting targets.
But the target-obsessed DH could not leave it at that and insisted that these improvements had to be officially measured. You can’t be providing better patient care unless you measure the how, why and wherefore with statistics, tables and complex data. Apparently, according to DH evidence,
high-performing teams are characterised
by the use of measurement to support improvement.
And so, alongside High Quality Care for All, came Measuring for Quality Improvement, which placed “a particular emphasis on the need to measure what we do as a basis for transforming quality”. And along with that came instructions to staff
that they should consistently measure what they do.
But it obviously needed more staff to make these measurements and write the quality accounts. No wonder management figures in the NHS are soaring. The latest official figures from the British Medical Association show that, since 1995, the number of senior managers in the NHS has increased by 91 per cent compared with a 35 per cent rise in doctors and nurses combined.
Only this week, NHS London, the strategic health authority for the capital, is advertising for an “Assistant Director – Clinical Improvement”. It is looking for “someone to head up the Clinical Improvement Team for the Clinical and Health Intelligence Directorate, accountable for delivery of London’s Quality Observatory”. The job will involve “developing a Patient Safety and Clinical Quality Strategy and a Governance Structure for Quality”. The annual salary is up to £101,413. I hope the successful applicant understands that explanation of what they are responsible for.
He, or she, will work with the “Clinical and Health Intelligence Directorate’s Clinical Director” – another new job advertised a week ago. The annual salary not disclosed, except for it being an “attractive package”, applicants must be “entrepreneurial, self-confident and self-motivated individuals and action-orientated team players”.
Both positions come under the auspices of Commissioning Support for London, a new quango formed last year to provide clinical and business support to NHS commissioners across London. Or, according to its website, “a new enterprise with a fascinating agenda”.
It is worth noting that this new enterprise and the many non-clinical jobs and finances needed to run it were unnecessary before the DH commercialised the health service and became fixated with the market, and the NHS was split into commissioners and providers. It’s a typical waste of resources.
As if there are not enough market-led rules and regulations in the NHS, those “healthcare providers” (hospitals to you and me) who don’t do what the DH wants in regards to improving quality will be financially penalised. The Commissioning for Quality and Innovation (CQUIN) payment framework means a percentage of payment will be based on meeting quality improvement and innovation goals.
Repeat these commissioning support services, clinical and health intelligence directorates and clinical improvement teams all over the country and we are talking of hundreds of new jobs and many thousands of pounds. And this is at a time when the NHS has been warned that it will have to deliver between £15 billion and £20 billion in efficiency savings over three years from 2011 to 2014.
Sadly, there are some hospitals and some areas of the country where quality is better than others and it is right and proper that information about these gold-standard care packages is spread throughout the NHS. But there must be a better way of sharing information that will improve quality and efficiency of care than all this gobbledygook – which must be confusing to trust managers, let alone medical staff.
Money and staff, which are urgently needed on the frontline, are being swallowed up in a bureaucratic black hole. Surely having more doctors and nurses to treat patients is a better way of improving quality of care than employing number crunchers to write quality improvement reports?
