Debate continues on care quality and integration in the NHS
Elliot Bidgood, 28 May 2013
Care quality and the need for service integration continue to dominate the health news agenda. Last week in the Health Service Journal, senior advisor at MHP Health Bill Morgan wrote an incisive analysis of the new safety and quality regulations in the coalition’s new Care Bill, which I wrote about recently. He stresses that the measures “should not be underestimated simply because they pale in comparison against the bill’s provisions on social care”, but crucially makes clear his concern that the planned regulations do not entirely reflect the recommendations made by Robert Francis QC in February’s Francis Report.
Morgan is critical of the bill for splitting enforcement from inspection, both of which are currently CQC responsibilities, especially in light of Francis’s observations that bureaucratic complexity in the NHS inspectorate has in itself been a problem – Francis had written that the “structure under which the CQC is required to work is over-bureaucratic and does not separate clearly what is absolutely essential from what is merely desirable” (the Nuffield Trust echoed these concerns in its original response to Francis – “Given the complexity of current regulatory arrangements for the NHS, we propose that the Department of Health further clarifies the ways in which health providers are to be monitored and held to account for quality of care and financial management”). Second, Morgan states a concern that the government has implicitly decided that independent providers require a different, and perhaps lesser, regimen of regulatory oversight. Finally, he warns that the government bill does not, as initially reported, clearly enshrine the chief inspector role recommended by Francis, and that a clear ability on the part of the chief inspector to trigger failure regimes at failing trusts (on quality, not just financial grounds, as Jeremy Hunt has spoken of for some time) will be needed for care standards to be enforced.
Meanwhile, a study in the journal Critical Care warning about after-care for intensive care patients has highlighted another area in which the government’s planned integration of health and social care services could do some good – referring to the highlighted problems, lead researcher Dr Stephen Brett told the BBC that “A lot of this is around better communication, organising of care”. 73% of discharged intensive care patients still felt substantial pain a year later, and 44% had problems with depression. Another expert commented that “There is often little or no support for these people once discharged from hospital.” It is in instances such as this that greater cooperation between the NHS and council social care is needed, something which the Department of Health encouragingly seemed to recognise in its official statements responding to the study, pledging £859 million in funding for efforts in this direction.