Recommendation that patients should report incidents is welcome

THE latest report by the Bevan Commission identifies a number of priorities for the Welsh NHS in the coming years.

Many are about the way the NHS works with others – especially its potential and actual customers – but at least two are fairly and squarely addressed to the NHS itself – “make quality the pressing priority for all” and “making integration work”.

Simple?

The first of these reminds us of the recent report from the Older People’s Commissioner for Wales, Ruth Marks, on hospital care for older people in Wales.

Here are just two of the quotes contained in that report, from people who spoke to Ms Marks’ panel of inquiry: “She leant forward only inches from my mother’s face and said: ‘Listen love, I have 38 other patients to see too, you’ll have to wait’.”

And: “When asked if her pad could be changed as it was wet we were told that they could only change them after they have been wet five times as they were very expensive and were designed for this.”

There are passages in this report, which will make any reader cringe and remind one of the observation of Lord Justice Munby, the chair of the Law Commission, who said: “One reads too often for comfort accounts of conditions in various institutional settings… which are a disgrace to any country with pretensions to civilisation and which ought to shock the conscience of any decent minded person.”

Such disgraceful treatment is very rare, but how rare exactly? The truth is, we can’t be sure.

So Ruth’s recommendation that the NHS should start to ask its patients regularly about such incidents is also most welcome.

This is what making quality “the pressing priority for all” actually means. After all, the English code of conduct for NHS managers has required since 2002, that “I will… make the care and safety of patients my first concern and act to protect them from risk”.

The second injunction from the Bevan Commission – to make integration work – is a challenge of a different type.

We now have seven unified health boards in Wales, making all services in each locality accountable to the same board and chief executive.

What then can now stand in the way of getting services properly connected up, shifting the balance towards the community and closing some hospital services?

The answer, of course, is history, custom and practice, patterns of investment, fear of change and perhaps most important of all, stopping the merry-go-round so we can get off it.

Take the example of a new heart test. This could be carried out by GPs, and would significantly reduce the need to refer patients to hospital for tests. For the patient, it would mean quicker diagnosis, and for the hospital, a reduction in demand.

Good news all round, but how will it be paid for?

By a transfer of funds from the hospital budget – which will, after all, now be testing fewer patients – to the community services?

This might appear to be obvious. But for the hospital-based service, it is anything but. Already struggling to cope with all the other demands on its resources, this new test simply offers a slight respite for the cardiology staff, freeing up time to enable them to cope with all the other demands, and certainly not leaving any resources over to be transferred.

And there, in microcosm, is the problem – change of this sort often requires some pump priming, at a time when budgets are looking at 6% cuts, each year, for the next three years.

Who’d be the new health minister?

Written by Professor Marcus Longley, Director and Professor of Applied Health Policy

Reproduced from an article published in the Western Mail on Monday 27th June

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