Accountable care

Accountable care: policy fad or step forward on the journey towards integrated care? | Nicola Walsh |The Kings Fund

Accountable care is under discussion almost everywhere in the NHS. Groups of NHS providers (sometimes with the local commissioner) are exploring how they can work more closely together to take on the responsibility for the health and care of a given population within a given budget. Currently, we are seeing emerging accountable care arrangements adopting various forms according to local needs and preferences: in some areas the focus is on creating a single organisation; in others, organisations are keen to use the words ‘system’ or ‘partnership’ – to reinforce the notion of working together.

In this Kings Fund blog, Nicola Walsh looks in more detail at Accountable Care Systems and partnerships.

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Care Quality Commission regulating health and social care

Care Quality Commission regulating health and social care | The National Audit Office .

The report found that the Commission has completed its inspection and rating programme comprising more than 28,000 provider locations, which provides a benchmark of the quality of health and social care services. It has significantly reduced staff vacancies and is increasing its focus on cost savings. In addition, the Commission has improved how it measures its performance, and takes action to correct poor performance.

The report found that the Commission can secure further improvement, if it continues its current direction of travel. Its main challenge now is to develop its digital systems and capabilities to support its move to a more intelligence driven and risk based approach to regulation.

CQC State of Care report

State of Care is the Care Quality Commission’s annual assessment of health and social care in England. The report looks at the trends, highlights examples of good and outstanding care, and identifies factors that maintain high-quality care.

This year’s report shows that the quality of care has been maintained despite a number of challenges. Most people are receiving good, safe care and many services that were previously rated inadequate have made the necessary changes and improved.

The CQC stress that the fact that quality has been maintained in the face of a number of challenges is testament to the hard work and dedication of staff and leaders. However, as the system continues to struggle with increasingly complex demand, access and cost, future quality is precarious.

The report makes the following points:

  • Health and care services are at full stretch
  • Care providers are under pressure and staff resilience is not inexhaustible
  • The quality of care across England is mostly good
  • Quality has improved overall, but there is too much variation and some services have deteriorated
  • To put people first, there must be more local collaboration and joined-up care

 

See also Health Foundation response to CQC State of Care Report

 

STP governance arrangements

The Healthcare Financial Management Association (HFMA) has published Sustainability and transformation partnerships: developing robust governance arrangements.

This document examines governance arrangements within Sustainability and Transformation Partnerships, accountable care systems and new models of care. It includes a diagnostic tool which can help highlight where robust arrangements are already in place and where more work is required.

Quality improvement

Making the case for quality improvement: lessons for NHS boards and leaders | The King’s Fund | The Health Foundation

This briefing outlines the following ten lessons for NHS leaders which provide a starting point for those seeking to embed quality improvement in their work:

  • Make quality improvement a leadership priority for boards.
  • Share responsibility for quality improvement with leaders at all levels.
  • Don’t look for magic bullets or quick fixes.
  • Develop the skills and capabilities for improvement.
  • Have a consistent and coherent approach to quality improvement.
  • Use data effectively.
  • Focus on relationships and culture.
  • Enable and support frontline staff to engage in quality improvement.
  • Involve patients, service users and carers.
  • Work as a system.

The briefing makes the case for quality improvement to be at the heart of local plans for redesigning NHS services.

Full report available here

NHS staff shortages are compromising patient care

New report from the Royal College of Nursing calls for urgent review of Nurse staffing levels to ensure patient safety this winter. 

rcn

Image source: http://www.rcn.org.uk

The Royal College of Nursing (RCN) has today published a report, Safe and Effective Staffing: Nursing Against the Odds which shows the results of a recent staff survey. The survey, carried out in May 2017  reveals more than half (55%) say shifts did not have the level of nurses planned, and that shortages were compromising patient care (53% ).

Nursing staff in all four UK countries were asked about staffing levels on their most recent shift and the quality of care provided. More than a third (36%) report having to leave elements of patient care undone due to a lack of time, while two thirds (65%) work an unpaid extra hour on average.

Seven in 10 nurses (71%) in England said their last daytime shift exceeded NICE guidelines, which states that more than eight patients to one nurse should act as a ‘red flag’. A quarter (26%) reported shifts with 14 or more patients per nurse.

The respondents also reported that:

  • patients are no longer afforded enough dignity, even dying alone;
  • colleagues have burned out and have become sick themselves, unable to come to work;
  • staff leave work “sobbing” at the impact of shortages on patient care;
  • many question their future in nursing and contemplate leaving the profession;
  • they struggle to give their children and families enough support after shifts that can exceed 12 hours.

Full report: Safe and Effective Staffing: Nursing Against the Odds

Royal College of Nursing: Urgent action needed to tackle staffing crisis

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