Does hospital competition improve efficiency?

Does hospital competition improve efficiency? The effect of the patient choice reform in England | The Centre for Health Economics

This report examines whether the introduction of patient choice of hospital has resulted in greater efficiency by stimulating hospital competition.  The results show that competition has had mixed effects on efficiency.  Greater competition encourages hospitals to increase efficiency by increasing admissions per bed and proportion of day cases, and by reducing the proportion of untouched meals.  However, hospitals appear less efficient in terms of cancelled elective operations.

Full report: Does Hospital Competition Improve Efficiency? The Effect of the Patient Choice Reform in England

 

 

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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. 

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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

Related:

Number of NHS beds more than halved over the past 30 years

The number of NHS beds has fallen by half in 30 years, and plans for further cutbacks are “unrealistic” | The Kings Fund

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A study from The Kings Fund has found that bed numbers – including general and acute, mental illness, learning disability, maternity and day-only beds –  have dropped from 299,000 to 142,000 since 1987.  Hospitals in England now have the least number of beds for their population compared with any other country in the European Union, with just 2.3 per 1,000 people.

The report explains that this decline is in part due to factors such as an increase in care being delivered outside hospitals. It also highlights the impact of medical innovation including an increase in day-case surgery, which has also had an impact by reducing the time that many patients spend in hospital.

The report however warns that there are signs of a growing shortage of beds. In 2016/17, overnight general and acute bed occupancy averaged 90.3 per cent, and regularly exceeded 95 per cent in winter, well above the level many consider safe. The authors state that in this context, proposals put forward in some sustainability and transformation plans to deliver significant reductions in the number of beds are unrealistic.

Full report: NHS hospital bed numbers: past, present, future

Dementia training programmes for staff working in general hospital settings

Although literature describing and evaluating training programmes in hospital settings increased in recent years, there are no reviews that summarise these programmes | Aging & Mental Health 

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Objectives: This review sought to address this, by collecting the current evidence on dementia training programmes directed to staff working in general hospitals.

Results: Fourteen peer-reviewed studies were identified with the majority being pre-test post-test investigations. No randomised controlled trials were found. Methodological quality was variable with selection bias being the major limitation. There was a great variability in the development and mode of delivery although, interdisciplinary ward based, tailor-made, short sessions using experiential and active learning were the most utilised. The majority of the studies mainly evaluated learning, with few studies evaluating changes in staff behaviour/practices and patients’ outcomes.

Conclusion: This review indicates that high quality studies are needed that especially evaluate staff behaviours and patient outcomes and their sustainability over time. It also highlights measures that could be used to develop and deliver training programmes in hospital settings.

Full reference: Scerri, A. et al. (2017) Dementia training programmes for staff working in general hospital settings – a systematic review of the literature. Aging & Mental Health. Vol. 21 (no. 8) pp.783-796

NHS acute hospitals report

The Care Quality Commission has published The state of care in NHS acute hospitals: 2014 to 2016: findings from the end of CQC’s programme of NHS acute comprehensive inspections.

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

The report has been derived from three years’ worth of CHC inspections into the quality of care being provided by NHS acute hospitals. It finds that most hospitals are delivering good quality care and looking after patients well, however, some trusts have blind spots about the quality of care they are delivering in a particular core service, even in some trusts rated good overall.

Related: CQC right to say care is at risk due to unprecedented pressure on hospitals | NHS Providers

NHS Indicators: England, January 2017

The House of Commons library has published NHS Indicators: England, January 2017.

The full briefing paper looks at trends in the following areas:

  • Accident & Emergency attendance and performance
  • Ambulance demand and response times
  • Waiting times and waiting lists for routine treatment
  • Waiting times for cancer diagnosis and treatment
  • Cancelled operations
  • Delayed discharges and transfers of care
  • Diagnostic waiting times and activity
  • Waiting times for mental health treatment
  • Workforce numbers for doctors, nurses and other staff
  • Hospital activity, referrals and admissions
  • Bed availability and occupancy

Access the full report here

Royal College of Physicians: ‘Quality of patient care threatened’

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Members of the Council of the Royal College of Physicians (RCP) have  written to the prime minister, Theresa May MP, to set out their concerns about the capacity and resources needed to meet the demands on the NHS.

The letter was signed by RCP president Professor Jane Dacre and 49 members of Council, representing 33,000 doctors across 30 specialties as well as 750 physician associates.

They say in their letter that the increase in patient need is outpacing the resources available, that services are ‘too often paralysed by spiralling demand to transform and modernise’, hospitals are ‘over-full, with too few qualified staff’ and services are ‘struggling or failing to cope’, and there are ‘increasing reports of staff contemplating the sad decision to leave the NHS’.

The Council members say that ‘current investment levels are not sufficient to meet current or future patient needs’ and the immediate actions needed are ‘the reinvigoration of social care services and urgent capital investment in infrastructure’.