Tag: 2012

Below is the text of the speech made by the Secretary of State for Health, Jeremy Hunt, to the King’s Fund on 28th November 2012.

Our health and social care system faces many challenges and we rightly have lively political debates about all aspects of health policy.

But sometimes problems are so deep-seated that when they surface no one really believes they can be solved. Or even worse, we stop noticing these problems because they have become so much part of the fabric.

And then you have to defeat the defeatism as well as dealing with the issue itself.

1. The normalisation of cruelty

Today I want to talk about one such problem, perhaps the biggest problem of all facing the NHS.

The crisis in standards of care that exist in parts of the health and social care system.

Just look at what has come to light in the last few years:

• Patients left to lie in their own excrement in Stafford Hospital, with members of the public taking soiled sheets home to wash because they didn’t believe the hospital would do it.

• The man with dementia who was supposed to be monitored every 15 minutes who managed to leave a Pontypool hospital and drown;

• The residents kicked, punched, humiliated, dragged by their hair, forced through cold showers at Winterbourne View.

• The elderly woman with dementia repeatedly punched and slapped at Ash Court care home.

• The cancer patient at St George’s, Tooting, who lost a third of his body fluid, desperately ringing the police for help, because staff didn’t listen or check his medical records.

Isolated incidents? Well, sadly not. But as well as the depressing regularity of these stories, the most worrying thing is the fact that in certain institutions this kind of care seems to have  become “normal.”

In places that should be devoted to patients, where compassion should be uppermost, we find its very opposite: a coldness, resentment, indifference, even contempt.

Go deeper, and look at the worst cases – like Mid-Staffs and Winterbourne View – then there is something even darker. A kind of normalisation of cruelty, where the unacceptable is legitimised and the callous becomes mundane.

There’s a simple test every layer of the health and social care system should be applying. And that is to ask: is this the care I would wish for myself, or for a loved-one?

Care as you would wish to be cared for. In Winterbourne, in mid-Staffs, in Pontypool, Tooting, Ash Court, this principle was utterly and horribly abandoned.

2. Betrayal of the majority

It’s really important to stress that this is not the picture in most of the NHS or social care system. But the outstanding care that you see in so many institutions – even those under severe financial pressure  – shows why we must face these cases with anger, and not with resignation.

Because they betray the outstanding men and woman who have given their lives to the NHS and caring professions – and who make this job for me the biggest privilege of my life.

People like the nurse I met at St Thomas’ who was looking after a terminally-ill patient who had lost touch with his family 20 years earlier. This nurse looked the family up on Google and arranged to fly the patient back to Ireland so he could spend his last two weeks reunited with them.

The Care Home Manager at Rathmore House in Swiss Cottage, caring for people with advanced dementia.  The manager who lives every day just to try to get a smile out of patients with advanced dementia even though, she says, they won’t remember the next day.

The GP who works 15 hour days trying to work out care plans to stop her frail elderly patients being unnecessarily admitted to A & E.

So many people represent NHS values at their finest. In every fibre of their body, they care as they’d wish to be cared for. And they are the ones most let down when we fail to tackle poor care head on.

3. Why good care matters

Nor should we make a false dichotomy between good treatment and good care. The King’s Fund, generously hosting us today,  has always championed a rigorous evidence-based approach to healthcare issues. They know good care directly supports good outcomes.

Veena Raleigh’s work for the Kings Fund this month showed the link between good care and good outcomes across GP practices, what she described as a “strong association” between patient satisfaction and clinical performance on the Quality and Outcomes Framework.

Consistent with this, a Lancet study in 2001 concluded that doctors who adopt a warm, friendly, and reassuring manner are more effective than those who don’t.

And the Commission on Improving Dignity in Care has shown that when elderly people are not treated with compassion and respect this can affect their recovery, even if the clinical treatment itself is excellent.

The argument is clear: good care means healthier patients and stronger balance sheets – yet too often the message isn’t hitting home.

4. Stronger accountability from managers

So what are the solutions?

Let’s start at the top. We urgently need to strengthen corporate and managerial accountability for the care provided.

Yet too often managers have seen their priority as financial or clinical outputs. Incentives in the system have driven people to focus on quantitative input measures rather than the basic human right to be looked after with dignity and respect.

Most managers get this – indeed their passion for the highest standards of care is why they have chosen to become managers in the NHS or care sector. But too many do not. Buried in spreadsheets, they become blind to the realities of what’s happening day-on-day inside their organisations.

It’s this whole culture of ticking the box, but missing the point which is what we have to put right.

And we have to be much clearer about the consequences that will follow if leaders fail to lead, and fail to drive high quality care throughout the organisation.

Just as a manager wouldn’t expect to keep their job if they lost control of finances, why should they if they lose control of care?

The same is true for owners and Boards of companies. Accountability must stretch to the top. And when we publish our response to Winterbourne View we will set out in detail how we intend to achieve this.

5. Greater transparency

Secondly, we need to know much more quickly where the problems are.

Next year we will roll out the “friends and family” test across the NHS. For the first time hospital users will be asked if they would recommend the care they received to a friend or close member of their family. NHS staff will also continue to be asked anonymously whether they would recommend their organisation to their own families.

This is the closest measure we can get to “care as you would wish to be cared for”. And we will publish the results.

So that’s a very important first step. But we need to do much more.

As an MP I know how well each school in my constituency is doing thanks to independent and thorough Ofsted inspections. But I do not know the same about hospitals and care homes.

Given the scale of the problems we’re uncovering, it’s now clear we need to have a proper independent ratings system.  It is not acceptable to deprive the public of the vital information they need, or remove the pressure for constant, relentless improvement in standards.

I am not advocating a return to the old ‘star ratings’ but the principle that there should be an easy to understand, independent and expert assessment of how well somewhere is doing relative to its peers must be right.

So this week I have asked for an independent study to be done as to how this might be achieved in a way that does not increase  bureaucracy.

I want to see a system that will provide – like Ofsted does for schools – clear, simple results that patients and the public can understand;

That will be – like Ofsted – an engine for improvement, driving organisations to excel rather than just cover the basics;

A system that gives greater certainty that poor care gets spotted and addressed before standards collapse.

When I receive the results of that study, I will consider it carefully alongside the Mid Staffs report from Robert Francis. I will then announce to Parliament how we intend to resolve this issue.

6. Better training

The final and equally important side to all of this is staff development. The King’s Fund and many others have shown that staff who feel engaged and valued in an open and supportive working environment deliver better care and support for patients.

And yet in these highly charged, busy, stressful environments, too many are left ‘not waving but drowning’, cut adrift from the help they need to do their jobs well.

And again the consequences can be profound. One well-respected study from 2006 found that hospitals with better supported staff provided better care and had lower mortality rates.

An incredibly powerful finding, which shows that a lack of staff support, ultimately impacts on patients’ survival chances.

Staff in healthy organisational cultures, given the space to process the difficult emotions that caring throws up, will provide better, safer care.

So what is in train to support them?

New standards for senior managers issued by the Council for Healthcare Regulatory Excellence – echoing the need for respect, compassion and care for patients at the heart of leadership and governance.

A leadership qualities framework for adult social care published by my department which will do a similar job for care organisations

Next week, we have the launch of the new Vision for Nurses, midwives and care staff following the £40m in leadership development programmes for nurses, midwives and registered care home managers announced by the Prime Minister in October.

Next month – the establishment of the Professional Standards Authority to make sure the professional regulators do their jobs and protect the public effectively; and the beginning of a new era of medical revalidation, making our systems the best in the world for supporting doctors and ensuring standards;

And then early next year – the first ever national set of standards and a code of conduct of conduct for health and social care support workers are published.

All of this is underpinned by:

an NHS Mandate explicitly saying quality of care should get the same attention as quality of treatment, and emphasising the pledges to staff in the NHS Constitution

And a new organisation – Health Education England – entirely focused on the education, training and development of the health workforce.

7. Addressing the challenges

So a lot is happening. Of course there will be those looking at this and saying “Can we really do it?”; “Is it realistic to expect organisations to invest more in people and in the quality of care at a time when money is so tight?”

There are indeed financial pressures in a period of rising demand and flat budgets.  But as the CQC said last week, most Trusts and care homes deliver excellent care despite a tough financial environment. So there is absolutely no excuse for those that do not.

But it is also wrong to equate better care with more money. More accurate would be to say what today’s Kings Fund report states plainly: it is bad care that costs more – including the £1.4 billion spent on unnecessary emergency admissions.

What about staffing levels and in particular the reduction in nursing numbers?

As people stay in hospital for shorter periods, and indeed 80% of hospital appointments now do not involve an overnight stay, patterns of care change.

But if quality of care is really to be as important as quality of treatment we should be clear that changes to workforce numbers must not compromise the care provided.

8. Conclusion: widening the circle of compassion

In surveying the broad sweep of the universe, Einstein once spoke of people shedding their individual perspectives and ‘widening the circle of compassion’ if humanity was to progress.

In the health and social care universe, which can be every bit as unpredictable and complex as the world around it, the same message rings true.

In its sixty-fifth year, pitted against its biggest ever challenges, we need an NHS that is always searching, always improving, always striving to do more for patients.

We take for granted improvements in medicine, in surgery, indeed in life expectancy. But none of this is real progress unless we are also treating our citizens with the dignity and respect they deserve.

Widening the circle of compassion. Denormalising the unacceptable in those rarer cases. And living the principle of care as you would wish to be cared for everywhere.

The founding ideals of the NHS expect no less.

Below is the text of a speech made by the Secretary of State for Health, Jeremy Hunt, to NCAS on 25th October 2012.

Thank you Sarah [Pickup, President of ADASS].

The importance of local authorities

I think it’s appropriate that the very first speech I give as Health Secretary – the first beyond the confines of the Conservative Party conference – is not to an audience of doctors or nurses, but to local authorities.

The word I have heard more often than perhaps any other in my first month is “integration.” Our National Health Service is an extraordinary organisation of which we are all deeply proud.  But by itself, it’s not enough.

And given the challenges of an ageing population, our single most important partner is without question local authorities. The success or failure of health and care very simply rests on the success or failure of my relationship with you – and in particular the progress we make together towards building a sustainable system.

Dilnot

So before I go any further, let me talk about funding.

How we pay for social care – both as a government and as individuals – is one of the big questions of our generation.

The current system is entirely inadequate.

It’s not sufficient, it’s not sustainable and it can be deeply painful for many, many people.

Forcing them to sell the home they have lived in, had children in, made so many memories in.  It’s one of the worst things about being old in this country.

So I am so proud that next year’s Care and Support Bill will introduce deferred payments meaning that no one is forced to sell their home in their lifetime to pay for care.

A historic change.  But we need to go further in three areas in particular.

Firstly the Dilnot cap, which we strongly support and are committed to introducing as soon as we are financially able. We need to build a society where it is as normal to make provision for your social care as it is for your pension – and until we do so we will never have a truly sustainable system.

Secondly by working with you to help you deal with the huge pressures created by the cuts in your budgets that have come at a time of rising demand. The support for adult social care budgets that has come through the Department of Health – over £7 billion in this spending review period – is a mark of our commitment. But I recognise that for many councils significant efficiency savings will be needed on top of that.

So we need to do something else, a third vital step. Which is to forge innovative partnerships between local councils and local NHS services that build more sustainable services to keep people healthy and in their own homes for longer. The new structures of the Health and Social Care Act, with clinically-led CCGs, local authority responsibility for public health and health and well-being boards, will provide the catalyst to make that happen – and it will have my enthusiastic support.

20th century health

When we look back over the last hundred years or so, this country has made incredible progress in health.

From the start of the 20th century to the early years of the 21st, life expectancy has basically doubled.

The causes are many.

One, certainly, is our NHS.  But it is far from the only one.

Better housing, clean water and sanitation, better working conditions, food quality standards, even road safety – all had a huge impact.

And you have played a key role in every one of them.

But there are more gains to be had, through:

•    Better, more appropriate housing,

•    By health and wellbeing becoming an integral part of planning, of transport and of education,

•    By being better at reaching the poorest, the most vulnerable and the hardest to reach in our communities.

Integration

Now, the last couple of years have inevitably been dominated by a debate on structures.

But structures are only a means to an end.  What really matters is better health and care outcomes.

And for that we need a culture of cooperation across health and social care, with a person’s individual needs at its heart.

The old structures simply haven’t worked well enough.

•    GP practices not talking to hospitals.

•    Hospitals not talking to each other.

•    And the divide between the NHS and local authorities sometimes beggaring belief.

This lack of openness, of communication, of trust… means that too many people simply fall between the cracks.

All too often those with the loudest voices and the sharpest elbows – or at least those who have parents or children who have them – get the best treatment.

Of course, we can point to examples of excellent, integrated care.

Like Blackburn with Darwen Borough Council, which, with the local NHS, now provides free leisure facilities for everybody – that’s right, for everybody.

The result?  The number of people doing the recommended amount of exercise has gone up by almost half [up 46% from 16.3% to 23.8%].

And in Liverpool, where by bringing NHS staff together with social workers in integrated care teams, they have been able to cut unplanned hospital admissions and length of stay in hospital by a quarter.

Good things happen when the NHS and councils come together.

But where this happens, it happens despite the system, not because of it.

You can’t design care around, say, a child with cystic fibrosis or a woman with breast cancer –her chemo- and radiotherapy, her drugs, her nursing visits, her social care, her mental health – if there is no meaningful contact between her GP, her consultant team, her local authority and her social care provider.

That’s the great opportunity presented by Health and Wellbeing Boards and by Healthwatch, both of which go live in April.

Bringing people together to improve the health of their community and the quality of care within it.

Looking at the needs of local communities and working out how to meet those needs.

Figuring out how to work together – councils, NHS, providers and the public.

But also making sure that Health and Wellbeing Boards do not become ‘just another committee’.

The work has already begun.  And I want to thank all of you who are involved making this happen.

NHS number

And while I’m on the subject of integration, can I give a plug for the NHS number? We have long spoken about using people’s NHS number to join up their records across health and social care. So I have a challenge for you.  If your council is not using the NHS number, please find out what needs to happen for it to be adopted.  It will be at the heart of the data exchange necessary for effective integration to be a reality

Priorities

As Health Secretary, I have been very clear about my four key priorities.

•    Giving Britain some of the best survival rates in Europe for the big killer diseases: cancer, stroke, heart, liver and respiratory disease.

•    Building a health and care system where quality of care is as important as quality of treatment.

•    Dramatically improving the care for people living with long-term conditions like diabetes, asthma or arthritis – who currently account for more than half of GP appointments and nearly ¾ of hospital admissions.

•    And transforming our care for people dementia so we become one of the best countries in Europe to grow old.

Let me talk about the last one.

A million people will have dementia by 2020. It already affects one in three over 65s.

But shockingly our system diagnoses less than half the people who have it, even when access to good drugs can help stave off the condition for several years.

There are some great examples of excellent dementia care.

Like Manchester City Council’s Shore Green Extra Care Housing Scheme.  There, they use technology and modern building design to reduce the impact of people’s dementia and memory loss.

Or the Meri Yaadain project in Bradford, raising awareness of dementia among the South Asian community.

Or Hampshire County Council working with businesses and others alongside the Alzheimer’s Society and Andover Mind to help them become more dementia friendly.

Dementia Compact

Earlier this year, we launched a Dementia Care and Support Compact.  An agreement – a commitment – by social care providers to deliver first rate care and support for people with dementia and their families.

In March, when we launched, 10 organisations joined up.  Today, we have 42, covering some eighteen hundred services across the country.

If you’re from a provider that cares for those with dementia – and if you haven’t yet heeded the call – please consider signing up.

That’s not an order.  It’s a heart felt request.  Because by making dementia care a priority, you will doing perhaps the single biggest thing that can transform the care of older people for whom you are responsible.

Just as I am asking the NHS to do, I ask all of you all to look at how you operate, at how you behave.  To be inspired by new ideas and to ask yourselves what more you could do.  And then to make that change happen.

Scandal of poor care

Because the need for change is urgent.

The best dementia care in England is exemplary.  But the worst is nothing short of scandalous.

We’ve all seen the reports – of people with dementia being criminally abused by their care-workers or drugged-up with a chemical cosh just so a care-assistant can get a good night’s sleep.

These may be extreme, isolated events but they do highlight a culture where those with dementia are not getting the dignity and respect they deserve.

The Prime Minister’s Challenge on Dementia sets out an ambitious plan to build a dementia-friendly society.

Yes, to invest in research and better treatment.  But more than that.

•    to end the stigma of dementia.

•    for people to feel comfortable talking to their GP if they think they have symptoms.

•    for people to feel in control of their condition.

•    for people with dementia to lead as near a normal life for as long as they can.

•    for those who care for them to feel supported and confident.

•    In short, for our communities to become dementia-friendly.

If we are to succeed, local authorities must take the lead.

And we will make sure we will give you every possible support.

Dementia friendly environments

So today I can announce that we are making £50 million available to support you and your NHS colleagues to create dementia friendly environments.

Carers tell us time and again that when it comes to hospitals, care homes, or other settings, it’s often small things – whether clear signage, light and airy rooms or good handrails – that make a big difference.  Whilst you could say that this is not a huge sum of money relative to the scale of the challenge, if it helps make some of the small things better it will be transformational.

Conclusion

Finally let me mention the one missing ingredient that will make the difference between success and failure.

Because it isn’t just about money or structures.

Most important of all is leadership.

Dementia friendly communities, better public health outcomes, deep and meaningful integration of NHS and social care services – none of this can happen without leadership.

Your leadership.

You are the ones who will make Health and Wellbeing Boards hot-beds of new ideas.

You are the ones who will work with your colleagues in the NHS to drive change.

You are the ones who will lead the charge on public health.

You are the ones who will ensure that people can lead a full and independent life, supported and cared for with humanity, dignity and respect.

You will make the difference.

I will play my part.  But real success will come from inspired local leadership. And I want to support you every step of the way.

Thank you.