Tag: Lord Hunt of Kings Heath

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-08.

To ask Her Majesty’s Government why beauty clinics undertaking nail care are not required to use autoclaves to sterilise their equipment to prevent fungal infections.

Baroness Altmann

The Control of Substances Hazardous to Health Regulations 2002 require businesses offering beauty treatments to ensure that any risks to their client’s health from exposure to hazardous substances including micro-organisms, are prevented or effectively controlled. The duty extends to preventing or controlling client’s exposure to the risk of contracting fungal infections. The regulations do not prescribe what specific control measures are necessary. These will be based on the type of treatment carried out and the risks of cross-infection.

Where sterilisation is required, autoclaves are the most effective and efficient means to do so, and should be used especially for packaged items and items which have hollow parts or cavities. However alternative methods such as steam sterilisers and disinfectants can be used for simple items such as tweezers.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-29.

To ask Her Majesty’s Government whether they will publish all evidence they have available on the mechanism whereby increasing the presence of consultants and diagnostic tests at weekends will result in lower mortality and reduced length of stay.

Lord Prior of Brampton

The Department published a summary of the research examining the association between weekend hospital admissions and poorer patient outcomes, including higher rates of mortality, on 15 October 2015 on the gov.uk website. A range of potential causal links for this association have been identified; one of these is the availability of staff and services at weekends.

The following studies were published on the gov.uk website at the following address:

https://www.gov.uk/government/publications/research-into-the-weekend-effect-on-hospital-mortality/research-into-the-weekend-effect-on-patient-outcomes-and-mortality

Of these, the following four articles are published in academic journals and are only available by subscription.

Freemantle et al (2015), BMJ 2015; 351:h4596, Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

Independent research that analysed 2013 to 2014 hospital episodes statistics (HES) data found:

– although there are fewer hospital admissions at weekends, patients who are admitted on Saturday and Sunday are sicker and face an increased likelihood of death within 30 days, even when severity of illness is taken into account;

– patients admitted on a Sunday have a 15% greater risk of mortality compared to those admitted on Wednesday;

– patients admitted on a Saturday have a 10% greater risk of mortality compared to those admitted on a Wednesday;

– there are around 11,000 excess deaths in hospitals every year among patients admitted on a Friday, Saturday, Sunday or Monday compared with other days of the week. The authors included the effect of Fridays and Mondays as ‘appropriate support services in hospitals are usually reduced from late Friday through the weekend, leading to disruption on Monday morning’;

– oncology patients admitted on a Sunday have a 29% increased risk of death compared to those admitted on a Wednesday; and

– patients with cardiovascular disease admitted on a Sunday have a 20% increased risk of death compared to those admitted on a Wednesday.

The study concluded that it is not possible to determine how many of the excess deaths were avoidable, but that the statistic is ‘not otherwise ignorable’ and ‘raises challenging questions about reduced service provision at weekends’.

The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week, BMJ Qual Saf Published Online First 6 July 2015, doi:10.1136/bmjqs-2014-003467

The Global Comparators dataset collects inpatient records across 50 hospitals in 10 countries. Analysis of a sub-sample of this data (28 hospitals across England, Australia, United States of America and Netherlands) for emergency admissions showed:

– there is an overall 30-day crude mortality rate of 3.9%; the English hospitals had the highest crude morality rate (4.6%); crude mortality rates for the English, Dutch and USA hospitals were higher at weekends compared with weekdays; and

– emergency patients in the English, USA and Dutch hospitals showed a significantly higher adjusted risk of death within 30 days following admission on a Saturday or Sunday compared with admission on a Monday.

This study did not show a difference in mortality within 30 days for patients admitted at weekends in Australian hospitals. However, when analysing mortality within seven days, the Australian hospitals showed 12% higher risk of death when admitted on a Saturday compared to a Monday, and 11% higher risk of death following a Sunday admission.

Freemantle et al (2012), J R Soc Med. 2012 Feb;105(2):74-84, Weekend hospitalisation and additional risk of death: an analysis of inpatient data

Analysis of 2009 to 2010 HES data found:

– patients admitted to hospital on a Sunday had a 16% greater risk of death within 30 days compared to those admitted on a Wednesday;

– patients admitted on a Saturday had an 11% increased risk of death within 30 days compared to those admitted on a Wednesday;

– day of admission was associated with increased risk of death in seven of the 10 most common CCS groups (clinical conditions), for example:

– patients admitted on a Sunday with acute and unspecified renal failure had a 37% increased risk of death compared with those admitted on a Wednesday; and

– patients admitted on a Sunday with acute myocardial infarction had an 11% increased risk of death compared to those admitted on a Wednesday.

Aylin et al (2010), Qual Saf Health Care 2010; 19:213-217, Weekend mortality for emergency admissions: a large multicentre study

This was one of the first, large scale studies of English data to explore weekend mortality rates for emergency admissions.

Using the data for financial year 2005 to 2006, the study found:

– crude mortality rates are higher for patients admitted at weekends compared to weekdays (5.2% for all weekend admissions; 4.9% for all weekday admissions; overall crude mortality rate: 5.0%);

– there is a 10% higher risk of death for patients admitted as an emergency at the weekend compared with those admitted on a weekday; and

– there may be a possible 3,369 excess deaths occurring at the weekend compared to weekdays (equivalent to a 7% higher risk of death).

East Midlands Clinical Senate (2014), 7 Day Services Report: Acute Collaborative Report

Ten East Midlands acute trusts undertook a data gathering exercise to look at current provision against the 10 clinical standards for urgent and emergency care that underpin consistently high quality care 7 days a week. A copy of this report is attached.

NHS Services, Seven Days a Week Forum (2013), was a clinically-led process which included an extensive review of the published literature alongside analysis of HES data to explore patient outcomes at weekends compared to during the week. A copy of this report is attached.

Academy of Medical Royal Colleges (2012), seven day consultant present care.

In light of evidence demonstrating less favourable patient outcomes at weekends compared to weekdays, the Academy of Medical Royal Colleges presented proposals for achieving parity for inpatient care throughout the week. A copy of the report is attached.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-03-14.

To ask Her Majesty’s Government why the Department of Health gateway final report regarding the contact between UnitingCare LLP and the Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) made no recommendations about the need to ensure that the business case was fully in-line with the accepted bid by UnitingCare LLP to run older people’s and adult community services for that CCG.

Lord Prior of Brampton

NHS England is responsible for the review of Cambridgeshire and Peterborough clinical commissioning group’s (CCGss) contract with UnitingCare LLP. NHS England advises that it has commissioned an independent review to ensure objectivity. The review is looking at the contract from a commissioning perspective, which means it will cover the role of NHS England, but the role of the Department is not within its scope.

The Department’s role in gateway reviews was to facilitate the review on behalf of the project owner. The procedure was that the Department’s Health Gateway Team, working with the project owner, selected a suitable review team from a pool of accredited, independent reviewers. At the end of the review, the independent review team produced a report which was presented to the project owner and was their property. The Department stopped providing this service in 2015.

NHS England advises that the CCG, as the project owner, used the Department’s Health Gateway Team to facilitate three independent gateway reviews into its procurement for older people’s and adult community services, two in 2013 before the submission of final bids and the third in November 2014. NHS England advises that these gateway reviews were not intended to undertake detailed financial reconciliation.

NHS England advises that it facilitated two gateway reviews in early 2014, before the appointment of the preferred bidder. These focused on reviewing significant service changes from a clinical pathway perspective. They were not intended to cover procurement and technical financial details.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-03-22.

To ask Her Majesty’s Government, further to the Written Answer by Lord Prior of Brampton on 21 March (HL7013), why the NHS Strategic Projects Team was said to have employees in view of it not being an organisation and therefore not able to employ staff.

Lord Prior of Brampton

The Strategic Projects Team is hosted by Arden GEM Commissioning Support Unit. The staff referred to in HL7013 were on secondment from the CSU and NHS England and were therefore employees.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-04-14.

To ask Her Majesty’s Government whether they accept the recommendation of the report of the equality analysis undertaken under section 149 of the Equality Act 2010 that a number of steps be taken to amend the draft new contract for doctors in training to address the position of part-time doctors in order to advance equality of opportunity between men and women doctors.

Lord Prior of Brampton

The contract published on 31 March is a huge step forward for achieving fairness for all trainee doctors. For the first time junior doctors will be paid and rewarded solely on the basis of their own hard work and achievement and pay progression will be linked to level of training rather than arbitrarily to time served.

All junior doctors should have the same terms and conditions – a level playing field – which is ultimately what employers and the British Medical Association (BMA) want and everyone deserves.

When the Secretary of State published the Equality Analysis on the new contract for doctors and dentists in training in the NHS (“Doctors”) on the 31 March 2016 on the GOV.UK website he made it clear that, as a result of considering the Equality Analysis, in accordance with his duties and obligations, he had asked for a number of changes to the draft contract to address specific issues for certain groups with protected characteristics. This has been done and the contract has been duly amended. These changes included changes that benefited staff who work part time. The new contract is not discriminatory it ensures that all junior doctors receive equal pay for work of equal value. The BMA’s own lawyers have advised that nothing in the new contract is discriminatory. Nevertheless the equality duty is an ongoing duty and it is intended that monitoring will continue after the introduction of the new contract in accordance with the public sector equality duty in the Equality Act 2010.

A copy of the Equality Analysis is attached.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-04-25.

To ask Her Majesty’s Government whether they will establish a public inquiry into care failings in the Liverpool Community NHS Trust in the light of findings that executive directors of the trust downgraded serious risks or incidents and kept information from non-executive board members.

Lord Prior of Brampton

We are assured by NHS Improvement that it continues to work closely with the Trust following the support provided by the NHS Trust Development Authority (NTDA). Following the Care Quality Commission’s report of 2014, the NTDA took immediate steps to improve the skill set within the executive team, commissioned a board capability review and provided clinical and quality support in developing and delivering a quality improvement plan. As further issues came to light, the non-executive and the executive teams at the time of the failings were replaced.

A recent independent review made clear that the drive of the board to achieve foundation trust (FT) status was a dominant factor which contributed towards the failures of the trust. The report suggests that the board was managed in the way it was to ensure the FT application remained on track and that this led to downplaying of risks. A copy of this review, Quality, safety and management assurance review at Liverpool Community Health NHS Trust, is attached.

The Trust withdrew its application for FT status in January 2015. It is now actively working towards a transaction that is likely to see the trust’s services being delivered by alternative providers

In addition to a new leadership team in place, a number of other measures are being progressed. There is an ongoing improvement plan, the continued support of NHS Improvement, implementation of the independent review’s recommendations and a well-advanced transaction proposal that is likely to lead to the eventual disestablishment of the Trust. However we will consider the possibility of a further review with the leadership of NHS Improvement.

NHS Improvement is currently developing a new approach to authorising FTs. It will allow National Health Service trusts to demonstrate they meet the standards expected of FT status without the process becoming a serious distraction for them.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-05-03.

To ask Her Majesty’s Government what the costs will be of the proposed conversion of all non-academies to academy schools.

Lord Nash

Taking the Spending Review and the Budget together, we have set aside the funding to support a high quality school system where all schools are academies.

Through the Budget and the Department for Education’s settlement in the Spending Review there are sufficient resources available to take advantage of the opportunities presented by all schools becoming academies. The Government has allocated £300 million that will be available to support schools to convert and, in particular, support sponsors to turn around failing schools. A further £300 million will be available to support strong and effective multi-academy trusts to grow and improve.

The Department will be issuing further detail on how funding will support the conversion of all schools to academy status in due course.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-05-23.

To ask Her Majesty’s Government why the independent review of the handling by the Royal Wolverhampton NHS Trust of concerns raised by and related to Mrs Haynes-Kirkbright did not inquire into wider governance concerns raised as part of the review when its terms or reference allowed it to report on other relevant matters that arose during the course of the review.

Lord Prior of Brampton

These are matters in the first instance for NHS Improvement. The Verita report, Independent review of the handling by The Royal Wolverhampton NHS Trust of concerns raised by and related to Mrs Haynes-Kirkbright, was commissioned by the NHS Trust Development Authority – a forerunner organisation – independently of Government.

NHS Improvement is commissioning a governance review to consider issues highlighted by the Verita report. A copy of the terms of reference for the new governance review are attached.

Verita was originally requested (under specific terms of reference) to review and provide a dedicated report on the handling by the Royal Wolverhampton NHS Trust of concerns raised by and related to Mrs Haynes-Kirkbright. Governance issues that fell outside of those terms of reference will be considered in the new review, to ensure thorough investigation.

The new review will take into account evidence provided by Mrs Haynes-Kirkbright and others in the course of the Verita review.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-07-19.

To ask Her Majesty’s Government, in the light of the National Audit Office investigation into the collapse of the Uniting Care Partnership Contract in Cambridge and Peterborough, whether they plan to dismantle the Strategic Projects Team.

Lord Prior of Brampton

The Department welcomes the National Audit Office (NAO) report. Decisions about the Strategic Projects Team (SPT) are, however, for NHS England. Following an internal review and the NAO report, NHS England identified concerns about the work of the SPT. As a result, the SPT will close and all its ongoing commitments will be reviewed with a view to bringing them to a conclusion.

NHS Improvement advises that it also welcomes the NAO report and is working closely with NHS England and the Department to consider assurance processes for such complex transactions. NHS Improvement further advises that its focus since May has been liaison with the NAO on its report and joint consideration with NHS England of the assurance issues raised.

NHS England confirms that the NAO investigation supports the findings of its previously published independent review. Before the NAO investigation, NHS England had already commissioned a follow-up review focusing on the role of external advisors, the effectiveness of the Gateway review process, and the role of the clinical commissioning group leadership and governing body. This work continues and NHS England expects to publish findings later this summer.

More widely, NHS England has been undertaking assessments of current and planned novel contracts and is developing an assurance framework for contracts of this sort. This is being informed by the findings of the Uniting Care reviews.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-09-14.

To ask Her Majesty’s Government what assessment they have made of the scale of trolley waits in the accident and emergency department of the Royal Blackburn Hospital and the consequent safety of patients.

Baroness Chisholm of Owlpen

No such assessments have been made. The provision of accident and emergency (A&E) services at the Royal Blackburn Hospital is a matter for the local National Health Service. The NHS in East Lancashire has established an A&E delivery board to oversee system performance and the effective delivery of urgent and emergency care locally.

Ministers consult weekly with NHS Improvement and the Care Quality Commission about A&E performance.