Policy and organisational responses to public inquiries in health: will we ever learn?:Paper presented at a Reading University Law Faculty Symposium

There have been over 100 public or otherwise independent inquiries in the UK National Health Services, dating back to the Ely Hospital Inquiry of 1969. Inquiries usually address major or serial lapses in duty of care to patients, seeking to set out what happened, explore possible causes and learn lessons for the future. In this paper, we explore the historical context to public inquiries in health, including their purpose and aim and identify the key themes that have recurred over five decades. These include hearing and heeding the patient voice; enabling staff to raise concerns with confidence; the impact of pressures in the health system; NHS top-down organisation culture; and regulation and inspection as a ‘cure’. This thematic framework is then used to assess the health policy, organisational and service progress that appears to have been made in response to public inquiries, taking the Francis Inquiry into the Mid-Staffordshire NHS Foundation Trust as a case study. We use the case of the Francis Inquiry to identify and explore the progress (or absence of progress) of the main developments for NHS organisations resulting from the Francis Inquiry including the strengthening of national regulatory bodies for health care quality; having greater transparency of staffing levels and deficits by regular reporting of local workforce data; introducing new ways in which staff can raise concerns or ‘whistle-blow’ where they fear harm is being done to patients; understanding better the potential harms from dysfunctional organisational culture; and how far the ‘duty of candour’ is working in practice. Drawing on this, we present an analysis of apparently persistent gaps in learning from inquiries in health, this being used to propose a set of potential policy recommendations for health and care in the UK context. These include the need for formal accountability processes to track progress with public inquiry recommendations; exploring how best to manage and support smaller or isolated hospitals; the need for formal accreditation and training standards for all NHS managers; heeding the evidence of the distraction caused by most health service reorganisation; and having a formal and funded long-term workforce plan for health and social care.The paper concludes by suggesting how this analysis offers insights into how publicly funded and accountable health systems can secure deep and sustained learning and improvement from holding public or other independent inquiries. <br/

Policy and organisational responses to public inquiries in health: will we ever learn?:Paper presented at a Reading University Law Faculty Symposium

There have been over 100 public or otherwise independent inquiries in the UK National Health Services, dating back to the Ely Hospital Inquiry of 1969. Inquiries usually address major or serial lapses in duty of care to patients, seeking to set out what happened, explore possible causes and learn lessons for the future. In this paper, we explore the historical context to public inquiries in health, including their purpose and aim and identify the key themes that have recurred over five decades. These include hearing and heeding the patient voice; enabling staff to raise concerns with confidence; the impact of pressures in the health system; NHS top-down organisation culture; and regulation and inspection as a ‘cure’. This thematic framework is then used to assess the health policy, organisational and service progress that appears to have been made in response to public inquiries, taking the Francis Inquiry into the Mid-Staffordshire NHS Foundation Trust as a case study. We use the case of the Francis Inquiry to identify and explore the progress (or absence of progress) of the main developments for NHS organisations resulting from the Francis Inquiry including the strengthening of national regulatory bodies for health care quality; having greater transparency of staffing levels and deficits by regular reporting of local workforce data; introducing new ways in which staff can raise concerns or ‘whistle-blow’ where they fear harm is being done to patients; understanding better the potential harms from dysfunctional organisational culture; and how far the ‘duty of candour’ is working in practice. Drawing on this, we present an analysis of apparently persistent gaps in learning from inquiries in health, this being used to propose a set of potential policy recommendations for health and care in the UK context. These include the need for formal accountability processes to track progress with public inquiry recommendations; exploring how best to manage and support smaller or isolated hospitals; the need for formal accreditation and training standards for all NHS managers; heeding the evidence of the distraction caused by most health service reorganisation; and having a formal and funded long-term workforce plan for health and social care.The paper concludes by suggesting how this analysis offers insights into how publicly funded and accountable health systems can secure deep and sustained learning and improvement from holding public or other independent inquiries. <br/

Integrated health and care systems in England : can they help prevent disease?

Objectives: Over the past 12 months, there has been increasing policy rhetoric regarding the role of the NHS in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change. Methods: We reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health. Results: The evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health. Conclusions: For ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants

Briefing: improving children and young people's mental health services: local data insights from England, Scotland and Wales.

In this briefing, we present analysis from the Networked Data Lab (NDL). Led by the Health Foundation, the NDL is a collaborative network of local analytical teams across England, Scotland and Wales. These teams analysed local, linked data sources to explore trends in mental health presentations across primary, specialist and acute services. This briefing includes: a) background on the trends in mental health disorders among children and young people and existing pressures on services, as well as an overview of the main policies in place in England, Scotland, and Wales to improve children and young people's mental health b) findings from NDL partners: we examine trends and patterns of service use, including the use of primary care, specialist mental health care and acute services, along with differences by demographic and socioeconomic characteristics c) examples of how local NDL teams used linked data to improve services in their area d) insights for national and local policymakers

Improving children and young people’s mental health services

Across the UK, the number of children and young people experiencing mental health problems is growing. Mental health services are expanding, but not fast enough to meet rising needs, leaving many children and young people with limited or no support. Too little is known about who receives care and crucially, who doesn’t. This briefing presents analysis from the Health Foundation’s Networked Data Lab (NDL) about children and young people’s mental health. The analysis from local teams across England, Scotland and Wales has highlighted three key areas for urgent investigation, to help ensure children and young people get the care they need. These are: rapid increases in mental health prescribing and support provided by GPs the prevalence of mental health problems among adolescent girls and young women stark socioeconomic inequalities across the UK. To inform national policy decisions and local service planning and delivery, the quality of data collection, analysis and the linkage of datasets across services and sectors need to be improved and used more effectively

Responses of Massachusetts hospitals to a state mandate to collect race, ethnicity and language data from patients: a qualitative study

<p>Abstract</p> <p>Background</p> <p>A Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients' race, ethnicity and preferred language using standardized methodology based on self-reported information from patients. This study assessed implementation of the regulation and its impact on the use of race and ethnicity data in performance monitoring and quality improvement within hospitals.</p> <p>Methods</p> <p>Thematic analysis of semi-structured interviews with executives from a representative sample of 28 Massachusetts hospitals in 2009.</p> <p>Results</p> <p>The number of hospitals using race, ethnicity and language data internally beyond refining interpreter services increased substantially from 11 to 21 after the regulation. Thirteen of these hospitals were utilizing patient race and ethnicity data to identify disparities in quality performance measures for a variety of clinical processes and outcomes, while 16 had developed patient services and community outreach programs based on findings from these data. Commonly reported barriers to data utilization include small numbers within categories, insufficient resources, information system requirements, and lack of direction from the state.</p> <p>Conclusions</p> <p>The responses of Massachusetts hospitals to this new state regulation indicate that requiring the collection of race, ethnicity and language data can be an effective method to promote performance monitoring and quality improvement, thereby setting the stage for federal standards and incentive programs to eliminate racial and ethnic disparities in the quality of health care.</p