Presentation Healthcare Commission

Risk & Regulation – the approach of the Healthcare Commission: 

Anna Walker CB Chief Executive 29 November 2006 Risk & Regulation – the approach of the Healthcare Commission BRC/NAO Independent Regulator Conference

HEALTHCARE COMMISSION: 

Established in 2004 to encourage improvement in health and healthcare cover public and private sector 400+ NHS trusts 2k independent sector bodies comparatively small staff 700 compared with 2.5k information rich sector HEALTHCARE COMMISSION

OUR FUNCTION: 

OUR FUNCTION Annual ratings for NHS organisations assessment by targets and standards regulation of independent sector investigations complaints (second stage) controlled drugs hygiene code “one off” reviews coordination of inspection / regulation in healthcare

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NEW CORE STANDARDS

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EMERGING FINDINGS FROM INDEPENDENT EVALUATION* - BENEFITS 94% of trusts reported that greater accountability was a benefit of the new system 75% that Core Standards Assessment raised the profile of quality within their trusts 82% of trusts agreed CSA has prioritised areas for improvement and 65% that it had highlighted both good and bad performance within the trust 62% thought that it had triggered the development of more integrated governance A third reported that the trust had become more patient focused following CSA CSA process drives local action before Commission action or publication of results *Results of an electronic survey of a representative sample of 220 NHS Trusts in July 2006 (response = 56%) conducted by Matrix Research and Consulting Ltd in collaboration with York Health Economics Consortium

REGULATION AT THE CUTTING EDGE: 

REGULATION AT THE CUTTING EDGE Broader and tougher assessment major investment in engagement with patients, the public & clinicians – to ensure that what we measure is grounded in what matters to the users and providers of services system designed to incentivise self improvement: self declaration wide publication of information innovative use of multiple sources of information and analytical techniques developing capability for year-round surveillance of information broadening focus from assessment of organisations to cover outcomes of services shifting focus to commissioning, rather than provision, of services more regular update of website to recognise improvement

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INDEPENDENT HEALTHCARE REGULATIONCASE STUDY: LONDON BRIDGE HOSPITAL In 2004 5 inspectors on site for 2-3 days each 80 standards assessed against 526 criteria 12 requirements plus 25 recommendations – but many are unfocused or burdensome, and reflect professional background of individual inspectors (eg “policies need to be cross referenced to other important documents so that consistent information is available”... “review floor cleaning equipment: sponges should be replaced with disposable mop heads”)

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CASE STUDY: LONDON BRIDGE HOSPITAL In 2005 3 inspectors, ½ to 1½ days on site inspection focused on specific areas: pediatrics, surgical laser, dialysis, infection control, medicines management, and staff recruitment 8 requirements, which are appropriate and clear (eg “Risk assessments in the dialysis unit were incomplete and undated. The Registered Person must ensure that every department has an up to date COSHH file which includes...”) (a 120 bed acute hospital)

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CASE STUDY: LONDON BRIDGE HOSPITAL In 2006 – regulations changed previous inspections show mostly administrative lapses, which were acted on promptly all issues from last year’s inspection addressed satisfactory evidence from self assessment and data potential to avoid any inspection this year (a 120 bed acute hospital)

CONCLUSIONS: 

CONCLUSIONS we had some advantages new organisation more work / fewer staff! new processes rely on self declaration input from patients and local government cross checking with information publication of information good initial results BUT we need to continue to develop systems