Essence of Care – Moving

Forward Maureen Morgan

Department of Health 11th June 2008 – London

Themes

• Reforming and transforming healthcare –creating ‘world class’ services

• What we are getting right – what must we do better?

• Focus on quality and on fundamental aspects of care

• Role of EoC

Ambition: World Class Services

• Now in year 8 of NHS 10yr plan to reform health care so we can respond to major societal changes and technical advances – demography – ageing population– major causes of mortality and morbidity – impact of

life-style – consumerism– escalating costs associated with new treatments

and medicines• Underpinned by unprecedented levels of investment -

£40 billion approx in 1997 – nearly £100 billion today – to deliver tangible results

• Three phases of reform:

Stage 1: Building capacity in the system

Stage 2: Introducing the reform levers

Stage 3: Transforming the service

12

3

We are entering the third and most difficult stage of

the reform journey

Improving the system

So far – So Good

• Achieved national targets on reducing mortality from cancer and cardio-vascular disease

• On track to reduce MRSA by 50%• Reducing waiting to 18 weeks• HCC survey 90% of patients rated

their care as good or excellent

BUT……..

• Wide regional variation – SMRs in some parts of UK among best in EU – others among the worst

• If 90% of patients rated care as good or excellent – 10% did not! [ 1:10 or 3 patients in 30-bedded ward]

• High profile cases [eg Maidstone] contributing to loss of confidence that the NHS ‘cares’

• Patients feel ‘at risk’ in our care

New Approach to New Approach to Managing Managing

Performance Performance • From central targets to self-improving From central targets to self-improving

systems systems • Emphasis on qualitative dataEmphasis on qualitative data• Clinically focused and evidence basedClinically focused and evidence based• Stronger accountability Stronger accountability • Responsive to patients, public and staff Responsive to patients, public and staff • Overseen by Care Quality Commission Overseen by Care Quality Commission

‘In spite of all this change, what patients want and need from nurses has changed very little. Patients want their contact with nurses to make them feel safe, cared for, respected and involved. They want to know that the nurse is there unconditionally for them, especially when faced with fear, pain or loss. They want to know that nurses’ actions will be in their best interests and will help them get better, keep well, live life to the full, or help towards a better death. This may sound obvious, almost simple, after all it is what nursing is and has always been about’.

Modernising Nursing Careers Sept 2006

Responding to Patients – role of EoC

Essence of Care– unique in building quality indicators from patients / users

perspective – addresses issues patients / users say matter to them –

and which they experience and judge for themselves– applicable to all settings and for all health professionals – generates comparable data – powerful mechanism for change– external validity, source of evidence of continual

improvement • Are we capturing this as well as we could?• Importance of clinical metrics

EoC Developments

• 11th benchmark – Environment of Care [Nov 07]– access– cared for environment– cleanliness– infection control precautions– ethos– personal space– leadership and competence of staff– supplies & equipment

• This year – refresh toolkit - ? Benchmark on pain

Summary • Focus of reform now on quality & patient experience –

service transformation • Reputation of organisations rests on actions / omissions of

staff • Strong performance management systems will require

evidence of continual improvement

• EoC can provide mechanism to improve fundamental aspects of care– harnesses enthusiasm of front-line staff– combines efforts of nurses, AHPs, doctors and others –

helps to create effective health care teams that meet expectations of patients, users and the public –

– help re-new trust and confidence in the NHS