NHS Response to Kennedy Report

Executive Summary re. Childcare

SOURCE
Department of Health



1. The BRI Inquiry Report provides us with a powerful analysis of the
organisation and culture of the NHS in the years up to 1995. It highlights
poor organisation, failure of communication, lack of leadership,
paternalism and a ‘club culture’ and a failure to put patients at
the centre of care. It draws attention to the lack of standards
for evaluating performance in the NHS and for assessing the quality
of care, and a lack of clarity about where the responsibility for
such assessment lay, at both the local and national level.
The failure to accord children’s services a sufficient
priority in Bristol and elsewhere in the NHS resulted in the
unnecessary death and damage of a number of very young children.
They were failed by the system that was supposed to make them well.


2. We accept that analysis. Without reservation we accept the
broad principles upon which the Kennedy Report is based. We
are seeking to develop an NHS where there is a culture of
openness and honesty; where all who work in and for the NHS
share the common purpose of delivering high quality, safe
health care; and where patients and staff work in genuine
partnership.


3. Our vision for the NHS was set out in the The NHS Plan. We
are pleased to see that the Kennedy Report recognises and
acknowledges the significant contribution the Plan will make
towards realising the recommendations of the Inquiry Report.


4. This calls, as the Kennedy Report recognises, for a new
relationship between government and the NHS and between the
NHS and patients. We recognise that the NHS needs fundamental
reform if we are to deliver a high quality, patient centred
service for the twenty first century. Until 1997 the
Department of Health was both the headquarters and the
regulator of the NHS. In the past there were no national
standards: different levels of care and services were provided
in different parts of the country. And there was uncertainty
about where clinical and managerial responsibilities began
and ended. As a result there were confused accountabilities
and a lottery of care for the individual patient. Patients,
faced with poor services locally, had no choice other than
to wait for treatment or to opt to pay for treatment instead
of it being provided by the NHS.


5. Since 1997 we have established new independent standard
setting and inspecting bodies – the Commission for Health
Improvement (CHI) and the National Institute for Clinical
Excellence (NICE) – outside the Department of Health.
There are new bodies too – the National Patient Safety Agency
(NPSA) and the National Clinical Assessment Authority (NCAA)
– to tackle poor clinical practice where it has been identified.
Through National Service Frameworks, national standards are
in place for the first time. Through the NHS Modernisation
Agency there is help for NHS organisations to improve
performance. And there is more information being provided
than ever before about local health service performance
with rewards and intervention where appropriate.


6. The NHS Plan sought to build on these developments to
give a new direction to the health service. The Inquiry
report adds further impetus still. Today, then, the role
of the Department of Health is no longer to run the NHS
as if it were a mid-twentieth century nationalised industry.
Instead, within the context of clear national standards
that ensure fairness and quality, we are moving towards an
NHS where resources and responsibilities are located in
front line services which are innovative and responsive to
the needs of patients. Care will be provided through a number
of providers – some public, some private - delivered and
inspected against those clear national standards, and all
providing NHS care to NHS patients according to NHS
principles. Patients will not just have more information
and a greater say over local services, but more choice
over who provides their care.


7. This will leave the Department of Health to set the
overall framework for regulation and inspection wherever
NHS care is delivered to ensure these arrangements are
working to the benefit of patients, to distribute resources
fairly to meet health needs and to ensure proper accountability.
Regulation will be undertaken by independent bodies working to
a framework of standards drawn up by patients, professionals,
health service and government. Information on clinical and
organisational performance will be produced independent of
both government and the NHS. This more clear cut division
of responsibility will tackle precisely the confusion that
underpinned much of the Bristol tragedy.


8. Specifically, this far reaching change to how the NHS
is run requires us to apply the Prime Minister’s 4
principles of public sector reforms:


high national standards and clear accountability;

devolution of power and resources to the front line to
give those professionals who deliver services the freedom to innovate;

increased flexibility for staff to cut across out-moded
professional barriers; and

a greater range of alternative service providers and
choice for the patient.

This will entail:


devolution of management responsibility to front line staff
through the creation of Primary Care Trusts (PCTs) and Strategic
Health Authorities through the NHS Reform and Health Care Professions Bill;

these NHS bodies to work within a framework of standards which
will include the continuing development of National Service
Frameworks through joint working between the NHS, the
professions, patients and the Department together with
the setting of evidence based standards for day to day
clinical practice by NICE;

a more independent role for NICE to set evidence based
standards for day to day clinical practice, and make
recommendations on the clinical cost effectiveness of
new therapies for introduction into the NHS;

in the short term, a strengthened inspection role for
CHI working with the Social Services Inspectorate and
National Care Standards Commission as appropriate to
give the public an independent assurance that each provider
of NHS services has proper quality assurance and quality
improvement mechanisms in place. We will take further steps
at the earliest opportunity to rationalise the number of
bodies inspecting and regulating health and social care;

the NPSA to establish a single national system of reporting
and analysis of adverse events and near misses which occur
within the NHS, and to ensure that effective learning takes
place to make the NHS a safer place for patients;

the NCAA to help NHS employers assess the small minority of
‘poorly performing doctors’ and make recommendations about
whether and under what circumstances they will continue to
practise in the NHS;

the establishment of a new Council for the Quality of Health
Care to provide greater co-ordination of these bodies;

the establishment of a new Council for the Regulation of
Health Care Professionals to strengthen and co-ordinate the
system of professional self-regulation; and

the establishment through legislation of Patients’ Forums in
every PCT and NHS Trust, and the Commission for Patient and
Public Involvement in Health to set standards and provide
training and guidance to build capacity for greater community
involvement in the health service.

9. The continuing improvement of services will be supported
by the work of the NHS Modernisation Agency and NHS Leadership
Centre in spreading good practice and developing leadership. All
the bodies involved will have a responsibility to ensure the
quality of services and the safety of the public. They will
work with the clinical professions to ensure that doctors,
nurses and other staff are supported to provide high quality
care and are held to account for their performance. In addition,
in the spirit of partnership on which the NHS in the future will
be based, the representatives of patients and the professions
will be involved at all levels in advising on strategy, inspection
and regulation, and the delivery of services.


10. In taking this approach, the Government is not only endorsing
the Kennedy Report’s arguments for a separation of the Department
of Health’s roles in management and regulation but is taking
these arguments a stage further.


Developing a high quality modern health service


11. In responding to the challenge set by the Kennedy Report
the key tasks which lie ahead of us are to:


put patients at the centre of the NHS;

improve children’s health care services;

set, inspect and monitor the standards of care (the roles of CHI,
NICE and NPSA);

ensure the safety of care;

develop a health service which is well led and managed;

improve the regulation, education and training of health care
professionals;

improve the quality, reliability and range of information which
supports decision making and strengthen the monitoring of performance; and

involve patients and the public in health care.

Putting patients at the centre of the NHS


12. We are committed to changing attitudes in the way care is delivered.
We want to develop a culture of openness, honesty and trust; to ensure
that patients have the information they need to make informed choices;
and to enable patients to become equal partners with health care
professionals in making decisions about treatment and care.


13. Our programme of reform will include:


more information provided to patients on how local health services
compare with others and greater choice for patients over where they are treated;

a consent process which engages patients fully in decisions about their care;

an Expert Patient Programme to support the development of partnerships
between clinicians and patients from late 2001;

from April 2003, a National Knowledge Service for the NHS to support the
delivery of high quality information for patients and staff;

the establishment of Patient Advice and Liaison Services (PALS) within
every Trust from April 2002 to assist patients in managing and accessing
information;

by the summer of 2002, guidelines about sharing information with patients
and parents of young children;

a review of bereavement services;

publication of a Code of Practice on communicating with families about
post-mortems in January 2002; and

a reformed NHS complaints procedure by December 2002.

Improving children’s health care services


14. We agree with Professor Kennedy that there should be stronger leadership
and integration at all levels in dealing with issues relating to children.
Over the last 4 years we have begun to take steps to ensure that high
quality and safe services are designed to meet the particular needs of
children. These include several cross-government initiatives such as
Sure Start and the appointment of a National Clinical Director for Children.


15. Our programme of action, includes:


a continued high level focus on children’s issues across government;

a senior member of staff with responsibility for children’s services
in every Strategic health Authority, PCT and NHS Trust;

children’s health services designed to meet the particular needs of
the children who use them and their families. The National Service
Framework module on hospital care for children will be published during 2002;

greater integration of primary, community, acute and specialist health
care across professional and agency boundaries - including closer
working with social services;

clear standards against which providers of services are inspected as
part of the Children’s National Service Framework;

paediatric training in an appropriate centre for all staff operating on children;

parents fully engaged in decisions about their child’s treatment and care; and

a review by the Paediatric and Congenital Cardiac Services Review of
specialist cardiac services for children. It will report in 2002.

Setting, inspecting and monitoring the standards of care – the roles
of CHI, NICE and NPSA


16. We agree with Professor Kennedy that the framework for setting,
delivering and monitoring standards should be made more explicit. We
also agree that those bodies which assure the quality of care in the NHS
should be at arm’s length from the Department. However, we also believe
that for standards to be achievable the bodies which assure quality must
operate within a broadly agreed framework of priorities set by government,
working with patients, professionals and the NHS against the overall level
of resourcing available for the NHS.


17. Our future programme of action, through legislation where necessary,
will include


setting of clear standards through NICE and the National Service Frameworks;

NHS bodies being directed to fund treatments recommended by NICE from January 2002;

NICE guidance will no longer need the approval of the Secretary of State
for Health before dissemination;

reinforcement of the independence of CHI in the NHS Reform and Health Care
Professions Bill;

strengthening of CHI to take on the role of inspection of NHS organisations
and service providers against the standards set for the NHS;

swift action where CHI identifies significant problems or where patient
safety is compromised, including the imposition of ‘special measures’;

the establishment of the Office for Information on Health Care Performance
as part of CHI to monitor clinical performance and to publish regular
performance indicators on all NHS Trusts and PCTs; and
the production of an annual report by CHI on the quality of NHS services
which the Secretary of State will lay before Parliament.

Ensuring the safety of care


18. Patient safety is at the heart of our agenda for improving the quality
of NHS services. In line with the findings of An Organisation with a Memory
and the blueprint outlined in Building a Safer NHS for Patients we have
established the NPSA to develop a national system for reporting and
analysing adverse events and ‘near misses’. In addition, we are fully
committed to minimising the number of adverse events occurring, for
example, when a clinician undertakes a procedure for the first time
or when new interventional procedures are introduced.


19. We recognise that the current system for dealing with clinical
negligence claims is slow and will therefore publish a White Paper
early in 2002 setting out our plans for reform.


20. Our programme of action also includes:

the establishment of a single national system of reporting adverse
events and ‘near misses’ through the NPSA during 2002;

analysis of the data collected by the NPSA which will feed back
lessons quickly to the NHS and elsewhere;

guidance on root cause analysis to help Trusts analyse adverse events;

work with the Design Council to identify opportunities for design
solutions to safety problems;

strengthened accountability arrangements and supervision responsibilities
through job plans for consultants to ensure that junior doctors are properly
supported and supervised when undertaking new procedures;

transfer of responsibility to NICE for providing the oversight and
scrutiny needed for the introduction of new interventional procedures;

guidance for NHS Trusts on the local systems they will need for
managing new interventional techniques; and

through the consent to treatment initiative, ensuring that
patients are told when their treatment is of an experimental nature.



SOURCE
Department of Health Website, March 2005