Saturday, 8 September 2012

Like getting blood from a stone

It started like this.....

Our local Hospital Trust and the Primary Care Trust (PCT) decided that they needed to reconfigure services across two of its three sites. I guess that there are many reasons why they should choose to consider such a redesign. There is the European working hours directive for doctors, medical training requirements &  Royal College recommendations etc etc., all of which suggest that some services needed to be centralised on one site and some on the  other site.

A few years ago they held a public consultation on the general principles of such a change and it passed without too much fuss. Obviously they then went away and developed proposals on how the reconfiguration might look, A number of options were identified, including leaving services as they were. This option appraisal then went out for another extensive round of public consultation.

The consultation agreed with the preferred option (surprise!) but once the implications of the proposals were known and discussed in the press the public began to express their concerns about the effects of the changes at a local level. 

These concerns were a) that it seemed that one of the two hospitals seemed to be reduced in size and in services, b) its A&E becoming an Emergency Medical Centre, and c) the issue of poor transport links between the two hospitals, especially for those living in the villages outside the major towns.

There was an extensive campaign by the local press and a 'Save our Hospital' group held meetings.  Managers from the hospital Trust and the PCT attended these meetings, made statements to the press and a useful debate took place. One of the interesting statements made was that the changes were designed to improve the quality of care and had nothing to do with money.  "Its all about quality".

This got me thinking about how we , as members of the public and patients, would know that the changes have achieved their desired outcome, that of improving the quality of care.  As a scientist and part time 'change manager' I realised that we needed a baseline measurement of the current quality of care provided by the existing services.  So I asked the question.

The County Council Health Overview and Scrutiny Committee was being updated on the reconfiguration and so I asked a question about getting quality information into the public domain.

The important part of the question was:

"Given that the aims of the changes.....are all about improving the quality of care ...can the Hospital and PCT provide the current level of quality of those services in a form that the public can understand."

Their answer in full (names and details removed to protect the innocent) (from the PCT director of communication and engagement) was:

"Quality reports are routinely considered at meetings in public of the PCT cluster Board. These look at issues such as waiting times, levels of hospital acquired infections and delayed transfers of care. In relation to the changes proposed by the programme, a 'benefits realisation' performance dashboard is being developed. This will contain a number of indicators which will be monitored to ensure that any changes are producing a better experience and better outcomes for patients.  This will look at factors such as patient satisfaction, mortality rates, length of stay and admission and readmission rates of these services which have been changed."

Now I know I am just a member of the public but I did spend two years teaching science to GCSE students and I reckon that comes under the category of 'this student did not answer the question'.

Now in my role of 'a stone in the shoe' I had a email conversation with the Trust representative ('the messenger') which resulted in no improvement and so I was allowed to re-ask the question at the next Overview and Scrutiny meeting .

This is the next answer, given by a senior clinician from one of the two embryonic local Clinical Commissioning Groups:

"At the moment a large amount of data is collected the Trust.  This includes data on length of stay, readmission rates and mortality rates. However the way in which this data is currently analysed and reported reflects the current arrangement of services not the proposed new reconfiguration. The Hospital Trust is currently undertaking an exercise to analyse the data to reflect the changes and to determine benchmarks from which outcomes can be monitored. Once this is completed the key indicators will be published and monitored in the public domain".

Once again it seems to me that they have avoided answering the question. In fact they seem to have missed the point about establishing the quality of the current services, entirely. Yet at the same time they say that the way the data is analysed at the moment does reflect the current services!  If this is so they should be able to give some indication of the quality of the current services.

Each time I go over the answers I see more confusion and lack of information.

It seems to me common sense that the baseline for measuring quality improvements should be taken before the changes are implemented and are an essential piece of information that any organisation should use when managing change. 

The more I look at what has happened over the last few months the more concerned I am about the ability of the local health services to understand the quality of service that it provides for the local population. They do not seem to understand the process for monitoring the change process either!

We are being told to choose the health care provider that gives the best quality care but if they cannot give us the information on quality how can we choose?

Or is it that they do not want to tell the public what is happening?

1 comment:

  1. Great blog, the NHS needs people reminding them what they're there for.