Improving quality of care

The publication of the Francis report on the shocking failures of care at Mid Staffordshire NHS Foundation Trust marked a watershed for the NHS, refocusing it on its core purpose – providing high-quality care.

The report has unleashed an avalanche of change, including a major overhaul of the hospital inspection regime, a new duty of candour, and a number of initiatives to make more information available to the public about the performance of services. Meanwhile, hospitals have responded to the report by recruiting additional staff to boost staff–patient ratios.

Much of this is to be welcomed, although it remains to be seen whether hospitals will be able to sustain staffing levels in the face of unprecedented financial pressures. However, it is important to be realistic about what can be achieved by regulation. The first lines of defence against poor-quality care are frontline staff and hospital boards. Quality must be top of their agenda.

A new culture of care

The culture of an organisation is the most important influence on the ability of its staff to deliver high-quality, compassionate care. Responding to the failures identified by the Francis report means creating a culture in which patients come first and openness, transparency and accountability are the norm. This will be a long haul. The task for the next government is to ensure that this type of culture is embedded across the NHS by supporting the local leaders responsible for it.

A shift is also needed to involve patients much more closely in decisions about their care. It is time to make shared decision-making between doctors and patients a reality; when patients are fully informed about their options, they often choose different and fewer treatments. While not appropriate for all patients, personal budgets deliver care that is more personalised and could be used more widely. The NHS should make better use of data and technology to support patients in managing their own care.

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Mental health on an equal footing with physical health

Mental health services are under increasing pressure. Access to psychological therapies remains limited, providing little choice of treatment and leaving many waiting with inadequate support. Meanwhile, community-based services are struggling to provide the care needed to keep patients out of hospital. When patients do need to be admitted, some are having to go to hospitals a long way from their local area. There is clearly some way to go before the same standards of care expected by people with physical health issues are experienced by those with mental health issues.

Although adult mental health services have been transformed in recent decades, there is a need for more investment in community-based support. Despite the fact that nearly a third of people with long-term physical conditions also have a mental health issue, their needs are often treated in isolation. Patient care could be improved and costs reduced by improving co-ordination between mental health, physical health and social care services. The next government will inherit the welcome commitment to putting mental health on an equal footing with physical health – it will need to work hard to make that a reality.

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A revolution in the care of older people

Many people live healthy, happy and independent lives well into old age. However, as people age they are also much more likely to live with multiple long-term conditions, disability and frailty. As a result, older people are the main users of health services – the average age of hospital patients is now over 80. Yet the NHS has been slow to adapt to this demographic shift – conditions associated with old age receive less investment, caring for older people has low professional status, and age discrimination remains a problem, despite legislation passed to stamp it out.

Transforming services for older people requires a fundamental shift away from reactive, hospital-based care built around single diseases, to proactive, preventive care that is co-ordinated around people’s needs and provided closer to their homes. This means focusing on every aspect of care from installing simple adaptations in people’s homes to prevent falls, to improving end-of-life care and ensuring that, wherever possible, people are able to die in the place they choose.

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