Who’s accountable for Public Health?

Under the Health and Social Care Act, local authorities were given statutory responsibility for protecting and improving the public health of their constituents, and are now liable to prosecution if they fail to identify public health risks and put in place suitable protection against harm. This makes sense, given that health and life expectancy depends more on income, housing and a safe environment than what the NHS has to offer. Much of what councils oversee, from alcohol policies to planning applications, have public health implications. So do councils understand their new responsibilities?

On September 3^rd, Bath and North East Somerset council (BANES) walked out of a Public Inquiry into a proposed asbestos landfill of Stowey Quarry in the Chew Valley (Eye 1311), because they ‘didn’t want to use public funds’ representing the public health objections of over 4000 residents who’d signed a petition and campaigned vigorously against the plan. Many are already  living in fear of the plan, and understandably so. The landfill would be in a shallow quarry at risk of landslip on a windy escarpment above the drinking reservoir which serves most of Bristol.

Landfills near drinking water reservoirs are never a

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Medicine Balls, Private Eye Issue 1348

Safe Staffing Levels

A key feature of the Health and Social Care Act is for every hospital to become a Foundation Trust, managed by the market rather than central control. But the government has skewed the market so hospitals only receive 30% of the tariff for each emergency patient ‘above the 2008 level’. In essence, successful hospitals lose money if word gets out that they’re good and patients choose to go there. And with the NHS at the start of the toughest financial slowdown its ever faced, the only way to balance the books is front line staffing cuts that lead to the Mid Staffordshire scandal and the problems at many other trusts.

NHS England’s in-house response to the Berwick safety review, ‘Lines to Take’, claims that all providers use recognised tools to evaluate and decide staffing levels and skill mix for different ward types and occupancies, and to regularly publish their staffing levels, along with the evidence underpinning them, in their board papers.’ But a ‘recognised tool’ is no use when there is no money. The reforms have created a hideous labyrinth of new management organisations that soak up money producing tools

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Really depressed by this response from NHS England to the Berwick Review’s call for an open, transparent NHS Culture. The two documents ‘Lines to Take on the Berwick Review’ and ‘Q&A – NOT FOR PUBLICATION’ say it all in the title.

 As my source, a frightened and despondent senior NHS manager puts it: ‘Lots of us are really disappointed with this response. Here is this wonderful report saying all the things we all feel; a new culture, an investment in teaching improvement science, let’s do things differently, and the response feels like some ‘tell them we’re doing it already’. It feels like ‘meet the new boss, same as the old boss’. Please do something with it and please don’t identify me.’

So much for a culture of speaking up without fear. Full story in todays Private Eye

Lines to take – NHS England’s current actions in ensuring patient safety

Final

5 August 2013

Improving patient safety

1. National Reporting and Learning System:  NHS England already operates the world’s most comprehensive patient safety incident reporting and learning system, the National Reporting and Learning System (NRLS). This invaluable tool allows clinicians to report safety concerns to a central

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Dial M for Mistake

The ‘call 111 cock-up’  has shown why competitive tendering, outsourcing and the fragmentation it brings are hopeless for safe, coordinated emergency care. Many NHS staff, academics and government advisers predicted the risks, but the government ploughed on regardless.  It  has ‘delayed’ minimum pricing for alcohol and plain cigarette packaging to await ‘more robust evidence’, and yet rushed through massive, unmandated market reforms of the NHS that have no evidence base at all. And as MD pointed out (Eye 1340), out of hours care is high risk and dangerous, triaging calls is extremely complex and the system has to have experienced clinical staff on hand, have a clear safety net, agreed and enforced quality standards and be joined up with the rest of the NHS. Since when was rushed outsourcing on the cheap going to be the solution?

Health Minister Earl Howe told the Lords that contractors were offered ‘an extra six months to bed in NHS 111’ but only two took up the offer’. NHS England should have insisted on the 6 month delay to make the service safer. Howe now claims ‘the NHS 111 service is not unsafe ? it is a safe service. In

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Medicine Balls Eye 1345  July 26

Keogh Facts

Sir Bruce Keogh’s review into the quality of care and treatment provided by 14 NHS trusts with high death rates was shrewd and thorough, but his proposals for proper NHS inspections lead by doctors are nothing new. In 2000, MD endorsed the idea of an independent medical inspectorate in his evidence to the Bristol Inquiry and the Eye (Feb 3?), based on the work of Dr William Pickering.

“Shipman got away with it for so long was because he knew that in the NHS, and in general practice in particular, doctors can do more or less what they like. They call it ‘clinical freedom’ and cherish it. No one (except the law) can meaningfully challenge their actions, and then only if they are found out. Medical ethics do not include commenting on another doctor’s practice, nor do they insist upon an open mentality. The ‘self-regulation’ of doctors is, therefore, equivalent to no regulation.”

‘Most medical disasters start with single errors or near misses, and yet they only come to light much further down the line when many more mistakes have been allowed to occur. Even then, it needs the strident clamour of

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