This document sets out Healthcare Improvement Scotland’s proposed scrutiny priorities for 2013–2015. It highlights why these are priority areas, how they link to the NHS Scotland Quality Strategy Outcomes and how we will go about our work.
Comments on
Healthcare Improvement Scotland
“Our scrutiny priorities for healthcare in Scotland (2013–2015)”
The Royal College of Physicians of Edinburgh (“the College”) is pleased to respond to Healthcare Improvement Scotland’s call for comments on “Our scrutiny priorities for healthcare in Scotland (2013–2015)”.
The aims, values and principles of these priorities are commendable, and the College feels that it is vital to place a strong emphasis on better outcomes for patients and that scrutiny priorities should always be focused to drive improvements in the care that patients receive. However, the proposals selected are not easily measurable in many cases and it will be challenging to benchmark progress in future.
The College has the following comments on specific issues raised in the draft document:
3.1 Care of older people in acute hospitals
The College welcomes recognition from Healthcare Improvement Scotland (HIS) that older people in acute settings are not always assessed for cognitive impairment. The College convened an event in September 2012 to consider how to improve diagnosis of patients with dementia, as it is estimated that up to 50% of patients with dementia in Scottish hospitals go undiagnosed. Data suggests dementia is now present in 25% of all Scottish hospital in-patients and over 40% of over-70s admitted to hospital and therefore that there are currently as many as 1600 patients with undiagnosed dementia in Scottish hospitals1.
The College would certainly welcome more general awareness-raising about the problem of undiagnosed dementia in hospitals and the examination of how additional training can be provided to doctors to address under-diagnosis of dementia.
The College supports the expansion of the unannounced inspection programme to help improve standards of care for older people in acute settings and would like to see further details of the ambition to roll out the programme.
The College is increasingly concerned about the pressure on acute medical admissions, many of which are for older patients. This growing problem affects all hospital services and should be a national priority for scrutiny. To this end the Scottish Government has announced a programme of joint working with the College to tackle the issue, including establishing models of best practice and clinical standards. The College would welcome an early opportunity to discuss how best to ensure these are incorporated into the HIS programmes.
4.1 Healthcare Environment Inspectorate (HEI)
The College notes the pledge that there will be a minimum of 30 inspections every year between 2013-2015 by the HEI and that effort will be focused on locations which present a higher risk to patient safety. This maintains rather than accelerates the HEI commitment to “undertake at least one announced and one unannounced inspection to all acute hospitals across NHS Scotland every 3 years2”, and indicates an even progression through the programme of inspections 2013 - 2015.
5.1 Improving learning from adverse events
Given the recent intense media interest in the handling of adverse events by the NHS in Scotland it is essential that a robust national framework and programme of review is developed as a matter of urgency to rebuild public trust and ensure NHS boards learn from adverse events in order to minimise the risk of reoccurrence. We would welcome further clarification of when the framework and programme of review will be in place.
7.1 Medical revalidation
The College welcomes the existing engagement of HIS with healthcare organisations and the revalidation process in Scotland, and the future involvement of HIS in providing external quality assurance of the systems that have been put in place by healthcare organisations to facilitate revalidation. This will provide assurance that the appraisal and revalidation recommendation systems are working as intended. The GMC has yet to finalise its own quality assurance proposals for revalidation and it will be important for HIS scrutiny efforts to compliment UK wide quality assurance of revalidation.
We would again welcome further information on the practicalities of the implementation of this commitment including whether HIS plans to scrutinise the output of revalidation, e.g. RO decisions.
8.1 Supporting good governance of the NHS in Scotland
The College welcomes the commitment to test a refreshed approach to the scrutiny of governance arrangement within the NHS over 2013-2014, and the recognition by HIS that the findings of the Francis Inquiry will potentially offer lessons that can be learned throughout the UK. The effectiveness of local whistle blowing policies may be of particular note.
The establishment of a reliable system of benchmarking and quality assurance is vital and the College looks forward to seeing more information in due course on the results of tests of this refreshed approach.
1 Today there are over 3000 patients with dementia in Scottish hospitals … up to 50% are undiagnosed