Essence of Care – Moving Forward Maureen Morgan Department of Health 11 th June 2008 – London

Themes Reforming and transforming healthcare –creating ‘world class’ services What we are getting right – what must we do better? Focus on quality and on fundamental aspects of care Role of EoC

Ambition: World Class Services Now in year 8 of NHS 10yr plan to reform health care so we can respond to major societal changes and technical advances –demography – ageing population –major causes of mortality and morbidity – impact of life-style –consumerism –escalating costs associated with new treatments and medicines Underpinned by unprecedented levels of investment - £40 billion approx in 1997 – nearly £100 billion today – to deliver tangible results Three phases of reform:

Improving the system

So far – So Good Achieved national targets on reducing mortality from cancer and cardio- vascular disease On track to reduce MRSA by 50% Reducing waiting to 18 weeks HCC survey 90% of patients rated their care as good or excellent

BUT…….. Wide regional variation – SMRs in some parts of UK among best in EU – others among the worst If 90% of patients rated care as good or excellent – 10% did not! [ 1:10 or 3 patients in 30-bedded ward] High profile cases [eg Maidstone] contributing to loss of confidence that the NHS ‘cares’ Patients feel ‘at risk’ in our care

New Approach to Managing Performance From central targets to self-improving systemsFrom central targets to self-improving systems Emphasis on qualitative dataEmphasis on qualitative data Clinically focused and evidence basedClinically focused and evidence based Stronger accountabilityStronger accountability Responsive to patients, public and staffResponsive to patients, public and staff Overseen by Care Quality Commission Overseen by Care Quality Commission

Patients tell us they want… more care closer to home to be treated as a person to be a partner in care to have choice ….‘fit into my life’ to be safe! Next Stage Review – focus on quality & patient voice

‘In spite of all this change, what patients want and need from nurses has changed very little. Patients want their contact with nurses to make them feel safe, cared for, respected and involved. They want to know that the nurse is there unconditionally for them, especially when faced with fear, pain or loss. They want to know that nurses’ actions will be in their best interests and will help them get better, keep well, live life to the full, or help towards a better death. This may sound obvious, almost simple, after all it is what nursing is and has always been about’. Modernising Nursing Careers Sept 2006

Responding to Patients – role of EoC Essence of Care –unique in building quality indicators from patients / users perspective –addresses issues patients / users say matter to them – and which they experience and judge for themselves –applicable to all settings and for all health professionals –generates comparable data –powerful mechanism for change –external validity, source of evidence of continual improvement Are we capturing this as well as we could? Importance of clinical metrics

EoC Developments 11 th benchmark – Environment of Care [Nov 07] –access – cared for environment –cleanliness –infection control precautions –ethos –personal space –leadership and competence of staff –supplies & equipment This year – refresh toolkit - ? Benchmark on pain

Summary Focus of reform now on quality & patient experience – service transformation Reputation of organisations rests on actions / omissions of staff Strong performance management systems will require evidence of continual improvement EoC can provide mechanism to improve fundamental aspects of care – harnesses enthusiasm of front-line staff –combines efforts of nurses, AHPs, doctors and others – helps to create effective health care teams that meet expectations of patients, users and the public – –help re-new trust and confidence in the NHS