08 December 2013

NCHA and BSHAA welcome the Government’s Response to the Francis Inquiry

NCHA and BSHAA welcome the Government’s Response to the Francis Inquiry into Mid Staffs NHS Foundation Trust as an opportunity to expand and develop a more outcomes-based approach to community hearing services across the country.

The National Community Hearing Association welcome’s Hard Truths the Government Response to the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis Report) published on 19 November 2013.

Mid Staffs, just like previous NHS failures such as Bristol, was an acute sector failure resulting from a lack of attention to quality and outcomes and distraction by targets and non-patient issues. We welcome the Government’s commitment that “targets and finance must never again be allowed to come before quality of care”[1]. As the evidence shows, this is far less likely to happen in a market driven system where patients have information, access, value and personal choice between providers such as community hearing services.

We therefore welcome the Government’s efforts to build on what is already in place, avoid duplication and to take an approach proportionate to risk by focussing on providers regulated by the Care Quality Commission. We look forward nevertheless to exploring with the Health and Care Professions Council (HCPC) and sector partners whether and how any aspects of the Government’s approach should also apply to audiologists and hearing aid dispensers in the community.

We also note the Government’s confirmation that, to an extent, the awful events at Mid Staffs were failures of commissioning [2] and the recognition that, after twenty years of the purchaser-provider split, commissioning has still not become as patient-focussed, innovative and flexible as it needs to be. We fully endorse this. From our perspective commissioning is still a bureaucratic process focussed primarily on driving down costs and hedged around with tick box process measures rather than being based on NHS and patient value, outcomes and service quality. The Government’s response to Francis provides an opportunity to revisit these issues, take unnecessary cost out of the system and shift the focus to quality, access and outcomes.

In our sector, the Any Qualified Provider (AQP) initiative has already begun to break down this old, restrictive approach to the commissioning of Adult Hearing Services and we hope that Government will give further encouragement to this through the NHS Commissioning Board and CCGs to bring the benefits, which in many places still only private patients enjoy, to NHS patients all in a cost-effective and affordable way. Currently 44 per cent of CCGs provide community hearing access in this more patient-friendly and flexible way but this still leaves some way to go before all NHS patients can exercise choice and benefit equally.
We therefore very much welcome and wholeheartedly endorse the Government’s
- clear statement that “the main aim of commissioning is to improve services for patients” [3]
- commitment that commissioners should “consider how the quality and efficiency of services might be improved in a range of ways including through services being provided in a more integrated way (in our case between hospital and community care) and through the adoption of evidence–based innovative approaches” [4]
- the recommendation of greater engagement between commissioners, providers and potential providers to focus on what really matters for patients and the public – outcomes, choice, access and clinical and service quality and that commissioners should establish mature dialogue with providers and other organisations in the health and care system[5] - currently the barriers to market entry on our sector are inappropriate and exclude potential providers, especially small providers, contrary to Ministers’ express intentions
- the commitment that “no matter where patients and people using the service choose to use a service, the overriding concern must be that patients and service users receive the best possible care from whichever provider they use, whether this is from the public, voluntary or private sector”[6].

We also welcome the recognition that the Standard NHS Contract is still a work in progress. In the case of Adult Hearing Services, we would very much welcome a more appropriate approach to health and patient safety through a much stronger focus on outcomes rather than the current ‘process’ requirements across the four IQIPS domains, and would welcome the opportunity to work with NHS England on these issues.

We also strongly endorse the encouragement to CCGs to reward providers for genuine transformation of services, higher standards in quality improvements rather than simply driving down fees to the point where this damages quality and inhibits providers from entering the market to offer high-quality care and reduce health inequalities[7].

We look forward to engaging with NHS England, CCGs and the HCPC and sector partners on these issues.
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[1]Vol 1 Statement of Common Purpose, paragraph 9
[2]Vol 1, paragraph 4.26
[3]Vol 1, paragraph 4.28
[4] Ibid
[5]Vol 1, paragraph 4.39
[6]Vol 1, Introduction, paragraph 14
[7]Vol 1, paragraphs 4.37 and 4.38