Health Management and Policy Alert

Does hospital competition reduce rates of patient harm in the English NHS?

Competition and Markets Authority - 

Previous hospital mergers have reduced the number of distinct organisations offering publicly funded and provided care in the English National Health Service, reducing choice and between-hospital competition in some areas. This working paper tests the impact of variation in concentration on a new quality indicator: the prevalence of patient harm from falls, pressure ulcers, blood clots and urinary tract infections. It exploits a new source of identifying variation accounting for the multi-product nature of hospitals, using instrumental variables to address endogeneity. It finds that hospital mergers in concentrated areas without offsetting clinical benefits could significantly increase rates of patient harm.

• Working paper
• More detail

Polypharmacy: getting our medicines right

Royal Pharmaceutical Society -
This report provides a summary of the scale and complexity of the issue of polypharmacy. It outlines how health care professionals, patients and carers can find solutions when polypharmacy causes problems for patients and points to useful resources that can help. The guidance recommends that all health care organisations have systems in place to ensure people taking ten or more medicines can be identified and highlighted as requiring a comprehensive medication review with a pharmacist.

• Report
• Royal Pharmaceutical Society - news

Does hospital competition reduce rates of patient harm in the English NHS?

Competition and Markets Authority -
Previous hospital mergers have reduced the number of distinct organisations offering publicly funded and provided care in the NHS, reducing choice and between-hospital competition in some areas. This research tests the impact of variation in concentration on a new quality indicator: the prevalence of patient harm from falls, pressure ulcers, blood clots and urinary tract infections. It finds that hospital mergers in concentrated areas without offsetting clinical benefits could significantly increase rates of patient harm.

• Report
• Competition and Markets Authority - publications

Opening the door to change: NHS safety culture and the need for transformation

Care Quality Commission -
This review was carried out at the request of the Secretary of State for Health and Social Care and sought to help understand the barriers to delivering safe care and to identify learning that can be applied to improve patient safety. It examines the issues that contribute to the occurrence of never events and wider patient safety incidents in NHS trusts in England. The report found that too many people are being injured or suffering unnecessary harm because NHS staff are not supported by sufficient training, and because the complexity of the current patient safety system makes it difficult for staff to ensure that safety is an integral part of everything they do.

• Report
• Care Quality Commission - press release

Developing a patient safety strategy for the NHS

Department of Health and Social Care (DHSC) - 
This consultation outlines NHS-wide proposals to ensure improved patient safety. The proposals include a commitment for some of the most important types of avoidable harm to patients to be halved over the next five years in areas such as medication errors and never events, alongside developing a 'just culture' for the NHS where frontline staff are supported to speak up when errors occur. The consultation is open for responses until 15 February 2019. 

• Consultation
• Press release

The independent breast screening review 2018

Department of Health and Social Care - 
This report sets out the findings and recommendations of the Independent Breast Screening Review, established to look into the failings in the breast screening programme in England. The review makes 15 recommendations for the Department of Health and Social Care, Public Health England and NHS England.

• Report
• Original review

Framework for effective board governance of health system quality

Institute for Healthcare Improvement -
This research finds that board members, and those who support them, desire a clear and consistent framework to guide governance of all dimensions of quality beyond safety, including identification of the core processes and necessary activities for effective governance of quality. The framework is published alongside a quality assessment toolkit and supporting guidance.

• Documents and further information

Each Baby Counts: 2018 progress report

Royal College of Obstetricians and Gynaecologists - 

This is the second Each Baby Counts annual report into stillbirth, early neonatal death and severe brain injury occurring during labour at term. Based on data for babies born in the UK in 2016, this report shines a spotlight on the care provided to women and their babies and provides an opportunity to measure progress and identify areas for improvement in maternity safety.

• Report
• More detail

Making hospitals safe for people with diabetes

Diabetes UK - 

This report has been developed through conversations with people with diabetes, diabetes inpatient teams, healthcare professionals working in hospitals and hospital managers. It highlights the challenges facing diabetes inpatient services and shows what should be in place in all hospitals.

• Report
• More detail

Sexual safety on mental health wards

Care Quality Commission (CQC) - 
This report calls for new national guidance to improve the sexual safety of people and staff on mental health wards, following analysis of how mental health trusts in England report sexual incidents. The report shares findings from a review of patient safety incidents which found that more than a third of incidents could be categorised as sexual assault or harassment of patients or staff.

• Report
• Press release