Sunday, 4 March 2012

What the risk assessments might tell us

Midstaffs Helps Us Understand What the Regional Risk Assessments Actually Mean

Midstaffs helps us understand what the Regional Risk Assessments actually mean. The government is strongly resisting the call to release the national risk assessment regarding the health reforms. In the mean time the Strategic Health Authorities have carried out their regular regional risk assessment process. A quick scan of these risks sounds all too familiar to anyone who has studied the Midstaffs Inquiry. There will I am sure be a tendancy to present these risk registers as an indication that the reforms could create “another Midstaffs”. Now that the government will for the first time find that the Midstaffs evidence is actually being used against their bill they may find it timely to clarify that the still prevalent myth about hundreds of “excess deaths” at Stafford is ill founded and based on a leak of some unauthorised and actively contested figures. I am sure they will also wish to bear in mind that Tom Kark, the counsel for the inquiry has made it clear that he does not think it is safe to take the view that Midstaffs is unique. The failings at midstaffs are very unlikely to have been on the scale that has commonly been portrayed, but they are problems that can easily be replicated anywhere subject to the wrong set of circumstances. What the Midstaffs inquiry does show us in detail is the effect of the huge disruption that occurred over the period of 2005/2006. Over that period we saw the restructuring of the Strategic health authority, The formation of the Primary care trust, the expansion of the Health care commission to create the Care Quality commission, and the process of becoming a Foundation trust, under the control of Monitor , rather than under the support of the PCT and SHA. With all these organisations in turmoil and tight budgets, key people left or moved or had their jobs redefined. There was a lack of clarity about the roles of the different organisations, or their mechanisms for communication with each other. There was duplication and gaps in cover, paper work went missing, and people were generally unsettled, demoralised and lacking in support when they really needed it. So these current concerns from the Midlands and East sound as if they could have been lifted directly from the Midstaffs Inquiry.
 In the Midlands and east of England, officials are most concerned that a combination of targets to reduce spending, and the management changes, will cause upheaval during the transition, and similarly warn of worse quality and safety, conflict between organisations, neglect of primary care, overspending, and failure to meet key targets such as limiting the number of patients who wait more than 18 weeks for treatment.  Moderate risks in the region include loss of key personnel, staff working in "silos" and so not co-operating as they need to, a rising risk of fraud, lack of clarity about structures for commissioning treatment for patients, staff distracted or overloaded by the upheaval leading to worse service and higher sickness levels among health service staff themselves, confused and unclear accountability leading to "organisational and system failures", culture clashes, "mission critical" staff leaving, lack of leadership skills among key staff, and loss of confidence among clinical staff leading to the reforms failing. If the risk assessment is to be believed the “reforms” appear to be unnecessary, They will be highly disruptive, they will do serious damage to communication and staff morale, and they are unlikely to deliver the governments underlying aims.

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