The Burden of Bureaucracy

1
The Burden of Bureaucracy

• Assessment and Regulation The Pros and Cons

2
The size of the problem.

• How many organisations can review an NHS body?
• 10, 20, 30.50.more?

3
Third parties with statutory enforcement powers
specific to healthcare.

• Human Fertilisation and Embryology Authority
• Human Tissue Authority
• Medicines and Healthcare Products Regulatory
  Authority
• Monitor

FROM THE BUREAUCRATIC BURDEN IN THE NHS NHS
CONFEDERATION 2007
4
Third parties with general statutory enforcement
powers that can visit hospitals

• Environment agency
• Fire authorities
• Health and Safety Executive
• Information Commissioner
• National Audit Office
• Local Authority Environmental Health Departments
• Audit Commission

5
Third parties with a specific statutory role in
healthcare but no enforcement powers

• Commission for Social Care Inspection
• Healthcare Commission
• Mental Health Act Commission
• Overview and Scrutiny Committees of Local
  Authorities
• Patient and Public Involvement Forums and the
  Commission for Patient and Public Involvement in
  Health

6
Third parties with a specific statutory role in
healthcare but no enforcement powers - continued

• Council for Healthcare regulatory Excellence
• General Chiropractic Council
• General Dental Council
• General Medical Council
• General Optical Council
• General Osteopathic Council
• Health Professions Council
• Nursing and Midwifery Council
• Royal Pharmaceutical Society of Great Britain

7
Third parties with no statutory role but a
legitimate interest in healthcare

• Health Protection Agency
• National Patient Safety Agency
• National Treatment Agency for Substance Misuse
• National Institute for Innovation and Improvement
• NHS Litigation Authority

8
Third parties with no statutory role but a
legitimate interest in healthcare - continued

• NHS Business Services Authority
• Counter Fraud and security Management
• Dental Practice Division
• Pensions Division
• Prescription Pricing Division
• Supply Chain Management Division
• Hosted and Managed Services

9
Third parties with no statutory role but a
legitimate interest in healthcare - continued

• Royal College of Anaesthetists
• Royal College of GPs
• Royal College of Midwives
• Royal College of Nursing
• Royal College of Obstetricians and Gynaecologists
• Royal College of Ophthalmologists

10
Third parties with no statutory role but a
legitimate interest in healthcare - continued

• Royal College of Paediatrics and Child Health
• Royal College of Pathologists
• Royal College of Physicians
• Royal College of Psychiatrists
• Royal College of Radiologists
• Royal College of Speech and Language Therapists

11
Third parties with no statutory role but a
legitimate interest in healthcare - continued

• Royal College of Surgeons
• Post Graduate Medical Education and Training
  Board
• Royal Pharmaceutical Society
• Skills for Health

12
Department of Health Initiatives Involving
Standards

• Cancer Peer Review
• Peer Review of Caner registries
• Cancer screening QA
• Breast cancer Quality Assurance review
• NHS Estates Cleaning
• NHS Estates Patient Environment Action Teams
• Health Information Accreditation Scheme
• Accreditation Scheme for Tissue Banks

13
NHS Developed Review Bodies

• A Quality Network for Inpatient Child and
  Adolescent Psychiatry

14
Examples of voluntary bodies invited by hospitals
to visit them

• Investors in People
• Clinical Pathology Accreditation Ltd
• Health Quality Services
• Hospital Accreditation programme
• Health Promoting Hospitals
• Clinical Informatics Centre
• The National Autistic Society

15
The Result

16
Personnel Clinical Standards

• Director of IM T (Chair)
• Director of Nursing (Adults)
• Director of Nursing (Children)
• Director of Clinical and Scientific Services
• Associate Director of Patient Services
• Associate Director of Human Resources
• Associate Director of Modernisation
• Director of Clinical Audit and Risk Management
• Director of Facilities
• Associate Director of Corporate Services
• Head of Risk Management
• Head of Clinical Audit
• Head of Midwifery
• Director of Pharmacy Services
• One Clinical Head of Division
• One Divisional Director Childrens Services
• Medical Devices Coordinator
• Associate Director of Clinical Governance

17
Evidence

• Paper
• Electronic
• Interviews
• Meetings
• Supporting Statements
• Records of accreditation

18
What are the Pros?

• Clinical quality and safety now share Board
  Assurance space with finance and performance
  targets.

19
What are the Pros? - continued

• Provided an invaluable structure against which to
  check the systems required for the organisation.
• Ensured clarity around issues of accountability.
• Informed planning.
• Improved communication and developed cross
  discipline awareness

20
What are the Pros? - continued

• Encouraged collaboration and structured problem
  solving.
• Informed the Trust risk register, and supported
  priority setting.
• Been an integral part of the overall Performance
  Assessment Framework for the Trust.
• Aided benchmarking.
• Carrot and stick approach

21
What are the problems?
22
Time
23
Associate Director of Clinical Governance
24
(No Transcript)
25
Duplication

• Same question different examiner..

26
Infection Control

• Improvement Review Team
• Primary Care Trust(s)
• Strategic Health Authority
• Healthcare Commission
• Department of Health
• Patient and Public Forum(s)
• Patient Environment Action Team (PEAT)
• Internal Audit
• NHSLA (DNV)

27
False deadlines

• Artificial deadlines based on regulation -
  though sometimes necessary and in the best
  interest of patients this is not always the
  case.

28
Clinical Engagement

• Reduction in duplication standards based in
  reality increased clinical engagement

29
Opposing performance measures

• Performance targets and quality measures
  sometimes compete

30
Solution

• Agree areas for regulation
• Agree evidence formats
• Assess each area once
• Share information
• Evaluate within realistic timescales

31
My objective in setting this event in place is
to see how we can create a simpler and more
effective system which removes overlaps in
regulation and reporting, increases real front
line clinical engagement, and is dramatically
simpler and less time consuming than today's
approach and better coordinates the whole process
of NHS Regulation.   Mr Peter Mount Chairman,
CMMC and NHS Confederation
32
.Questions?.