Download David Oliver - National Confidential Enquiry into Patient

NCEPOD Report launch “An Age
Old Problem”
Professor David Oliver
National Clinical Director for Older People
11 November 2010
NCD Role
• Clinical leadership for older people – with a
focus on improving outcomes
• Clinical input to cross government Ageing
Society strategy
• Promote prevention and early interventions for
older people
• Engage with leaders in health and social care
and the voluntary sector
• Support the integration agenda and
implementation of Coalition priorities relevant to
older people
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“An Age Old Problem”
• Powerful report - acts as a reality check
• Articulates what we know – we can and should be
achieving better and more consistent outcomes for older
people post-operatively
• No defence of poor practice
• This applies at every level in the system
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Why getting it right for older people
matters
• UK population is ageing rapidly - by 2033, almost a quarter of the population will be
over 65
• People over 65 are the core users of acute hospital care - 60% of admissions,
65% of bed days, 70% of emergency readmissions, over 90% of delayed transfers
• People long-term conditions account for 55% GP appointments, 70% of outpatient
and emergency attendances, 77% inpatient days, 90% drug spend in over 75s
• People over 65 account for 2/3 of acute and elective surgical admissions and a
significant proportion of these are over 80 - often with complex medical needs or
frailty and are at higher risk of postoperative complications
• We cannot ignore the specific needs of such a significant
patient group
NCEPOD Report adds to objective evidence of variable
care
• Equality Act consultation and evidence review
• National Audits (e.g. Hip fracture, stroke, continence, falls
and fragility fractures)
• All parliamentary enquiry into human rights of older
people in health and social care
• Work on dignity
• Nutritional care as a registration requirement and 2007 Nt
• Dementia strategy consultation
• Surveys of staff or patients
• Age UK “Hungry to be Heard”
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NCEPOD Report key findings & recommendations
• Key findings
• Just over 1/3 of patients surveyed (38%, 295/786) received good care.
• Poor nutrition and serious associated illness were very common in the group
studied.
• In over two-thirds of cases (67.7%, 653/965), patients were not reviewed by
specialists in Medicine for the Care of Older People.
• Clinically significant delays occurred in 1 in 5 patients between admission and their
operation.
• 1/4 of hospitals had no acute pain service.
• Key recommendations
• In elderly patients needing urgent surgery careful attention should be given to
improving fluid status, reducing unnecessary drug treatment and anticipating
nutritional support.
• Elderly patients undergoing surgery need access to routine daily clinical review
from specialists in elderly care.
• Delays in surgery, which lead to poor outcome, should be subject to rigorous audit
and rectified.
• Pain and its management should have a high priority to avoid patient suffering.
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Some levers for improving standards
• Implementing the Equality Act (no exemptions?)
• National Clinical Leadership (NCDs for Trauma, Kidney care,
DVT/PE, Older People)
• National Hip Fracture Database and Best practice tariff – early
involvement of specialists and shortened time to surgery
• New Measures – Standardised Hospital Mortality Indicators
(SHMIs)
• QIPP work streams (including Safer Care)
• CMOs recommendations on training in pain management “the
fifth vital sign”
• NICE Guidelines – existing and in development
• Enhanced Recovery model (NHI, DH and Cancer Action Team)
• Nutrition action Plan 2007 and nutritional care as a registration
requirement from 2010 plus SCIE resource
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• Acute Kidney Injury initiatives/CQIN scheme
Secretary of state’s vision for health and social care
The reformed NHS
April 2012: Monitor established as
economic regulator
April 2011: Shadow Board established as
special health authority
April 2012: Board fully established
Autumn 2012: Board makes allocations to GP
consortia for 2013/14
2013/14: All NHS trusts
become, or part of,
foundation trusts
2013/14: All providers
regulated by Monitor
April 2012:
HealthWatch
established
April 2011: Support for shadow health
and wellbeing partnerships
April 2012: Health and wellbeing
boards in place
By end 2010: Separation of SHA
commissioning and provider oversight
functions
2012/13: SHAs abolished
From April 2013: PCTs abolished
2011/12: Established in shadow form
2012: All consortia formally established
April 2013: Consortia hold contracts with
providers
From 2011: Choice of care – longterm conditions; diagnostic testing,
and post-diagnosis
From April 2011: Choice of
treatment and provider – some
mental health services
2012: Free choice of GP practice
2013/14: Choice of treatment and
provider – vast majority of NHS
services
And in future…
• Equity and Excellence: Liberating the NHS describes a system
with:
–
Patients at the heart of everything
–
Outcomes among the best in the world
–
Clinicians empowered to deliver results
• Focus on commissioning for better outcomes in 5 domains of
NHS Outcomes Framework
• Backed by National Quality Standards
• Continuing focus on more person centred care
• Strengthened role and priorities of CQC
• Importantly local accountability and freedom to achieve better
outcomes – the response to this cannot be top down
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In Summary
• This report is important and necessary as it highlights
deficiencies in the care of older people postoperatively in
hospital.
• I commend the rigour and thoroughness and the constructive
recommendations from NCEPOD to improve care
• I am not here to defend poor practice. Instead we need to
identify constructive solutions.
• Many of the solutions rest with good local clinical leadership
and a greater focus on safety and quality for older patients.
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Thank you
• Questions.....
• [email protected]
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