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What's Been Happening Since Issue 1?

Many of you know that our reports provide the basis for hearings of Parliament’s Senior Select Committee, the Committee of Public Accounts (PAC). This gives MPs the chance to discuss the issues with Nigel Crisp as head of the Department of Health and NHS and others, leading to a report of conclusions and recommendations from Parliament. The Government responds to these reports, setting out what action it proposes to take. Here we update you on what has happened so far in response to the reports summarised in Issue 1, on Hip Replacements, Hospital Acquired Infection, NHS Medical Equipment, and Inpatient Admissions and BedManagement.

For more information, Issue 1 can be accessed at: http://www.nao.org.uk/guidance/chiefexec1.htm

Hip Replacements - Getting It Right First Time

The PAC recommended that a review of the case for a national hip register be carried out as matter of urgency. The Department has consulted extensively on this and is now coming to a conclusion on whether and how this project should proceed.

The PAC raised concerns about equity of access for hip operations, length of stay and patient outcomes. These are being addressed by the Action on Orthopaedics programme. It promotes the use of integrated care pathways and good practice in managing hospital stays, including reduction of average length of stay.

The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England

The Department of Health told Parliament that it expects Trust Chief Executives to spend what is necessary to achieve improvements in infection control and has charged each one individually to deliver

Following a PAC recommendation, the Minister of State for Health announced in September 2000 that surveillance of hospital acquired infection would be made compulsory for all Acute Trusts from 1 April 2001 and that data on infection rates would be published from April 2002.The Department has established an NHS Healthcare Associated Infection Surveillance Steering Group to review surveillance needs at local, regional and national level, building on the Nosocomial Infection National Surveillance Scheme.

In the wake of Parliament's concerns about poor prescribing and misuse of antibiotics, the Government launched the new UK Anti-microbial Resistance Strategy and Action Plan. The Public Health Laboratory Service has developed and distributed a template intended to be used as a basis for the development of local evidence-based antimicrobial prescribing policies in primary care (http://www.hpa.org.uk/infections/default.htm).

The National Prescribing Centre has developed a tool-kit providing relevant clinical audit guidance which has been disseminated to all health authorities, primary care groups/trusts and hospital Trusts.

New evidence-based guidelines for the prevention and control of hospital acquired infection were published in January 2001, and £31 million was allocated for improvements in the patient environment, with a further £30 million allocated for next year. Compliance will be monitored by Internal Audit, through the NHS performance management process, and by the Commission for Health Improvement and the Audit Commission.

The Chief Medical Officer has accepted that a ratio of one infection control nurse to 250 beds is a good benchmark for NHS Trusts. The Department will have discussions with the Infection Control Nurses Association and other professional organisations about the development of an assessment tool for NHS Trusts, to help them reach decisions about staffing levels and skill mix required within the Infection Control Team.

Inpatient Admission, Bed Management and Patient Discharge in NHS Acute Hospitals

The Department is working with nine NHS hospitals to develop good practice to reduce cancelled operations. From 2002, hospitals will have to offer another binding date within a maximum of the next 28 days, or fund the treatment at the time and hospital of the patient's choice.

The Department endorses a PAC recommendation that NHS Trusts should improve their recording of cancelled operations. The National Patient's Access Team is working with NHS Trusts to reduce the likelihood of cancellations through better scheduling of operating theatres. The Booked Admissions Programme is helping NHS Trusts to schedule work more effectively. The Department will share best practice through the Modernisation Agency.

The PAC was concerned that some hospitals are operating at bed occupancy levels of up to 99 per cent.The Department has now issued guidance that requires each region to expand bed numbers. Its latest planning guidance to health authorities is that they should plan bed numbers in order to achieve an occupancy rate of no more than 82 per cent in 2003-04.

The Department plans to end widespread bed blocking by 2004 through increased investment in intermediate care services and improving the assessment process for health and social care. Teams from NHS Executive regional offices are also visiting locations with problems in delayed discharge to review the causes and help them redesign the parts of the system causing bed blocking.

For more information on the Department of Healths initiatives, please visit their website at http://www.dh.gov.uk/

The Department is issuing guidance in 2001 to NHS Trusts that they should have discharge co-ordinators inplace to achieve appropriate and prompt patient discharge from hospital.

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