BMJ 2015;351:h3885 doi: 10.1136/bmj.h3885 (Published 17 July 2015)
Page 1 of 2
News
NEWS Hunt promises more transparency and fewer targets in “more human” NHS Gareth Iacobucci The BMJ
England’s health secretary, Jeremy Hunt, has promised more transparency and fewer targets as part of his vision for a seven day “more human” NHS.
In a speech at the King’s Fund, which he described as his most important to date, the health secretary said that the NHS was facing a “Reformation moment.”1 As he outlined his bold plan, which he says will transform the service over the next 25 years, Hunt said that he wanted the NHS to become “the world’s largest learning organisation supporting the world’s most powerful patients.” But he set himself on a collision course with the BMA by threatening to impose changes to doctors’ contracts that would remove consultants’ ability to opt out of weekend working, unless the association agreed a deal with the government within six weeks.2
Hunt said that the move to seven day working across the NHS was central to his plans to reduce the number of avoidable deaths and that he would not allow the BMA to be “a roadblock to changes.” But Mark Porter, chairman of the BMA, accused Hunt of “a cynical attack on doctors” and said that the speech was “a blatant attempt by the government to distract from its refusal to invest properly in emergency care.”
In addition to his tough stance on seven day working, Hunt used the speech to announce a series of new policy initiatives that he said would create “a profound change in culture in the NHS.” A new regulator named NHS Improvement will be created to replace the dual functions of Monitor and the Trust Development Authority. This new body will host a new independent patient safety investigation service modelled on the accident investigation branch used by the airline industry and will also complete a review of safe staffing levels in hospitals, Hunt said. Patient choice will be enhanced through a new requirement for general practitioners to inform patients of Care Quality Commission ratings and waiting time data of hospitals to which they are being referred, and patients will also be given “meaningful choice” and control over services offered in maternity, end of life care, and long term conditions, Hunt added.
The government has also enlisted the entrepreneur Martha Lane Fox to develop proposals for increasing take-up of new technologies in healthcare, which Hunt identified as a key facet of his vision. Hunt also announced a new international buddying programme that will see five NHS hospitals partnered with
For personal use only: See rights and reprints http://www.bmj.com/permissions
Virginia Mason Hospital in Seattle as part of a new drive for safer care and “intelligent transparency” in the NHS.
Hunt said that forcing the NHS to be more open about its mistakes after the Mid Staffordshire inquiry had led to improvements in care, citing the example of NHS hospital trusts that had shown “dramatic signs of improvement” after being placed into special measures. He said that the NHS would go further next March by publishing avoidable deaths by hospital trust, making England the first country to do so.
He said, “For too long we have assumed that the only way to tackle problems is a combination of money and targets. Both have their roles—but both, too, have unintended consequences. Our focus should be different: not top-down targets but transparency and peer review; learning and self directed improvement that tap into the basic desire of every doctor, nurse, and manager to do a better job for their patients; empowered leaders with the permission and the space to excel. “And this is my offer to the NHS today: more transparency in return for fewer targets. Learning and continuous improvement at the heart of a more human system where we eliminate any conflict between organisational priorities and what is right for the patient sitting in front of you.”
Rob Webster, chief executive of the NHS Confederation, said, “Simplifying targets and encouraging transparency will give greater assurance to local organisations that they can address their issues accurately and openly without fear of recrimination or over-regulation.” Nigel Edwards, chief executive of the Nuffield Trust, said, “We’ve argued for some time that fixating on just a few targets risks warping behaviour, and looking at wider information will do much more to help the NHS improve. It’s good to see the secretary of state acknowledge this.”
Chris Ham, chief executive of The King’s Fund, said, “Many of the themes in the speech will strike a chord with NHS staff, but they will take time to deliver results. The test will be whether the emphasis on devolution and self improvement can be maintained in the face of short term political imperatives—ministers invariably find it difficult to resist intervening, particularly when NHS performance declines.” 1 2
Department of Health. Making healthcare more human-centred and not system-centred. www.gov.uk/government/speeches/making-healthcare-more-human-centred-and-notsystem-centred. Kmietowicz Z. New consultant contract will exclude “opt-out” for weekend working, says government. BMJ 2015;351:h3883.
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BMJ 2015;351:h3885 doi: 10.1136/bmj.h3885 (Published 17 July 2015)
Page 2 of 2
NEWS
Cite this as: BMJ 2015;351:h3885
For personal use only: See rights and reprints http://www.bmj.com/permissions
© BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
News
NEWS Hunt promises more transparency and fewer targets in “more human” NHS Gareth Iacobucci The BMJ
England’s health secretary, Jeremy Hunt, has promised more transparency and fewer targets as part of his vision for a seven day “more human” NHS.
In a speech at the King’s Fund, which he described as his most important to date, the health secretary said that the NHS was facing a “Reformation moment.”1 As he outlined his bold plan, which he says will transform the service over the next 25 years, Hunt said that he wanted the NHS to become “the world’s largest learning organisation supporting the world’s most powerful patients.” But he set himself on a collision course with the BMA by threatening to impose changes to doctors’ contracts that would remove consultants’ ability to opt out of weekend working, unless the association agreed a deal with the government within six weeks.2
Hunt said that the move to seven day working across the NHS was central to his plans to reduce the number of avoidable deaths and that he would not allow the BMA to be “a roadblock to changes.” But Mark Porter, chairman of the BMA, accused Hunt of “a cynical attack on doctors” and said that the speech was “a blatant attempt by the government to distract from its refusal to invest properly in emergency care.”
In addition to his tough stance on seven day working, Hunt used the speech to announce a series of new policy initiatives that he said would create “a profound change in culture in the NHS.” A new regulator named NHS Improvement will be created to replace the dual functions of Monitor and the Trust Development Authority. This new body will host a new independent patient safety investigation service modelled on the accident investigation branch used by the airline industry and will also complete a review of safe staffing levels in hospitals, Hunt said. Patient choice will be enhanced through a new requirement for general practitioners to inform patients of Care Quality Commission ratings and waiting time data of hospitals to which they are being referred, and patients will also be given “meaningful choice” and control over services offered in maternity, end of life care, and long term conditions, Hunt added.
The government has also enlisted the entrepreneur Martha Lane Fox to develop proposals for increasing take-up of new technologies in healthcare, which Hunt identified as a key facet of his vision. Hunt also announced a new international buddying programme that will see five NHS hospitals partnered with
For personal use only: See rights and reprints http://www.bmj.com/permissions
Virginia Mason Hospital in Seattle as part of a new drive for safer care and “intelligent transparency” in the NHS.
Hunt said that forcing the NHS to be more open about its mistakes after the Mid Staffordshire inquiry had led to improvements in care, citing the example of NHS hospital trusts that had shown “dramatic signs of improvement” after being placed into special measures. He said that the NHS would go further next March by publishing avoidable deaths by hospital trust, making England the first country to do so.
He said, “For too long we have assumed that the only way to tackle problems is a combination of money and targets. Both have their roles—but both, too, have unintended consequences. Our focus should be different: not top-down targets but transparency and peer review; learning and self directed improvement that tap into the basic desire of every doctor, nurse, and manager to do a better job for their patients; empowered leaders with the permission and the space to excel. “And this is my offer to the NHS today: more transparency in return for fewer targets. Learning and continuous improvement at the heart of a more human system where we eliminate any conflict between organisational priorities and what is right for the patient sitting in front of you.”
Rob Webster, chief executive of the NHS Confederation, said, “Simplifying targets and encouraging transparency will give greater assurance to local organisations that they can address their issues accurately and openly without fear of recrimination or over-regulation.” Nigel Edwards, chief executive of the Nuffield Trust, said, “We’ve argued for some time that fixating on just a few targets risks warping behaviour, and looking at wider information will do much more to help the NHS improve. It’s good to see the secretary of state acknowledge this.”
Chris Ham, chief executive of The King’s Fund, said, “Many of the themes in the speech will strike a chord with NHS staff, but they will take time to deliver results. The test will be whether the emphasis on devolution and self improvement can be maintained in the face of short term political imperatives—ministers invariably find it difficult to resist intervening, particularly when NHS performance declines.” 1 2
Department of Health. Making healthcare more human-centred and not system-centred. www.gov.uk/government/speeches/making-healthcare-more-human-centred-and-notsystem-centred. Kmietowicz Z. New consultant contract will exclude “opt-out” for weekend working, says government. BMJ 2015;351:h3883.
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;351:h3885 doi: 10.1136/bmj.h3885 (Published 17 July 2015)
Page 2 of 2
NEWS
Cite this as: BMJ 2015;351:h3885
For personal use only: See rights and reprints http://www.bmj.com/permissions
© BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
