Injury Report Template

Document Sample
Injury Report Template Powered By Docstoc
					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

2   DH template
                  “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

3   DH template
   Why getting it right for older people

  • 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
• 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”

5    DH template
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

• 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

• 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.
6   DH template
    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

• 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
7   DH template
• Acute Kidney Injury initiatives/CQIN scheme
Secretary of state’s vision for health and social care
 The reformed NHS                                                       April 2012: Monitor established as    By end 2010: Separation of SHA
                                                                        economic regulator                    commissioning and provider oversight
                                                                                                              2012/13: SHAs abolished
                                                                                                              From April 2013: PCTs abolished

April 2011: Shadow Board established as
                                                                                                                          2013/14: All NHS trusts
special health authority
                                                                                                                          become, or part of,
April 2012: Board fully established
                                                                                                                          foundation trusts
Autumn 2012: Board makes allocations to GP
                                                                                                                          2013/14: All providers
consortia for 2013/14
                                                                                                                          regulated by Monitor

April 2012:
                                                                                                             From 2011: Choice of care – long-
                                                                                                             term conditions; diagnostic testing,
                                                                                                             and post-diagnosis
                                                                                                             From April 2011: Choice of
                                                                                                             treatment and provider – some
                                                                                                             mental health services
               April 2011: Support for shadow health   2011/12: Established in shadow form
                                                                                                             2012: Free choice of GP practice
               and wellbeing partnerships               2012: All consortia formally established
                                                                                                             2013/14: Choice of treatment and
               April 2012: Health and wellbeing        April 2013: Consortia hold contracts with
                                                                                                             provider – vast majority of NHS
               boards in place                          providers
                              And in future…

• Equity and Excellence: Liberating the NHS describes a system
        –    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

10   DH template
                        In Summary

• This report is important and necessary as it highlights
  deficiencies in the care of older people postoperatively in

• 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.

11   DH template
                       Thank you

• Questions.....


12   DH Template

Shared By:
Description: Injury Report Template document sample