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NHS reforms hamper serious incident reviews

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Loss of staff due to NHS reforms has left primary care trusts struggling to review thousands of serious incidents before their abolition in April, LGC’s sister title Health Service Journal has learned.

Health reporting HSJ and LGC logo

The news follows the publication of the Mid Staffordshire Foundation Trust public inquiry report, which warned that past structural reorganisations had hindered NHS organisations’ ability to focus on care quality and patient safety.

A report to NHS North of England’s most recent board meeting warned that at the end of December the north had 2,447 “open incidents” recorded on a national database for the reporting of serious incidents.

Once a provider has reported an incident on the system, it cannot be closed until its PCT is satisfied any necessary investigations into the cause have been carried out, and an appropriate action plan developed.

The report said the “rate of review and closure” in the north had slowed at the end of 2012, due in part to “the movement of staff as a result of organisational change which has reduced the available capacity within PCTs”.

The report, by NHS North of England chief nurse Gill Harris and medical director Stephen Singleton, estimated the region would have 2,000 incidents still open on 31 March.

“Significant numbers” of open incidents would be handed over to the local area teams of the NHS Commissioning Board and clinical commissioning groups (CCGs) that take over from strategic health authorities and PCTs in April, the paper added. It warned that these new organisations “may not have the capacity or capability to manage the volume”.

NHS North of England chief nurse Gill Harris, who co-wrote the report, told HSJ that since the publication of her report, “work has continued in line with [an] action plan to address the issues identified”.

Meanwhile, HSJ reported that CCGs are set to face tighter scrutiny as a result of the Francis report.

The NHS commissioning board is already devising the regime it will use to assure CCGs’ performance and is due to make an announcement by April. HSJ understands it is likely the board will commit to tight requirements, particularly in quality oversight and patient feedback and involvement.

A source involved in discussions about assurance said the issue would be considered in light of Mr Francis’s report. The source said: “It will have quality and safety at the heart of it.”

Robert Francis QC’s inquiry report endorsed commissioners’ role in ensuring quality and safety, particularly through the use of a set of agreed standards.

His report said the NHS should “rebalance and refocus commissioning” on “fundamental and enhanced standards of service”.

It is likely that tighter scrutiny will also be extended to commissioning support units, the groups that provide back-office service and data analysis for CCGs.

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