The Keogh Review turns out to one of the best documents produced for our NHS. Clear, concise, brief and informed by evidence. It doesn’t look to blame, doesn’t make overt recommendations that can be tracked and ticked off. It just makes sense.
It does not portray 14 further Mid Staffs and its forensic approach probably should make us think again about what exactly we learned from a review by lawyers.
It bears no resemblance to the media coverage it received before it was published. It draws lessons only when justified from the evidence from the 14 trusts that were examined – it makes no links at all to politics or policies. It is about now, not about years ago.
It actually talks to an NHS before the Lansley reforms! It makes no allowance for competition and markets and assumes parts of the NHS will be willing to help out other parts; commissioners will work with providers and even puts a strategic body into play focused on quality. It talks as if the old levers were still there to pull! It hardly refers to commissioning, money flows, targets, the drive for FT status don’t get much traction.
It will greatly disappoint the various conspiracy theorists and those who claimed it should show the whole NHS was awful; how long before the accusations of a cover up or use of whitewash begin.
It makes clear that the process used, let’s call it peer review, is far more effective than anything regulators can deploy and that it found things they would not. It sets out that they found poor management, poor leadership including clinical leadership and many examples of issues caused by inappropriate levels of staffing; and it found too many trust specific issues that needed urgent attention. It leaves that as problems for local management to resolve with some external help – it does not say the problems were caused by particular policies or particular external forces. It does not castigate regulators for not being able to find as much. It does not call for sackings and retribution or apologies.
It puts the use of HSMR and SHMI where it should be, pointing out they give different answers, and refuting in strong terms the stupid and dangerous claims about excess deaths, as did Francis – for all the good it did. The proposed development of proper measures, based on case notes review, and measuring avoidable deaths is one we have long argued for.
The ambitions set out are not for magic or instant solutions – it will take years to achieve them. But they sound right.
- Moving on from statistical arguments (often backed by commercial interests) to actually reducing avoidable deaths.
- Making sure those who manage can actually understand and analyse the wealth of data that is already produced.
- Making far better and more creative roles for patients, carers and public – convincing them they are listened to; making them partners.
- Having a CQC that we can have some confidence in because it involves clinicians and the patients.
- Reinforcing the coherence of the NHS – stopping the idea of trusts as separate isolated (competing?) entities.
- Having the right skill mix at all times matching the caseload, not in theory but in place 24/7.
- Making best use of the small army of junior doctors (one we haven’t advocated!).
- Valuing the staff and understanding that happy and engaged staff will deliver the best patient outcomes (always our favourite!).
This is good solid sensible stuff.