Health CommitteeSupplementary written evidence from the Department of Health (FRA 04A)

During my appearance before the Health Select Committee on 23 April, I agreed to provide the Committee with further information, which I have set out in this letter.

Children’s Heart Surgery at Leeds Hospital

The Committee asked for a full timetable, detailing when the Department received information relating to mortality data at Leeds Hospital.

The decision to suspend surgery at the Leeds unit was taken because concerns had been raised from a variety of sources about the safety of surgery at the unit. The hospital decided to close the unit.

In any decision about the suspension of services, the ultimate consideration is patient safety. We support NHS England and the Trust in coming to a joint decision about what is best for patients, and I am pleased that surgery has now resumed for low-risk patients.

The closure of the children’s heart surgery unit in Leeds is separate from the national review of children’s congenital heart surgery and is not connected to the court proceedings in which a Leeds-based charity Save Our Surgery won its judicial review against the decision to close the unit.

A full timeline of events is set out in Annex A.

Health Education England Pilots

The Committee asked to see additional detail regarding proposals for nurses to undergo a year’s training as a healthcare assistant, prior to beginning a nursing degree course. This information is set out in Annex B.

Death Certification

The committee asked for a full revised timetable for reforms to death certification, that takes into account the recommendations made by Robert Francis. I would like to advise the Committee that we intend to engage further with our key partners to inform the timetable for the reforms over the coming weeks. I will then write to the Committee with further details by the end of this month.

I do hope that this information is helpful, and would of course be happy to provide further detail as requested.

Rt Hon Jeremy Hunt MP
Secretary of State for Health

8 May 2013

Annex A

CHILDREN’S HEART SURGERY AT LEEDS HOSPITAL: TIMELINE

Earlier this year, the office of Sir Bruce Keogh received correspondence from the Children’s Heart Federation expressing concern that children were not receiving the level of service that should be provided to them at the Leeds Unit, and that the Leeds Unit was not referring appropriately to other centres.

During 2013, the Medical Director of Leeds Teaching Hospitals NHS Trust (LTHT) received complaints from cardiologists in LTHT alleging poor communication and poor team working within the Unit by one of their congenital cardiac surgeons.

26 March 2013—Sir Bruce Keogh received telephone calls from two paediatric cardiac surgeons and an eminent cardiologist. They expressed similar concerns to the Children’s Heart Federation and additional concerns over surgical staffing.

27 March 2013—Sir Bruce Keogh was provided with a first draft of data from the Central Cardiac Audit Database (CCAD).

28 March 2013—Sir Bruce Keogh and the NHS England Area Director and Medical Director for West Yorkshire met the Chairman, Chief Executive and acting Medical Director of LTHT to discuss the concerns. A CQC representative also attended the meeting. A decision to suspend surgery at the unit was taken. Patients and families whose surgery was affected by this decision were notified.

28 March 2013—I was informed of the situation at LTHT by NHS England.

29 March 2013—Sir Bruce Keogh appeared on the “Today” programme and I spoke to three local lead MPs (Hillary Benn, Stuart Andrew and Greg Mulholland). LTHT continued to provide reassurance to the families involved.

4 April 2013—A risk summit, chaired by Dr Mike Bewick (Deputy Medical Director of NHS England), and attended by representatives from NHS England, NTDA, CQC and the Trust met to discuss the suspension further. The summit agreed that further work was required.

5 to 7 April 2013—Discussions continued between the Trust, NHS England, CQC and the independent review team to address concerns that had been raised.

8 April 2013—First stage of the review by a multi-disciplinary independent clinical team completed. It found:

assurances could be given that the quality of surgery and staffing levels were sufficient to allow the phased resumption of operations; and

the Trust’s data for monitoring surgical results was uniquely poor, triggering concerns about death rates and gaps in information.

8 April 2013—Risk summit met to discuss the outcome of the first-stage review and recommended that surgery could re-commence on a phased approach.

10 April 2013—Surgery re-started at the Trust on a phased basis, starting with lower-risk cases.

A second stage of the review will now begin. This will comprise:

a review of the way complaints from patients are handled, including the issues raised by the Children’s Heart Federation; and

completion of a review of patients’ case notes over the last three years.

Sir Bruce Keogh will agree the terms of reference for this review within the next few days and will appoint an independent clinician to undertake this work. The findings of the second stage of the review will be considered at a future meeting of the Quality Surveillance Group and may lead to a further risk summit if required.

In addition, NHS England will further explore issues that have been raised about referral practices to ensure they are clinically appropriate.

Annex B

PILOTING A YEAR SPENT AS A CARER BEFORE ENTERING NURSING EDUCATION AND TRAINING

Introduction

To deliver high-quality care, we need staff in the right numbers, with the right skills and the right values and behaviours. The intention in asking those who commence NHS funded nursing degrees to first spend up to a year as a carer is to promote an experience of frontline care underpinned by those values and behaviours needed to work in the NHS.

Recommendation 187 from the Robert Francis Inquiry into the Mid Staffordshire NHS Foundation Trust said that “There should be a national entry-level requirement that student nurses spend a minimum period of time, at least three months, working on the direct care of patients under the supervision of a registered nurse. Such experience should include direct care of patients, ideally including the elderly, and involve hands-on physical care. Satisfactory completion of this direct care experience should be a pre-condition to continuation in nurse training. Supervised work of this type as a healthcare support worker should be allowed to count as an equivalent. An alternative would be to require candidates for qualification for registration to undertake a minimum period of work in an approved healthcare support worker post involving the delivery of such care”.

The Government response suggested that this should be tested to see if up to a year would be better, and asked Health Education England (HEE) to pilot and evaluate pre-degree nurses undertaking a year as a carer before recommending how it should be taken forward.

We believe this important development in nursing education will be invaluable in enabling prospective student nurses to gain hands-on experience whilst appreciating the care support roles and their vital place in delivering the best possible patient care.

This change will also help students to find out whether healthcare and nursing is right for them; attrition rates show that a significant number of students who start an undergraduate nursing degree do not complete the programme.

Steering Group

A steering group will direct the pilot, chaired by Sir Stephen Moss. Stephen is a former director of nursing at Nottingham University Hospitals NHS Trust who was invited by Monitor to take on the Chair of the Mid Staffs NHS Foundation Trust after the initial Healthcare Commission report into standards of care at the Trust. His direct experience with the patients and families affected by the poor standards of care at the Trust will be invaluable.

The steering group will comprise key stakeholders including HEE and LETB directors, CNO Jane Cummings, PHE director of nursing Viv Bennett, NTDA director of nursing Peter Blythin, the NMC and the Council of Deans, representatives from the RCN and UNISON, NHS Employers, a provider Trust chief executive, Healthwatch, and Sally Brearley, chair of the Nursing and Care Quality Forum.

Piloting a Year as a Carer

HEE have made some early decisions on the scope:

In line with the Department of Health’s mandate with HEE, the pilot placements will start by September 2013 with student experience evaluated by summer 2014 in order for them to commence their studies at the beginning of the 2014 academic year;

Further evaluation will be undertaken to test the pilot’s efficacy in demonstrating and testing NHS values and behaviours; reducing attrition rates; giving experience and appreciation of a hands-on patient care experience, and building an understanding of a career in the NHS;

Between 150 to 200 prospective nurse students will be selected for the pilot. Those undertaking placements will have to meet the academic entry requirements for their course;

The placements will be paid jobs of one year in duration and will allow students to gain experience across different care settings. Through evaluation, this will allow HEE to determine the right length of experience needed, between the three months suggested by Robert Francis, and up to a year proposed by the Government; and

Students will be recruited for NHS values and behaviours, and will sign up to the Skills for Health/Skills for Care code of conduct for care support workers and receive induction training to the minimum training standards. These were published in response to the Francis Inquiry recommendations.

The steering group will drive the implementation, management and evaluation of the pilot, considering how it will be arranged, and how students will be supervised and assessed. The scoping work will also take into consideration patient safety, the impact on nurse recruitment and the current nursing workforce, and the impact on hospitals as they support this change.

Cost

The cost of the pilot is estimated at around £3.5m. The majority of this is paying people to do a real job, supporting the service, at Agenda for Change pay band 2. Other costs will be for the steering group, assessment tools and evaluation of the pilot. The steering group will work with providers and pilot organisations to agree the most appropriate approach to funding the pilot, recognising the extra responsibility we are placing on Trusts but also the added benefit they will gain from hosting these posts.

The Government’s response to the Francis Inquiry recommendations said that the scheme will need to be tested and implemented carefully to ensure that it is neutral in terms of costs, and as part of this work we will undertake robust economic modelling and costing analysis—the results of which will form part of the final report.

There is more value to the NHS than just cost savings; the real value will be for patients and their families. Time spent as a carer will contribute to supporting the service with people doing real jobs, gaining front-line care experience, getting to know the NHS and other career options open to them, and understanding the interface with social care which is often key to patient recovery and long term wellbeing.

Prepared 17th September 2013