Improving the management of digital government

Improving the management of digital government argues that the digitisation of public services in the UK is happening too slowly | Institute for Government

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It says that appointing a minister responsible for digital government would help drive change and advance standards. Digital improvements would make government cheaper, more effective and more secure. The report points to the recent NHS cyberattack as an example of the fragility in some systems being used in the public sector.

The report warns that the Government Digital Service (GDS), the Cabinet Office unit responsible for leading digital transformation of government, faces resistance from many corners of Whitehall. Without a strong minister in charge, GDS is not able to drive digital improvements in a way that meets citizens’ expectations. It sets standards for digital government, but these need to be improved and extended throughout the civil service, and with IT contractors.

The report also makes several recommendations for both GDS and Whitehall departments on how they can work better together. The Government needs to organise services around people’s needs and to urgently clarify which system citizens should use to securely identify themselves online.

 

Tackling variations in clinical care: Assessing the Getting It Right First Time (GIRFT) programme

The Getting It Right First Time (GIRFT) programme aims to bring about higher-quality care in hospitals, at lower cost, by reducing unwanted variations in services and practices | The King’s Fund

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Image source: The King’s Fund

It uses national data to identify the variations and outcomes, shares that data with all those concerned with a service – not only clinicians, but also clinical and medical directors, managers and chief executives – and monitors the changes that are implemented.

The programme began with orthopaedics and is now being rolled out to 32 different surgical and medical specialisms across the English NHS. Through an informal assessment of the programme, this paper sets out what the programme is, why it is needed, what is different about it, what it has achieved, what challenges it faces and what potential it has. It also contains vignettes illustrating hospitals’ experiences of the programme.

Getting research into policy in health – The GRIP-Health project

For many, the idea that health policy should be informed by evidence is an obvious goal. And indeed, the global health community has widely called for increased use or uptake of research and evidence, in health policymaking | LSE Health and Social Care Blog

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However, a vast majority of these calls have been made without explicit recognition of the decidedly political nature of policymaking, and without consideration of how this may affect the use of evidence to inform decisions.

Indeed, calls for ‘evidence-based’ policymaking have become ubiquitous in recent years, applied in social sectors such as health, education, crime prevention and many others. Many have seen these calls deriving from the successes of the ‘evidence based medicine’ movement – a movement that has helped to ensure that clinical practice is informed by rigorous assessments of evidence of effects of different treatment options.

The GRIP-Health research programme was funded by the European Research Council to bring an explicitly political lens to the study of evidence use for health policymaking in low, middle and high income countries. It draws particularly on policy studies theories to consider how the nature of the policy process, the politicised features of health decisions, and the existing institutional arrangements for policymaking in different countries all can work to shape which evidence is utilised, and how it is utilised to inform or shape health policy decisions.

Why UK hospital staff find it difficult to make improvements based on patient feedback

Patients are increasingly being asked for feedback about their healthcare experiences. However, healthcare staff often find it difficult to act on this feedback in order to make improvements to services | Social Science and Medicine

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This paper draws upon notions of legitimacy and readiness to develop a conceptual framework (Patient Feedback Response Framework – PFRF) which outlines why staff may find it problematic to respond to patient feedback.

A large qualitative study was conducted with 17 ward based teams between 2013 and 2014, across three hospital Trusts in the North of England. This was a process evaluation of a wider study where ward staff were encouraged to make action plans based on patient feedback.

Through the development of the PFRF, we found that making changes based on patient feedback is a complex multi-tiered process and not something that ward staff can simply ‘do’.

  • First, staff must exhibit normative legitimacy – the belief that listening to patients is a worthwhile exercise.
  • Second, structural legitimacy has to be in place – ward teams need adequate autonomy, ownership and resource to enact change. Some ward teams are able to make improvements within their immediate control and environment.
  • Third, for those staff who require interdepartmental co-operation or high level assistance to achieve change, organisational readiness must exist at the level of the hospital otherwise improvement will rarely be enacted.

Case studies drawn from our empirical data demonstrate the above. It is only when appropriate levels of individual and organisational capacity to change exist, that patient feedback is likely to be acted upon to improve services.

Full reference: Sheard, L. et al. (2017) The Patient Feedback Response Framework – understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study. Social Science & Medicine. 178. pp. 19-27.

 

NHS England has issued a call for the world’s best healthcare innovations

The NHS Innovation Accelerator has already improved the uptake of pioneering ideas, equipment and technology such as ventilation tubes that reduce cases of pneumonia and new approaches to mental health care | NHS England

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The NHS Innovation Accelerator (NIA) has already successfully helped transform patient care across the NHS by fast-tracking the uptake of pioneering ideas, equipment and technology such as ventilation tubes that reduce cases of pneumonia and new approaches to mental health care.

NHS England Chief Executive Simon Stevens has now confirmed a further round of the programme which will focus on the clinical priorities outlined in the Next Steps Five Year Forward View plan including mental health, primary care and urgent and emergency care.

The initiative, supported by England’s 15 Academic Health Science Networks (AHSNs) and hosted at UCLPartners, has to date helped support the uptake of ground-breaking concepts in 469 NHS organisations. The aim is to provide innovators with a package of tailored support – including access to a 2017 bursary fund totalling £240,000 and mentoring from a team of experts – in order to help their ideas gain uptake across the NHS.

Acting without delay – How the independent sector is working with the NHS to reduce delayed discharge

NHS Confederation, June 2017

This report from the NHS Partners Network highlights examples where the independent sector is working with the NHS to avoid delayed discharges of care.  Reducing delayed discharge – where often frail and elderly patients are unable to leave hospital due to necessary care, support or accommodation in the community being unavailable – is arguably one of the biggest priorities for the NHS.

Delayed discharges and transfers of care (DTOCs) have a significant impact on the ability of NHS acute trusts to provide routine treatment such as elective surgery. It is vital, both for the patient and the trust, to be able to discharge patients speedily to avoid adverse effects to patient flow.

Sustainability and transformation plans: how serious are the proposals? A critical review

London South Bank University, School of Health and Social Care, May 2017

This report argues that in order to deliver a better future for the NHS, all 44 STPs would need to be given legislative powers and support necessary to achieve effective collaboration, plus some much-needed clarification on their role. It also recommends that STP leaders need to plan ahead based on the reality of their current situation, identify changes that are evidence-based, develop workforce plans that match their ambitions, and focus on reducing demand before removing resources from the acute sector. Alongside the main report, 44 sub-reports are available, each critically reviewing the plans for each STP locality.