"As a clinician and a member of the public, I would want to go to a hospital with the best and safest treatment possible."
Right care, Right place, Right time - saving lives
What are the Quality and Safety standards?
National organisations such as the Royal College of Surgeons and the College of Emergency Medicine describe the standards that should be followed to provide the highest quality and safest care. Senior doctors and nurses in Greater Manchester reviewed these standards and identified those that they felt must be delivered in every hospital in Greater Manchester. Nearly 500 standards were described.
The standards include a description of how and when care should be delivered and by whom. For example, patients who need an emergency operation on their abdomen (tummy) should have a scan within 30 minutes of being referred for one. If the patient is considered ‘high risk’*, the standard is for them to be assessed by a consultant surgeon within 4 hours. If the patient needs an operation, they should be operated on by a consultant surgeon and a consultant anaesthetist. Following the operation the patient should be cared for in intensive care.
*Patients who need emergency general surgery are assessed using a standard tool to work out how risky, or life threatening, their condition is. This then determines the standards that should be followed to ensure that their care matches their level of risk.
Do the hospitals in Greater Manchester meet the Quality and Safety standards?
The Hospitals in Greater Manchester were assessed by the National Clinical Advisory Team against 143 of the full library of nearly 500 standards. This assessment found that no hospital in Greater Manchester meets all the standards.
Some examples of the standards are given below with the current number of Trusts attaining these standards shown.
The Healthier Together standard is for a consultant to be present in A&E for a minimum of 12 hours per day 7 days per week. In Greater Manchester, 3 out of 8 Trusts currently meet this standard. Healthier Together wants to upgrade consultant presence in all A&Es to 12 hours, some to 16 hours and some to 24 hours.
For high risk general surgery operations, a consultant surgeon and consultant anaesthetist should be present. In Greater Manchester, 3 out of 8 Trusts currently meet this standard. Healthier Together wants to invest in consultants to ensure that very ill patients are treated by specialists.
Patients with a life or limb threatening emergency who need a surgical assessment should be assessed within 30 minutes of being referred. Patients who need a routine surgical assessment should be assessed within 60 minutes or referral. In Greater Manchester, 1 out of 8 Trusts currently meet this standard. Healthier Together wants to invest in consultants to ensure that emergency patients can be assessed by a specialist when they need it.
Evidence shows that patients undergoing emergency general surgery who have access to an intensive care bed following surgery have a better chance of survival and reduced risk of long term complications. In Greater Manchester, 4 out of 8 Trusts currently meet this standard. Healthier Together wants to ensure that there is an intensive care bed for all patients who need it.
National and Healthier Together standards are for a consultant to be present in the Acute Medical Unit for 12 hours per day 7 days per week. In Greater Manchester, 5 of 8 Trusts currently meet this standard. Healthier Together wants to invest in consultants to ensure that very ill patients are treated by specialists.
Analysis has found that there needs to be a different way of working and an investment in experienced doctors and nurses to meet the standards in every hospital.
Can we implement the standards in every hospital in Greater Manchester?
No. There are a number of reasons why we cannot implement the standards in every hospital in Greater Manchester.
Many of the standards relate to the types of doctors and nurses that there should be in each department as well as how many there should be at different times of the day. However, for some key staff types there are simply not enough doctors and nurses available to achieve these standards everywhere. For example, fewer junior doctors are choosing to become A&E doctors because it is currently seen as a very challenging job. This means that nationally there is a shortage of experienced and junior A&E doctors. Therefore, even if money was no object, it would simply not be possible to meet the standards for A&E doctor staffing in every hospital in Greater Manchester.
In General Surgery there is a different reason why we cannot meet the standards in every hospital in Greater Manchester. General surgery operations can be divided into very complex specialist operations – for example for bowel cancer – and routine operations, for example an endoscopy which is a diagnostic procedure.
The standard is for complex specialist operations to be performed by a consultant surgeon as they are more experienced. However, there are not very many of these types of operation each year. If we spread these across all 10 hospitals in Greater Manchester, each hospital will not perform very many of this operation. As these are complex and risky operations, it is better to perform these operations on fewer hospitals that specialise in these complicated procedures.
This is why we need to change to meet the standards and deliver the best care for people across Greater Manchester. Healthier Together is proposing that there is an investment in experienced doctors and nurses to meet the standards in every hospital in Greater Manchester.
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