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In this report the Health Committee welcomes improvements in the performance of the Nursing and Midwifery Council (NMC) over the last year, but expresses continuing concern that the progress made so far remains fragile. The Committee emphasises that it is important to ensure that the new challenges facing the NMC do not become a distraction from the continuing requirement to improve its performance of its core functions. The report is the first example of a Health Committee review of a professional regulator which builds on the work of the Professional Standards Authority (PSA). The length of time the NMC takes to conclude its fitness to practise cases has been an enduring concern for the Committee. From 2015, the NMC proposes to toughen the target period for resolving fitness to practise cases to 15 months (eventually to 12 months). The NMC has announced plans to introduce a system of revalidation by the end of 2015 which is welcomed. The Francis Report into the failings at Mid Staffs examined the role of regulators, including the NMC, in detail. The report stresses the importance of ensuring firstly that registrants understand their professional obligation to raise concerns when they see evidence of poor patient care, and secondly that patients and public are made more aware of the role of the NMC as the regulator of professional and clinical standards. The NMC should take urgent steps to raise the profile of the NMC both among its registrants and among patients and public.
This year's inquiry into the work of Monitor concludes that the model of care provided by the health and care system is not changing quickly enough with the result that pressures continue to build, threatening the financial stability of individual providers, and therefore the quality of care provided The pressures are likely to be particularly marked in the acute sector as plans are prepared and implemented to achieve the resource transfer required by the introduction of the Better Care Fund from April 2015. Continuing this theme, the Committee argues that as the NHS financial situation tightens, the challenge for Monitor in supporting trusts in financial difficulty is likely to increase. The MPs emphasise the importance of addressing pressures within individual providers in the context of the local health economy. The requirement for major change in the care model can only be delivered if individual providers, and Monitor as their regulator, look beyond preserving existing structures and address the need to develop different structures to meet changing needs. The Committee also expresses concern that Monitor has not done enough to reform the system of tariff payments for providers, arguing that the current tariff arrangements often create perverse incentives for providers and inhibit necessary service change. It recommends that Monitor and NHS England should initiate a formal joint process for a prioritised review of the NHS tariff arrangements with the objective of identifying and eliminating perverse incentives and introducing new tariff structures which incentivise necessary service change
GMC's fitness to practise successfully produces outcomes that protect patients from sub-standard doctors but failures to communicate the reasons for decisions and poor investigative practices have undermined a small number on investigations. The GMC should review its fitness to practice procedures to prevent such mistake. The Committee also found that while it is still too early to judge whether revalidation has been effective there is a worrying approach to the oversight of revalidation. Each designated body has a responsible officer for revalidating their medical staff, but the degree to which the responsible officer will be held to account is unclear. It is imperative that the GMC clarifies the personal responsibility and accountability of responsible officers. There is also concern over the number of responsible officers available to oversee the revalidation of doctors working in primary care. GPs are revalidated not by their own employers but by one of the 27 NHS England local area teams that oversees Clinical Commissioning Groups in England. Just 27 responsible officers will be tasked with overseeing revalidation for approximately 45,0000 GPs in England. The Government's intention had been to give the GMC the power to allow it to appeal decisions made by the Medical Practitioners Tribunal Service (MPTS) in 2014 by using a mechanism in secondary legislation called a section 60 order. The Government now plans to introduce the reform in primary legislation as part of a proposed Law Commission Bill thus meeting with even further delay
Diet, obesity, and physical activity all have important impacts on health. For too long however, physical activity has been seen merely in the light of its benefits in tackling obesity. A core message from this inquiry is the compelling evidence that physical activity in its own right has huge health benefits totally independent of a person's weight. The importance of this - regardless of weight, age, gender or other factors - needs to be clearly communicated. Interventions focused on encouraging individuals to change their behaviour with regard to diet and physical activity need to be underpinned by broader, population-level measures. Whilst both are important, population-level interventions have the advantage of impacting on far greater numbers than could ever benefit from individual interventions. The Committee recommends that the next Government prioritises prevention, health promotion and early intervention to tackle the health inequalities and avoidable harm resulting from poor diet and physical inactivity. The Committee regards it as inexplicable and unacceptable that the NHS is now spending more on bariatric surgery for obesity than on a national roll-out of intensive lifestyle intervention programmes that were first shown to cut obesity and prevent diabetes over a decade ago. All tiers of weight management services should be universally available and individual clinicians should use every opportunity to help their patients to recognise and address the problems caused by obesity and poor diet, and to promote the benefits of physical activity.
15 million NHS patients in England with long-term conditions such as diabetes, arthritis and asthma account for 70% of the annual expenditure of the NHS in England. One projection estimating that the bill for treatment of long-term conditions will require the NHS to find £4 billion more each year by 2016. Increasingly, patients do not have a single long-term condition but live with two or more conditions, complicating treatment and adding to its cost. The Committee strongly supports the development of individual care planning for people with long-term conditions, based on the principles successfully demonstrated in the NHS House of Care programme. Care planning approaches will involve GPs, community health services and specialists sitting down with the patient to draw up a personalised plan for the care required, which includes the support needed to help the patient manage his or her own condition. The challenge, though, of introducing personalised care planning for 15 million people is substantial. The Committee looked at the prevailing view that services to treat long-term conditions should be moved out of hospitals and into primary and community care. To provide effective care for these conditions, services have to be maintained across all settings, from support in the home through to acute specialist care, and many conditions will continue to require specialist services delivered in hospital. Effective management of long-term conditions also requires collaboration with other government providers, such as housing and transport services.
Most of those who complain about NHS services do not seek financial redress. They do so because they wish to have their concerns and experiences understood and for any failings to be acknowledged and put right so that others do not suffer the same avoidable harm. Where such errors occur, patients and their families deserve to be met with a system which is open to complaints, supports them through the process and which delivers a timely apology, explanation and a determination to learn from mistakes. The current system for complaints handling however, remains variable. Too many complaints are mishandled with people encountering poor communication or at worst, a defensive and complicated system which results in a complete breakdown in trust and a failure to improve patient safety. The Committee welcomes the progress made since their last report, but in this, the Committee's final report on complaints and concerns in this Parliament, an overview is set out of the developments and recommendations to date as well as those expected in 2015. The Committee also makes a number of recommendations where further action is required.
The Ombudsman investigated three cases in which local statutory supervision of midwives failed, all of which occurred at Morecambe Bay NHS Foundation Trust. The cases clearly illuminate a potential muddling of the supervisory and regulatory role of supervisors of midwives. The current arrangements do not always allow information about poor care to be escalated effectively into hospital clinical governance or the regulatory system. This means the current system operates in a way that risks failure to learn from mistakes, which cannot be in the interests of the safety of mothers and babies and must change. Working with the Nursing and Midwifery Council (NMC), the Professional Standards Authority for Health and Social Care, NHS England and the Department of Health, the Ombusdman has identified two key principles that will form the basis of proposals to change the system of midwifery regulation: that midwifery supervision and regulation should be separated; that the NMC should be in direct control of regulatory activity. The Department of Health should convey these recommendations to its counterparts in Northern Ireland, Scotland and Wales and develop proposals to put these principles into effect.
Designed to teach nurses about the development, motivational, and sociocultural differences that affect teaching and learning, this text combines theoretical and pragmatic content in a balanced, complete style. --from publisher description.
Underpinned by relevant epidemiology, demography and policy, this book explores the management of long-term conditions. It discusses communication and multidisciplinary working, including discussion of the student nurse's role. Each chapter includes learning points and uses a questioning/reflective approach, which draws on the reader's own experiences.
Brain disordersâ€"neurological, psychiatric, and developmentalâ€"now affect at least 250 million people in the developing world, and this number is expected to rise as life expectancy increases. Yet public and private health systems in developing countries have paid relatively little attention to brain disorders. The negative attitudes, prejudice, and stigma that often surround many of these disorders have contributed to this neglect. Lacking proper diagnosis and treatment, millions of individual lives are lost to disability and death. Such conditions exact both personal and economic costs on families, communities, and nations. The report describes the causes and risk factors associated with brain disorders. It focuses on six representative brain disorders that are prevalent in developing countries: developmental disabilities, epilepsy, schizophrenia, bipolar disorder, depression, and stroke. The report makes detailed recommendations of ways to reduce the toll exacted by these six disorders. In broader strokes, the report also proposes six major strategies toward reducing the overall burden of brain disorders in the developing world.