London’s hospitals to check maternity and emergency care service standards

London’s hospitals have been asked to measure themselves against a set of ‘quality standards’ in a fresh drive to improve the safety of acute emergency and maternity services.

London’s Quality Standards – developed by clinicians across the capital – are designed to address variations in the quality of patient outcomes between weekdays and weekends and between hospitals. The standards mean that these services should have senior consultant cover and access to diagnostics at weekends

NHS England medical director, Dr Andy Mitchell and Dr Howard Freeman, Chair of London’s GP Clinical Commissioning Council, have written to hospitals asking them to report how they meet the Quality Standards for acute medicine, emergency general surgery, emergency departments, critical care, the fractured neck of femur pathway, paediatric emergency services – medicine and surgery – and maternity services.

Research underpinning the Quality Standards shows that patients admitted to hospital for emergency treatment at the weekend have a 10 per cent higher risk of dying compared to those admitted on a week day. Both clinicians and patients have raised concerns about how services are delivered over the weekend, with lack of access to senior medical staff and limited access to diagnostics cited as major factors in poor outcomes for patients.

Speaking at the Westminster Forum ‘Delivering the 7 day NHS’ Dr Anne Rainsberry, London’s Regional Director of NHS England, told delegates:

“Patients have a right to expect the same quality of emergency service seven days a week. The weekend variation in outcomes used to be greatest for stroke services but by redesigning this service across London there is now no variation for that very pathway. This shows that it is possible to make improvements and London has led the way in developing robust, clinically-led, quality standards to eradicate the ‘weekend effect’. We have made the introduction of these standards in emergency care and maternity services a priority.

“If we had the same outcomes at weekends as we do in the week then 500 fewer people would die. We know that there is still much to be done but the principle of consistent, high quality services, seven days a week should be at the heart of the way we deliver health care to Londoners.

“It will take time to implement the standards everywhere. Last year a survey showed that no one hospital met all the standards. Since then, Trusts have been working very hard and we expect to see good progress. The results of the self-assessments will be published soon.”

London is leading the way in improving safety and quality through setting robust standards. The approach taken by Professor Sir Bruce Keogh’s Seven Day Services national review mirrors that taken in London: a review of the evidence base; setting out a case for change; and, the development of clinical standards to address the issues. The national clinical standards which will be published soon will be in line with London’s Quality Standards. There is now an opportunity for London to be at the forefront of commissioning and providing standards of high quality care, seven days a week.

Implementation of the London Quality Standards will also help trusts address significant pressure to meet the four hour Accident and Emergency standard. Clinical opinion is that implementing the standards is the single biggest factor in improving Accident and Emergency performance as this will improve patient flow throughout hospitals.

London’s Quality Standards, which have been developed with input from patients and clinicians, were published in February 2013. A quality and safety audit data was published at in February 2013 and showed that while all London hospitals met some of the standards, no hospital in London currently met them all.

All of London’s 32 Clinical Commissioning Groups have agreed to commission acute emergency and maternity services in line with the Standards from April 2014. The Standards align with recommendations from the Academy of Medical Royal Colleges and are supported by the British Medical Association (BMA).