Crerar Review: Public Scrutiny in Scotland

The Report by Professor Lorne Crerar of the “Independent review of regulation, audit, inspection and complaints handling of public services in Scotland” was published on Tuesday 25th September 2007 on http://www.scrutinyreview.org/

The Crerar review concludes there is widespread agreement that Scotland’s scrutiny system is too complex, costly and burdensome on public bodies. From the evidence gathered, Crerar finds that the scrutiny system doesn’t necessarily scrutinise the right things, has grown in a piecemeal fashion and requires strategic co-ordination.

The Crerar report short to medium term recommendations

• a radical increase in the sharing of information and co-ordination
between bodies.
• a renewed focus on users of services
• involving service users in standards setting
• an increased role for parliament
• fewer scrutiny organisations
• accessible reports by scrutiny bodies
• proportionality - focusing on poorer performing service providers and higher risk situations

Crerar Report - One scrutiny body for all?

In the longer term the report proposes moving to one national scrutiny body, one audit body, and one complaints handling body for the whole public sector.

Crerar report - other recommendations

The Crerar report also recommends that –
• Core risk criteria should be agreed by Ministers and agreed by Parliament to assess the need for current and future scrutiny
• Ministers should redistribute resources and functions from within NHS QIS,
the Scottish Government’s Health Directorates and the Care Commission in relation to private hospitals and related treatment – to an independent external scrutiny organisation
• All external scrutiny organisations should have one “status” with clearly defined lines of accountability to Parliament and to Ministers.
• Where scrutiny is needed, if there is more than one existing organisation, only one should be asked to do the work and be fully responsible and accountable. Creating a new scrutiny organisation should not be an option.

Crerar Report: Principles of scrutiny

The focus should shift to self assessment, supported by risk based, proportionate
external scrutiny. As service provider performance management improves in quality
and ability to reassure users, public and elected members, scrutiny can become
more proportionate to the risks, which in turn frees up delivery organisations to focus
further on improving their front line services. The scrutiny framework should –
􀂃 focus on the needs of the people who use services being scrutinised,
􀂃 drive improvement,
􀂃 ensure that public money is used as efficiently and effectively as possible.
The principles behind the system are for a simplified scrutiny landscape, with a
proportionate and co-ordinated approach.

Crerar Report: The future for Scrutiny bodies

The report does not make specific recommendations in relation to the future of particular scrutiny bodies as this was not the remit of the review. However the report does recommend that in the longer term there should be the development of one scrutiny body and this will have implications for a number of existing bodies.

Crerar Report: A Risk based and Outcome focussed approach to Scrutiny?

The report argues strongly for scrutiny which is risk based and which moves away from scrutinising inputs and processes and towards measuring outcomes.

The full report can be downloaded at http://www.scotland.gov.uk/Resource/Doc/82980/0053065.pdf

Healthcare associated infections study

National Healthcare Associated Infections (HAI) Point Prevalence Survey

This survey, carried out by Health Protection Scotland, is the most
comprehensive study ever undertaken into the extent of infections in Scotland
and leads the way in HAI research in Europe.

The survey recorded the presence of all types of infections in one day for every patient in every acute hospital. The survey found that the prevalence of HAI was 9.5 per cent in acute hospitals
and 7.3 per cent in community hospitals and the cost of these infections was approx. £183m per
year.
The study found that the highest numbers of HAI in acute hospitals were present in care of the elderly, medical and surgical wards.
The HAI task force will take these findings forward and is focusing on the following areas:
• examining the case for introducing an MRSA screening programme - targeting skin and soft tissue infections
• reducing blood stream infections
• ensuring additional surveillance data are put to use in the areas of general medicine and care of the elderly.

Vulnerable Young People transitions research

Scottish Executive: Review of Research on Vulnerable Young People and Their Transitions to Independent Living

The Scottish Executive has published a Review of research on vulnerable young people which was conducted by the Centre For Research on Families and Relationships, The University of Edinburgh ( Authors; Susan Elsley, Kathryn Backett-Milburn, Lynn Jamieson) The Full report is available from www.scotland.gov.uk/research

The report examines available research and data on the issues around vulnerable young people and their transitions from care to indepenedent living.

Recovered memories of abuse:new research

New research suggest that memories of abuse recovered through therapy may be less reliable than memories which are recovered spontaneously.

Some years ago an intense debate began about the reliability of recovered memories of abuse when a number of very high profile cases hit the headlines in a number of coutnries. In some of these cases memories of abuse had been recovered through intensive therapy and there was much debate whether such memories could be relied upon as accurate recollections of past events.

The whole issue of the reliability of recovered memory became a very hot topic in the fields of psychology and psychiatry with fierce advocates on both sides.

Elke Geraerts, a psychology post doctoral researcher at Harvard University and Maastricht University, the Netherlands, aimed to try to throw light on this problem using a large-scale research study designed to test the validity of such memories.


Of course people who recover memories in this way will tend to be convinced they are real authentic memories and this makes validating the recovered memories difficult.

Geraerts and her colleagues avoided this problem by using outside sources to corroborate the memories.

The researchers recruited people who reported being sexually abused as children.

They divided them into three groups.
1) Those whose memories were categorized as either "spontaneously recovered" (the participant had forgotten and then spontaneously recalled the abuse outside of therapy, without any prompting),
2) those whose memories had been "recovered in therapy" prompted by suggestion

3) those whose memories ofthe abuse was "continuous" in that they had always been able to recall the abuse.

Interviewers, who had no knowledge of which group the subject fell into, then interviewed other people who could confirm or refute the abuse events. these included others who heard about the abuse soon after it occurred, others who reported also having been abused by the same perpetrator, and those who admitted having committed the abuse.


The results to be published in the July issue of Psychological Science, journal of the Association for Psychological Science, showed that,

1) overall, spontaneously recovered memories were corroborated almost as often (37% of the time) as continuous memories (45%) but were less reliable.

2) memories that were recovered in therapy could not be corroborated at all.

Of course not being able to of confirm that the abuse had happened does not prove that the memory is false. It does however suggest that memories recovered in therapy need to be treated with a great dela of caution, as the therapy context raises the opportunity for suggestion.
.
Source: news release issued by Association for Psychological Science.

Care Home Standards:When big is not better

The Care Home market in the UK has seen a significant move over recent years towards the consolidation of ownership into the hands of fewer and larger ownership organisations. While in financial terms this may make sense there has been concern among commissioners and regulators whether these larger corporate organisations are always delivering a better quality of care in their homes in comparison to the smaller or single single home providers that are becoming a less significant part of the market.

Much of the concern about the standards in the Care Homes provided by the "big players" has admittedly been anecdotal and we are not aware that there has been any systematic study of this in the UK. Nevertheless the anecdotal evidence seems quite strong and it has been interesting to speculate why these larger organisations sometimes do not match the quality of care in smaller scale provider organisations.

Now a study by the University of Michigan School of Public Health suggests that the very strengths of the larger nursing home chain- its ability to standardize and perfect administrative practices throughout the chain-may also be the very thing that hurts patient care. While the study was confined to the more Nursing Home oriented facility in the US, it may have important lessons for the delivery of care across the Care Home sector.

"Consumers need ways to identify what is a good or bad nursing home when making choices about where to place a loved one," said Jane Banaszak-Holl, corresponding author on the study. "Right now, we have an easier time distinguishing the quality in McDonalds versus Boston Market than we have distinguishing how, for example, a Sun-owned nursing home differs from a Beverly Enterprises nursing home."

As in the UK these larger chain-owned nursing homes are the predominant type of institutional care in the United States. Studies in the US have shown that care in chain-owned nursing homes is generally not as good as care in nonprofit and singly-owned nursing homes.

"If they (chain-owned nursing homes) are really not as good, we need to think about how to improve them," said Akiko Kamimura, a U-M doctoral student in Health Management and Policy at the School of Public Health, and first author of the study.

The study suggests that corporate standardization of clinical and facility processes improved resident care, but that corporate standardization of administrative processes hurt patient care. The study concluded that chains need to balance administrative efficiency with the local needs of the individual chain-owned facilities to optimize the quality of their patient care.

The researchers surveyed 203 nursing homes in Michigan and North Carolina and looked at the effects of corporate standards and training in three areas: administrative processes, clinical processes, and facility design. The study examined the impact on the total number of health deficiencies given to facilities on state inspections, and the percentage of residents with bedsores. An example of a health deficiency would be inserting a catheter unnecessarily because it makes care easier.

An example of standardizing administrative processes would be to share common marketing materials. An example of facility standardization would be to use the same facility layout, and an example of standardizing clinical processes might be to implement guidelines for the treatment of resident bedsores throughout the chain.

"Standardization is a way to think about changing service delivery across many areas, including administrative and clinical processes and even within facility layout," said Banaszak-Holl. Chains that over-emphasize administrative processes don't take advantage of how much their staff can learn---and ultimately improve patient care---from the shared knowledge of developing protocols for handling resident needs.

"What we have stressed in the larger project is that chain ownership is not necessarily bad for the quality of health care, Banaszak-Holl said. "What is problematic is a shift away from community values and local needs, and an overly strong emphasis on administrative rather than clinical outcomes. A good corporate chain can implement a set of practices that still attends to local needs and resident outcomes while introducing greater economies of scale and better business practices."

The study, "Do corporate chains affect quality of care in nursing homes" The role of corporate standardization" appears in Health Care Management Review.

Dementia: Research supports person centered care

An intensive comparative study of two nursing home units using contrasting approaches to dementia care for elders with severely disturbed behaviors has shown that "humanizing" approaches to dementia care may not only extend quality of life for patients, but also their length of life.

Central Michigan University professor of anthropology Athena McLean in her recently published book, "The Person in Dementia: A Study of Nursing Home Care in the U.S.," demonstrates the very different outcomes of two approaches to dementia care: a rigid task-oriented maintenance approach which placed emphasis on disease progression and a flexible person-centered approach which focussed on the older persons communication and individual needs.

There were dramatic differences in patient quality of life at the two nursing units.

Patients at the person-centered unit, where staff looked beyond physical and reasoning abilities to the person's will and relationship with others, were happier, had improved quality of life and lived longer.

Those at the unit which focussed on disability and pathology tended to have personal needs ignored, were heavily medicated and often failed to thrive.

"These findings address issues that medicine can't answer," said McLean. "They are valuable not only for improving the general quality of life for these elders, but also for the long-term outcome based on how they are treated and cared for. These elders require attention, time and a lot of caring interaction."

The study also showed that relations among professional and administrative staff within a service can significantly affect the quality of the dementia care elders receive.

According to McLean; "Good caregivers are leaving the profession because they are underpaid and unappreciated. It needs to be understood by policy makers, family members and clinicians alike that money needs to be put into retaining quality caregiving staff, instead of only fancy facilities, which is currently the trend."

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Translate documents to Braille free

A Danish company has launched a free service which will automatically translate documents into either Braille or speech. The service is free for non-commercial use and may be of great assistance for organisations seeking to ensure equality of access for the sight impaired.

The service can be obtained through the RoboBraille website .

RoboBraille allows the user to;

• Translate documents into contracted Braille
• Translate documents into speech
• Translate text into visual Braille
• Convert text documents between different character sets
• Convert Braille documents to specific Braille character sets
• Partition documents into smaller parts