Quality improvement updates - 10 January 2013

New policy guidance, tools and initiatives from across the UK. For more information about the quality improvement theme see Quality and Safety e-Bulletin: quality improvement. 

Some of the resources linked to are in PDF format - see how to access PDF files.

Entries are arranged under the following headings:

Audit, reviews, legislation

Care Quality Commission (CQC): CQC statement on the Liverpool Care Pathway. The CQC has agreed this statement with other health and care regulators, about each organisation’s role and responsibilities in relation to the Liverpool Care Pathway.

CQC: Working with the Human Tissue Authority and the Human Fertilisation and Embryology Authority. The Human Tissue Authority (HTA), the Human Fertilisation and Embryology Authority (HFEA) and CQC have agreed on a memorandum of understanding (MoU) to ensure the safety of people who use services.

DH: Review of the regulations of cosmetic interventions: summary of the responses to the call for evidence (PDF222KB). This report summarises responses to a call for evidence issued as part of NHS Medical Director Sir Bruce Keogh’s review of the regulation of cosmetic interventions. Many respondents felt that: training requirements were disproportionately weak; there is a lack of data being collected on implants, procedures, adverse incidents and outcomes; and there are some procedures where legislation is insufficient to protect the public. Suggestions welcomed by respondents included: the banning of free consultations for cosmetic surgery; tighter restrictions on advertising, including the banning of offers on procedures; and better patient information on the potential risks and side-effects of cosmetic procedures.

Healthcare Quality Improvement Partnership (HQIP): Child Health Reviews-UK case notification. The Child Health Reviews UK (CHR-UK) case review project is looking at cases of children and young people with epilepsy, who have either died of any cause or been admitted to intensive or high dependency care following a prolonged seizure, in order to identify where care received may have contributed to adverse outcomes.
Child Health Reviews – UK: Newsletter Issue 1, December 2012 (PDF 245.7KB).

House of Commons Health Select Committee: 2012 accountability hearing with the Care Quality Commission. The report looks back at the CQC’s work since 2009. It focuses specifically on whistleblowing, registering GPs and the way the CQC inspect health and social care services. It makes a number of recommendations on how the CQC can improve and develop ways of working in the future.
RCN: RCN welcomes Health Select Committee report on the CQC.
CQC: CQC statement on Health Select Committee report. 
BBC: Health regulator problems ‘persist’. 

HQIP: Emergency laparotomy and COPD removed from 2012/13 QA list. The Department of Health has removed the Emergency Laparotomy and Chronic Obstructive Pulmonary Disease (COPD) national clinical audits from the 2012/13 Quality Accounts list. The correction reflects the fact that neither of these audits have collected national patient-level data collection in the 2012/13 financial year.

HQIP: Postoperative death fall, says Bowel Cancer Audit – emergency admissions still cause for concern. The audit shows that the proportion of bowel cancer patients who die following major surgery has fallen for the fourth consecutive year. The audit also shows that keyhole (laparoscopic) surgery rates rose in the same time period from 25 per cent to over 40 per cent.

HQIP: National Pain Audit report – patients with long-term pain experience a very low quality of life but are helped by services. The first ever National pain Audit carried out jointly by the British pain Society and Dr Foster Intelligence finds that many pain services make a substantial difference to patients whose quality of life is extremely poor with high reliance on emergency care.

HQIP: 2013/14 Quality Accounts List. HQIP has published the list of national clinical audits to be included in NHS providers' 2013/14 Quality Accounts, on behalf of the Department of Health. “Using HQIP's Quality Accounts Resource, providers can plan their programme of national audit participation for the next financial year, knowing which audits will need to be reported on.”

Monitor: Monitor introduces improvements to assessment process. For the first time, board members of NHS Trusts seeking foundation trust status will be asked to make a declaration confirming that they have provided all relevant information to Monitor in the course of the assessment process.

NICE: How NICE can help GPs register with the Care Quality Commission (CQC). All providers of primary care medical services, such as GP surgeries, out-of-hours services and NHS walk-in centres, are required to register with the CQC by April 2013. NICE can help providers of primary care achieve a number of the essential standards.
CQC: Providers of NHS general practice. An introduction to registration with CQC (PDF 535.6KB).

Regulation and Quality Improvement Authority (RQIA): RQIA E-zine: Assurance, challenge and improvement issue 2 December 2012. This is the second in a series of electronic newsletters from the Regulation and Quality Improvement Authority, Northern Ireland’s regulator of health and social care services.

Scottish Government: Developing a Community Child Health Service for the 21st Century. A report on a review of the community child health service in Scotland, this charts the current service, and suggests future options and suitable outcome measures by which the service can be evaluated and improved.

Scottish Government: Waiting times audit reports. Audit reports on the management of waiting times across Scotland were have been published by all health boards in Scotland. "The reports show that that there was no evidence of deliberate manipulation of the figures but all boards will put in place improvements in the way in which information is captured and the way it is reported."

Guidance, innovation, tools

Association for palliative medicine et al: Commissioning guidance for specialist palliative care: helping to deliver commissioning objectives. Developed by a collaboration of key organisations and groups this document aims to provide commissioners with key information to help them commission specialist palliative care, as a specific component of the whole spectrum of palliative and end of life care service provision.

IHI: A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. In 2008 Don Berwick, Tom Nolan, and John Whittington first described the Triple Aim of simultaneously improving population health, improving the patient experience of care, and reducing per capita cost. The IHI developed the Triple Aim as a statement of purpose for fundamentally new health systems that contribute to the overall health of populations while reducing costs. This white paper provides a menu of suggested measures for the three dimensions of the Triple Aim.

British Library: New online portal for social welfare professionals. The British Library has launched an online portal which provides a single point of access to the Library’s social welfare content and collections for the first time. The Social Welfare Portal will offer access to the latest thinking on social policy for anyone with a special interest in the subject, including researchers, social workers, policymakers, and policy liaison officers in the voluntary, statutory and independent sectors. Developed in partnership with the Social Care Institute for Excellence and the University of Staffordshire Social Work and Advice Studies, the portal includes a range of free digital content.

DH: Improving the use of medicines for better outcomes and reduced waste: an action plan (PDF 588KB). This report looks at ways of improving the use of medicines and tackling avoidable wastage in primary and community care, secondary care, and in care homes and end of life care. It also looks at how patients can be better engaged in decisions about their medicines as well as how information can be better provided to patients and health and care professionals. The action plan outlines how best practice could be shared across the NHS in the future.

DH: Payment by Results (PbR) 2013-14 road test package. This exercise provides an opportunity to test out the new PbR tariff and supports the planning process. The main focus of the road test is to gather comments on the draft 2013-14 PbR guidance and PbR code of conduct.

Foundation of Nursing Studies (FoNS): Improving bowel care after stroke. Stroke is the single largest cause of disability and affects approximately four million people in the United Kingdom. Approximately 40% of all stroke survivors are affected by faecal incontinence in the immediate days following their stroke. As well as impacting on the long term outcomes of recovery, faecal incontinence can severely influence self-esteem and dignity of patients suffering a stroke. The aim of the project was to improve the dignity and management of patients with faecal incontinence within a stroke service in London. It was anticipated that by developing an understanding of the contributing factors these would be used to inform developments in practice.

King’s Fund: Hospital Pathways programme – lessons learnt. The hospital pathways programme aims to improve both processes of care and interactions between staff and patients through a collaborative programme involving five acute trusts, the King's Fund and the Health Foundation to apply techniques, not widely used in the NHS.

National Council for Palliative Care (NCPC): Commissioning guidance for specialist palliative care: helping to deliver commissioning objectives (PDF 491KB). This guidance aims to provide commissioners with the key information that they need to help them commission specialist palliative care, as a specific component of the whole spectrum of palliative and end of life care service provision.

National End of Life Care programme (EoLCP): End of Life Care Quality Assessment Tool (ELCQuA). This has been updated to align with the NICE Quality Standard for End of Life Care.

NHS Commissioning Board (NHS CB): Everyone counts: Planning for patients 2013/14. This guidance outlines the incentives and levers that will be used to improve services from April 2013 and is accompanied by other documents intended to help local clinicians deliver more responsive health services.

NHS Improvement: Supporting direct access to diagnostic imaging for cancer. Best practice pathways for diagnostic imaging teams (PDF 1.5MB). This NHS Improvement document has been written to support diagnostic imaging teams, and to help them to understand the best practice pathways for GP direct access to diagnostic imaging tests for suspected cancer.

NHS Improvement: New set of stroke publications. The new publications cover: continuing health care in stroke; early supported discharge (ESD); patient and public engagement and experience; psychological care; rapid response to acute stroke; six month reviews; seven day therapy services and Transient Ischaemic Attack (TIA).

NHS Institute for Innovation and Improvement: Spread and Adoption Tool. This practical web tool from Britain’s National Health Service (NHS) Institute for Innovation and Improvement is dedicated to increasing the spread and adoption of innovation in the NHS. Along with many resources, it allows visitors to assess the likely success of the adoption of an innovation.

NHS Institute for Innovation and Improvement: Quality Improvement (QI) posters. Since its creation in 2010 over 50 doctors, nurses and those in non clinical positions have completed 38 improvement projects. This page has a selection of some of the transformational work.

NHS Technology Adoption Centre: NTAC Publish new technology adoption and implementation guides. NTAC has recently published three new guides on the NTAC website which look at Portable Ultrasound Bladder Scanning technology and BNP and NT-proBNP diagnostic testing technolgies.

Progress for Providers Series. The series provides a range of simple self-assessments to enable providers to deliver more personalised services. The assessments take about 40 minutes to complete and each one has pages for action planning and suggested resources. They have been developed with commissioners and providers in partnership with people, families, academics and professionals.

Royal Society for Public Health (RSPH): Perth Charter for the Promotion of Mental Health and Wellbeing. The charter is an outcome of the Seventh World Conference on the Promotion of Health and the Prevention of Mental and Behavioural Disorders held 17-19 October in Perth, Western Australia.  Following on from the Ottawa Charter which focussed primarily on physical health, the Perth Charter places emphasis on the role of health promotion for mental health.

Scottish Government: National Guidance for Child Protection in Scotland: Guidance for Health Professionals in Scotland. This guidance is intended to act as a practical reference point for all healthcare staff working within an adult and child service context. It highlights the specific roles and responsibilities of specialist staff working in particular settings wherever children and young people will usually be seen. It sets out the framework to aid practitioners in their role in dealing with child protection concerns.

Scottish Government: The Scottish Child Health Programme: Guidance on the 27-30 month child health review. Guidance on the core issues which should be addressed and recorded at the 27-30 month review, and standardised methods of assessment to ensure consistency of practice across Scotland.

Scottish Government: NHSScotland Local Delivery Plan Guidance 2013/14. Local Delivery Plans are the performance 'contract' between Scottish Government and NHS Boards. This document sets out for NHS Boards the Guidance underpinning the production of their plans for 2013/14.

University of Manchester: Centre for Mental Health and Risk: Safer mental health services: a self-assessment toolkit. This toolkit based on the findings of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness is intended to be used as a basis for self-assessment. Mental health care providers can self-assess their local services and individual practice against key Inquiry recommendations.  

Practice examples, case studies

CQC: Case study: CQC inspector’s persistence pays off. “When we find care providers are not meeting standards of quality and safety we always take action. In the case of one care home in Cheshire, that meant four inspections in a six month period after we found residents weren’t experiencing the standard of care they were entitled to expect.”

Institute for Healthcare Improvement (IHI): Storyboards. These storyboards are from the 24th Annual National Forum on Quality Improvement in Health Care {you need to register and log-in to access these].

Reports, commentary, statistics

2020health: The morning after: a cross party inquiry into unplanned pregnancy. This survey, carried out by a cross party parliamentary inquiry, found that over half of unplanned pregnancies happen because people are not using sufficient contraception. It highlights a need for more adequate sex education in schools and improved access to contraception for over 25s. It makes policy recommendations for royal colleges, the Department of Health, the NHS Commissioning Board and local authorities in order to tackle the rate of unplanned pregnancies.

CentreForum: Delivering Dilnot: paying for elderly care (PDF 439KB). This report includes comments from a wide range of contributors, including Paul Burstow, former Care Services Minister under the Coalition; Lord Sutherland, former chair of the Royal Commission on Long Term Care under Labour; as well as carers and elderly patients. It emphasises that tough political decisions must be made to deliver reform, and proposes how this can be funded a way that is fair and sustainable. It also looks at the private sector contribution to delivering the necessary insurance products.
Press release: Time to deliver Dilnot says former care minister.

DH: Funding made available for dementia research projects. The Department of Health has made £22 million available to 21 pioneering research projects to boost dementia diagnosis rates and trial ground-breaking treatments. Health Secretary Jeremy Hunt emphasised the crucial role of medical research in making breakthroughs in the prevention and treatment of dementia, while ensuring that research can help people with dementia live well with the condition today.

DH: Final report by Trust Special Administrator at South London Healthcare NHS Trust published. In accordance with his statutory duty, the Secretary of State for Health has published the final report of the Trust Special Administrator appointed to South London Healthcare NHS Trust. The report was presented to the Secretary of State on 7 January.  It makes recommendations in relation to the South London Healthcare NHS Trust to secure sustainable provision of health services to those patients served by the trust and in the south east London health economy.

DH: National Drug Evidence Centre, University of Manchester. Drugs and alcohol Payment by Results (PbR) pilot evaluation: scoping and feasibility report. This report, commissioned by the Department of Health, looks at a pilot project which took a new approach to commissioning and delivering drug and alcohol misuse treatment.

DH: Improving access to psychological therapies. Six local projects have begun work to help improve access to psychological therapies for those with severe mental illnesses. The 6 NHS demonstration sites have been chosen to implement the National Institute of Clinical Excellence’s recommended psychological therapies. Over the next 5 months, funding of £1.2m will be used to help these trusts share information with other health organisations, about how they deliver the best treatments that lead to improved patient choice and recovery.

DH: Accountable officer and director of finance roles for the financial closedown of PCTs (PDF 364KB). This letter from Janet Perry, NHS Chief Financial Controller, provides an update for NHS Commissioning Board Local Area Team Directors regarding the financial closedown of PCTs. It outlines the accountability arrangements for the 2012/13 financial accounts, and their role in managing the discharge of balances transferred to the department in early 2013/14.

DH: Determining arrangements for supporting research in primary and community care: discussion paper. This paper aims to support local organisations, in collaboration with local networks, to consider how to achieve a smooth transfer of capability within the changing NHS for supporting primary and community care research.

DH: Cancer services coming of age: learning from the improving cancer treatment assessment and support for older people project. This report summarises a series of pilots that tested whether appropriate assessment of older cancer patients would result in improved access to appropriate cancer treatment, based on need and not age. It also tested whether action, as a result of an age appropriate assessment, improved the scope for older people to benefit from treatment.

DH: Interim procedures for the approval of independent sector places for the termination of pregnancy (abortion) (PDF 363KB). These procedures set out the required standard operating principles that approved organisations need to comply with in order to obtain Secretary of State approval under section 1(3) of the Abortion Act 1967. They have been updated to reflect the Care Quality Commission’s (CQC’s) regulatory framework, including other relevant professional guidance, and should be used by all independent sector providers of abortion services. Under the new arrangements, all providers of regulated activities must meet the relevant outcomes set out in the CQC’s guidance on essential standards of quality and safety.

Department for Health, Social Services and Public Safety (DHSSPS): Statistics on community care for adults in Northern Ireland 2011-12. The report presents information on activity for all Programmes of Care gathered from HSC Trusts including comparisons over the past 5 years for the main activities.
Key facts and figures.

East Midlands Strategic Health Authority: A good death: The role of the local authority in end of life care (PDF 618KB). In recent years the health sector has taken the lead role in end of life care provision and the engagement of local authorities has been more mixed. However, many local authority services, such as social care and housing, are crucial components when delivering high quality end of life care. This report looks at how councils can develop their part in this important service provision.

Health and Social Care Information Centre (HSCIC): Health survey for England – 2011, Health, social care and lifestyles. This is the twenty first annual survey in this series which provides regular information that cannot be obtained from other sources on a range of aspects concerning the public’s health and many of the factors that affect health. As well as core questions and measurements included every year, there is data on specific issues that vary from year to year. Trend tables.
News: Women underestimate their weight by five pounds on average.

HSCIC: Hospital outpatient activity – 2011-12. Key facts: In 2011-12 there were 91.0 million outpatients appointments, of which 70.3 million (79.8 per cent) were attended. While the total number of appointments has increased year on year, the proportion of attendances has remained relatively constant since 2007-08. 

Home Affairs Committee: Drugs: breaking the cycle. This report provides a wide-ranging and in-depth inquiry examining all areas of UK drug policy and has called for a Royal Commission on the issue. Whilst it supported a number of steps the Government has taken in its 2010 drug strategy, it believes more needs to be done to comprehensively address the drugs problem in the UK. ‘Drugs: breaking the cycle’ focuses on the need to ‘break the cycle’ of drug addiction, and highlights in particular the need for improved treatment in prisons and wider society, and for early intervention with better education and preventative work.

IHI: Improvement journeys: Essays by IHI Fellows. This collection of first-person essays is written by IHI Fellows, reflecting their personal stories about what fuels the passion of these dedicated professionals to improve health and health care [you will need to register and log-in to access these].

Implementation Science: Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments. “Continuous quality improvement (CQI) methods are widely used in healthcare; however, the effectiveness of the methods is variable, and evidence about the extent to which contextual and other factors modify effects is limited. Investigating the relationship between these factors and CQI outcomes poses challenges for those evaluating CQI, among the most complex of which relate to the measurement of modifying factors. We aimed to provide guidance to support the selection of measurement instruments by systematically collating, categorising, and reviewing quantitative self-report instruments.”

King’s Fund: Time to think differently – future trends. This is a comprehensive analysis of the trends that will influence the way health and social care is delivered in future. This will be a useful resource for those thinking about service change, and looks at the following topics: demography; healthy behaviours; disease and disability; workforce; public attitudes and expectations; broader determinants of health; medical advances; information technologies; sustainable services and economic pressures.

London Councils: A case for sustainable funding for adult social care. This analysis of adult social care funding in London forecasts a funding gap of £907m within the next five years. It highlights how councils are already taking action to narrow the funding gap by working more closely with the NHS, improving procurement and developing new ways to provide social care for older and disabled people. It sets out ways in which the government could help councils in order to improve the planning, funding and delivery of adult social care in the capital.

National End of Life Care Programme (NEoLCP): Transforming end of life care in acute hospitals. Feedback from a focus group of pilot site representatives looking at factors that have influenced progress during the first phase. Following the publication of The route to success in end of life care, the Transform Programme was set up by NEoLCP to provide practical support for managers and clinicians delivering end of life care and 25 acute trusts participated in the first phase pilot. This document reports on a focus group discussion based on the pilot discussing the practical issues that have helped and hindered.

NHS Commissioning Board: Developing Operational Delivery Networks: the way forward (PDF 99KB). Operational Delivery Networks (ODNs) will cover areas such as neonatal intensive care, adult critical care, burns and trauma, and are focussed on coordinating patient pathways between providers over a wide area to ensure access to specialist support and expertise. They will also complement the newly created strategic clinical networks. This report sets out the steps necessary to ensure the safe transfer of current delivery networks.
News: Developing operational delivery networks: The way forward.

NHS Commissioning Board: CCG and local authority information packs. These information packs set out key data at local authority and CCG level to inform the local position on outcomes. The local authority level packs present high level comparative information on the NHS, the adult social care and the public health frameworks. The CCG level packs provide a more detailed analysis of NHS outcomes and other relevant indicators.

NHS Commissioning Board: Bulletin for proposed CCGs: Issue 26, 9 January 2013. 

NHS Confederation: Children and young people’s health and wellbeing in changing times. The purpose of this report from the Children and Young People's Health Outcomes Forum (CYPHO) is to support implementation of the health reforms to improve children and young people’s health and wellbeing. It makes key recommendations, provides support and evidence to national government and bodies, and local organisations and professionals, and shares best practice of where local areas are innovating effectively to improve health outcomes.

NHS Confederation: Making integrated out of hospital care a reality. This report, based on issues raised at a round-table event convened by the NHS Confederation and the Royal College of General Practitioners (RCGP) in April 2012, discusses the foundations for integrated care for adults, children and young people, with a focus on implementing out of hospital care, and connecting primary, community and social care. It highlights key evidence and draws on learning from partners across health and social care.
News: Six principles for delivering integrated out-of-hospital care.

Nuffield Trust: The health and social care ratings review. The Nuffield Trust has been commissioned by the Secretary of State to review whether aggregate ratings of provider performance should be used in health and social care. To inform this review, views from the public and professionals are being sought in order to gain a consensus on this issue.

Royal College of Physicians: Action on obesity: Comprehensive care for all. Report of a working party. This report looks at some of the issues arising from obesity as an increasing and costly public health problem and sets out how the NHS should adapt to meet the demands of an increasingly obese nation. It emphasises the need for increased numbers of multidisciplinary teams across the UK, to provide a comprehensive service rather than the current patchy one and provides guidelines on setting up such a team. Improved training on obesity for all healthcare professionals is also recommended.

Royal Society for Public Health: Promotion of mental health and wellbeing. Following on from the Ottawa Charter, the focus of which was primarily physical health, the Perth Charter places needed emphasis on the role of health promotion for mental health, taking a step towards the integration of physical and mental health promotion. The Perth Charter is an outcome of the Seventh World Conference on the Promotion of Mental Health and the Prevention of Mental and Behavioural Disorders held 17-19 October in Perth, Western Australia. The Perth Charter is proposed as a ‘work-in-progress’ and it is envisaged that the Charter will be updated on an annual basis.

Scottish Government: Evaluation of the Family Nurse Partnership Programme in NHS Lothian, Scotland: 3rd Report – Infancy. Findings from the implementation the Family Nurse Partnership in NHS Lothian during the infancy phase of the programme delivery (specifically the period between when clients' babies are 6 weeks old to their first birthdays). 

Scottish Government: Integration of Adult Health and Social Care Consultation Analysis Report. This report provides an analysis of responses to the consultation on proposals for legislation to support the integration of adult health and social care in Scotland. The consultation ran from 8 May until 11 September 2012, and a total of 315 responses were received.

Scottish Government:  Getting Our Priorities right - Consultation Analysis. This report provides an analysis of responses to the Scottish Government’s Consultation on the refreshed “Getting Our Priorities Right” (GOPR) guidance for practitioners working with children and families affected by substance misuse. 

Smith Institute: Getting started: prospects for health and wellbeing boards (PDF 924.2KB). The report "suggests the new health and wellbeing boards could improve integrated care, provide a more democratic approach and help develop a shared plan for their local populations. However, building good relationships and adequate resources will be required if they are to be effective." 

Social Enterprise UK: The social value guide. This guide is designed to help with embedding social value in commissioning and procurement practices. It aims to help those in local government or public bodies who are affected by the Social Value Act prepare for its implementation in January 2013.

Social Market Foundation: A future state of mind: facing up to the dementia challenge. The UK has a poor diagnosis rate, with only 41% of people with dementia estimated to be diagnosed. This report draws on in-depth interviews with people with Alzheimer's and their carers and a wealth of research to identify the barriers to early diagnosis, from a patient and professional perspective. New policies are proposed to better incentivise the health system to diagnose dementia earlier.

Yorkshire and Humber Public Health Observatory (YHPHO): Diabetic complications and mortality: PCT level analysis of the National Diabetes Audit 2010/11. One of the key messages is that "Using PCT level data from the 2010/11 National Diabetes Audit there are no clear associations between the extent of additional diabetic complications and additional mortality among people with diabetes.”