Quality improvement updates - 11 October 2012

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): Registering with CQC: Information for GPs and other primary medical services. The Care Quality Commission has reached the stage in the registration of providers of general practice where they are beginning to submit their applications.

Centre for Public Scrutiny: Local Healthwatch, health and wellbeing boards and health scrutiny - Roles, relationships and adding value. This guide aims to help local leaders and others to understand the independent, but complementary, roles and responsibilities of council health scrutiny, local Healthwatch and health and wellbeing boards.

Healthcare Quality Improvement Partnership (HQIP): National Joint Registry study reveals "unacceptably high" hip resurfacing failure rates. “Hip resurfacing - an alternative to hip replacement often recommended to younger patients - is prone to early failure in many instances, and should not be used in women”. 

Royal College of Paediatrics and Child Health (2012) National Paediatric Diabetes Audit (NPDA). The quality of care for infants, children and young people with diabetes is at an eight-year high, according to the results of the largest ever paediatric diabetes audit published by the Royal College of Paediatrics and Child Health. But despite improvements in care processes and outcomes for children with diabetes in England and Wales these remain significantly worse than those for adults - and Hba1c outcomes (a marker of overall diabetes control) still remain poor in comparison to some other European countries. 
Healthcare Quality Improvement Partnership (HQIP): National Paediatric Diabetes Audit Report 2010-11 September 2012.

Guidance, innovation, tools

Australian Resource Centre for Healthcare Innovations (ARCHI): ARCHI News. The October edition of the Australian Resource Centre for Healthcare Innovations (ARCHI) News has been released. This issue includes items on: long stay patients; trauma team redesign and surgery redesign.

Centre for Mental Health: No Health without Mental Health: guides for local services. A partnership of leading mental health charities has launched a series of six briefings on World Mental Health Day to help develop better local mental health services. The briefings, commissioned by the Department of Health, explain in practical terms the ways that the new Clinical Commissioning Groups, Local Authorities, Directors of Public Health, Overview and Scrutiny Committees, Local Healthwatch and Health and Wellbeing Boards can make sure that there are good quality mental health services in their local area as well as improving mental health and wellbeing for everyone in the community. 
News:  Mental health charities launch guides to improve local mental health services.

Department of Health, Social Security and Public Health (DHSSPS): Childminding and day care for Children Under Age: 12 Minimum Standards. Health Minister Edwin Poots has formally launched the Minimum Standards for Childminding and Day Care for Children Under Age 12. The new standards will ensure quality childcare for children and parents.

Department of Justice: Working Arrangements for the Welfare Protection of Adult Victims of Human Trafficking. The guidance was developed jointly by Department of Justice and the Department of Health Social Services and Public Safety, in consultation with Amnesty International and the Law Centre, and is primarily aimed at the Police Service of Northern Ireland (PSNI) and Health and Social Care (HSC) Trusts. It sets out working arrangements for the welfare and protection of adult victims of human trafficking.

DH: Health intelligence requirements for local authorities set out. The Department of Health has set out the health intelligence requirements for local authorities and the actions local areas may wish to take to support their new public health duties from an information and intelligence perspective. This information is available as a series of separate factsheets and as a single combined document. 

DH: Briefing gives short overview of the ban on age discrimination. This is specifically aimed at those who plan, commission or provide NHS services, whether in the NHS, voluntary or private sectors. The ban is only intended to prevent harmful uses of age.  Positive use of age in providing, commissioning and planning services will be able to continue.

DH: Revised guidance on overseas visitors hospital charging regulations published. This guidance is for NHS bodies in carrying out their duties to make and recover charges for NHS hospital treatment from overseas visitors not exempt from charge. It also includes guidance to safeguard the health of those not entitled to free NHS hospital treatment.
HIV treatment for overseas visitors in England. From 1 October 2012 an amendment to the NHS (Charges to Overseas Visitors) Regulations means that HIV treatment will no longer chargeable to any overseas visitor. 

End of Life Care: End of life care in extra care housing: learning resource pack. This resource pack provides practical information and advice for managers and support staff working in extra care housing schemes. It covers a range of issues relating to the care of residents with a life-limiting or progressive condition, including: identifying opportunities to start talking about end of life care; the core end of life path care pathway; diversity issues such as care of the body after death; and an individual’s capacity to make decisions as their condition deteriorates. As well as case studies, the pack includes template local directories of key contacts and support plans.

Mental Health Foundation: Peer support in long-term conditions. This guidance supports organisations to deliver peer support for people with long term conditions. It was generated following a research project undertaken from 2010 to 2011. The research found that peer support activity for people with long term conditions across Scotland had a positive impact on people’s emotional and physical health but that access to such services was inconsistent. Support services also reported some challenges to integrate with statutory services and felt they often lacked credibility in the eyes of potential referrers including clinicians and beneficiaries. As a result, The guidance aims to provide a starting which is accessible to a wide audience and applicable to all long term conditions.

NHS Improvement: Improving adult asthma care: Testing the case for change. This publication is aimed at healthcare professionals, commissioners, patients and other key stakeholders involved in asthma services. It draws together the evidence and learning from the work undertaken by the national asthma improvement projects over a 12 month period in 2011/12 as part of the asthma workstream within the NHS Improvement – Lung programme.

NHS Institute for Innovation and Improvement: 15 Steps Challenge for mental health inpatient care toolkit. The 15 Steps Challenge was sparked by a comment from a parent who said: "I can tell what kind of care my daughter is going to get within 15 steps of walking on to a ward". A  series of toolkits has been co-produced with patients, service users, carers, relatives, volunteers, staff, governors and senior leaders to help look at care in a variety of settings through the eyes of patients and service users and capture what good quality care looks, sounds and feels like. The toolkit for mental health inpatients has recently been launched. The 15 Steps Challenge for community services is due to launch on 15 October 2012 [you need to register and log-in to access or request the toolkit]. 

Reports, commentary, statistics

2020Health: Forgotten conditions. The report criticises those professionals whose overwhelming focus is on treating a handful of major illnesses rather than developing systems for diagnosing and treating the increasing number of rarer diseases. As a result, thousands of people suffer for years with misdiagnosis and inadequate treatment.

DH: Social Care Bulletin: issue 22 September-October 2012. Shaun Gallagher, Acting Director General for Social Care, Local Government and Care Partnerships, makes his voicepiece debut.

DH: Transforming Public Health Bulletin, September 2012.   

DHSSPS: Statistics on Smoking Cessation Services in Northern Ireland: 1 April 2011 – 31 March 2012. Key findings are presented.

DHSSPS: Publication of Statistics from the Northern Ireland Drug Misuse Database: 1 April 2011 – 31 March 2012. The statistical bulletin provides information on individuals presenting to treatment services with problem drug misuse that is collected through the Northern Ireland Drug Misuse Database (DMD), which was established in April 2000.

Joint Commission: Improving America’s Hospitals. The Joint Commission’s Annual Report on Quality and  Safety (PDF 462.5KB). The seventh annual Joint Commission report summarizes the performance of hospitals across 45 accountability measures. The first annual report, published in 2007, included data from 2002-2005 and covered 15 measures of performance. This year’s report covers 45 measures and reflects from one to 10 years of improvement results. Three new accountability measure sets are included in the calculation for the first time: stroke, venous thromboembolism (VTE), and inpatient psychiatric services.

Joseph Rowntree Foundation (JRF): Creating a dementia-friendly York. The York Dementia Without Walls project looked into what's needed to make York a good place to live for people with dementia and their carers. 

King’s Fund: Building an integrated system of care: key factors for success. Presentations from an events held by the King’s Fund in September 2012.

King’s Fund blog: How can we deal with financial pressures in health and social care? Chris Ham’s blog - “Organisations can adopt a fortress mentality and seek to protect themselves in the current harsh climate, regardless of the impact on others. Alternatively, they can reach out to partner organisations and work towards a whole-system solution, even if this means sacrificing their own interests for the greater good.” 
Developing a culture of compassionate care. Jocelyn Cornwell comments on the recent consultation paper from the Chief Nursing Officer. 

National Treatment Agency: 'Drug treatment 2012: progress made, challenges ahead'. Record numbers of drug addicts in England are recovering from addiction. Nearly 30,000 (29,855) successfully completed their treatment in 2011-12, up from 27,969 the previous year and almost three times the level they were seven years ago (11,208). The data also reveals that nearly one third of users in the last seven years successfully completed their treatment and did not return, which compares favourably to international recovery rates.

NHS Alliance and NHS Clinical Commissioners : Getting to grips with integrated 24/7 emergency and urgent care (PDF 2.9MB). This report includes key learnings and discussions taken from two health communities - one in the North West and one in East Kent - that participated in workshops facilitated by the NHS Alliance, and supported by the Department of Health. The workshops aimed to develop understanding of what helps better integration of urgent care, what gets in the way, and what people can do about it.
Press release.

NHS Commissioning Board: Bulletin for proposed CCGs – Issue 21, 2 October 2012. The NHS Commissioning Board has published its latest bulletin for CCGs from Dame Barbara Hakin, national director for Commissioning Development. 

NHS Commissioning Board: Commissioning Support Bulletin – Issue 5. Issue five of the Commissioning Support Bulletin is now available.

NHS Confederation: Mental health and the market. Mental health services represent a significant area of expenditure in the NHS. In 2010/11, the total investment in adult and older people’s mental health services in England was £7.19 billion. The Department of Health commissioned the NHS Confederation’s Mental Health Network and Mental Health Strategies to produce an analysis of the current landscape for mental health service provision in England.  This Briefing summarises the main findings of the report.

NHS Right Care: The accountable lead provider: developing a powerful disruptive innovator to create integrated and accountable programmes of care (PDF 734KB). This report in the NHS Right Care Casebook Series recognizes the serious failure to coordinate care, especially for people with chronic conditions, within the NHS. It argues for a strong integrator who is given the power to both deliver care and also to bring together the previously episodic providers of care into a single pathway. The Accountable Lead Provider is far more than a "navigator" or "integrator" but a provider that both provides and subcontracts health care.

Nuffield Trust: Primary care for the 21st century: learning from New Zealand's independent practitioner associations. This report offers insights from the independent practitioner associations (IPAs) through which many GPs and other primary care clinicians have worked collaboratively over the past two decades in New Zealand. Although IPAs have not held budgets on the scale of that planned for clinical commissioning groups (CCGs) in England, "they nevertheless demonstrate the significant potential of organised general practice to enable innovation and expansion in the local provision of care, and to help in the development of more integrated services."           

Nuffield Trust blog: Institutional entrepreneurs – it’s the information that matters. There are three requirements for entrepreneurship to flourish: the capacity to invest and innovate; the autonomy to make decisions over resources; and the confidence that the fruits of success can be retained, either by the individual or the enterprise.

Office for National Statistics: Breast cancer: incidence, mortality, revival. In 2010, 41,259 new cases of breast cancer were diagnosed, an increase of 1.8 per cent (731 cases) compared to 2009. There were 126 new cases per 100,000 women in 2010, compared with 125 new cases per 100,000 women in 2009. These incidence rates have increased by 90 per cent between 1971 and 2010. Just over 9,700 women died from breast cancer in England in 2011, a rate of 24 deaths per 100,000 women. These mortality rates fell by 37 per cent between 1971 and 2011.

Pharmaceutical Services Negotiating Committee (PSNC): The Future of Community Pharmacy, Building a Sustainable Industry. This report looks at the impact of some of the key challenges facing community pharmacies, including the squeeze on healthcare budgets, intensifying competition and patient demand for convenience and expertise. It concludes that pharmacy is at a crossroads and sets out some business strategies that pharmacies should consider.

Public Health Wales: Executive Director of Public Health Annual Report 2012: Health and fulfilment in the older years. The report focuses on older people in north Wales. It also highlights the variations and inequalities in health status amongst local communities and recommends targeting resources to improve health.  Key priorities for better health outcomes include protecting health through immunisation, preventing falls and treating chronic illness early in the community. 

RAND Europe: Evaluating disease management programmes: Learning from diverse approaches across Europe The DISMEVAL consortium (Developing and validating disease management evaluation methods for European healthcare systems – a consortium of ten partners) examined approaches to chronic disease management in 13 countries across Europe, testing the methods being used to evaluate in six countries.