Quality improvement updates - 13 December 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

Audit Scotland: Health inequalities in Scotland. The report assesses how well public sector bodies are working together to target resources at health inequalities and monitor their collective performance, and reviews health services and initiatives aimed at reducing health inequalities. The report says it is not clear how much money NHS boards and councils spend in this area, or what it is spent on.
BBC: Scottish health: Inequalities still 'substantial', Audit Scotland says.

DH: Regulations laid for clinical commissioning groups. The NHS Commissioning Board and Clinical Commissioning Group (Responsibilities and Standing rules) Regulations 2012 set out the healthcare services that will be commissioned by the board and specify the categories of people for whom CCGs will commission services.

DH: Contractual ‘duty of candour’ to drive a more open NHS culture. New rules to toughen transparency in NHS organisations and increase patient confidence have been announced by Health Minister Dr Dan Poulter following a public consultation. The government will create regulations that require the NHS Commissioning Board to include a contractual duty of openness in all commissioning contracts from April 2013.

Guardian: Winterbourne View scandal prompts 'fitness' tests for hospital owners. "Corporate owners of private units for NHS-funded patients with learning disabilities are to face closer scrutiny after abuse revealed."

Health and Social Care Information Centre (HSCIC): National Diabetes Audit 2010-11 Report 2 – Complications and Mortality. New audit shows that people with diabetes are 65 per cent more likely to have heart failure than the general population in England and Wales. They are also at a much greater risk of potentially fatal conditions like heart attack, angina and stroke and of needing amputations, according to the National Diabetes Audit, which analysed the care of nearly two million people with diabetes in 2010/11 in England and Wales.

Healthcare Quality Improvement Partnership (HQIP): National lung cancer audit report 2012 (PDF 772KB). Lung cancer patients in Great Britain are benefiting from improved treatment and care - including a higher rate of curative surgery - thanks in part to the continued commitment of clinical staff to a major national audit. Data developed for the first time through the National Lung Cancer Audit has played a major part in helping healthcare organisations understand and improve the standard of care they offer and, ultimately, patient outcomes.
Press release: Lung cancer care continues to improve but regional variation remains. 

HQIP: Sentinel Stroke National Audit Programme (SSNAP): Acute organisational audit report Public Report for England, Wales and Northern Ireland (PDF 3.6MB). While there has been rapid growth in the number of NHS services offering six- or seven-day working for acute stroke therapy, the number of therapists has not changed substantially. The study finds that there has been little increase in staff numbers since the report's predecessor - the National Sentinel Stroke Organisational audit (2010) - and shows wide variation between hospitals.
Press release: Stroke audit report recommends seven-day working for therapists.

HQIP: National Audit of Schizophrenia report. The audit was carried out by the Royal College of Psychiatrists' Centre for Quality Improvement (CCQI) in partnership with other organisations. It assessed the care for people affected by schizophrenia who are living in the community in England and Wales and examined how well guidelines produced by the National Institute for Health and Clinical Excellence were being followed. The audit highlighted several areas of concern, including the management of physical health problems and its co-ordination between GPs and specialist services, prescribing practice, consultation with service users and availability of talking therapies. 

Healthcare Improvement Scotland: ADHD services over Scotland: final report. This report looks at the recommendations made in the previous implementation review, the extent to which these recommendations have been implemented, and if they have improved services in Scotland for children and young people with Attention Deficit and Hyperkinetic Disorders (ADHD).
News: Better behaviour.

National Audit Office: Progress in making NHS efficiency savings. “The NHS made a substantial amount of efficiency savings in 2011-12. These will need to be sustained and built on if savings targets are to be met.”
RCN: Cuts threaten care, says RCN.

Regulation and Quality Improvement Authority (RQIA): RQIA Baseline assessment of the care of children under 18 admitted to adult wards in Northern Ireland (PDF 538.88KB) . The overall conclusion of the review team is that the current provision of services in Northern Ireland is resulting in significant numbers of children being cared for in adult wards who should be admitted to paediatric wards. This report makes 14 recommendations for improvements to service delivery.

Royal College of Physicians: Ground breaking new national Chronic Obstructive Pulmonary Disease audit announced. A new national Chronic Obstructive Pulmonary Disease (COPD) audit programme for England and Wales has been announced. The programme will be clinically led by the Royal College of Physicians (RCP), the British Thoracic Society (BTS), the Primary Care Respiratory Society (PCRS-UK) and in partnership with the British Lung Foundation (BLF), and will commence in early 2013. The new audit programme brings together primary care, secondary care, rehabilitation and patient experience, marking a ground breaking, partnership approach with multidisciplinary, collaborative working to drive improvements in COPD patient care.

Wales Audit Office: Operational Protocol between Healthcare Inspectorate Wales and the Wales Audit Office - Developing co-ordinated work programmes and sharing intelligence to support improvement in the NHS. The Wales Audit Office and Healthcare Inspectorate Wales” have a close working relationship and a history of positive collaborative working”. To help embed and further develop these arrangements these they have published a joint operational protocol.   

Guidance, innovation, tools

BAPEN (British Association of Parenteral and Enteral Nutrition): BAPEN Commissioning Toolkit. Malnutrition Matters, Meeting quality standards in nutritional care. A toolkit for commissioners and providers in England 2nd.ed.  This is an update of the toolkit first published in 2009. The principles underlying the tools are that potentially vulnerable individuals should be screened for malnutrition and that those identified as at risk should be offered person-centred nutritional care plans appropriate to their needs.

British HIV Association (BHIVA): Standards of care for people living with HIV in 2013. The British HIV Association (BHIVA), working in partnership with care providers, professional associations, commissioners and people living with HIV, has produced a set of quality standards for the care of people with HIV in the UK. Derived from the best available evidence, they cover 12 key themes, prioritised as being the most important issues for the care of people with HIV and focus on aspects of care that have particular relevance for delivering equitable high-quality services.

Care Quality Commission (CQC): CQC digital innovations. The Care Quality Commission (CQC) has launched new digital innovations including an email alert service, an information sharing CQC Widget and improved historical information on care homes. The email alert service will allow people to sign up for the most up-to-date standards and quality reports about care providers across England. The alerts will provide direct, timely and reliable access to CQC activity about health and social care providers. The CQC widget gives one click access to the latest CQC inspection reports and findings. Also, inspection reports from providers and locations which are no longer registered with the CQC are once again available to the public, allowing them to see the histories of care at a particular location. 

Institute for Healthcare Improvement (IHI): A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. The Triple Aim concept – of simultaneously improving population health, improving the patient experience of care, and reducing per capita cost – was espoused a few years ago. The IHI has released this paper that “provides a menu of suggested measures for the three dimensions of the Triple Aim”. This ‘menu’ is based on a combination of the analytic frameworks and the practical experience of organisations involved in piloting the Triple Aim.

Medicines and Healthcare products Regulatory Agency (MHRA): MHRA publishes medicines reclassification guidance. Following the announcement in the Chancellor’s Autumn Statement, the MHRA has launched a new, streamlined procedure to speed the process of moving medicines from prescription-only to over-the-counter medicines. The new procedure, which could cut the time from application to decision by three months or more,is underpinned by a new guideline on How to change the legal classification of a medicine in the UK published on the MHRA website.
How to change the legal classification of a medicine in the UK (PDF 334.6KB).

NHS Commissioning Board: Online tools to help improve health, care and wellbeing. The NHS Commissioning Board is looking for good examples of online tools to help people improve their health and wellbeing. It is creating a directory of online tools, often called apps, to help people find the best online tool for their condition or health need. People and organisations who are designing online tools for specific conditions or health areas are invited to submit these for consideration for the directory. The directory will be a trusted listing of online health and care tools, all of which will be accessible from mobile devices or PCs. The tools will help people use good information to make choices about their health and care. People will be able to input their own health details to receive personalised information through the tool and then share this with their clinicians or care staff if they choose to do so.

NHS Confederation: Zero tolerance: making ambulance handover delays a thing of the past. Handing over a patient from an ambulance to an ED is expected to take no more than 15 minutes. But as the National Audit Office highlighted in its review of ambulance services in June 2011, only around 80 per cent of handovers meet this expectation. This report is intended to support healthcare leaders in their efforts to make handover delays a never event in their local health economies. It includes 10 key recommendations.

NHS Confederation: All systems go: testing the new licensing system for providers of NHS-funded care. From April 2013, a new licensing system for most providers of NHS-funded services is expected to be established. Through this licence, Monitor will protect the interests of patients by promoting services that are economic, efficient and effective. The development of Monitor’s role and the introduction of the provider licence marks a significant change in regulating the provision of care in the NHS. It introduces a sector regulator to sit alongside the Care Quality Commission (CQC), which will continue its role as the quality regulator. The proposals for sector regulation are complex and they have significant implications for the future provision of NHS-funded services and, ultimately, patient care. 

NHS Education for Scotland: Promoting Excellence in Dementia Care Newsletter, Winter 2012. Articles include: Post Diagnostic Support for People with Dementia and a Focus on Palliative and End of Life Care in Dementia.  

NHS Improvement: Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF). New user guides and resources for this query and risk stratification tool available for use with all GP clinical systems in England.  

NHS Improvement – Lung: Data for chronic obstructive pulmonary disease (COPD) and asthma: making a real difference (PDF 1.6MB). This guide based on the learning from NHS Improvement COPD and asthma service improvement projects, aims to help future sites get started and make progress in improving quality, understand their use of resources, and measure improvement. The guide covers acute and primary care, home oxygen services, and asthma care. 
Success Principles: how to make a real difference to COPD and asthma services. Scroll down this publications page to find the resources.

NHS Institute for Innovation and Improvement (NHS Institute): Spread and adoption tool. The Spread and Adoption Tool is a free web based application to help healthcare staff increase the scale and pace of sustainable spread and and adoption of innovation in the NHS. 

NHS Institute: The Directory of Ambulatory Emergency Care for Adults. 3rd.ed. This can be downloaded by NHS England staff, or alternatively can be purchased. The directory identifies 49 emergency conditions and clinical scenarios (eg cellulitis) - with guidance - that have the potential to be managed on an ambulatory basis.

NHS Sustainable Development Unit: International pharmaceutical and medical device guidelines. The NHS SDU and partners have launched the world’s first international greenhouse gas life cycle accounting and reporting guidance (carbon footprinting guidance) for the pharmaceutical and medical devices sectors. This guidance provides essential information on how pharmaceutical and medical devices related CO2e emissions can be reduced and sustainable healthcare as a whole facilitated.

NHS Wales Informatics Service: Coders in Wales introduce new WHO standards. The central clinical coding team in Wales is introducing a new edition of the World Health Organisation (WHO) international standards, impacting how information is gathered and analysed throughout UK healthcare. One of the advantages of the new codes is that falls (and similar accidents that could occur in hospital) can be recorded more accurately allowing Health Boards to put safeguards in place.

Welsh Government: Together for Health, Stroke Delivery Plan for the NHS up to 2016. This Delivery Plan provides a framework for action by Local Health Boards and NHS Trusts working with their partners. It sets out the Welsh Government’s expectations of all stakeholders to tackle stroke in people of all ages for: The population outcomes; the outcomes from treatment and support to return to health and independence; How success will be measured and the level of performance; themes for action by the NHS, together with its partners. 

Practice examples, case studies

DH: Health visitors leading the way in transforming services for children and families. These 20 case studies highlight innovations developed as part of the Health Visiting Programme and are intended as a resource for sharing and learning amongst NHS public health professionals and early years staff. They cover one or more of the strands of the health visitor service vision and family offer: Community, Universal services, Universal plus and Universal partnership plus.

NHS Institute: Implementing the Productive Mental Health Ward and Productive Community Services in learning disability services (PDF 170.8KB). Nottinghamshire Healthcare describes ways in which they have implemented the programme. Some of the improvements they have made include the introduction of a new Shift Co-ordinator role and using visual techniques from the programmes to improve clinical care.

Ofsted: Improving outcomes for disabled children by integrating early support and prevention services: Luton Borough Council. This good practice case study of Luton Borough Council outlines how services for disabled children and their families have brought together practice across health, social care and education services. The changes went hand in hand with innovative short break and early support provision. The development of an extensive range of integrated early support and prevention services has improved outcomes for disabled children and prevented situations deteriorating so that child protection or looked after services become necessary.

Reports, commentary, statistics

Abdominal Aortic Aneurysm Screening Programme: Abdominal Aortic Aneurysm Screening Programme report. Figures published by the NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) show that AAA screening has helped drive significant improvements in outcomes for patients who undergo elective (planned) aneurysm repair surgery. The figures cover the period 1 April 2011 to 31 March 2012 and show how quickly elective AAA repair mortality has fallen in recent years. This consistent improvement has been driven by the remodelling of UK vascular services which has seen AAA repair procedures move to fewer, higher volume hospitals.

Academy of Medical Royal Colleges: Seven day consultant present care. “Patients in hospital should be reviewed by a consultant at least once every 24 hours, including weekends and bank holidays, unless there are good reasons for them to not to have a daily review”. Currently, the availability of consultants and equivalent senior doctors varies widely across locations and across different areas of medicine in the evenings and at weekends. This report recommends three key standards to ensure all patients receive high quality care led by a consultant regardless of the day of the week.

All Party Parliamentary Group (APPG) for Continence: National continence survey (PDF 312KB). The all party parliamentary group (APPG) for continence care is pushing to make integrated services more widely available to all age groups, and also to help break the taboo which prevents individuals seeking and receiving medical attention. The APPG has developed a survey to help provide an up-to-date picture of continence services in England. 

Audit Commission: Best practice tariffs and their impact. This briefing sets out the Audit Commission's assessment of how best practice tariffs (BPTs) impact at a local level and how implementation can be improved. It looks at the influence of best practice tariffs on day case surgery, fragility hip fractures and acute stroke.

Centre for Mental Health and Criminal Justice Alliance: The Mental Health Treatment Requirement: Realising a better future. The Mental Health Treatment Requirement (MHTR) is one of twelve options available to magistrates and judges when they make a Community Order - a sentence served by an offender in the community. "The MHTR has unfulfilled potential to offer offenders with mental health problems the option of a sentence in the community which will enable them to engage with appropriate treatment and support". There have been a number of barriers to its effective use and this briefing examines these barriers and how they can be overcome. 

Centre for Mental Health: Briefing 45: Probation services and mental health. This briefing paper summarises the ways in which health and probation services can work together to meet the needs of offenders with mental health conditions and ensure they get access to effective support.

Department of Health, Social Services and Public Safety (DHSSPS): Northern Ireland quality and outcomes framework (QOF) information 2011/12. The DHSSPS has published the achievement figures from the Northern Ireland Quality and Outcomes Framework 2011/12. The QOF measures achievement against a range of evidence-based indicators, with points and payments awarded according to the level of achievement.

DHSSPS: Children in Care in Northern Ireland 2010/2011 Statistical Bulletin. This statistical bulletin presents information on children and young people looked after continuously for at least 12 months at 30 September 2011, gathered from Health & Social Care Trusts. It details findings from the OC2 collection of information on the educational achievements of these young people at Key Stage Assessments and GCSE/GNVQ. It also includes information on their age and gender, religion, disability, length of time in care, placement type, health assessments completed and offences and convictions. 

DH: Improving outcomes: a strategy for cancer: second annual report. Jeremy Hunt, Secretary of State for Health has pledged that England is to be ‘among best in Europe at tackling cancer’. He emphasised the need to reduce variation across England and pledged to make England among the best in Europe at tackling the top five killers: cancer, stroke, and heart, respiratory and liver disease.
Infographic: Improving cancer care findings.  

DH: Summary of responses to the draft Care and Support Bill consultation published. Over 1,000 comments were received, with around 430 unique respondents submitting written comments. The summary document does not set out the government’s view or response to the comments made.

DH: Social Care Bulletin December 2012. This issue includes articles about the Winterbourne Review and care and support reform.

DH: Creating change: Innovation health and wealth one year on. This report provides an update on the implementation of the NHS Chief Executive’s report “Innovation health and wealth, accelerating adoption and diffusion in the NHS” published in December 2011. It highlights what more should be done to deliver the improvements needed to fully embrace and embed innovation in the NHS and improve outcomes and quality for patients and the NHS and drive growth for the UK. 

Health and Social care Information Centre (HSCIC): National Child Measurement Programme: England, 2011/12 school year. The report provides high-level analysis of the prevalence of ‘underweight', ‘healthy weight', ‘overweight', ‘obese' and 'overweight and obese combined' children, in Reception (aged 4–5 years) and Year 6 (aged 10–11 years), measured in state schools in England in the school year 2011/12.
News: One in three final year primary school children overweight or obese.

HSCIC: NHS maternity: hospital deliveries to teen mums fall by a fifth in five years. NHS hospital deliveries to mothers aged 13 to 19 have fallen by just over a fifth in five years. Hospitals in England recorded just over 33,600 deliveries to this age group in 2011/12; a 21.9 per cent (9,450) fall on the number recorded in 2006/07 (43,100), while the delivery rate per 1,000 of the population for this age group also fell during the same period from 19.1 to 14.9.

HSCIC: Adult Social Care Survey - England, 2011-12, Final release. Adult Social Care Survey - England, 2011-12, Final release. The Personal Social Services Adult Social Care Survey for England is an annual survey and took place for the second time in 2011-12. It is designed to cover all service users aged 18 and over receiving services funded wholly or in part by Social Services during 2011-12, and aims to learn more about whether or not the services are helping them to live safely and independently in their own home and the impact on their quality of life.

Healthcare Financial Management Association: The Value Journey. Organizational Road Maps for Value-Driven Health Care. A value gap is currently emerging as healthcare costs outpace improvements in quality. This American report from the Healthcare Financial Management Association (HFMA) provides a road map for value, identifying steps organizations should take to build competencies and skills in increasing the value of services. 
   
Implementation Science: A stakeholder-driven agenda for advancing the science and practice of scale-up and spread in health. Based on a conference held in Washington, USA in 2010 and follow-up activities the authors discuss priority activities that are needed to advance research, practice and policy to accelerate the scale-up and spread of effective health programmes. 

Joseph Rowntree Foundation (JRF): Austerity in the UK. Over the coming months, JRF will be presenting regular 'Insights' from around the country charting how austerity and cuts are impacting on individual communities. 

King’s Fund: General practice in London: supporting improvements in quality. General practices in London face a number of demographic and socio-economic challenges in addition to the unprecedented financial pressures facing the NHS as a whole. This report, commissioned by NHS London, has been prepared by a team of researchers at the King's Fund and Imperial College London to provide a fresh analysis of those challenges and the improvements that will be needed to address them. It is a companion piece to a framework that NHS London will be co-creating with practices across the capital as a resource for clinical commissioning groups.

King’s Fund: Health policy under the coalition government. Written halfway through the 2010–2014 parliament, this review considers how the NHS is performing under the coalition government, following on from The King’s Fund’s major review of NHS performance from 1997 to 2010. It examines the policies introduced by the coalition government, assesses how far these will address current and emerging performance issues, and identifies further action needed. 
King’s Fund blog: Is the NHS entering treacherous waters?

King’s Fund: Time to Think Differently: Re-thinking the location of care. The King’s Fund has launched a new question, blog and infographics on the Time to Think Differently site, asking people whether there is a place for the hospital as we currently know it in the health system of the future.
Infographics.
Blog: The end of the hospital as we know it?

Local Government Information Unit (LGiU): A good death: the role of local authority in end of life care. "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". This report looks at the role of local authorities in this agenda and how councils can develop their part in this important service provision.

LSE Centre for Economic Performance: Free to Choose? Reform and Demand Response in the English National Health Service. This paper aims to understand the responses of health care consumers when they are offered more choice and to analyse how this translates into changes in the competitive environment hospitals are facing. It aims to “quantify changes in the elasticity of demand with respect to quality of services when patients are offered more choice”.

NHS Improvement - Stroke: Psychological care after stroke: economic modelling of a clinical psychology led team approach. This paper models the costs and potential cost savings of delivering a psychological support service for people with problems affecting their mood after stroke. "A stroke service where psychological care is led by a clinical psychologist using a stepped approach has the potential to reduce the cost burden of stroke, with savings to the NHS and adult social care recovered in around two years."

NHS Improvement: Making connections with the challenges of unscheduled care (PDF 315KB). Identifies some of the challenges of urgent and emergency care and some of the solutions to these that have been tested by different trusts.

NHS Institute: Interviews reveal importance of financial-clinical partnership. Interviews with over twenty senior NHS leaders reveal the importance of financial-clinical partnerships to deliver the NHS’s unprecedented cost and quality improvement challenge. They provide further evidence of the growing need for clinical and finance leaders to develop a shared understanding of their organisation’s ‘business’ and to work together towards shared organisational goals. 

NICE: NICE 'will ensure consistent care in commissioning landscape'. At the NICE webinar on commissioning held on 28 November experts on the panel agreed that NICE has an important role to play in the commissioning landscape, working with the Outcomes Framework to help ensure that there is no regional variation in care. The webinar is available to watch on-demand. 

Nuffield Trust: a decade of austerity? The funding pressures facing the NHS from 2010/11 to 2021/22. This research highlights the funding challenges facing the NHS and social care system in England over the next decade, with NHS funding growth likely to be restricted beyond 2015, and aims to quantify the pressures facing the NHS in England over the next decade. The report forms part of the Trust’s work on Buying time: what is the scale of the financial challenge facing the NHS and how can it be met?
Nuffield Trust blog: The Chancellor's Autumn Statement: austerity could get worse for the NHS.  

Nuffield Trust: Care for older people: projected expenditure to 2022 on social care and continuing health care for England’s older population. This analysis by the London School of Economics, commissioned by the Nuffield Trust, projects expenditure on social care and health care for older people in England from 2010 to 2022. 

Office of National Statistics (ONS): Death certification reform: a case study on the potential impact on mortality statistics, England and Wales. A case study on medical examiner scrutiny of death certificates found that: in 78 per cent cases the underlying cause of death remained unchanged; The broad underlying cause of death (as defined by International Classification of Diseases chapter) changed after medical examiner scrutiny in 12 per cent of cases; in the remaining 10 per cent of cases the underlying cause changed but remained in the same International Classification of Disease chapter.
Guardian: Certified causes of death inaccurate in fifth of cases, study suggests. 

RCN: Improving hospital care for older people: a call for action. Key messages for commissioners and NHS hospital providers (PDF 569KB). This publication was developed through an event held in October on improving hospital care for older people that brought together key stakeholders including leading members of royal colleges, charities, think tanks and practitioners.  It identifies seven key themes that must be addressed by commissioners and providers in order to make hospital care fit for now and the future. Three prioritised themes are: person centred care; training and competence; culture and structure.

Social Care Institute for Excellence (SCIE): Returning children home from care. This briefing gives an overview of research evidence that currently exists. It's been written with Professor June Thoburn from the University of East Anglia (UEA). A child may finally settle into a home that is permanent, by, for instance, being adopted, living with relatives, or returning to their birth family. This is called the "permanence option". However, for those children who have been maltreated, going home to live with a parent is the least successful "permanence" possibility.

Which? Consumer report: A taste for change: Food companies assessed for action to enable healthier choices (PDF 938.8KB) . In their research Which? looked at 20 leading food manufacturers and retailers to assess the steps they have taken to deliver positive changes that will benefit consumers and make healthy choices easier.  
Guardian: Voluntary food health plan failing, says Which?