Quality improvement updates - 13 September 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

Health Education England: Local Education and Training Board framework approved. Prior to the parliamentary reshuffle last week, Andrew Lansley was able to approve the Local Education and Training Board Authorisation Framework in his role as Secretary of State. The summary document provides a high-level overview of the key steps in the process for Local Education and Training Boards to prepare and complete the authorisation process to set up governing bodies of LETBs by the end of March 2013.

Healthcare Inspectorate Wales (HIW): programme for 2012-2015. HIW’s programme for the next three years takes into account views expressed in the consultation that ended in July. Building on the programme of routine work, the plan also includes proposals to assess some key areas of healthcare services, including those for children and young people and older people.

Healthcare Quality Improvement Partnership (HQIP): Procurement for two new topics Chronic Kidney Disease in Primary Care and Rheumatoid Arthritis. HQIP has announced the procurement of two new topics for national clinical audit, Chronic Kidney Disease in Primary Care and Rheumatoid Arthritis. These topics are the sixth and seventh out of a total of eleven new topics for national clinical audit announced by the Department of Health last year (October 2011). The eleven topics will join the 29 projects already commissioned and managed by HQIP as part of the National Clinical Audit and Patient Outcomes Programme.

HQIP: NCAPOP: National Audit of Psychological Therapies launch Quality Improvement Competition. The Healthcare Quality Improvement Partnership and the National Audit of Psychological Therapies (NAPT) are pleased to announce the Quality Improvement Competition, a national audit prize to recognise the quality improvement work carried out by pychological therapy services since the publication of the latest NAPT report (2011).

HQIP: National Hip Fracture Database: National Hip Fracture Database National Report 2012. The National Hip Fracture Database (NHFD) is a clinically led, web-based audit of hip fracture care and secondary prevention in England, Wales, Northern Ireland, and the Channel Islands. Care is audited against six standards: prompt admission to orthopaedic care; surgery within 48 hours and within normal working hours; nursing care aimed at minimising pressure ulcer incidence; routine access to orthogeriatric medical care; assessment and appropriate treatment to promote bone health; and falls assessment. This report covers casemix, care and outcomes of 59,365 cases submitted between 1 April 2011 and 31st March 2012 by 180 hospitals meeting the case threshold of 100 (or a high percentage submission rate in smaller hospitals).

King's Fund: How should the NHS prioritise quality? With the Francis Inquiry report due in the autumn, Dr Anna Dixon, Director of Policy at The King's Fund, discusses the role of the regulator and looks at how care quality can be improved.
Quality First: are we expecting too much from the regulator? Further presentations around this topic from a breakfast event organised by the King's Fund. 

National Assembly for Wales Children and Young People Committee: Inquiry into neonatal care (PDF 842.4KB). This reports a follow-up inquiry to the previous report of 2010 looking at what progress has been made.   It identifies further progress required in a number of important areas “not least addressing the shortfall in medical and nursing staff and the effective distribution and utilisation of cots”, and makes fourteen recommendations. 
Guardian Neonatal nurse shortage ‘puts babies lives at risk in Wales’. 

Welsh Government: All-Wales approach to child contact services in Wales. CAFCASS Cymru has introduced an all-Wales approach to the provision of child contact services in Wales, by appointing the National Association of Child Contact Centres (NACCC) as the network manager for Wales. “As the accreditation body for child contact centres, the NACCC has the appropriate expertise to provide advice around levels of need and ensure services are consistently delivered to a high standard across Wales”.

Guidance, innovation, tools

DH: Health protection in local government. The Department has published provisional guidance on health protection arrangements in the new public health system for local authorities and public health professionals. The document is subject to further review in early 2013 in the light of public health regulations to be made under the 2006 Act as amended by the Health and Social Care Act 2012.

General Medical Council (GMC): New GMC child protection guidance comes into effect. New guidance from the GMC to help doctors protect children from abuse and neglect came into effect on 3 September. 
Protecting children and young people: the responsibilities of all doctors.

K Initiative: K refers collectively to different knowledge translation, brokering and mobilization fields. This website, initiated by the United Nations University Institute for Water, Environment and Health was created to share knowledge of K between different sectors and prevent duplication of efforts. This site serves as a collaborative resource and is the online home of the K* Concept Paper Expanding our understanding of K* (KT, KE, KTT, KMb, KB, KM, etc.).

National Eye Health Week 17-23 September 2012. Details of events and activities.

National Obesity Observatory (NOO): Standard evaluation frameworks. NOO has published further Standard Evaluation Frameworks (SEFs) to support high quality and consistent evaluation of weight management, diet and physical activity. The SEFs provide introductory guidance on the principles of evaluation, and list ‘essential’ and ‘desirable’ criteria.

National Treatment Agency for Substance Misuse: Recovery resources available to help commissioners and services meet the drug strategy outcomes. New online resources to support drug treatment and recovery are now available on the NTA website. Organised around the eight drug strategy outcomes, the Recovery Resources are primarily for commissioners, though treatment services and professionals will also find them useful.
Recovery resources.

NHS Change Model Dashboard. This model brings together improvement knowledge and experience around quality improvement from across the NHS. Tools and resources to help organisations implement each of eight key components are now available on the site and will be expanded in the coming months.

NHS Commissioning Board. Configuration of NHS communications and engagement services agreed. The high level configuration of the fourth set of ‘scale’ commissioning support services – communications and engagement services – has been agreed. Four communications collaboratives will go forward with a lead commissioning support unit (CSU) in each.

NHS Diabetes: The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes. Joint British Diabetes Societies (JBDS) for inpatient care, supported by NHS Diabetes, has produced up-to-date guidance developed by a multidisciplinary group of practicing specialists, with considerable experience in this area. The guideline is the sixth in the JBDS series.
The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes, August 2012, JBDS 06 (PDF 3.2MB). 
JBDS guidance on management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes, August 2012 (PDF 175.8KB).

NHS Education for Scotland (NES): Issue 2 of the Promoting Excellence in Dementia Care Newsletter. This newsletter includes articles on developing a National Dementia Infrastructure for Social Services in Scotland, dementia ambassadors and the Dementia Managed Knowledge Network (MKN).

NHS Employers: Guidance on the Medicines Use Review service. The Medicines Use Review (MUR) service guidance is now is updated to cover the changes to the service which took place on 1 July and 1 September 2012. These changes update the data recording and reporting requirements for pharmacists providing the MUR service. The amended guidance also clarifies that, where a patient has recently been discharged from hospital with changes to their medicines, they will be eligible for a post-discharge MUR even if they have had a New Medicine Service (NMS) intervention in the previous six months, or an MUR consultation in the previous 12 months.

NHS Institute for Innovation and Improvement (NHS Institute): The Productive Series and finance teams. The Productive Care national QIPP workstream has launched a new web page which helps finance teams understand the correlation between The Productive Series and improved finance performance of trusts, and also contains examples from trusts that have made significant finance savings through Productive programmes.

NHS Institute: Energise for Excellence (E4E): Pressure Ulcer Week of Action. The pressure ulcer week of action, 17-21 September includes a series of events - webinars and workshops aimed to help clinical teams and leaders eliminate, prevent and manage pressure ulcers.

NHS Institute: Ambulatory Emergency Care Delivery Network. The NHS Institute will be running a second cohort of the Network starting in the autumn supporting organisations to accelerate their implementation of high quality AEC services. Organisations can register their interest on the website. 

NHS Right Care: Commissioning for value. “Essential Reading” is a series of reading lists on specific themes relevant to the Right Care programme themes. This reading list is on the theme of Commissioning for value.

Primary Care Commissioning (PCC): Designing and commissioning services for adults with asthma: a good practice guide. To help improve asthma care, PCC has produced a good practice guide with input from the major professional bodies, patient groups and health service managers. It sets out the 15 points that good asthma services need to include, with detailed advice for commissioners and service developers together with examples of good practice. 

Stonewall: Meeting the needs of lesbian, gay, bisexual and transgender people. This guide offers practical advice to organisations providing care and support services about how to meet the needs of lesbian, gay and bisexual people. Sometimes changes to policy, staff training and awareness about the law can make things better. But often it is about simple things such as awareness and communication – individual actions will have a big impact.

Yorkshire and Humber Public health Observatory (YHPHO): Spend and Outcome Tool: PCT CCG Spend and Outcome Factsheets and Tool (SPOT). Data for Clinical Commissioning Groups have been added to the Spend and Outcome Tool (SPOT). The tool includes the latest programme budgeting data and outcome indicators for the period 2010/11. As well as the tool itself which can be used to explore the data, summary fact sheets are available for each CCG.

Practice examples, case studies

CQC: Case study: CQC works with NHS hospital to meet government nutrition standards. Ensuring people have enough food and drink is one of the government standards that all hospitals must meet by law. This case study focuses on the CQC’s work with an NHS hospital which they found was not meeting government standards on nutrition. During an unannounced inspection of the hospital they found patients were not getting the support they needed to stay hydrated.

FoNS Centre for Nursing Innovation: project reports. New reports. These reports are:

NHS Institute: Care Homes Programme: case studies. The Care Homes Programme is working with a range of care homes to test and develop guidance and tools to help care homes make improvements. 
Care Homes Programme Newsletter 3 – August 2012 (PDF 507.6KB). Updates on overall progress of the programme and recent events.

NHS Institute: Treating emergency patients in a day – the Weston experience. "At Weston Area Health NHS Trust, back in 2006, demand for emergency care was outstripping supply on a daily basis. Many patients were having a poor experience and staff were frustrated and demoralised by the situation. The Trust management knew it had to act. It examined the data around emergency admissions and realised that not all of them were appropriate. But, if admission was not the answer, how could it deal with these patients differently?" 

Report, commentary, statistics

Centre for Mental Health: Recovery, personalisation and personal budgets. This briefing paper explores the links between recovery and personalisation and demonstrate how both are part of a common agenda for mental health system transformation.

Centre for Policy Studies: The social cost of litigation. In this report the authors show that "far from increasing safety and accountability, the culture of litigation has resulted in significant costs to the quality of services, the experience of those who use them, and the role of professionals".

Cervical Screening Wales: 2011/12 results published. The latest statistical report published by the programme, which is part of Public Health Wales, shows an overall 0.1 per cent increase in the number of women being screened, with a 0.8 per cent increase in women under the age of 30.
Public health Wales news: Cervical Screening Wales report shows increase in screening. 

DH: Report recommends which specialised services should be commissioned nationally. A report by the Clinical Advisory Group for Prescribed Services (CAG) has been published recommending which specialised services for people with rare conditions should be commissioned nationally in England. The services listed in the report will be commissioned by the NHS Commissioning Board from April 2013.

Guardian: More doctors on boards improves hospital performance. Article discusses recent research which suggests that greater clinical leadership leads to better performance. 

Health and Social Care Information Centre (HSCIC): Primary Care Trust Prescribing Data - England, April to June 2012. This release contains data for the quarters April - June 2008 to April - June 2012. Other quarters will be added subsequently.

HSCIC: Provisional Monthly Hospital Episode Statistics for Admitted Patient Care, Outpatient and Accident & Emergency data: April - May 2012. The monthly special topic covers two different conditions: stress (the feeling of being under too much emotional or mental pressure) and also anxiety (the feeling of mild or severe unease, such as worry or fear). In contrast to stress; admissions for anxiety fell by almost three per cent (220) in the same time period, from 8,810 to 8,590 and admissions for this condition were highest among the elderly. 
News: Hospital admissions for stress rise by seven per cent in 12 months. 

HSCIC: Measures from the Adult Social Care Outcomes Framework, England - 2011-12 - Provisional Release. The first figures for the new adult social care outcomes framework have been published by the Health and Social Care Information Centre (HSCIC). The report includes data for 14 measures which are designed to enable users to compare the effectiveness of care delivered by councils responsible for adult social care services.
Press release: First ever Adult Social Care Outcomes Framework published.

HSCIC: Improving Access to Psychological Therapies, Key Performance Indicators (IAPT KPIs) - Q4 2011/12 final and Q1 2012/13 provisional. The IAPT programme is designed to support the NHS in delivering by 2014/2015, evidence-based psychological therapies, as approved by the National Institute for Health and Clinical Excellence (NICE), for people with depression and anxiety disorders.

HSCIC: Routine Quarterly Mental Health Minimum Dataset Reports - Final Q4 2011/12 and Provisional Q1 2012/13 summary statistics and related information. Mental Health Minimum Dataset (MHMDS) is a regular return of data from providers of NHS funded adult secondary mental health services, produced during in the course of delivering services to patients. Providers currently submit data every quarter. From Quarter 1 2011/12, a new version of MHMDS (version 4) includes new data items and is processed using a new system. Some of the changes have been introduced to support the implementation of of Payment by Results for mental health.

Institute for Government: Choice and competition in public services. This publication is based on sessions reviewing attempts to create markets in public services in four key areas – welfare-to-work, social care, health care and local government. “It seeks to draw out high level lessons that those currently operating public service markets, or seeking to extend them, should consider”.

Institute of Medicine (IOM): Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. “Achieving higher quality care at lower cost will require fundamental commitments to the incentives, culture, and leadership that foster continuous ‘learning’, as the lessons from research and each care experience are systematically captured, assessed, and translated into reliable care.”

King’s Fund: Transforming the delivery of health and social care: the case for fundamental change. “The UK has the second highest rate of mortality amenable to health care among 16 high-income countries, and evidence shows that variations in health outcomes between social groups are widening”. This paper, the first in a series, explores how the current care delivery system has failed to keep pace with the population’s needs and argues for a much bolder and more innovative approach.
Transforming health and social care: can the chrysalis become a butterfly? Chris Ham comments in the King’s Fund blog.
Event highlights. Presentation and responses from a discussion which brought together leaders in health and social care and policy makers to discuss the case for change and how transformation can be achieved
RCN welcomes report on transforming health and social care.

RCN: Unprecedented demand in Wales. Acute hospital emergency departments in Wales are dealing with unprecedented demands, the Royal College of Nursing has said. The comments were made as officials in Wales revealed continuing overspends in the NHS. Cuts are being made to overtime and agency staff spending, and all health boards are struggling to meet savings targets.

RCN: New factsheets on commissioning. Under reforms outlined in the Government's Health and Social Care Act, clinical commissioning groups will take over responsibility. The first two factsheets are:
RCN fact sheet on clinical senates and strategic clinical networks (PDF 42.8KB).
RCN fact sheet on health and wellbeing boards (PDF 48.8KB).

Royal College of Physicians: Hospitals on the edge? The time for action. The report sets out the magnitude of the challenges facing acute care services. It is a call for action for all involved in the design and delivery of health services. “It is increasingly clear that we must radically review the organisation of hospital care if the health service is to meet the needs of patients” .
Guardian: Acute hospital care ‘on brink of collapse’ say doctors.

Royal National Orthopaedic Hospital: Getting it right first time. This report, launched in the House of Commons, describes the issues facing orthopaedic care in England and warns the Government that they could be in the ‘last chance saloon’ in terms of preventing increased waiting times and widespread rationing unless fundamental changes are made. It proposes a series of reforms for a joined up approach across the NHS to improve orthopaedic treatment.