Quality improvement updates - 21 February 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): Issues affecting the delivery of good home care services. The findings of this review show that good care is being delivered, but a minority of people are affected by issues including late or missed calls, lack of continuity of care workers, and poor care planning. It recommends that services work more closely with commissioners to improve care, find solutions to common problems and put systems in place to monitor the impact of missed or late visits.
BBC health: Elderly 'suffer from poor home care'.

DH: Regulations on procurement, patient choice and competition published. Following the public consultation carried out in August 2012, the government has now laid regulations. These regulations are to help ensure that commissioners’ decisions on buying clinical services are transparent and fair, and that they improve the quality and efficiency of health care services for patients. 

DH: UK public sector internal audit standards published. The UK public sector internal audit standards (PSIAS), which are based on the mandatory elements of the Institute of Internal Auditors (IIA) International Professional Practices Framework (IPPF) have been published. 

DH: Independent Mental Capacity Advocacy service – fifth annual report. The report provides statistical information on the continued increase in referrals to this statutory advocacy service and makes recommends to clinical commissioning groups and local authorities about its use for those who lack capacity.

Healthcare Quality Improvement Partnership (HQIP): First patient-focused heart attack and failure audit reports published. Cardiac patients and their families are set to receive a major boost in information about heart conditions with the launch of two major patient-focused reports covering heart attack and heart failure care. These are the first-ever patient versions of the annual MINAP (heart attack care) and National Heart Failure Audit reports and have been written in collaboration with patient representatives in an attempt to increase awareness of the audits, particularly in patients with cardiovascular disease and their families. 
Patient-friendly MINAP report (PDF 3.17MB).
Patient-friendly National Heart Failure Audit report (PDF 827.8KB).

Healthcare Quality Improvement Partnership (HQIP): Clinical Audit for Improvement 2013 - a joint conference between HQIP and Healthcare Conferences UK. Presentations are now available from the conference.

Monitor: The new NHS provider licence. Monitor's new provider licence has now been finalised and published, and is the new main tool that will regulate providers of NHS services. Monitor has agreed with ministers that foundation trusts will be licensed from April 2013, and other eligible NHS providers from April 2014. The licence has been shaped by stakeholders' responses to their extensive engagement and consultation during 2012. Monitor is holding four regional events in London, Leeds and Birmingham to update NHS providers and commissioner on the preparations for the new regulatory system. These will cover the NHS provider licence and how it will be enforced, and will be an opportunity to feed back views on the proposed risk assessment framework.

Guidance, innovation, tools

1000 Lives Plus: Improving care, delivering quality. The 1000 Lives Plus blog. People interested in improving the quality of healthcare in NHS Wales can comment and discuss key issues on a blog launched by 1000 Lives Plus, the national programme supporting organisations and individuals to deliver the highest quality and safest healthcare for the people of Wales. “Importantly, the blog will give all NHS staff the opportunity to comment and give their views. We hope these two-way conversations will engage new people and bring the improvement work to a wider audience". 
News: New blog invites discussion on improving care and delivering quality.  

Academy of Medical Royal Colleges: Measuring up: the medical profession’s prescription for the nation’s obesity crisis. This report follows a 6-month inquiry by a steering group comprising representatives from 20 of the Royal Medical Colleges and Faculties. The report presents an action plan for future campaigning activity, setting out 10 recommendations for healthcare professionals, local and national government, industry and schools which it believes will help tackle the nation’s obesity crisis.

Care about your care. American website with new resources available from the Care About Your Care programme, including a discharge preparation checklist and care transition plan for leaving hospital, and a fact sheet ‘How to avoid being readmitted to hospital’, which recommends six steps patients should take to improve their experience post-discharge. 

District Councils’ Network: District action on public health: How district councils contribute towards the new health and wellbeing agenda in local government. This publication explores the district contribution to the new public health system in England. Demonstrating the sector’s impact across the wider determinants, health improvement and health protection, the publication provides essential information for public health stakeholders and best practice case studies of service delivery and public health collaboration in two-tier areas.

FoNS Centre for Innovation: Creating Caring Cultures programme. "The Creating Caring Cultures Programme (with support from NHS London) has a simple purpose; helping nurse-led teams to create healthcare workplaces that are conducive to the delivery of high quality care and that provide a supportive place for staff to work. In caring cultures, staff feel valued and are more able to take responsibility for what happens in practice". Last year FoNS commenced two pilot projects, focused on workplace culture. The pilots are taking place the West Middlesex Hospital on a medical ward and on the medical assessment unit at Queen’s Hospital, Romford. These pilots will take place over a two year period.

Implementation Science:  Measuring factors affecting implementation of health innovations: A systematic review of structural, organizational, provider, patient, and innovation level measures. The review identified 62 measures. “Results indicate that organization, provider, and innovation-level constructs have the greatest number of measures available for use, whereas structural and patient-level constructs have the least. Additionally, relatively few measures demonstrated criterion validity, or reliable association with an implementation outcome (e.g., fidelity)”. 

King’s Fund: The evolution of clinical commissioning: learning from local experience. The King's Fund and the Nuffield Trust are working together to understand the development of Clinical commissioning groups (CCGs) and the challenges they face. As part of a major national research study, the project is following the evolution of clinical commissioning in six case study sites. The findings will be used to support CCGs across England by spreading good practice and learning. The first report is due for publication in summer 2013 and the project continues to 2015. 

National Treatment Agency for Substance Misuse: Substance misuse resources. The National Treatment Agency for Substance Misuse has published three new recovery outcome resources:

Network of Public Health Observatories: Local tobacco control profiles for England. New features have been added to the tool in 2013. The tool allows a local authority to compare with other local authorities in the region and also to benchmark against the England average.

NHS Kidney Care: Kidney Disease CCG Profiles. A new set of resources has been launched to help clinical commissioning groups (CCGs) provide high quality kidney services. NHS Kidney Care has produced a kidney disease profile for each of the 211 CCGs. The profiles are intended to help CCGs and other stakeholders, such as GPs and service providers, assess local kidney care need and current service levels in order to inform planning. This will facilitate improvements where necessary in the quality and productivity of services for those with kidney disease. 

Primary Care Commissioning (PCC): Commissioning for providers e-learning course. Commissioning for providers charts the changes to the commissioning process. It introduces the building blocks of commissioning - planning, securing and monitoring – and explains how they can be used to provide better services. The course is designed to support those from a general practice or other service provider background who are involved in commissioning as a CCG member and/or as a provider.

Royal College of Ophthalmologists and College of Optometrists: Joint clinical commissioning guidance for glaucoma services. The guidance focuses on services for glaucoma describing ways in which services for the diagnosis and treatment of glaucoma may be able to improve value for money. Even relatively simple steps like maintaining a register of people with or at risk of glaucoma can lead to major improvements in the quality of care. In the coming months, the Colleges will publish their recommendations on improving services for: age-related macular degeneration, cataract, diabetic retinopathy, low vision, oculoplastics and urgent eye care.
News: Alessi praises new guide to commissioning high value eye care.

Practice examples, case studies

Guardian: Mend helps families in the fight against obesity – video. "Mend, which stands for 'mind, exercise, nutrition … do it', is the world's most successful childhood obesity programme". The Guardian filmed families who have joined the programme in Oldham, which aims to teach them how to see food differently and lead more active lives.

Reports, commentary, statistics

Centre for Policy Studies: Capitalism for the little guy: 10 ways to extend competition and strengthen consumer clout. Dominic Raab MP sets out ten ways in which more competition can widen consumer choice and reduce costs in five key sectors: energy, water, retail banking, schools and health.

Department of Health, Social Services and Public Safety (DHSSPS): Domiciliary care services for adults in Northern Ireland. The DHSSPS has published a statistical bulletin summarising information on adults receiving domiciliary care services during a survey week in September 2012. The bulletin presents information on the numbers of clients receiving domiciliary care, visits, contact hours and intensive domiciliary care provision.

DHSSPS: Children adopted from care in Northern Ireland. This bulletin details statistical information relating to children adopted from care in Northern Ireland, during the year ending 31 March 2012. The tables within the bulletin present a range of information about these children, including gender and age and durations between different stages in the adoption process. The bulletin is based on the DHSSPS statistical return AD1 2011/12, which was collected from each of the five Health and Social Care Trusts in Northern Ireland.

DH: Overview of responses to NHS Constitution consultation published. Further information about the government’s response will be available when the updated constitution is published by April 2013. 

DH: Response to consultation on proposals for commissioners to deliver best value published. The Department of Health’s response to the consultation on proposals to protect patients’ interests by ensuring commissioners operate within a framework of rules to secure the best clinical services for patients and deliver best value.

Guardian Public health hub: Will progress on public health follow policy? At the final debate in a series of four on responsibility for public health in England transferring to local councils, professionals in the sector discussed how they hoped the move would tackle inequalities.

Guardian: Why do GPs prescribe too many drugs?  The York Health Economics Consortium has estimated the cost of unwanted prescriptions in England at £300m a year. In Scotland last year, the cost of collecting and destroying unwanted medicines was more than £500,000.

Health and Social Care Information Centre (HSCIC): Routine Monthly Improving Access to Psychological Therapies Data Quality Reports - England, final November and provisional December 2012. The Information Centre has published 'Routine Monthly Improving Access to Psychological Therapies Data Quality Reports - England, final November and provisional December 2012'. The Improving Access to Psychological Therapies (IAPT) dataset is a regular return of data generated by providers of NHS-commissioned IAPT services in England (including services provided by independent organisations). This report provides details of all people accessing these services.

HSCIC: Obesity, physical activity and diet statistics - England. The NHS Information Centre has published 'Obesity, Physical Activity and Diet - England 2013'. This statistical report presents a range of information on obesity, physical activity and diet, drawn together from a variety of sources. The topics covered include: overweight and obesity prevalence among adults and children; physical activity levels among adults and children; trends in purchases and consumption of food and drink and energy intake; and health outcomes of being overweight or obese.
Press release: Obesity-related hospital admissions increase in England, new report shows.

HSCIC: Provisional Monthly Patient Reported Outcome Measures (PROMs) in England - April 2012 to September 2012. This provisional publication of PROMs data includes eligible HES episodes with an episode start date between 1 April 2012 and 30 September 2012 and pre-operative questionnaires with a completion date between 1 April 2012 and 30 September 2012.

HSCIC: Community Care Statistics, Social Services Activity - England, 2011-12, Final release. This is a report on the social care activity of Councils with Adult Social Services Responsibilities (CASSRs) in England.  It contains information taken from council administrative systems used to record the process of assessing eligibility to state funded social care and providing services where people are eligible. It combines data from two sources: the Referrals, Assessments and Packages of Care (RAP) and the Adult Social Care Combined Activity Return (ASC-CAR). Information presented here is final and relates to England for the period 1 April 2011 to 31 March 2012.

HSCIC: Measures from the Adult Social Care Outcomes Framework - England, 2011-12, Final. This report contains the final figures for the 2011-12 Adult Social Care Outcomes Framework (ASCOF) measures for England and supersedes the provisional ASCOF release in September 2012. The data that are used in the report are also available in CSV format and can be accessed on NASCIS.

HSCIC: Mental Health Bulletin: Annual report from MHMDS returns - England 2011/12, initial national figures. The figures in this annual report provide a more comprehensive picture of people using adult specialist mental health services than has been published before.  The new version of the dataset (MHMDS v4) that underpins this annual report was introduced in April 2011/12, with changes to the way some data was collected and processed and these have contributed to a significant increase in overall numbers. The report also uses the latest population figures from the 2011 census.

Housing LIN: Housing, Dementia and the Maintenance of Independence. Written originally for the Yorkshire and Humber Dementia Alliance programme, this report has been updated by the ADASS Housing Policy Network and the Housing LIN. It takes a look at the emerging housing policy and practice developments in relation to supporting people with dementia. It explains that housing conditions and access to appropriate care and support can impede the ability of people with dementia to remain independent. It makes a number of thoughtful points and ends with a useful list of 10 'top tips' of things you should do.

Housing LIN: Housing network newsletter, February. The latest edition of Housing LIN newsletter covers the latest policy, funding and practice developments relevant to housing with care and housing related support for older people and those with long term conditions.

Implementation Science: Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments. "Measuring team factors in evaluations of Continuous Quality Improvement (CQI) may provide important information for enhancing CQI processes and outcomes; however, the large number of potentially relevant factors and associated measurement instruments makes inclusion of such measures challenging. This review aims to provide guidance on the selection of instruments for measuring team-level factors by systematically collating, categorizing, and reviewing quantitative self-report instruments".

Joseph Rowntree Foundation (JRF): Measuring child poverty: a consultation on better measures of child poverty. This paper forms the JRF response to this consultation which is being run by the Department for Education. 

King’s Fund: How is the health and social care system performing? February 2013. For the first time, the quarterly monitoring report also includes a survey of directors of adult social services in English local authorities alongside its usual survey of NHS finance directors. The report finds that "while most NHS organisations are on track to meet financial targets, it is clear that pressures are growing towards the end of the second year of the so-called Nicholson Challenge". 
Press release: Outlook for NHS and social care pessimistic as financial squeeze bites.  

King’s Fund blog: Are delayed transfers a growing problem? “Thankfully, the long-term trend in delayed transfers of care has been reducing”.

King’s Fund Think differently blog: Where to begin? This summarises a recent Think differently debate on what we need to do differently on inequalities in health and wellbeing.

Macmillan Cancer: Facing the fight alone: isolation among cancer patients. This report which looks at the number, profile and experiences of isolated people living with cancer, has found 23 per cent of the 325,000 newly diagnosed cancer patients in the UK - an estimated 70,000 patients each year - lack support from family and friends during their treatment and recovery.  It indicates that: 53 per cent of health professionals have had patients opt not to have treatment at all due to a lack of support at home from family and friends; 89 per cent of health professionals felt that a lack of support at home leads to a poorer quality of life for patients; whilst over half of health professionals felt that it can lead to poorer treatment decisions (54 per cent) and a shorter life expectancy (56 per cent).
Press release: A quarter of cancer patients face isolation each year.
BBC Health: Many cancer patients are struggling alone, charity says. 

National end of life care Intelligence Network: Deaths from cardiovascular diseases: implications for end of life care in England. The number of cardiovascular disease deaths has fallen from 178,067 in 2004 to 130,192 in 2011. This report describes the patterns in mortality from cardiovascular diseases in England, highlighting variation in place and cause of death by age, sex, socioeconomic deprivation and disease group. 
News release: Report finds people dying from cardiovascular diseases are more likely to die in hospital.

NHS Commissioning Board (NHS NCB): Securing Excellence in Commissioning NHS Dental Services. The NHS Commissioning Board (NHS CB) has published Securing Excellence in Commissioning NHS Dental Services. From April 2013, the NHS CB will take commissioning responsibility from primary care trusts for all NHS dental services: primary, community and secondary, including dental out of hours and urgent care.

NHS Confederation: Making it better? Assuring high-quality care in the NHS. The Francis report painted a shocking picture of appalling standards of patient care. This paper aims to start a constructive debate, leading to concrete proposals about how to tackle these issues and find ways of reinforcing both organisational and individual accountability for delivering and improving the quality of NHS patient care. 

NHS Confederation: Lessons from Europe: provider governance. This Briefing outlines key insights from a 'Lessons from Europe' seminar that examined the impact of recent reforms in hospital governance in Spain and the Netherlands. It identifies lessons for NHS managers and policymakers in England on how to approach the challenge of effective provider governance as the present NHS reforms are implemented.

Nuffield Trust: Access highlights from Euro Summit 2013. Video interviews, slideshows, blogs from the summit which explored making primary care fit for the future. 

Office for National Statistics (ONS): Injury and poisoning mortality statistics. This document presents annual data on deaths from injury and poisoning in England and Wales.
 
Primary Care Commissioning (PCC): Francis report: implications for CCGs and general practice. This PCC briefing looks at the implications of the Francis report on the Mid Staffs public enquiry for CCGs and general practice.

Public Health Wales Observatory: Changes to statistical geographies in Wales 2001 to 2011. The report illustrates the differences between the statistical geographies released based on 2001 Census results, compared to those released in the more recent 2011 Census. 

Scottish Government: Growing Up in Scotland - Birth Cohort 2. Key Early Years Indicators on Pregnancy and Birth. This document presents key findings on pregnancy and birth from the second birth cohort (BC2) of the Growing Up in Scotland (GUS) study, surveyed for the first time during 2010/11 when children were aged 10 months. It considers specific indicators related to pregnancy and birth which are relevant to the Early Years Framework and the Early Years Collaborative. These include: mother’s supplement intake during pregnancy; alcohol, smoking and drug use during pregnancy; and birth weight. 

Scottish Government: Growing Up in Scotland - Birth Cohort 2. Patterns of Childcare Use amongst Families with 10 month old Children. This reports findings in relation to patterns of childcare use amongst families with 10 month old children. It considers provider types, patterns of use, issues of cost and perceptions of accessibility and availability. 

Scottish Government: Growing Up in Scotland: Birth Cohort 2. Results from the First Year.
This report provides a detailed insight into the first set of data collected from the study’s second birth cohort – representative of all children born in Scotland between 1st March 2010 and 28th February 2011 – around the time they were all aged 10 months old.

Scottish Government: Integration of Adult Health and Social Care in Scotland Consultation: Scottish Government Response. The Scottish Government's response to key points made by respondents to the Integration of Adult Health and Social Care consultation.