Quality improvement updates - 21 March 2013

New policy guidance, tools and initiatives from across the UK. For more information about the quality improvement theme see Quality and Safety eBulletin: 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) Dignity and nutrition inspection programme published. The Care Quality Commission (CQC) has published its first dedicated review of privacy, dignity and nutrition in both care homes and hospitals. The 2012 Dignity and Nutrition Inspection Programme (DANI) has found that while most older people are having their needs met, a number of hospitals and care homes need to make improvements. It highlights the fact that often small changes can make a big difference to people’s experience of care. 
Dignity and nutrition for older people. This page brings together the 2012 and 2011 review publications and related information.
Time to listen: Dignity and nutrition in NHS hospitals. This review looked at the care provided to older patients in 50 NHS hospitals between July and August 2012. CQC inspectors found many examples of hospitals that were providing good care in relation to dignity and nutrition. This section highlights what worked well and what needs to improve.  
Time to listen: Dignity and nutrition in adult social care. This presents the findings from the inspection of 500 care homes, highlighting some of the good examples and also what needs to improve. "One in six care homes (87 homes) were not always supporting people to eat and drink sufficient amounts. Some staff failed to identify or provide the support to people who were at risk of malnutrition".
RCN: RCN responds to CQC reports into dignity and nutrition. Dr Peter Carter, RCN Chief Executive & General Secretary, said: “These are comprehensive reports, which show the improvements some care providers have made, and the dedication of many staff. However, two thirds of care homes meeting all five standards is not enough ...We all want our relatives to have dignified care, nutrition, adequate staff to look after them, good record keeping and proper safeguarding procedures, and these should now be the norm.” Dr Carter highlighted a particular concern of one failing leading to another, with about half of the homes not meeting nutritional needs also being beset by staffing problems. 

CQC: Care update (issue 2): Impact of dementia care. This report brings together findings from inspection reports and themed reviews, views and experiences of people using services, and data from other sources. It focuses on the impact that dementia is having on the quality of care that people receive. It also outlines the number of services that are providing a good quality of care, compared to those that need to make improvements, and the progress that services have made since the findings in the first care update. 
Infographic: Care update (PDF 1.4MB). 
Guardian: Care homes and hospitals 'failing people with dementia'.

DH: Regulations on procurement, patient choice and competition laid. The 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.

Healthcare Improvement Scotland: Scottish Confidential Audit of Severe Maternal Morbidity 9th Annual Report 2011. This ninth annual report describes severe maternal morbidity fulfilling defined criteria reported from all 17 consultant-led maternity units in Scotland in 2011. Detailed assessments of cases of major obstetric haemorrhage (MOH) and of eclampsia, and of their care in relation to national guidelines are reported.

Healthcare Quality Improvement Partnership (HQIP): The National Hip Fracture Database national report 2012 – supplement. The report demonstrates continuing improvements in acute care but also documents concerns about the later stages of care. A new analysis has provided disturbing data on ‘superspell' (the overall length of NHS stay), which across 180 hospitals ranges from 12.4 to 44.5 days: a more than three-fold variation. This has serious implications for NHS costs and serious implications for patients too.

MHP Health Mandate: Quality at a glance: Using aggregate measures to assess the quality of NHS hospitals (PDF 909.6KB). “Quality in the NHS is complex, with information often resting in different places in different formats, with little or no linkage or context. In this sense, the idea of an aggregate quality score – or ‘OFSTED-style’ rating – is attractive. However the complexity of quality also makes this challenging. Different indicators can tell very different stories and aggregation can hide this complexity. This matters because different patients may have different priorities when it comes to the quality of their care”. The report makes fourteen recommendations on how aggregate quality ratings should be developed, presented and communicated. 
Quality index. This has been published as part of this report. The 10 highest performing trusts on the Index are highlighted.

Monitor: Monitor report highlights pressure on foundation trust A&E services. "Overall, the NHS foundation trust sector continues to perform well in the challenging healthcare climate in terms of delivering services for patients and sound finances". However, Monitor is concerned that there has been a significant increase in the number of trusts failing to meet patient accident and emergency waiting times. In the third quarterly report (Q3) for 2012/13 more than twice as many trusts (32) have failed to meet this target compared with this time last year (14). 
RCN: System struggling to cope, says RCN. Dr Peter Carter, RCN Chief Executive & General Secretary, said: “This report is an unsettling but unsurprising insight into a system which is struggling to cope with fewer resources and rising demand, and it is patients who are suffering as a result".

RCN Policy and International Department: Policy briefing 11/13 March 2013: Ratings in health and social care: a short briefing on the Nuffield Trust Review (PDF 133.8KB). This briefing provides an overview of recent work on the merits of using aggregate or overarching ratings of providers in both health and social care. At the moment there is a range of information available on providers but there is no longer an aggregate rating for a provider overall. Currently the Care Quality Commission (CQC) as the quality regulator does not summarise their view of a provider other than to highlight whether a provider is compliant or not compliant with the essential standards of quality and safety. However, in the past there have been aggregate ratings, such as the star ratings. There is interest in whether such ratings could prove useful in today’s health and social care system. 
Nuffield Trust: Ratings review.

Regulation and Quality Improvement Authority (RQIA): RQIA has published its Independent Review of the Governance Arrangements of the Northern Ireland Guardian Ad Litem Agency (NIGALA) (PDF 484.2KB). The review team used NIGALA's six principles of good governance and Theme 1 of the HPSS Quality Standards for Health and Social Care in respect of corporate leadership and accountability to examine the effectiveness of leadership, professional and corporate accountability. This review makes 17 recommendations for consideration by DHSSPS and NIGALA, which provide a framework to further strengthen and improve governance arrangements across the organisation.

Society for Cardiothoracic Surgery in Great Britain and Ireland: Blue Book online. In a further move towards greater transparency, patients will now be able to access a wealth of data about heart surgery in the UK with the launch of the Blue book online This has been developed in partnership with the National Institute for Cardiovascular Outcomes Research (NICOR), North West eHealth and Manchester Academic Health Science Centre. The website allows access to information that is held in the UK National Adult Cardiac Surgery Audit.

Guidance, innovation, tools

Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange: How to think about evidence when deciding whether to adopt an innovation. This article from the U.S. Agency for Healthcare Research and Quality examines issues regarding the interpretation and use of effectiveness evidence about care delivery and policy innovations, and outlines an alternative approach to thinking about the information required when making decisions about the adoption of such innovations.

AHRQ: Re-Engineered Discharge (RED) Toolkit. “A variety of forces are pushing hospitals to improve their discharge processes to reduce readmissions. Researchers at the Boston University Medical Center developed and tested the Re-Engineered Discharge (RED). Research showed that the RED was effective at reducing readmissions and posthospital emergency department (ED) visits. The Agency for Healthcare Research and Quality contracted with BUMC to develop this toolkit to assist hospitals, particularly those that serve diverse populations, to replicate the RED” (American).

DH: A framework for sexual health improvement in England. This document sets out the evidence base for sexual health and HIV improvement It has been developed to provide the information, evidence base and support tools to enable everyone involved in sexual health to work collaboratively at local level to ensure that accessible services and interventions are available.

DH Guidance on commissioning sexual health services and interventions: Best practice guidance for local authorities. This includes: guidance on the legal requirements to provide comprehensive, open access sexual health services for contraception and testing and treatment of sexually transmitted infections; best practice, and references to a number of other resources which local authorities may find useful.

DH: Supporting hospitals to become dementia-friendly. This letter to chief executives of acute trusts follows up on a campaign by The Dementia Action Alliance, the Right Care, launched in October 2012, aimed at encouraging all hospitals to commit to becoming dementia-friendly by March 2013.
Dementia Action Alliance (DAA): D: KIT. The NHS self assessment resource for creating dementia friendly hospitals.

DH: Developing a specification for lifestyle weight management services: best practice guidance for tier 2 services. This includes: explanatory notes for developing a specification for tier 2 lifestyle weight management services; two best practice example service specifications, one for adults and one for children; information on outcomes that a commissioner should expect from a tier 2 service.      

Help the Hospices: Widening access to palliative care for people with learning disabilities: guidance and resources for professionals. The number of people over 60 years old with a learning disability is expected to grow by 36 per cent between 2011 and 2021. This publication shares some of the thinking, good practice and resources that have been developed by learning disability and end of life care services.

International Council of Nurses (ICN): Trends and issues in nursing: Improving the health and well-being of women: a life-course approach (PDF 3.4MB). The ICN has produced this manual as an informative document for nurses and other health care practitioners who have an interest in helping women improve their health and well-being. "This manual is not a comprehensive guide to providing well women services but one that addresses the missed opportunities and provides guidance on actions that can be taken to enhance the health of women".

Joint Commissioning Panel for Mental Health (JCP-MH): Mental Health panel issues new guides. The Joint Commissioning Panel for Mental Health (JCP-MH) has launched three commissioning guides. The JCP-MH is a collaboration between 17 leading organisations. It will publish 18 guides for commissioners by June 2013.  
Guidance for commissioners of perinatal mental health services (PDF 419KB).
Guidance for commissioners of rehabilitation services for people with complex mental health needs (PDF 411KB).
Guidance for commissioning public mental health services (PDF 1.2MB).

King's Fund: Making integrated care happen at scale and pace: lessons from experience. This publication is intended to support the process of converting policy intentions into meaningful and widespread change on the ground. The authors summarise 16 steps that need to be taken to make integrated care a reality and draw on work by The King’s Fund and others to provide examples of good practice.

Medicines and Healthcare products Regulatory Agency (MHRA):  MHRA launches an ‘Innovation Office’ to encourage the development of novel medical products and devices. The MHRA is launching an ‘Innovation Office’ to help organisations who are developing innovative medicines, medical devices or using novel manufacturing processes to navigate the regulatory processes in order to be able to progress their products or technologies. The ‘office’ will be a web-based portal accessed via the MHRA website. Developers of such technologies will be able to fill in a simple form which will be submitted confidentially to the most appropriate person at the MHRA.

National electronic Library for Medicines (NeLM): QIPP resources to optimise wound care. New resources that support the optimisation of systems and processes associated with wound care.

NHS Commissioning Board (NHS CB): Securing excellence in commissioning for offender health. From April 2013, the NHS CB will be introducing a step change in the commissioning of offender health services. The intention is to move away from regionally and locally isolated commissioning to a clear and consistent national approach, with national standards based on the best available evidence to ensure efficient provision of care, and improved health outcomes. This sets out the national strategy for commissioning and how it will be co-ordinated via the four NHS CB regional teams. It also outlines how the NHS CB will move towards a national contract framework with a national set of service specifications, standards, policies and quality measures.

NHS Confederation - National Ambulance Resilience Unit: Emergency preparedness, resilience and response: a guide for ambulance commissioners. This briefing supports commissioners by outlining the scope and importance of emergency preparedness, resilience and response (EPRR) and their own role in it, key questions and answers regarding EPRR, and sources of further information and guidance.

NHS Institute for Innovation and Improvement: New toolkits for ‘15 steps challenge’. Two new toolkits have been launched for the “15 steps challenge”.  The series now includes toolkits for clinic and outpatient settings as well as children and young people's inpatient services.

Regional Voices: Working with the voluntary and community sector: a guide for health and wellbeing boards. This guide describes the value of and mechanisms for health and wellbeing boards to work closely with the voluntary sector and discusses different ways of working with the voluntary sector to access its expertise and networks.

South East Public Health Observatory (Sepho): National Cardiovascular Disease (CVD) profiles. The page holds profiles for each Local Authority and Strategic Clinical Network in England.

Reports, commentary, statistics

2020health: The Wells Family Challenge: a pharmacist first approach. This report analyses and presents a qualitative evaluation of the benefits of the Wells Family Challenge which assessed the impact that in-store pharmacists could have on the health and lifestyle of a group of families over the course of one year. The assessment was carried out from November 2011 to November 2012, in ten Sainsbury’s stores with in-store pharmacies across the UK. The results show that 65 per cent of participants lost weight and 58 per cent reduced their risk of stroke or heart attack within the next 10 years.

Centre for Mental Health: Centre for Mental Health lecture calls for early intervention and integration. Professor Richard Frank, Professor of Health Economics at Harvard Medical School and a former adviser to the US Government, delivered the 2013 Centre for Mental Health Lecture with a call for mental and physical health services to 'meet people where they are' and to focus on intervening early to get the best results. He set out the US Government's approach to integrating support for people with mental health conditions and to intervening early to prevent problems from developing. With limited funding, Professor Frank described how the US Government was "placing smart bets on the most likely approaches" to improving mental and physical health.

Commonwealth Fund: Quality matters – February/March 2013. The February/March edition of the Quality Matters newsletter focuses on improving maternal care.

Department of Health, Social Services and Public Safety (DHSSPS): Northern Ireland Care Leavers aged 16-18 2011/12. This statistical bulletin presents summary information on young people aged 16-18 years who left care in Northern Ireland during the year ending 31 March. Key findings indicate care leavers continue to have higher proportions of young people coping with disability (13 per cent) than in the general population (6 per cent), and in terms of education higher proportions of care leavers had received Statements of Educational Need (16 per cent), compared with the general school population (4 per cent).
News.

DHSSPS: Statistics from the Northern Ireland Drug Addicts Index. A statistical bulletin summarising information from the Index has been published. People are registered on the index if they are known to be, or if a medical practitioner considers them to be, addicted to one or more of 14 controlled drugs. These controlled drugs include Heroin, Cocaine, Methadone and Morphine.
Drug addicts index 2012.

Diabetes UK: Putting feet first: fast track for a foot attack. Each week in England there are around 120 amputations in people with diabetes. The majority of diabetes-related amputations are caused by a "foot attack" – a foot ulcer or infection failing to heal. In October 2012 people with diabetes, vascular surgeons, podiatrists, diabetologists, commissioners, researchers and policy advisers, GPs and a health economist came together in Westminster to spend a day sharing their expertise and experience of footcare for people with diabetes. This report sets out key recommendations for Clinical Commissioning Groups arising from the day.

Health and Social care Information Centre (HSCIC): Provisional Monthly Hospital Episode Statistics for Admitted Patient Care, Outpatients and Accident and Emergency Data - April 2012 to November 2012. In the year from December 2011 to November 2012 there were: 17.7 million finished consultant episodes (FCEs), 59.7 per cent (10.6 million) of which included at least one procedure or intervention, and 6.1 million of which were day cases; 15.2 million finished admission episodes (FAEs), of which 5.3 million were emergency admissions. Special topic on hospital dental services.
News: Hospital admissions for tooth decay highest amongst England's most deprived.

HSCIC: Provisional Monthly Patient Reported Outcome Measures (PROMs) in England - April 2011 to March 2012, Pre- and post-operative data, March 2013 release. There were 247,696 PROMs-eligible procedures carried out in hospitals; 184,777 pre-operative questionnaires returned so far, a headline participation rate of 74.6 per cent (69.9 per cent for 2010-11).

House of Commons Library Standard Note: Social care reform: funding care for the future. This note provides a brief history of the proposals to reform the system of adult social care in England including information on the Coalition Government’s Caring for our future white paper and the accompanying progress report on funding reform published in July 2012. It provides information on the Government’s announcement made in February 2013, to introduce a cap on social care costs and a revised means test. 

House of Lords Committee on Public Service and Demographic Change: Ready for Ageing?  “The National Health Service will have to transform to deal with very large increases in demand for and costs of health and social care. Overall, the quality of healthcare for older people is not good enough now, and older people should be concerned about the quality of care that they may receive in the near future. England has an inappropriate model of health and social care to cope with a changing pattern of ill health from an ageing population. Further fundamental reform to the NHS in the next few years would be undesirable, but radical changes to the way that health and social care is delivered are needed to provide appropriate care for the population overall and particularly for older people, and to address future demand.”

King’s Fund: Improving public health outcomes: Conference presentations. The publication Clustering of unhealthy behaviours over time: implications for policy and practice, has shown a clear link between the health inequalities in socio-economic and educational groups and the uptake of multiple unhealthy behaviours. The conference held on 6 March 2013 explored how this knowledge can be used to improve the health outcomes for local populations and, in particular, how to ensure that the health outcomes for the poorest section of the population can be improved.

King’s Fund blog: The hospital bed: on its way out? In his British Medical Journal data briefing, John Appleby examines trends in the number of hospital beds and wonders how low we can go.

LSE: Lessons from Europe: governance of health care providers. This briefing outlines key insights from a 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.

Mental Welfare Commission for Scotland: When parents are detained. Mental health services are neglecting their duties to parents and families. This report looks at awareness of section 278 of the Mental Health Act, which places a duty on mental health services to consider the impact of compulsory treatment on parental relations where patients have children under 18. It also makes recommendations for health boards and social work departments and encourages inter-agency working. It also highlights the importance of improved understanding between social workers who specialise on mental health and those who work with children and families.

National Audit Office (NAO) Memorandum on the provision of the out-of-hours GP services in Cornwall. Whistleblowers played a significant role in highlighting concerns about the out-of-hours GP service in Cornwall, prompting Serco and the primary care trust to take action, a report by the National Audit Office has found.  

NAO: Cabinet Office and HM Treasury – Integration across government. According to this report by operating in a more integrated way, government could reduce inefficiencies in public services and deliver a better service to citizens. "In the 17 departmental business plans published in May 2012, 24 per cent of departments’ 444 ‘actions’ referred to joint working with other departments. NAO analysis suggests there are varying degrees of collaborative working across departments".
Press release. 

National Treatment Agency for Substance Misuse (NTA): Fall in heroin and crack use. The number of heroin and crack cocaine users in England has fallen below 300,000 for the first time. The latest estimates support the continuing shift away from the most harmful drugs, particularly among younger people. Independent research published by the NTA reveals a significant fall in use among the under 25s and under 35s in the last year. According to the new estimates, the number of heroin and crack users fell to 298,752 in 2010-11, from a peak of 332,090 in 2005-06. The number of people injecting drugs has also fallen significantly, from 129,977 in 2005-06 to 93,401 in 2010-11.

Nesta: Five hours a day. ”With life expectancies increasing by five hours a day and Baby Boomers entering their later years, our assumptions about ageing and who is 'old' are fundamentally challenged”. This report sets out Nesta's thoughts on the impact of ageing on society and what that means in terms of innovation. It makes the case for a systematic look at how we live in the context of changing demographics, with a priority on the issues which have most impact on older people's lives.

NHS Confederation: Tough times, tough choices series of publications:

NHS Confederation Community Health Services forum: Transforming local care: community healthcare rises to the challenge. This briefing shows how the community health sector is driving the transformation of local care systems and how innovative community healthcare providers are enabling people to stay healthy and independent and avoid crises that lead to unplanned hospital admissions. The briefing also details the challenges that need to be overcome to build upon this work and drive forward the necessary shift of care into the community.

NHS Diabetes: Impact of paediatric diabetes network co-ordinators (PDF 1.2MB). The findings of the evaluation suggest that the co-ordinator role has become embedded in the structure of the regional networks and has become pivotal to the effective functioning of the networks. The role has been the driver for many projects and has helped maintain the momentum of several network activities, ensuring outcomes are delivered in a timely manner.

NHS Diabetes Briefing March 2013. Includes articles from Anna Morton, Director for NHS Diabetes, and an interview with Jonathan Valabhji, MD FRCP, National Clinical Director for Obesity and Diabetes at the NHS Commissioning Board, as well as updates on the team's recent work.

NHS Kidney Care: You're not alone:  Peer support for people with long term conditions (PDF 2.7MB). This publication draws together the key findings from a national survey of peer support in kidney care, and the evidence and learning from the work undertaken by two renal networks (north-east and West Midlands) commissioned by NHS Kidney Care to establish peer support programmes.

NHS Improvement: Making the case for cardiac rehabilitation: modelling potential impact on readmissions (PDF 284.7KB). This report summarises the findings of a short study, commissioned by NHS Improvement, which models the relationship between uptake of CR and unplanned cardiac readmission rates both nationally and at commissioner level. The primary purpose of the study was to examine the Quality, Innovation, Productivity and Prevention (QIPP) potential of CR and to establish whether the benefits of CR outweigh the costs in terms of the potential impact on readmissions alone.

Nuffield Trust: The Francis Public Inquiry Report: a response. This Nuffield Trust policy response offers an analysis of several key themes from the Francis report where the Trust has expertise including funding, patient-level data, commissioning and regulation.

Nuffield Trust: Health Policy Summit 2013. This page brings together an overview of the key themes, reactions on Twitter and you can view the live streamed sessions from the Summit which was held on 7-8 March.

Primary Care Commissioning (PCC): Commissioning Excellence March 2013. In this issue, commissioning support needs to be focused on transformation not on transactions, according to Bob Ricketts, the man in charge of commissioning support at the NHS CB. Post Francis concerns about quality and safety and renewed emphasis on QIPP need to be at the heart of CCG efforts and therefore driving commissioning support, he argues.

Policy Connect: Redesigning Public Services Inquiry: Report. Restarting Britain 2: Design and Public Services. The culmination of a nine month inquiry, this report is the second publication in the Design Commission’s ‘Restarting Britain’ series. The first set out the strategic importance of design education as a driver of economic renewal and growth. This report turns to the question of public service renewal. The authors "strongly recommend that policymakers and public managers take a much more professional stance towards the design element of policymaking and public services". The report identifies steps that could help move towards this goal.

Prison Reform Trust: Turning young lives around. This briefing paper seeks to encourage effective joint working between Health and Wellbeing Boards and youth justice services, in particular, to ensure that local strategies reflect the needs of children and young people who offend, especially those with mental health problems and learning disabilities. It outlines a practical action agenda and provides examples of good practice to help turn these young lives around.

Royal Society for Public Health (RSPH): Health improvement in local government. This report is the third in a series of briefings reviewing changes in commissioning public health in England, with a particular focus on public health improvement. Based on in-depth interviews with a range of professionals working in public health and associated fields, it provides an update on health improvement commissioning as public health moves into local authorities, while also identifying key opportunities and challenges that arise as a result of the transition.

Scottish Government: National Corporate Parenting Training Programme Evaluation: research publication. An evaluation of the impact of the National Corporate Parenting Training programme developed and delivered by Who Cares? Scotland. Since 2010 the Scottish Government has been funding Who Cares? Scotland to develop and deliver a national corporate parenting training programme. The aim of the programme is to raise awareness among corporate parents about their responsibilities so they can improve the support they give to young people in and leaving care. Research findings.     

Skills for care: the economic value of the adult social care sector in England. This is the final report of a study commissioned by Skills for Care to provide evidence of the current scale of the economic contribution of the adult social care sector in England. The study confirms that the sector is worth an estimated £43 billion - including all direct, indirect and induced effects. It was also found that the sector supports a total of 2.8 million full time equivalent jobs.

World Health Organization (WHO) The European health report 2012: charting the way to well-being. The 2012 European health report describes both the overall improvements in health in the WHO European Region and their uneven distribution within and between countries. "It breaks new ground, however, by helping both to define well-being, a goal of Europe’s new health policy, Health 2020, and to map the way towards achieving it".
Executive summary.