Quality improvement updates - 24 January 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:

Audits, reviews, legislation

Academy of Medical Royal Colleges: Hospital Episode Statistics and Revalidation report. The Academy funded the Royal College of Surgeons of England to produce this report. The aim was to assess the strengths and weaknesses of using administrative data for revalidation in the areas of ischaemic heart disease, urological malignancies, and peripheral vascular disease. The Project Group distinguished between procedure-specific indicators and disease-specific indicators as well as between hospital-specific and consultant-specific outcomes.

Care and Social Services Inspectorate Wales (CSSIW): Annual report 2011-12. The report highlights the importance of the voice of the service user in the regulation of social care. As well as involving service users and families more in inspections, CSSIW will also establish a National Advisory Board and Regional Panels and is in the process of piloting an Independent Visitor scheme involving care groups and charities in inspections.
News: Voice of service user important in regulation of social care in Wales. 
Health in Wales: Deputy Minister welcomes CSSIW annual report. 

Care Inspectorate: Care Inspectorate Annual Report and Accounts 2011/12. The Care Inspectorate in Scotland has published their first Annual Report and Accounts. This provides an overview of their progress and achievements since the organisation started in April 2011.

House of Commons Health Select Committee - eighth report: National Institute for Health and Clinical Excellence. The report makes a series of recommendations including the need to progress the change to a new system of pricing for drugs in the NHS, and for greater openness about the results of clinical drug trials. It also argues that now that NICE is developing standards for social care there is a greater opportunity for creating integrated standards and clinical guidance across health and social care.
News: Decisions needed urgently on new drug pricing regime.
NICE: MPs welcome NICE’s move into social care.

NHS Confederation: Information overload: tackling bureaucracy in the NHS. The NHS Confederation has for many years emphasised the need to tackle the bureaucratic burden of gathering and sharing information to support various types of monitoring, regulation, inspection and accreditation. This paper sets out their ambitions for tackling the burden of bureaucracy. They urge strong leadership from ministers and actions which the Department of Health and other national bodies should take now.

Nuffield Trust: Ratings review: Have your say. The Nuffield Trust has been commissioned by the Secretary of State for Health to conduct a review that will consider whether aggregate ratings of provider performance should be used in health and social care, and if so how best this might be done. A final report will be presented to the Government in March 2013. 
Ratings review: Q&A.  

Welsh Government: New system to drive up standards in NHS Wales. NHS organisations have been asked to produce Annual Quality statements as part of the Welsh Government’s commitment to high quality and safe services underpinned by transparency on performance. The statements will give patients easy access to a range of information about the services available to them and how well those services perform in a range of areas. NHS organisations will also introduce new ‘quality triggers’ made up of organisational data and feedback from patients. The triggers will enable monitoring and act as an early warning system to pick up signs of services that may give cause for concern and help organisations take action to mitigate risks.

Guidance, innovation, tools

DH: Best practice for ensuring the efficient supply and distribution of medicines to patients. This updated guidance, first published in February 2011, is produced by organisations representing the supply chain, regulators, and the government. The references in the guidance have been revised to reflect current law.  

DH: How to establish a Quality Surveillance Group guidance. The National Quality Board (NQB) is publishing accompanying guidance to the system on establishing Quality Surveillance Groups (QSGs). A network of QSGs is being established across the country between now and March 2013, to bring together different parts of health and care economies locally and in each region in England to routinely share information and intelligence to protect the quality of care patients receive. The new system will go live in April 2013.

Foundation of Nursing Studies (FoNS): FoNS announces Volume 8 of Improvement Insights. Volume 8 of their most popular Improvement Insights, features innovative practice in healthcare settings including large acute trusts, primary care, hospices, mental health settings and prison healthcare.

Health Foundation: Responding to the Francis Inquiry Report. The Francis Inquiry, which is formally known as the 'Mid Staffordshire NHS Foundation Trust Public Inquiry', was set up in June 2010.  The report is expected to be published soon. This page includes: tools; resources; related publications from the Health Foundation; related blogs from the Health Foundation; background to the Francis Inquiry and ongoing work by the Health Foundation. 

Kidney Research UK: A Package of innovation for managing kidney disease in primary care. Coordinated by Kidney Research UK, the ENABLE–CKD project aims to improve the management of people with chronic kidney disease (CKD) in primary care. Working with 26 GP surgeries in England and Wales, the approach used a care bundle for CKD involving asking patients to take part in a self-management programme; measuring and treating proteinuria; measuring and treating high blood pressure; and assessing cardiovascular risk.

NHS Business Authority Service: NHS prescription service hints and tips. The NHS Prescription Service has published two new quarterly hints and tips bulletins; one for dispensing contractors, and one for information services users.

NHS Diabetes and Diabetes UK: Implementing local diabetes networks. The report, aimed at commissioners of diabetes services, provides guidance and support needed to create the local diabetes networks "that really can deliver high-quality, cost-effective care through the effective commissioning, delivery and monitoring of services". 

NHS Wales Informatics Service: Governance toolkit for community pharmacies. The first Clinical Governance self assessment toolkit has been launched for community pharmacies in Wales allowing them to document their existing practice and further develop Best Practice; whilst ensuring awareness of minimum compliance requirements with NHS Pharmaceutical Regulations. The toolkit uses an online self assessment questionnaire which covers clinical aspects of service and provision; including assessing aspects of clinical effectiveness, risk, patient and public involvement as well as standards of premises and equipment.

Primary Care Commissioning (PCC): Top tips for a profitable practice. Tips on customer service and effective marketing and promotion. 

Royal College of General Practitioners (RCGP): Personal health budgets: a guide for GPs. The guide covers what PHBs are, which patients are eligible, and how they can be used effectively. It includes a FAQ section and decision tree for quick reference purposes. It uses case studies to bring scenarios to life.

World Health Organization (WHO): Making health services adolescent friendly: developing national quality standards for adolescent friendly health services. This guidebook draws on international experience and sets out the public health rationale for making it easier for adolescents to obtain the health services that they need to protect and improve their health and well-being, including sexual and reproductive health services. It defines ‘adolescent-friendly health services’ from the perspective of quality, and provides step-by-step guidance on developing quality standards for health service provision to adolescents.

Yorkshire and Humber Public Health Observatory: Diabetes Outcomes Versus Expenditure tool 2011/12. The Diabetes Outcomes Versus Expenditure (DOVE) 2011/12 tool allows users to compare expenditure on diabetes care with clinical outcomes for a selected CCG, other CCGs with similar populations and all other CCGs.

Practice examples, case studies

King’s Fund: Developing supportive design for people with dementia: The King’s Fund’s Enhancing the Healing Environment Programme 2009-2012. This report marks the completion of 26 schemes in 23 NHS acute, community and mental health hospitals in England to improve the environment of care for people with dementia. It seeks to provide practical, value-for-money examples to encourage and inspire staff and their organisations. As well as case studies with before and after photographs from participating sites, the report includes information about the development and evaluation of the EHE assessment tool; overarching design principles for creating a more supportive environment for people with dementia; and a project directory detailing the artists and designers involved in each scheme along with costs involved.

National Housing Federation: Providing an alternative pathway: the value of integrating housing, care and support. This report, aimed at local commissioners of health and social care, tells the real stories of five people who receive integrated care, housing and support. Each service shows local authorities, housing providers, GPs and acute trusts working together to provide an alternative care pathway which reduces the demand an individual has for other services, as well as improving their quality of life.

NICE: Using NICE guidance to remodel services for type 2 diabetes. An example from the NICE Shared Learning Awards entries about the redesign of services for diabetes in Northamptonshire using the NICE clinical guideline on type 2 diabetes.

Reports, commentary, statistics

Centre for Mental Health: Annual review for 2012. Overview of activities and  their impact, and future plans.  

DH: Audit and Risk Committee Annual Report 2011-12. The committee advises the Department of Health’s Principal Accounting Officer and the Departmental Board on risk management, corporate governance, and assurance arrangements in the department and its subordinate bodies.

Globalization and Health: Crossing the quality chasm in resource-limited settings. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective health care to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas.

Health and Social Care Information Centre (HSCIC): Experimental data published on use of recommended medicines and treatments by NHS. The publication presents limited data at organisational level about the use of medicines and medical technologies recommended for use in the NHS in England by the National Institute for Health and Clinical Excellence (NICE). It takes the form of an interactive spread-sheet and accompanying report, which describes the data and its limitations.

HSCIC: General Ophthalmic Services - Selected statistics for England, April 2012 to September 2012. The objective of the General Ophthalmic Services (GOS) is to provide, through community opticians' practices, preventative and corrective eye care for children, people aged 60 and over, people on low incomes and those suffering from or pre-disposed to eye disease. These tables show selected statistics of NHS Ophthalmic activity during the first half of 2012/13, at national, PCT and SHA level. For detail on data coverage and collection see the beginner's guide to NHS Eye Care Data.

HSCIC: Statistics on NHS Stop Smoking Services: England, April 2012 to September 2012 (Q2 - Quarterly report). This quarterly report presents provisional results from the monitoring of the NHS Stop Smoking Services (NHS SSS) in England during the period 1 April 2012 to 30 September 2012. This report includes information on the number of people setting a quit date and the number who successfully quit at the 4 week follow-up. It also presents in depth analyses of the key measures of the service including pregnant women, breakdowns by ethnic group, socio-economic classification as well as by intervention type and setting and type of pharmacotherapy received and regional analyses at Strategic Health Authority (SHA) and Primary Care Trust (PCT) levels.

Healthcare Improvement Scotland: Annual State of the NHSScotland Assets and Facilities Report for 2012. A review of asset and facilities management performance in NHSScotland, identifying the current state of the estate and facilities management, highlighting areas of best practice and areas for improvement.

Healthcare Quarterly: Toward Performance and Quality. This special edition of Healthcare Quarterly highlights the transformation that is under way in Ontario’s healthcare system. Many topics are discussed such as patient-centred care, successful Quality Councils, leadership, linking evidence and quality, and The Excellent Care for All Act [Canadian].

Healthcare Quality Improvement Partnership (HQIP): HQIP becomes a CHAIN stakeholder. HQIP is a stakeholder in CHAIN - the contact, help, advice and information network - and as a facilitator to a new sub-group for clinical audit. The new sub-group already has over 700 members.

Health Foundation: The year ahead - our plans for 2013. This issue looks at the priorities and challenges for health services and the Health Foundation over the coming year, including a focus on improving patient safety and person-centred care which will continue to be a major theme with support for spread and adoption.

Health Foundation: Leading networks in healthcare. This report presents the experiences of participants in the Health Foundation's network support programme, highlights key learning and early insights from the programme and examines how this relates to research evidence about running networks.

Ipsos MORI: State of the Nation 2013. The State of the Nation 2013 report finds that Britons are “showing a glimmer of hope about the future, with pessimism levels reducing compared to 2012”. The report showed 16-75s were a little bit more optimistic about Britain than they were a year earlier, according to polling carried out for the thinktank British Future by Ipsos MORI.
British Future.

Joseph Rowntree Foundation (JRF) Monitoring poverty and social exclusion in Scotland 2013. JRF's sixth study of poverty and social exclusion in Scotland assesses a wide range of indicators including unemployment, education, and health. It highlights a huge rise in unemployment for under-25s, and stark and growing health inequalities.

JRF: publications on different aspects of housing:

King's Fund: Future of health and social care 2013-33 timeline. This new timeline picks out some of the key trends – from changes in population make-up to advances in technology – that will affect how health and social care is delivered over the next 20 years.

King's Fund: Time to Think Differently programme: Broader determinants of health. This explores how the complex interaction between individual characteristics, lifestyle and the physical, social and economic environment is changing, and how that will affect future trends in health.

King’s Fund: Think differently blog: Shifting care closer to home: slogan or solution? Nigel Edwards sums up the blog posts on this topic.

NHS Kidney Care: Sharing learning to improve care. This study highlights the importance of learning networks in improving care for long term conditions. It examines the role played by learning networks in two NHS Kidney Care improvement projects with sites located across England. The study found that healthcare professionals benefit greatly from working in environments that allow them to share experiences, learn from others, discuss relevant issues, and express concerns. The learning networks were a valuable resource for the groups in both projects, and were so successful that new networks have been established to embed and sustain opportunities for improvement beyond the life of the original projects. The report concludes with a series of recommendations that are relevant for all long term condition service areas, including making use of technology to facilitate shared learning through virtual meetings, which help save time and resources.

Primary care Commissioning (PCC): The new NHS. This provides a concise overview of the new arrangements resulting from the Health and Social Care Act 2012 and from the perspective of a typical general practice, focussing on the changes that affect GP practices as providers.

PCC: New Practice Management newsletter 11 January 2013. First issue of weekly newsletter which "will keep you up to date with important policy developments and practical advice not just on the effective day-to-day running of your practice but on the strategic issues of business development and working as part of a commissioning group". 

Queen’s Nursing Institute (QNI): ‘Opening Doors’ project publishes Final Impact Report (PDF 2.9MB) . The Opening Doors project which ran from 2011-2012 in England, was designed to improve the quality of support for homeless people and homeless families, especially those affected by substance misuse. The project provided support to nurses in the form of guidance, information and training on issues related to drug and alcohol addiction and developed a network of over 730 professionals. 

Royal College of Midwives (RCM): State of Maternity Services report 2012. The Royal College of Midwives has released its second annual State of Maternity Services report. The report provides an update, highlighting the very latest developments and looks at a number of indicators of the pressures on maternity care and the resources available to cope in each of the four United Kingdom countries. It focuses on the latest available statistics revealing what is happening on the frontline of care.
News: Report shows strain on maternity services.  

Royal College of Surgeons (RCS) Reshaping surgical services: principles for change. "The RCS believes that if surgical, and indeed all medical services, are to change then the whole pathway of care for patients must be considered. From primary care delivered by GPs to diagnostic tests, hospital treatment, discharge, follow-up and rehabilitation, this document asserts that any discussions about reshaping services must be open and transparent. It firmly states that patients should be at the centre of all decision making".

Scope et al: The other care crisis: making social care funding work for disabled adults in England (PDF 1.8MB). Published by leading disability charities this report brings together three new pieces of evidence and “exposes the true scale of the Government's social care crisis for disabled people, which has left thousands without access to basic care to help them eat, wash properly and leave their homes”. The charities warn of a social care system on the brink of collapse as a result of years of chronic underfunding.
News: Thousands struggling to eat, wash or leave their homes.  

University of Birmingham Health Services Management Centre: Health and social care commissioning: an exploration of processes, services and outcomes. The study found that joint commissioning as a concept has a high degree of acceptance and many stakeholders unquestioningly believe in this as a fundamentally 'good thing'. The study concluded "that there may not be anything that is specific about joint commissioning and is different to other ways of working and it is far from a coherent model with a set of clear organisational processes and practices. The very value of joint commissioning may be in its ambiguity and symbolism as a concept that is seen as inherently good and able to deliver against a range of the very sorts of pernicious issues that contemporary health and social care organisations struggle with".