Quality improvement updates - 25 October 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

Care Inspectorate: Registration policy and guidance published. The Care Inspectorate in Scotland is publishing two new documents to clarify when a separate registration is needed rather than a variation or notification.
The Policy on Dispersed Services and Peripatetic Management. Sets out the Care Inspectorate’s criteria for assessing whether one registration can cover multiple sites and whether more than one registered service can share a manager.
The guidance on Variations, notifications of changes and new registrations – Housing Support and Care at Home services complements this policy. It covers changes to housing support and care at home services, including when providers inform the Care Inspectorate of an increase in staffing or the configuration of their service.

Healthcare Improvement Scotland: Care for Older People in Acute Hospitals: Six-monthly report (February-July 2012). This report provides a summary of Healthcare Improvement Scotland findings from the first 6 months of inspections of the care of older people in acute hospitals. It reflects what was found during eight inspections to acute hospitals in four NHS boards across Scotland from February 2012 to July 2012. All of inspections we carried out were announced.

Healthcare Quality Improvement Partnership (HQIP): National Bowel Cancer Audit  supplementary and interactive report. About a quarter of bowel cancer patients in England are only diagnosed with the disease after an emergency admission to hospital, new advanced research from a national audit has found. This equates to about 8,000 out of 31,000 patients admitted in a 12 month period, whose records were analysed by the National Bowel Cancer Audit and linked for the first time with hospital data (Hospital Episode Statistics). 

HQIP: NCAPOP: Vascular registry and prostate audit contracts awarded to Royal College of Surgeons. These are the latest pair of new projects to be added to the National Clinical Audit and Patient Outcomes Programme (NCAPOP) - the third and fourth of the 11 new topics announced in October 2011.

National Confidential Enquiry into Patient Outcome and Death (NCEPOD): Bariatric surgery: Too lean a service. This NCEPOD report highlights the process of care for patients aged over 16, who underwent bariatric surgery for weight loss. The report takes a critical look at areas where the care of patients might have been improved during the whole patient journey, from referral to follow up. Remediable factors have also been identified in the clinical and the organisational care of these patients.

Regulation and Quality Improvement Authority (RQIA): RQIA statement regarding Marie Stopes International (Updated 15 October 2012). The nature of services proposed by Marie Stopes International in Northern Ireland are currently not subject to regulation under The Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003. RQIA will continue to liaise with the service provider to ensure that any changes in the proposed service model that results in a requirement for regulation are dealt with appropriately.

Scottish Government: Consultation on the National Personal Footcare Draft Guidance. This consultation is seeking views on the national draft personal footcare guidance that has been developed by a multi-agency working group. This is a key action highlighted for implementation in the National Delivery Plan for Allied Health Professionals in Scotland, 2012-2015. The overall aim is to improve the way in which personal footcare for older people is supported and delivered through the implementation of training and good practice guidance. The consultation closes on 30 November 2012. 

Guidance, innovation, tools

4Children: Over the Limit: The Truth about Families and Alcohol. This report warns of a silent epidemic of alcohol misuse by British families. The report warns that too many parents remain oblivious to the negative effects that alcohol can have on their parenting. An alarming 19% believe alcohol has a positive effect on their parenting ability and 62% of parents say that their drinking behaviour has no impact on their family at all. Over the Limit says it does.

AHRQ Effective Health Care Program: Closing the quality gap series: quality improvement measurement of outcomes for people with disabilities. The study “found very few direct examples of work conducted from the perspective of disability as a complicating condition. The sparse literature indicates the early stages of research development. Capturing the disability perspective will require collaboration and coordination of measurement efforts across medical interventions, rehabilitation, and social support provision.”

Alcohol Harm Map: Alcohol misuse costs the NHS £2.7 billion each year. This map reveals the real cost of alcohol on local health services.

Avalere Health: Establishing a Vibrant Evidence Paradigm to Support Innovation (PDF 1.8MB). Avalere Health, with funding from the Pharmaceutical Research and Manufacturers of America, convened senior healthcare thought leaders in July 2012 as part of a Dialogue series to advance a common understanding of the current dynamics facing pharmaceutical innovation and establish a vision for an “ideal” health system that supports value-based healthcare and rewards innovation. This paper reflects key insights from the discussion (American).

Help the Hospices: Towards excellence in hospice care: widening access through nurse leadership. Guidance and resources for professionals (PDF 3.3MB). "People with a terminal illness are less likely to receive palliative care if they are from an ethnic minority or marginalised group, or if they have an illness other than cancer". This report based on the Widening Access through Nurse Leadership project which saw hospices across the UK reaching out to underrepresented groups, calls for more innovation and collaboration between providers and community groups to improve access for all affected by terminal illness.
News: Urgent action needed to widen access to palliative and end of life care. 

Improving Health and Lives: Learning Disabilities Observatory: Improving the health and wellbeing of people with learning disabilities: an evidence-based commissioning guide for Clinical Commissioning groups. Good practice guidance for Clinical Commissioning Groups (CCGs) on commissioning general and specialist health services for people with learning disabilities. A presentation and easy-read guide are also available.

National Osteoporosis Society: Falls and Fractures Alliance. The National Osteoporosis Society and Age UK have established a new Falls and Fractures Alliance in England. "By working together, members of the Alliance are better placed to achieve the common goals of preventing falls and fractures and, specifically, reducing the rate of hospital admissions for hip fractures and for falls-related injuries among older people". Members of the Alliance have all signed the Falls and Fractures Declaration which is a commitment to reduce the rate of hip fractures and falls related injuries in older people over the next five years.
The Falls and Fractures Declaration
News: Fall and Fractures Declaration launched.

NHS Improvement: First steps to improving chronic obstructive pulmonary disease (COPD) care (PDF 828KB). This is a basic guide to the key principles every area should be adopting to provide good COPD care. It is also a helpful starting point for those new to commissioning for COPD services or for a stocktake for a local respiratory team.

NHS Commissioning Board: Bulletin for proposed CCGs. Issue 22, 22 October 2012.

NHS Kidney Care: ‘Buttonhole’ needle technique supports self-care and home dialysis. NHS Kidney Care has published a new how-to guide that explores how to use the 'buttonhole' technique which is a way of inserting a needle for dialysis, but unlike other methods of cannulation, it allows dull (sometimes referred to as blunt) needles to be used. The guide describes how Sussex Kidney Unit at the Royal Sussex County Hospital in Brighton have introduced buttonholing for their dialysis patients, and are seeing greater patient satisfaction and an increase in self-care and dialysis at home as a result.
‘Buttonhole’ needle technique How-to guide.

Social Care Institute for Excellence (SCIE) Social Care TV: End of life care videos. Three new films on the theme of end of life care: coordination of care; personalisation – the need to discuss death and dying; supporting staff in care homes.

Practice examples and case studies

Health Foundation: Championing safety and quality improvement. In 2001 Salford Royal NHS Foundation Trust was a poorly performing trust. Today, it is widely considered the leading trust in safety and quality improvement. The Executive Nurse Director, Elaine Inglesby explains how they’ve achieved so much in a short space of time.

Reports, commentary, statistics

Action on Hearing Loss: Cut off. This report uses data gathered via Freedom of Information requests from audiology departments at 128 NHS trusts to reveal the impact that budgetary cuts are having on the quality of hearing services across the country. It found that reduced budgets have led to 16% of trusts to reduce their follow-up appointments; 15% to experience an increase in waiting times; and 8% to reduce the number of specialist staff for complex cases.

Care inspectorate: Care News – Autumn 2012. Latest news and good practice stories from the Care Inspectorate in Scotland.

Centre for Mental Health: A chance to change: delivering effective parenting programmes to transform lives (PDF 1.2MB). This report “the most comprehensive review of the implementation of parenting programmes to date”, calls for a national campaign to raise public and professional awareness of childhood conduct problems and do more to support well-implemented and evidence-based early interventions. It finds that “the majority of parents whose children have behavioural problems ask for help, usually from GPs or teachers, but few receive the support that can make a difference”.
News: Parenting interventions must be fully funded and run well to help the most vulnerable children.

DH: End of life care strategy: fourth annual report. This is the fourth annual report on progress in delivering the end of life care strategy, published in 2008. The strategy states that, wherever possible, people should be able to spend their last days in the place of their choosing. This report confirms that almost 30,000 more people have been able to die where they usually live, whether this is at home or in a care home.

DH: Health visitor implementation plan quarterly progress report: July-September 2012. This report confirms that the Department of Health remains on track to increase the number of health visitors by an extra 4200 by April 2015. It includes updates on: the work to support health visitor professional development; the progress of the second wave of early implementer sites and the health visiting communities of practice; communications and the success of the marketing campaign; and transition plans and how health visiting will be affected.

DH: Department of Health annual report and accounts 2011-12. This report provides parliament and the public with an account of how the Department of Health has spent the resources allocated to it. It provides commentary on departmental performance, structural and transition changes and progress against the structural reform plan.

DH: Notification of proposal to extend adult social care social work practice pilot sites. This letter signals the intention, subject to parliamentary approval, to extend the period for which the social work pilots may run. The proposed extension will allow the sites to continue providing services up until the 31st March 2014 (pending approval) when the independent evaluation will have been produced. If approved, this decision will come into force on the 13th December 2012.

DH: Department of Health annual report and accounts for 2011 to 2012 published. This report provides parliament and the public with an account of how the Department of Health has spent the resources allocated to it. It provides commentary on Departmental performance, structural and transition changes and progress against the structural reform plan.

DH: Response to the inquiry into sport and exercise science and medicine published. This Command Paper sets out the government’s response to the House of Lords Science and Technology Select Committee inquiry into sport and exercise science and medicine. The government welcomes the Committee’s report and its focus upon the quality and application of sports and exercise science and medicine. Scientific breakthroughs into health benefits for patients and the public represents a major opportunity as a legacy of the London 2012 Olympic and Paralympic Games.

Department of Health, Social Services and Public Safety (DHSSPS): Drug Use in Ireland and Northern Ireland Drug Prevalence Survey 2010/11: Sedatives or Tranquillisers, and Anti-depressants Results. The Bulletin was published jointly with the National Advisory Committee on Drugs in Ireland and relates to a survey carried out jointly in Northern Ireland and the Republic of Ireland between October 2010 and May 2011. Key findings are presented here.
Bulletin 6 (PDF 667.7KB).

Guardian: How to bring back ward rounds. Following the RCP/RCN report calling for daily hospital ward rounds to be made a cornerstone of patient care, Dr Yogi Amin explains how the declining practice could be rejuvenated.

Health Foundation blog: We should be celebrating increased life expectancy. Blog from Simon Mackenzie, a Health Foundation Quality Improvement Fellow, who will be looking at matching supply and demand across the health care system in order to put capacity where patients need it.

HSCIC: Eating disorder hospital admissions rise by 16 per cent in a year. Hospitals recorded 2,290 eating disorder admissions in the 12 months to June 2012; a 16 per cent rise on the previous 12 month period, provisional figures show.

HSCIC: Cervical screening programme, England 2011-12. This includes data about the call and recall system, screening samples examined by pathology laboratories and referrals to colposcopy clinics.
News: Cervical screening: little change in a decade with around one in five women still not screened within five years.

HSCIC: Summary Hospital-level Mortality Indicator (SHMI) - Deaths associated with hospitalisation, England, April 2011 - March 2012, Experimental Statistics. This is the fifth publication of the SHMI. This publication introduces two additional contextual indicators: Provider spells split by deprivation quintile; Deaths split by deprivation quintile.

IPC Market Analysis Centre, Oxford Brookes University: Where the heart is: a review of the older people's home care market in England. This report offers a picture of the current home care market, some of the challenges it faces and a model for its future development.  It aims to provide a basis for dialogue between commissioners, consumers and providers about what home care services might look like in the future.  It was written during the period of consultation on the proposals put forward by the government in the 2012 care and support white paper.

London Health Observatory (LHO): The Slope Index of Inequality (SII) in life expectancy: interpreting it and comparisons across London. This briefing is intended to aid London’s public health professionals by explaining how to interpret the SII; comparing 2006-2010 SII scores across London; illustrating SII trends across local areas; and demonstrating how to use an SII to drive local area improvement.

Monitor: NHS foundation trusts: review of three months to 30 June 2012. The regulator Monitor is urging NHS foundation trusts to start delivering hospital cost savings earlier in the year in order to reduce their exposure to financial risk. The advice comes in the latest quarterly report on the health of the foundation trust sector, which now comprises two-thirds of all NHS secondary care providers running about 1,000 hospitals.

NHS Diabetes: Diabetes transition - Assessment of current best practice and development of a future work programme to improve transition processes for young people. This report summarises the work by a number of small groups looking at transition in diabetes care and includes examples of good practice as well as a set of principles that can be used to deliver improvement in transition services.

Nuffield Trust: Understanding patterns of health and social care at the end of life. This report presents the findings of a study tracking the ways that more than 73,000 people used publicly funded health and social care services during the last months of their lives. It reveals variation between local areas in the care people receive at the end of life and suggests that social care may prevent the need for hospital admission.

National Council for Voluntary Organisations (NCVO): Open public services: experiences from the voluntary sector. This report highlights examples of innovation in practice where the voluntary sector has worked in new ways with statutory authorities to develop specialist services. It argues that there needs to be greater openness and flexibility in commissioning services to capitalise on the contribution from charities. It also highlights new opportunities emerging from social investment and open data which could ease contract risks and make services more accountable to their users if adopted. It is aimed at those involved in improving services: government; local authorities; voluntary organisations; and social investors.

Nuffield Trust: Understanding patterns of health and social care at the end of life. This report details the key findings from a study of over 73,000 people in England during the last 12 months of their lives. It suggests that social care may help prevent hospital admission.
RCN: Social care needs proper funding.

Royal College of General Practitioners (RCGP): Sessional GPs in commissioning. This report surveyed sessional GPs and those involved in emerging CCGs in order to find how engaged sessional GPs are with commissioning and to find examples of best practice, models of inclusion, engagement and leadership including the necessary conditions for their success, along with any barriers preventing these.

Royal College of Surgeons (RCS), MHP Communications and Age UK: Access all ages: assessing the impact of age on access to surgical treatment. The report examines the patterns of surgical treatment in relation to age across eight areas of surgery and shows the large gap between the number of people living with a condition or health need and the surgery rates to treat older people. The report looks at the potential causes of these trends and makes recommendations as to how the NHS can ensure that all patients can access the best possible surgical treatment, irrespective of their age. 
News:  Age should not close the door to surgery, warns RCS and Age UK. 

Scottish Government: Exploring the scale and nature of child sexual exploitation in Scotland. The report provides a summary of known evidence about the scale and nature of child sexual exploitation in Scotland, based on existing statistics and research and workshops with practitioner experts.

Scottish Government: Consultation analysis: National Framework for Child Protection Learning and Development. This report presents the findings of a consultation carried out by the Scottish Government on the National Framework for Child Protection Learning and Development in Scotland between 5 April and 5 July 2012.

Scottish Government: Responses to the Integration of Adult Health and Social Care in Scotland Consultation. Copies of non-confidential responses to the Integration of Adult Health and Social Care in Scotland Consultation, which closed on 11 September 2012.

Scottish Public Health Observatory (ScotPHO): Scotland’s mental health: adults 2012. This report provides the second systematic assessment of mental health and its contextual factors for adults in Scotland. It analyses 51 indicators from the previously established national adult mental health indicator set which cover both the state of mental health (mental wellbeing and mental health problems) and its context (including individual, community and structural factors). Where possible, the report provides an analysis of time trends over the last decade and equalities analysis by age, gender and area-based deprivation.
NHS Health Scotland. Second report of adult mental health indicators shows high levels of inequalities.

UNICEF: Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK (PDF 4.11MB). This report looks at how raising breastfeeding rates could save money through improving health outcomes. It finds that for five illnesses, moderate increases in breastfeeding would translate into cost savings for the NHS of £40 million and tens of thousands of fewer hospital admissions and GP consultations. It analyses three conditions: cognitive ability, childhood obesity and Sudden Infant Death Syndrome (SIDS) and finds that modest improvements in breastfeeding rates could save millions of pounds.
Press release: Breastfeeding could save the NHS millions.

Youngminds and Cello Group: Talking taboos: Talking self-harm. The report calls for more knowledge, awareness and understanding around self-harm in a bid to establish a consistency of responses to provide for young people. "Online information should be presented in a sensitive way and young people should be involved as experts in the development of online service provision". The report also calls for teachers to be provided with advice on how to respond to individual cases of self-harm.
BBC: Doctors don’t understand self-harm, a new report claims.