Quality improvement updates - 27 September 2012

New policy guidance, tools and initiatives from across the UK. For more information about the quality improvement theme see Quality and Safety e-Bulletin: quality improvement. 

Some of the resources linked to are in PDF format - see how to access PDF files.

Entries are arranged under the following headings:

Audit, reviews, legislation

Audit Commission: NHS financial year 2011/12. A summary of auditors' work. A summary of the findings from the Commission’s 2011/12 audit of primary care trust, NHS trust and strategic health authority accounts. The report has revealed that NHS organisations in England reported a combined underspend and surplus of £1.6m in 2011-12. It also revealed that the number of NHS trusts with a deficit has more than doubled from 13 to 31 in a year. Dr Peter Carter is quoted in the Guardian, the Daily Telegraph and Daily Mirror as saying: “Patients will question why as many as 61,000 posts are at risk in the NHS when there is an overall surplus of £1.6bn.”
Guardian: NHS has cash reserves of £4bn, report shows.
BBC Health: NHS trusts in debt double in year.
RCN: RCN comments on Audit Commission NHS report.

BBC Health: Loss of patient data was 'serious management failure'. Papers from an external review show how delays built up over three years. Patients affected by the problems at Imperial Healthcare Trust included those referred because of suspected cancer.

Care Inspectorate: Care Inspectorate progress Review: Renfrewshire Child Protection Committee Significant Case Review. In Renfrewshire, the Care Inspectorate was invited by the Chair of the Renfrewshire Child Protection Committee and the Chief Officers Group to review progress services are making to implement the recommendations of the Significant Case Review into the death of Declan Hainey. The Care Inspectorate report notes the progress made by all the partner organisations towards implementing the recommendations contained within the Action Plan.

Guidelines and Audit Implementation Network (GAIN): A Retrospective Regional Audit of Paediatric Acquired Brain Injury 2003-2009 (PDF 2.3MB). The purpose of the audit is to provide accurate figures on the prevalence and characteristics of children with ABI across Northern Ireland whilst also determining whether standards of care are met. The standards for this audit were based on the Department of Health’s (2004) best practice guidelines titled “Acquired Brain Injury, National Service Framework for Children, Young People and Maternity Services” specifically the exemplar ‘Jack’s Journey’.

Health and Social Care Information Centre (HSCIC): NHS Outcomes Framework indicators - September 2012 Release. This release includes nine indicators published as part of the NHS Outcomes Framework for the first time.

Healthcare Quality Improvement Partnership (HQIP): National Joint Registry ninth annual report (PDF 5.8MB). The report summarises the data and findings for hip, knee and ankle procedures carried out in England and Wales between1 January 2011 and 31 December 2011. 
News: NCAPOP: hospital non-compliance risking joint patient safety, NJR report finds. Key findings.

HQIP: Paediatric Intensive Care Audit Network (PICANet) annual report 2009/2011. Standards of care in children's intensive care units have come under scrutiny in a new audit report published by the University of Leeds and the University of Leicester which showed that death rates in children's intensive care units are low and continue to fall. The national audit also found that only five children's intensive care units across Britain and Ireland were staffed with the number of qualified nurses recommended by the Paediatric Intensive Care Society.

HQIP: NCAPOP Variation in care for children with epilepsy revealed in first UK-wide audit: Epilepsy12 press release. About 1 in 200 children in the UK are affected by epilepsy - yet the standard of care they receive remains variable, according to the results of the UK's first national audit of epilepsy care for children and young people which was largely undertaken by local paediatricians and nurses keen to find ways to continue improving the services they provide - 98 per cent of children's NHS Service took part. The audit was led by the Royal College of Paediatrics and Child Health. Documentation includes a report for parents and young people.

Monitor: Monitor takes regulatory action at Sherwood Forest Hospitals. Monitor is taking regulatory action at Sherwood Forest Hospitals NHS Foundation Trust as it has found the Trust in significant breach of two terms of its authorisation.

NHS Benchmarking: National Audit of Intermediate Care 2012 report. The National Audit of Intermediate Care was launched in November 2011 as a partnership project which includes the Royal College of Nursing. The audit aims to take a whole system view of the effectiveness of intermediate care services and the contribution made to demand management across health and social care systems in England, Wales and Northern Ireland. As well as the Audit report there are presentation from the launch event.

Royal College of Paediatrics and Child Health (RCPCH): Epilepsy 12. Epliepsy12, the first UK-wide-audit of services for epilepsy care, has found stark variations in the quality of care available to children with epilepsy. Thousands of children are being denied access to an epilepsy specialist nurse or a paediatric neurologist, and more than one in three did not have an adequate first clinical assessment.
RCN: RCN’s concerns over epilepsy care. 

Guidance, innovation, tools

DH: Guidance published on sharing information to tackle violence. This guidance highlights how Community Safety Partnerships  (CSPs) made up of local authorities, the Police and other local agencies can reduce violence in their community by encouraging A&Es to collect and share information on time, type and location of assault, as part of the Government’s commitment to deliver on Information Sharing to Tackle Violence.

Midlands East Quality Observatory (MEQO): Acute Trust Quality Dashboard. The Acute Trust Quality Dashboard brings together indicators from various sources providing an indication of quality across the five domains of the NHS Outcomes Framework: Preventing people from dying prematurely; Enhancing quality of life for people with long term conditions; Helping people to recover from episodes of ill health or following injury; Ensuring that people have a positive experience of care; Treating and caring for people in a safe environment and protect them from avoidable harm. A sixth domain has been created for the dashboard “Organisational approach to quality” which contains a number of metrics which look at organisational behaviour.
Published Dashboards for summer 2012.

NHS Commissioning Board: Procurement of healthcare (clinical) services: Briefings for CCGs. Working with CCGs and others, the NHS Commissioning Board Authority has developed a series of procurement briefings for CCGs that summarise the key elements of legislation and guidance currently governing NHS procurement of healthcare services. These briefings also provide an overview of the different procurement approaches that CCGs may adopt and outlines some of the key considerations when undertaking a procurement process.

NHS Commissioning Board: Bulletin for proposed CCGs – Issue 20, 13 September 2012. This issue crucially sets out proposals going to our next Board meeting on 20 September which will discuss how the moderation, conditions and decision-making elements of the CCG authorisation process will operate. 

Primary Care Commissioning (PCC): Designing and commissioning services for adults with asthma: a good practice guide. This guide outlines the case for improving outcomes for people with asthma and what the elements of a good service look like. It provides information for everyone involved in commissioning and delivering care to those with asthma, so that they can work alongside clinicians and patients to improve outcomes.

RCN: Liverpool Care Pathway for the Dying Patient (LCP). The Royal College of Nursing has joined other royal colleges and patient organisations in signing a consensus statement designed to provide clarity about the Liverpool Care Pathway. Since the late 1990s, the pathway has been used to spread elements of the hospice model of care into other health care settings, including care homes and patients’ own homes. But there have been accusations that the pathway has been used as a means of withholding treatment, including hydration and nutrition.

RCN: Record keeping – the facts (PDF 754KB). This RCN fact sheet busts the myths and lists key principles on record keeping.

RCN: Top tips from Tanis – Principle E. The HCA and AP newsletter is featuring a series on the RCN Principles of Nursing Practice. This newsletter looks at Principle E - Nurses and nursing staff are at the heart of the communication process: they assess, record and report on treatment and care, handle information sensitively and confidentially, deal with complaints effectively, and are conscientious in reporting the things they are concerned about.

Right Care: Casebooks. Right Care is sharing local examples of commissioning work which demonstrate the philosophy and tools of the Right Care programme.
From insights into action: identifying opportunities to improve value in NHS Derby and Derbyshire County’s CCG population (PDF 1.02MB).  

Right Care: Atlas of Variation in Healthcare for People with Respiratory Disease. The themed Atlas highlights variation in care for people with respiratory disease. "The Respiratory Disease Atlas, together with the 2011 Outcomes Strategy for COPD and Asthma  and the NHS Companion Document to the Strategy, can be used by healthcare professionals to increase the value of care they offer to people with respiratory disease."

Scottish Government: Diabetes treatment success. Twelve patients have been cured of a life threatening complication of type one diabetes thanks to an innovative Scottish transplant programme. Eighteen months on from the first operation, the Scottish National Pancreatic Islet Transplant Programme has carried out 18 islet cell infusions, and improved the lives of 12 patients.

Social Care Institute for Excellence (SCIE) Social Care TV: Avoiding unnecessary hospital admissions. There is much in the news about the pressure that is being placed on busy hospitals, often because of the increasing numbers of older people. Three new films have been launched on Social Care TV, which explore the realities behind the headlines. Older people often have complex health care needs which require a range of health and social care interventions, including hospital admissions when necessary. The films look at what steps can be taken to help avoid unnecessary hospital admissions.
Press release: Avoiding unecessary hospital admissions.

Reports, commentary, statistics

BMC Health Services Research: The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact. “Healthcare accreditation standards are advocated as an important means of improving clinical practice and organisational performance. Standard development agencies have documented methodologies to promote open, transparent, inclusive development processes where standards are developed by members. They assert that their methodologies are effective and efficient at producing standards appropriate for the health industry. However, the evidence to support these claims requires scrutiny. The study's purpose was to examine the empirical research that grounds the development methods and application of healthcare accreditation standards”.

Bowel CancerUK: Improving capacity, saving lives: endoscopy in the UK. This briefing shows that despite the Government's aspiration to diagnose people earlier, groups or individuals who need to undergo regular endoscopic procedures because they are at higher risk of bowel cancer (for example, because of a genetic condition or an inflammatory bowel condition) are not getting the timely surveillance they require.

Carers UK: Caring conversations. Half a Million Voices: Improving support for BAME (Black, Asian and Minority Ethnic) Carers – One Year on (PDF 58KB). As part of a series of Caring Conversations policy and practice papers focussing on carers, Carers UK and the Association of Directors of Adult Social Services (ADASS) have jointly produced a briefing looking at improving recognition, responsiveness and outcomes for Black, Asian and Minority Ethnic (BAME) carers, to mark the first anniversary of the publication of the research Half a Million Voices.

Catalyst: Healthcare services sector: mergers and acquisitions update (PDF 1.7MB). This report argues that changes in healthcare policy and pressures on public finances will present major opportunities for private healthcare providers. It examines the impact of the changes and potential for mergers and acquisitions in the sector.

Council of the Federation: From Innovation to Action: The First Report of the Health Care Innovation Working Group (PDF 3.8MB). This Canadian report identifies innovations in healthcare delivery across Canada that was established by Canada’s provincial premiers. This report focuses on three priority areas: clinical practice guidelines, team-based health care delivery models, and health human resource management initiatives.

DH: Clinical Advisory Group for Prescribed Services Final Recommendations . This report recommends which specialised services for people with rare conditions should be commissioned nationally in England. The services listed in the report will be commissioned by the NHS Commissioning Board from April 2013, rather than by Clinical Commissioning Groups. The list will be agreed by Ministers and the Commissioning Board in the autumn.

DH: New statutory arrangements for Healthy Start vitamins. From 1 April next year, the NHS Commissioning Board, Clinical Commissioning Groups and/or local authorities will be responsible for providing or arranging the provision of Healthy Start vitamins to women and families who qualify for the Healthy Start scheme in their area.

DH: Government response to the House of Commons Health Select Committee inquiry on the Government’s Alcohol Strategy. The Government has published its response to the House of Commons Health Select Committee inquiry on the Government’s Alcohol Strategy. The Committee gave a positive welcome overall to the Government’s Alcohol Strategy and it welcomed the decision to introduce a minimum unit price for alcohol. The Government will consult on the level of minimum unit price and on other proposals set out in the Strategy during the autumn.

DH: Public health transitional support funds available for local authorities. The Department of Health is making available public health transitional support funds for local authorities. Financial support is available to each unitary and upper tier local authority. This will enable the capacity to manage the change by contributing towards the costs associated with administrating the transition and minimising the diversion of staff and resources from day to day duties and delivery.

DH: Amendments to NHS (Pharmaceutical Services) Regulations 2012 from 1 November. The Department of Health have amended the NHS (Pharmaceutical Services) Regulations 2012, which came into force on 1 September. These amendments will come into force on 1 November.

Health-EU Newsletter: Issue 96, 21 September 2012. Sharing knowledge to advance dementia care in Europe. “Alzheimer’s disease and other dementias (AD) affect 7 million Europeans and 20 million family carers. These numbers will double between now and 2040. September 2012 marks the first global World Alzheimer’s Month, an international campaign to raise awareness and challenge stigma. The theme of this year is ‘Dementia, Living together’.”

HSCIC: Investment in General Practice 2007/08 to 2011/12 England, Wales, Northern Ireland and Scotland. The report draws on information obtained from country level financial monitoring reports discussed by the Technical Steering Committee (TSC), which is chaired by the Health and Social Care Information Centre and has representation from the four UK Health Departments, NHS Employers and the British Medical Association.

HSCIC: New features to be added to mental health report following successful consultation. The Health and Social Care Information Centre is to further enhance one of its biggest annual mental health reports following a successful consultation held earlier this year. New and revised data tables will be included in the next annual publication of; Inpatients Detained under the Mental Health Act 1983, and Patients subject to Supervised Community treatment', due for release next month.

Implementation Science: Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework—A Systematic Review (PDF 411KB).“Primary care practices in the United Kingdom have received substantial financial rewards for achieving standards set out in the Quality and Outcomes Framework since April 2004. This article reviews the growing evidence for the impact of the framework on the quality of primary medical care.”

iMPOWER: Home truths: how dysfunctional relationships between GPs and social care staff are driving demand for adult social care. This research argues that GPs inflate demand for residential care by at least 60,000 older people every year because they don’t understand the alternatives. The study, based on interviews with older people, social care professionals, GPs and directors of adult social care, suggests that by not addressing this, local authorities are failing to manage demand for residential care.

Institute of Medicine (IOM): Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Since 2004, British primary care practices have received financial rewards for achieving standards set out by the National Health Service (NHS) Quality and Outcomes Framework. This systematic review from the Annals of Family Medicine examines evidence of the framework’s impact on UK primary medical care.

Institute of Public Care (IPC): Developing care markets for quality and choice (DCMQC) programme. The DCMQC programme, run in collaboration with the Department of Health and the Association for Directors of Adult Social Services, is designed to help local authorities with three aspects of market facilitation - market intelligence, market structuring and market intervention. These briefings give an overview of the programme itself and key concepts which are being promoted by the programme.

Institute of Public Care (IPC): People who fund their own personal care at home in Hampshire. This report's overall aim was to judge the likely number of self-funders in the local authority area and compare that figure with the estimate made in an earlier study. Specifically, it sought to ascertain the kind of services people paid for, from whom they bought them and in what volume, what contact if any they had had with the county council in arranging the care, and why they were self-funding. It also examined the critical role of unpaid carers.

ISD Scotland: Scottish MS Register national report 2012 (PDF 53.3KB). This is the 2nd National Report from the Scottish Multiple Sclerosis (MS) Register. It contains data on all known patients registered by a Consultant Neurologist with a new definite diagnosis of MS from 1st January 2010 to 31st December 2011 in Scotland.

King's Fund: How is the NHS performing? September 2012. Quarterly monitoring report. This quarter's report aims to take stock of how the NHS is performing, 18 months into the Nicholson Challenge. The report finds that NHS performance is continuing to hold up well, but there is concern that quality of care may suffer as financial pressures bite from next year.
BBC Health: NHS 'could get worse from 2013'.

King's Fund: Dealing with financially unsustainable providers: how will the failure regime work? This paper explains why a failure regime is required in the NHS; outlines how the failure regime for NHS trusts (currently being applied in South London) works; and how the failure regime for foundation trusts introduced by the Health and Social Care Act 2012 will work in future. It concludes with a discussion of key issues that need to be resolved if providers of acute services to the NHS are to be put on a financially sustainable footing.

National Centre for Social Research: British Social Attitudes 29 (PDF 3.1MB). This is a study of how people's lives are changing and their views on how Britain is run. It draws on three decades of data, and spans three recessions and seven elections. The results for health show a decrease in the public's satisfaction with the way the NHS is run.
Full report: British Social Attitutes 29
Health chapter: Health care in Britain: is there a problem and what needs to change?

NHS Confederation: Papering over the cracks: the impact of social care funding on the NHS. This Briefing outlines the current demographic and financial realities of social care and how these impact upon the NHS, and the additional pressure that will be put upon the health and care system in the coming years. It sets out the NHS Confederation’s recommendations for a lasting solution for the funding of social care and a redoubling of efforts to integrate care. We are calling for a cross-party consensus on solving the challenges raised.

Nuffield Trust: Patient-level costing: can it yield efficiency savings? This report argues that many hospitals in England are still unable to track costs because they are using outdated IT systems. It examines in depth the experience of one NHS trust which is more advanced than most, in that it has a ‘patient-level information and costing system’. These computerised information systems were introduced in the NHS in the mid-2000s, and are currently used in many other countries.

Scottish Government: Self-Directed Support (Direct Payments), Scotland, 2012. Presents the latest figures on the number of people in Scotland who use Direct Payments to purchase and manage for themselves some or all of the social care and support services they need. Over the last year, the number of people in receipt of Direct Payments has increased by 15 per cent from 4,392 in 2011 to 5,049 in 2012.