Quality improvement updates - 7 February 2013

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

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

Entries are arranged under the following headings:

Audit, reviews, legislation

Audit Scotland: NHS management of GP prescribing has improved. The report says the health service has improved its management of GP prescribing, and family doctors are getting more support and guidance on their prescribing. But there is scope for further improvements and potential to save up to £26 million a year without affecting patient care. This could mostly be done through reducing waste and cutting the use of less suitable medicines. Along with the report there is a podcast, a key findings document and a self-assessment checklist for NHS boards.

Care Quality Commission (CQC): Mental health services must improve the care they provide to patients. The CQC have published their Mental Health Act Annual Report revealing that 15 per cent of people receiving care under the Act are not being involved in the decisions made about their care. The Act is the law under which a person with a mental disorder may be detained and treated in hospital against their wishes or treated in their community under a community treatment order (CTO). The CQC visits to people who are detained or on CTOs are carried out by Mental Health Act (MHA) commissioners. They check that patients’ basic human rights are being supported during their care and treatment under the Act. The CQC are intending to make mental health a high priority this year.

Centre for Public Innovation (CPI): Information sharing to tackle violence: audit of progress on delivering the Coalition Commitment 2012 (PDF 1.2MB). This audit report, produced on behalf of the Department of Health, assesses national progress on information sharing to tackle violence and provides a rating for every local area in the country.

CQC: Equality Matters. This report builds on the CQC’s reporting from last year and covers both equality issues in how they regulate services and equality in the workforce.
What progress are we making on equality?

CQC: Northern Ireland joins the National Joint Registry (NJR). The NJR records data on hip, knee, ankles, elbow and shoulder replacements for England and Wales and is the largest registry of its type in the world with more than 1.3 million records.

Grant Thornton: NHS governance review 2013: the formula for clear governance. This annual review is based on research of over 100 NHS trusts, FT and PCT annual reports. It assesses NHS governance and how these arrangements are communicated.

Health Education England (HEE): Introducing Health Education England: our strategic intent. This document sets out HEE's purpose and the role that they will play in leading education, training and development across the system to deliver improvements in the quality of care for patients. It also includes high level guidance for workforce planners. HEE are welcoming views and feedback on this document at HEE.StrategicIntentFeedback@nhs.net.

Healthcare Quality Improvement Partnership: National Audit of Percutaneous Coronary Intervention. The 2011 annual report of this audit highlights the significant progress within hospitals to expand PCI services to treat more patients with acute coronary syndromes. Key findings and full report available.

NHS Sustainable Development Unit: Sustainable development strategy consultation. This consultation aims to capture views from various stakeholders across the health care system in order to develop a sustainable development strategy for the NHS, public health and social care system to 2020. The consultation closes on 31 May 2013.

Welsh Government: Social services and well-being (Wales) Bill. The draft Social Services and Well-being (Wales) Bill was introduced in to the National Assembly for Wales on 28th January 2013 for consideration and scrutiny. If legislation is passed, it will provide the legal framework for improving the well-being of people who need care and support or support and to transform social services in Wales.

Guidance, innovation, tools

Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange: Medical home models for specialty care. Providers are now applying principles of the medical home to the delivery of specialty care in an effort to provide comprehensive, coordinated care and improve health outcomes. The featured Innovations examine how three different providers in the USA have adapted the primary care medical home model to specialty care,"including a community-based oncology practice that redesigned its care delivery processes, a pediatric center serving children with special health care needs, and a statewide medical home program that improved access to comprehensive pregnancy care for Medicaid beneficiaries".

AHRQ: New Tools Help Health Providers Reduce Patients' Risk of Falls. This American online toolkit focuses on reducing falls that occur during a patient’s hospital stay. Nearly one million patients fall in U.S. hospitals each year. The Toolkit is organized under six major areas that address hospital readiness, program management, choosing fall prevention practices, implementation, measurement, and sustainability. Fall prevention programs require an interdisciplinary approach to care in order to manage a patient’s underlying fall risk factors, such as problems with walking and transfers, medication side effects, confusion, and frequent toileting needs. 

Department of Health, Social Services and Public Safety (DHSSPS): Translating learning into action: an overview of learning arising from case management reviews in Northern Ireland 2003-2008. This brings together key learning from 24 Case Management Reviews with the aim of transforming practice and bringing about improvements in services to children and families.

FoNS Centre for Nursing Innovation: Patients First – Supporting nurse-led innovation in practice: Nine new projects. The Patients First Programme provides support and facilitation to clinically based nurse-led teams to help them to develop, implement and evaluate locally focused innovations that improve patient care in any healthcare setting across the UK.

General Medical Council (GMC): Good practice in prescribing and managing medicines and devices (PDF 191KB). This guidance strengthens and broadens the current advice on prescribing medicines to include medical devices and gives key updates on using unlicensed medicines.

GMC: Guidance for the investigation committee and case examiners when considering allegations about a doctor’s involvement in encouraging or assisting suicide (PDF 265KB). This guidance is designed to help GMC decision-makers consider (fairly and consistently) allegations about doctors encouraging or assisting suicide. It may also be helpful to doctors, patients and others as it sets out clearly how the GMC will consider complaints in this area.

GMC: When a patient seeks advice or information about assistance to die (PDF 131KB). This document provides guidance to doctors who have been asked for advice on assisted death by patients. It provides advice on how the principles in Good medical practice and Treatment and care towards the end of life: good practice in decision making apply when patients who are reaching the end of their life, or who have severe disabilities, seek help or advice about ending their lives.

Healthcare Improvement Scotland: Colorectal and lung cancer QPIs published. National Cancer Quality Performance Indicators (QPIs) are being developed under the auspices of the Scottish Cancer Taskforce. Specific indicators are underpinned  by core generic QPIs that are applicable to all types of cancer.
Colorectal cancer Quality Performance Indicators (PDF 462K).
Lung cancer Quality Performance Indicators (PDF 571K).

NHS Commissioning Board (NCB): Supporting planning for 2013/14 for Direct Commissioning. This document describes the processes that will be used to support planning for 2013/14 for Direct Commissioning in area teams. It provides further information to Everyone Counts: Planning for Patients 2013/14.

NHS Confederation: Stronger together: how health and wellbeing boards can work effectively with local providers. The main duties and functions of health and wellbeing boards require them to have strong engagement across their communities. This report sets out a framework of different ways that boards might approach engagement in their localities, highlighting examples of current mechanisms being used, exploring how these have developed and the advantages of working in these ways.

NHS Institute for Innovation and Improvement (NHS Institute): 15 Steps Challenge toolkits. The challenge arose from a comment made by a parent "I can tell what kind of care my daughter is going to get within 15 steps of walking on to a ward". The toolkits have been co-produced with patients, service users, carers, relatives, volunteers, staff, governors and senior leaders, to help look at care in a variety of settings through the eyes of patients and service users, to help capture what good quality care looks, sounds and feels like. Each toolkit provides a series of questions and prompts to guide patients, service users, carers and NHS staff through their first impressions of a care setting. There are now three toolkits available for different contexts: acute services; mental health services; community services - focussing on care in people's own homes.

NHS Kidney Care: Embedding patient decision aids in clinical practice: a survey from NHS Kidney Care. This report outlines the findings of a survey of kidney units who are being supported in their use of patient decision aids. It highlights challenges that are brought up by the implementation of patient decision aids; as well as the use of and attitudes to these tools.

NHS National End of Life Care Programme: Advance decisions to refuse treatment: a guide for health and social care professionals. This guide is designed to help health and social care professionals understand and implement the law relating to advance decisions to refuse treatment (ADRT) contained in the Mental Capacity Act (2005). This version replaces that published in September 2008 and covers: how to make an advance decision to refuse treatment; who can make an advance decision; when a decision should be reviewed; and how it can changed or withdrawn.

Regional Voices: Influencing local commissioning for health and care: guidance for the voluntary and community sector (PDF 1.1MB). This guidance is intended to support the voluntary and community sector in understanding and influencing health and wellbeing boards. It gives an overview of health and wellbeing boards, joint strategic needs assessments and joint health and wellbeing strategies and the role of the voluntary sector.

Royal College of General Practitioners (RCGP): Primary care drug and alcohol treatment: commissioning and provision against a backdrop of localism. This paper produced jointly with Substance Misuse Management in General Practice considers the future impact of the changing commissioning environment on primary care drug and alcohol treatment. "It considers the specific challenges and opportunities for primary care, being uniquely placed to respond to this in a period of significant change as part of the wider health and social care economy".
News: Primary care predicts future of substance misuse recovery.

Royal College of Surgeons: Professional standards for cosmetic practice. Aimed at all doctors, dentists and nurses involved in cosmetic practice, the standards document focuses on the behaviour and competencies medical professionals should be expected to demonstrate when providing cosmetic procedures. It recommends that only surgeons should provide cosmetic surgery and only doctors, dentists and nurses who have undertaken appropriate training should provide non-surgical cosmetic treatments such as Botox, and underlines the importance of psychological assessment.

Scottish Government: Improving diabetic foot care. People with diabetes across Scotland are to receive new feet checks in hospital as the latest figures reveal over 1,350 Scots have lost a leg due to the illness. The new checks, known as ‘CPR for Feet’, aim to identify patients with a foot ulcer or those at risk of developing them. Patients will be offered the checks at hospital and foot clinics.  

The Really Clear Guide to MS: An RCN member who has multiple sclerosis (MS) has written a new guide designed to help other people live with the condition. Kaz Aston was a student nurse when she found out that she had MS and has lived with the condition for 18 years. When she was diagnosed, she decided to learn as much as she could about MS, how it affects people and what they can do to help themselves to lead healthy lives. With the support of specialist nurses at Charing Cross Hospital in Hammersmith, Kaz has produced The Really Clear Guide to MS, which uses straightforward language to explain how MS develops and the treatments available.
RCN: MS guide produced by RCN member.

Practice examples and case studies

Care Quality Commission (CQC) Case study: Member of the public triggers safeguarding alert and immediate inspection at care home. This case study describes the follow-up to information received from a member of the public about a care home in Dorset.

Reports, commentary, statistics

Care Quality Commission (CQC): Monitoring the Mental Health Act in 2011/12 (PDF 2.5MB). This report reveals that 15 per cent of people receiving care under the Mental Health Act are not being involved in the decisions made about their care. In addition, some patients did not have any information about being discharged from hospital, including what they had to do to prove they could be discharged. It also outlines examples of hospitals that provide good care and treatment to patients who are detained under the Act.
Press release: Mental health services must improve the care they provide to patients.

Centre for Health Economics (CHE): Does a hospital’s quality depend on the quality of other hospitals?: a spatial econometrics approach to investigating hospital quality competition (PDF 624KB). This research paper sets out a theoretical model with regulated prices which specifies conditions on demand and cost functions which determine whether a hospital will have higher quality when its rivals have higher quality. Findings show that a hospital’s quality is positively associated with the quality of its rivals for seven out of the sixteen quality measures and that in no case is there a negative association. Also, in those cases where there is a positive association, an increase in rivals’ quality by 10% increases a hospital’s quality by 1.7% to 2.9%.

Commonwealth Fund: Gaining ground: care management programs to reduce hospital admissions and readmissions among chronically ill and vulnerable patients. These three case studies from the USA illustrate the potential of care management programs in addressing preventable hospital admissions and readmissions by improving care coordination and transitions among high-risk patients. Study sites included two academic medical centers and a managed care organisation owned by a home health agency. The sites employed bundles of interventions involving multidisciplinary teams to improve provider communication, patient and family education, care transitions from the hospital, and follow-up ambulatory care.

DH: South London Healthcare NHS Trust: notice of decision by Secretary of State. This notice of the Secretary of State's decision in relation to South London Healthcare NHS Trust aims to secure sustainable provision of health services to those patients served by the trust and in the south east London health economy. It states that the trust will be dissolved, with each of its hospitals taken over by a neighbouring hospital trust.  These mergers are subject to approval from the relevant regulators. All 3 hospitals within the trust will be required to make the full £74.9 million of efficiencies identified by the Trust Special Administrator. All vacant or poorly utilised premises will be vacated, and sold where possible. The Department of Health will pay for the excess costs of the PFI buildings and write off accumulated debt so that the new organisations are not saddled with historic debts.  It will also negotiate an appropriate level of transitional funding to cover implementation.
Press release: South London Healthcare NHS Trust to be dissolved by 1 October 2013.

DH: 2012/13 governance statement guidance. This letter sets out the requirements for completion and submission of 2012/13 governance statements for SHAs, PCTs and NHS trusts. The governance statement records the stewardship of organisations to supplement the accounts. It also gives a sense of how successfully it has coped with the challenges it has faced and of how vulnerable performance is or might be. It also draws together position statements and evidence on governance, risk management and control.

DH: Quality accounts: reporting arrangements for 2012/13. This letter describes amendments to the NHS Quality Accounts Regulations 2010. These amendments come into effect from February 2013 and change the reporting requirements for Quality Accounts being published in June this year.

DH: Quality of life of cancer survivors in England: analysis of patients’ free text comments. This report summarises text responses from cancer survivors on how they feel about their quality of life following diagnosis and treatment. It is aimed at commissioners, commissioning support units and providers to help them understand how services may offer appropriate education, advice and support to the growing numbers of people who are living well, following completion of cancer treatment.

DH: Front of pack nutrition labelling: joint response to consultation. This response to a joint consultation held on behalf of health ministers in England, Scotland, Wales and Northern Ireland on front of pack nutrition labelling demonstrates the wish for a move towards a more consistent form of front of pack nutrition labelling.

DH: Public health services contract 2013/14. This non-mandatory contract is designed for use by local authorities in commissioning services to meet their new public health functions. It is adaptable for use for a broad range of public health services and delivery models. Although the contract is non-mandatory it provides a robust framework to hold providers to account for the delivery of high quality public health funded services to achieve improved health outcomes.
Guidance: Public Health Services Contract 2013/14 Guidance on the non-mandatory contract for public health services (PDF 152KB).

DH: Mental health payment by results (PbR) in 2013-14. This letter from David Flory outlines the next steps in the implementation of the PbR approach for adult mental health services. These include mandating the rebasing of current contracts on the basis of the clusters, and mandating the use of some quality and outcome measures. There is also emphasis on the need to improve the quality and completeness of the clinical data that flows to the mental health minimum dataset, and the accuracy of costing the services provided.

DH: The medical care of suspected internal drug traffickers (SIDTs): independent report of the chief medical officer’s expert group. This independent report gives clinical advice on the medical care of SIDTs. The Chief Medical Officer commissioned an expert group to produce this report, which has been submitted to the UK Border Agency for consideration. The intention of this report is to assist in the ongoing development of clinical guidance on the care of such detainees and to inform the future planning of services.

DH: Towards a public health surveillance strategy for England. This overview of the vision and plans for the delivery of a public health surveillance strategy is part of Public Health England’s broader information strategy. It sets out the key benefits and challenges in delivering such a strategy, and acknowledges that improved surveillance will underpin the protection and improvement of health and service delivery through outputs that are timely, accurate, accessible and meaningful to users of this information at local, national and international levels.

DH: Government response to consultation on fertility and human tissue regulators. The Department of Health has published its response to its consultation on proposals to transfer functions from the Human Fertilisation and Embryology Authority (HFEA) and the Human Tissue Authority (HTA) to the Care Quality Commission (CQC) and the Health Research Authority (HRA). The public consultation ran from June to September 2012.

DH: Structural reform plan progress report, December 2012. This publication is part of a commitment across government to promote transparency and accountability. It outlines the progress made so far on the structural reforms in the Department of Health.

DH: Family Nurse Partnership (FNP) programme evaluations. Two independent evaluation studies on delivering the FNP programme have been published. They cover themes on the cost of delivering FNP locally and the family nurse workforce. The first study explore motivations, job satisfaction, career plans as well as recruitment and retention issues amongst the family nurse workforce across England to help plan the future expansion and sustainability of the programme. The second study determines the average annual cost of delivering a typical FNP team and a FNP place at local level so as to inform future national and local commissioning and planning of the FNP programme.

DH: Change4Life alcohol campaign warns of ‘sneaky drinks’. A Change4Life campaign launches today to raise awareness of the health risks associated with drinking regularly over the guidelines. Four weeks of nationwide TV advertising form the main part of the campaign. The advert shows how drinking can easily ‘sneak up on you’ and encourages people to check their drinking online using the Change4Life Drinks Checker.

Ethical Standards in Health and Life Sciences Group (ESHLSG): Consultation on public register of payments made to healthcare professionals by commercial organisations. This consultation on the introduction of a system of public disclosure of payments across Europe by 2016 is open to all healthcare organisations, commercial companies and individual healthcare professionals. Comments are invited over the next three months.

Health and Social Care Information Centre (HSCIC): Personal Social Services: Expenditure and Unit Costs - England, 2011-12, Final Release. This report provides information about the money spent on adult social care by Councils with Adult Social Services Responsibilities (CASSRs) in England.

Health Foundation Blog: Why measuring the quality of nursing really does matter. “The problem is that many people don’t know what nurses contribute to either clinical outcomes or to person-centred care. Florence Nightingale wrote in 1859 that the elements of nursing are all but unknown – I would suggest that, nearly 150 years later, they are still unknown to large numbers of people”.

Joseph Rowntree Foundation (JRF): Poverty and ethnicity in Northern Ireland. This study finds that despite positive policy changes, people from minority ethnic groups have often experienced poverty and racism. It examines the evidence on how people across different ethnic groups in Northern Ireland experience poverty and how this affects their access to work and support, including key services.

King's Fund: Improving the health of the nation infographics. This set of infographics highlight some of the most striking statistics in public health, health inequalities and mental health and how these are changing over time.

Labour Party: 21st century NHS and social care: delivering integration. This challenge paper seeks engagement and discussion on the policy challenges facing the NHS and social care. It seeks views and feedback on how health and social care could be best integrated; how intervention and prevention could be prioritised; the provision of more personalised care; extended access to primary care; and the reform of the social care funding system. The consultation runs until 28th Febuary 2013.

Local Government Association (LGA): Tackling drugs and alcohol – local government’s new public health role. This briefing for councillors and officers explains the challenges facing councils and the opportunities they have to tackle drug and alcohol problems and reduce health inequalities in local communities.

Men’s Health Forum in Ireland: A report on the All-Ireland Young Men and Suicide Project (PDF 2.7MB). Suicide is the major cause of death among young males on the island of Ireland. This report aims to identify a range of possible means to promote positive mental health among young men and to assess the efficacy of these approaches. It makes a series of twelve recommendations.
DHSSPS: New report important step in tackling suicide.

National Audit Office (NAO): Departmental overview: a summary of the NAO's work on the Department of Health 2011-12. This guide is designed to provide a quick and accessible overview of the Department of Health, and focuses in particular on where performance could be improved, using examples from previously published work. Areas covered include: the department's responsibilities and how it spends its money; financial management; reported performance; and issues identified in NAO reports.

NHS Commissioning Board: 2013/14 NHS standard contract. This contract is for use by commissioners when commissioning healthcare services (other than those commissioned under primary care contracts) and is adaptable for use for a broad range of services and delivery models. It reflects the requirements set out in Everyone counts: planning for patients 2013/14.

NHS Confederation: NHS sport and health. This Briefing highlights the benefits of sport in improving the nation’s physical and mental wellbeing. It outlines how the NHS can work in partnership with local sporting bodies to harness the expertise, profile and attraction of sport clubs to reach greater numbers of people and promote sport as a way to improve people’s health.

NHS Improvement: Service improvement in blood sciences: how to improve quality, delivery and efficiency for laboratory providers and their customers (PDF 3.6MB). Working in partnership with the Department of Health Pathology Programme, NHS Improvement has supported a number of blood sciences teams to learn how lean methodology can enable the service to achieve improvements to support the QIPP transformation programme. This report outlines how multidisciplinary teams worked collaboratively to test and implement changes that deliver improvements for patients, staff and users of the service.

Office for National Statistics (ONS): Suicides in the United Kingdom 2011. The number of people taking their own life in the UK rose “significantly” in 2011, latest figures from the Office for National Statistics have shown.  Some 6,045 people killed themselves in 2011, an increase of 437 since 2010.  The highest suicide rate was among men aged between 30 and 44.  On average, across both sexes, 11.8 people per 100,000 people killed themselves in 2011, up from 11.1 people the previous year.
BBC Health: UK suicide rate rises 'significantly' in 2011.

Policy Research Unit in Commissioning and the Healthcare System (PRUComm): Study of the use of contractual mechanisms in commissioning. This interim report presents findings from research into how commissioners negotiate, specify, monitor, and manage contractual mechanisms to improve services and allocate financial risk in their local health economies, looking at both acute services and community health care.

Rarer Cancers Foundation (RCF): New RCF analysis shows big variation in hospital usage of NICE-approved cancer drugs. The Foundation has published the first ever comparison of usage rates of NICE-approved cancer drugs. It reveals an unexplained 40-fold variation in usage between hospitals.  “This is particularly striking given that NHS organisations have a legal duty to make available drugs which have been recommended by NICE.”

Social Care Institute for Excellence (SCIE) Report 63: Improving personal budgets for older people: A research overview. This short report is an evidence overview of key pieces of UK research between 2007 and 2012, which focused on the implementation and uptake of personal budgets and direct payments for older people (including those with dementia) in England. "More detail is now known about what helps and hinders, and how direct payments can work for older people with dementia". This work supports ‘Improving personal budgets for older people: A review’, published by the Think Local Act Personal partnership and supported by SCIE.

Target Ovarian Cancer: 2012 Target Ovarian Cancer Pathfinder Study. Three key issues highlighted by the study are: delays in diagnosis; the current financial climate is impacting negatively on the ability of Clinical Nurse Specialists to support women with ovarian cancer; the fall in the number of women being offered clinical trials. 

World Economic Forum: Sustainable Health Systems. Visions, Strategies, Critical Uncertainties and Scenarios (PDF 1.7MB). In 2012, the World Economic Forum worked with the McKinsey consultancy group to engage over 200 international health system leaders, policy-makers and experts in a global effort to provide a holistic long-term analysis of sustainable health systems. This report examines what health systems could look like in 2040.

XES: Unprotected nation: the financial and economic impacts of restricted contraceptive and health services. The financial analysis in this publication argues that NHS efficiency savings could potentially add £612.8 million to NHS costs by 2020. Reforms to contraception and other sexual health services could lead to a significant increase in the number of unintended pregnancies and sexually transmitted infections. The report also projects the economic impact of improving access to contraception services and argues that savings could be made to the NHS, public health spending and wider social expenditure costs.