Quality improvement updates - 7 March 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: Management of patients on NHS waiting lists. The report highlights the need for the Scottish Government and health boards to improve the management and scrutiny of NHS waiting lists. The audit was carried out following the discovery of manipulation of waiting lists and misreporting of performance by NHS Lothian during 2011 and covered April to December 2011, the period during which lists were known to be manipulated. The report says the waiting list systems have inadequate controls and audit trails, and limited information is recorded in patient records.

Clinical Audit Support Centre (CASC): The State of clinical audit. Results of the December 2012 online survey (PDF 797KB). Every year since 2010, CASC have conducted an independent online survey to help find out current views in relation to clinical audit. The report includes feedback on a range of important matters: resourcing for clinical audit, quality of national audits, patient involvement in audit, uptake and usefulness of clinical audit resources.

General Medical Council (GMC): Effective governance to support medical revalidation. A handbook for boards and governing bodies. This is a handbook for Boards and governing bodies to help them assess if their organisations have strong enough systems in place to support quality patient care and revalidation. The General Medical Council (GMC) developed the handbook in partnership with England’s Care Quality Commission, Monitor, Healthcare Improvement Scotland, Healthcare Inspectorate Wales, Northern Ireland’s Regulation and Quality Improvement Authority as well as the Government Procurement Service.

Health Select Committee: Health Committee - Ninth Report  2012 accountability hearing with the Nursing and Midwifery Council. “The Nursing and Midwifery Council (NMC) has been subject to sustained criticism emanating from a variety of sources for a number of years. It is apparent that much of this criticism has developed due to the NMC's basic failure to understand its core purpose and properly prioritise patient safety. We are now satisfied that as a result of the criticism it has received the NMC is beginning to prioritise its core functions. We are optimistic that the NMC will now concentrate its efforts on improving its performance in relation to Fitness to Practise (FTP) and developing an effective model for revalidation in order to achieve its objective of delivering public protection.”
BBC Health: Nurse regulator ‘not good enough’.
NMC: Health Select Committee welcomes NMC progress but urges faster movement.
RCN: RCN responds to Health Select Committee report into NMC.

Monitor: Team of experts proposes health service change in Mid Staffordshire. A team of experts working to make sure that patients in Mid Staffordshire can access quality services in the longer term has proposed a set of changes for consideration by a Trust Special Administrator. The Contingency Planning Team has worked with local healthcare providers, commissioners and patient groups to draw up long term options for providing health services in the area. 

National Audit Office (NAO): Improving government procurement. This report provides an overview of the procurement reform strategy, reviews the governance and accountability arrangements in place, and examines progress in its implementation. It considers several departments, including the Department of Health.
Press release: Improving government procurement.

Regulation and Quality Improvement Authority (RQIA): RQIA’s Regulation of Independent Health Care Services (Updated 5 March 2013). RQIA regulates a range of independent health care services in Northern Ireland in line with The Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003 and The Independent Health Care Regulations (Northern Ireland) 2005. Under current legislation, RQIA’s inspections of these services are based on The Independent Health Care Regulations (Northern Ireland) 2005, and the draft Independent Health Care Minimum Standards - Hospitals and Clinics. "It should be noted, RQIA does not have any statutory power to assess the clinical decisions made by a doctor in any facility, including an independent clinic".

RQIA: 2011-12 annual regulation report (PDF 1814.2KB). The report provides an overview of RQIA’s regulation activity over the period 1 April 2011 to 31 March 2012. It outlines RQIA’s role in respect of registration and inspection of services, and includes a summary of inspection outcomes from the different categories of service.

Guidance, innovation, tools

DH: Guidance: local authority charging for public health activity. This guidance contains information on what health improvement activity local authorities can charge for and what services must be free at the point of use, just as they were when provided by the NHS. It is aimed at local authorities charging for public health activity.

DH: Hints and tips for companies considering a Patient Access Scheme (PAS) proposal in England. This guidance brings together hints and tips for manufacturers and sponsors considering making a PAS proposal.

DH: Department of Health to build ‘Dementia Village’ at Healthcare Innovation Expo. The Department of Health is hosting a major dementia event at the Healthcare Innovation Expo at ExCeL London on 13 and 14 of March 2013. A dedicated area of the exhibition hall will be devoted to a ‘Dementia Village’ to showcase good practice and innovation in dementia care, dementia friendly communities and research.

Diabetes UK: Fast track for a foot attack: reducing amputations. The majority of diabetes-related amputations are caused by a 'foot attack' (a foot ulcer or infection failing to heal). People who have rapid access to treatment by a specialist multi-disciplinary team have experienced faster healing and fewer amputations, saving money and lives. This report recommends the promotion of the commissioning of an integrated footcare pathway through the Putting Feet First campaign. It also sets out recommendations for CCGs and health and wellbeing boards on how to achieve this.

Health in Wales: Improving Quality together. Staff across NHS Wales are to be equipped with new skills to help them improve the quality of services for their patients and the public. The new framework will provide a national approach to improving standards and delivering care, giving frontline staff, contractors, management and board members in every NHS Wales’ health board and trust the opportunity to develop their improvement skills.
Leaflet: Your opportunity to develop your quality improvement skills (PDF 1.3MB).
Staff share what they have learned from Improving Quality Together.

Monitor: NHS Foundation trust annual reporting manual 2012/13. It may be necessary for Monitor to issue amendments to this manual as issues arise. Directors of finance will be notified, by email, of any amendments to the current manual and the amendments will also be published on Monitor's website.

NHS Commissioning Board (NHS CB): Securing excellence in commissioning for the armed forces and their families. The NHS Commissioning Board has published the single operating model for the commissioning of health care for the armed forces and members of their families who are registered with Defence Medical Services (DMS) GP practices. It sets out where commissioning responsibility lies for all members of the armed forces community, i.e. serving armed forces, their families, reservists and veterans.

Royal Pharmaceutical Society (RPS): Best practice standards for managing medicines shortages in secondary care in England. These standards provide advice to NHS hospitals in managing medicines shortages at local level to minimise any risks to patients through delays to treatment. Aimed at all staff, particularly chief pharmacists, the standards outline guiding principles including collaborative working to ensure that medicines in short supply are used for patients with greatest clinical need.  Steps suggested include prohibiting the sale of medicines to third parties or stockpiling by individual trusts.

Scottish Government: NHS improvement tool. A new system which measures and helps to improve the performance of health boards is being rolled out across Scotland. Funding of £2.1 million has been given to NHS National Services Scotland to implement the service across NHS boards in Scotland. It allows boards to look at how they are doing across a range of different areas, and compares clinical and other data across health boards in Scotland, and health trusts throughout the rest of the UK. 

Scottish Government: Neonatal care in Scotland: a quality framework. The framework defines the approach to the provision of high quality care for neonates and their families to which NHSScotland is committed and is presented under six quality dimensions. For the purposes of the framework, the patient group is taken to be newborn infants who require care at the a level greater than standard perinatal care. It is recognised that not all hospitals have a neonatal unit: nevertheless certain elements of the framework included in this document will be applicable in any hospital providing newborn care.

Scottish Government: Hospital at home. A project which has enabled 80 per cent of patients to stay in their home rather than being admitted to hospital, is to be adapted for use across Scotland. NHS boards and their local authority partners are trialling models similar to the ‘Hospital at Home’ initiative, which has been piloted by North Lanarkshire Partnership. Speaking at the ‘Building the Connection’ event run by the Alliance Scotland, Health Secretary Alex Neil announced the roll out of the project as he set out final plans to legislate for the integration of adult health and social care.

Think Local Act Personal (TLAP): TLAP to lead work to make health and social care personal budgets a reality. TLAP will work with project partners the NHS Confederation and the Social Care Institute for Excellence (SCIE), and alongside leaders of the health and social care system to identify how to maximise the benefits and minimise challenges associated with implementation.
NHS Confederation news: Personal budgets project helps make seamless care a reality. 

Think Local Act Personal (TLAP): A problem shared: making best use of resources in adult social care. This report and accompanying toolkit will help political and managerial leadership in councils make the best use of the available resources for developing and delivering adult social care and promoting personalisation. There is a summary report and also a report on progress in delivering budget savings in adult social care 2007/8-2011/12.

Practice examples and case studies

Care Quality Commission (CQC): Case study: How a NHS hospital in north west England made improvements following inspection. The purpose of the review was to assess whether patients with a learning disability were receiving care that: was effective, safe and appropriate; met their needs; protected their rights and safeguarded them against possible abuse. There was major concern about some aspects of care.

NHS Confederation: Service redesign case studies. The case studies are part of a wider programme of work which the NHS Confederation is undertaking to help local NHS organisations effectively communicate and engage with staff, patients, local communities and stakeholders around changes to local services.

Reports, commentary, statistics

Agency for Healthcare Research and Quality (AHRQ): Closing the Quality Gap Series. This American series, Closing the Quality Gap: Revisiting the State of the Science has just been released. This series broadens the scope of settings, interventions, and clinical conditions, while continuing the focus on improving the quality of health care through critical assessment of relevant evidence.

College of Optometrists: Better data, better care: ophthalmic public health data report 2013. This report has been compiled through a process of research and engagement within the ophthalmic public health sector. It is intended to stimulate debate and to highlight actions that necessary to improve public eye health. It is aimed at a wide range of interested parties, including politicians, civil servants, local authorities, trade, regulatory and consumer bodies, as well as the media.

DH: Call to action on reducing avoidable deaths. Improvements in the fight against the 5 major causes of death, including new plans to tackle cardiovascular disease, could save 30,000 lives by 2020, Health Secretary Jeremy Hunt has announced.
Report: Living Well for Longer: a call to action to reduce avoidable premature mortality (PDF 687KB).
RCN: RCN supports calls to reduce preventable deaths.

DH: Improving cardiovascular disease outcomes: strategy. The Cardiovascular Disease Outcomes Strategy provides advice to local authority and NHS commissioners and providers about actions to improve cardiovascular disease outcomes. It sets out outcomes for people with or at risk of cardiovascular disease (CVD) in line with the NHS and public health outcomes frameworks. It identifies 10 main actions to improve outcomes.

DH: Lifecourse tracker: wave 1 spring 2012: interim summary report. This report is a summary of the first stage of research that records how health behaviours vary across life stages. It forms a baseline against which changes in behaviour over time and seasonal variations can be assessed and also informs the Department of Health's social marketing strategy.

DH: Health behaviours through lifecourse: baseline report published. This report was commissioned by the Department of Health and independently conducted by the market research company GfK NOP. It is a summary of the first stage of research, which was carried out in March 2012, that records how health behaviours vary across life stages.

DH: Ensuring fair and transparent pricing for NHS services: response to consultation. The Department of Health’s response to proposals for objecting to proposed pricing methodologies has been published today. The Department received 48 responses from various parties to the consultation to help ensure fair and transparent pricing for NHS services.

DH: Successful applicants announced for stage 1 of the Department’s dementia environment funding. The Department of Health has announced the successful applicants for stage 1 of the £50 million funding of capital projects to improve care environments for people with dementia. Following a robust evaluation process, which included moderation and oversight by the Department’s Programme Delivery Board, 42 NHS schemes and 74 social care schemes have been approved at stage 1.

DH: Payment by Results: guidance for 2013-14. This guidance has been clarified and expanded in a number of areas, in response to feedback received at road test which concluded on the 25th January 2013.

DH: Direct payments for healthcare: a consultation on updated policy for regulations. This consultation proposes some changes to the regulations based on learning from the recent pilot programme and discussions with personal health budget holders, healthcare professionals and other organisations. It discusses what will be excluded, for example acute and unplanned care and access to GP services. It also asks for views on issues including eligibility, paying family members for carrying out administrative functions, allowing local authorities to make direct payments for healthcare and separate bank accounts. Responses are invited until the 26th April 2013.

DH: Report of the children and young people's health outcomes forum. This report outlines proposals on how health-related care for children and young people can be improved. Recommendations include: integration and partnership; safe and sustainable services; and workforce education and training. It also recommends a number of new outcomes measures and the strengthening of existing indicators, making specific recommendations for different organisations within the health and care system to ensure these improvements are achieved.

DH: Earnings disregard for residential care charging. People in employment who are supported by local authorities in residential care currently have all of their earned income charged to pay for care. This impact assessment suggests that this creates a disincentive for individuals to take up employment since the individual is financially no better off working than not working. It states that government intervention is required to remove the current legislative barriers to people in residential care taking up employment.

Guardian: Productivity in the NHS remains “stubbornly stagnant” says report. Productivity in the NHS remains "stubbornly stagnant", its workforce is shrinking and GP surgeries are receiving less money than before to spend on patient care, according to a report by the Nuffield Trust. The report also concluded that an increasing number of NHS organisations, especially hospital trusts, are getting into financial difficulties partly because of the cost of PFI deals. Dr Peter Carter was quoted on Guardian Online saying: “Nurses at trusts which have continual financial trouble are worried their employers' focus on finances may mean they struggle to keep delivering high quality care”.

Health and Social Care Information Centre (HSCIC): Hospital Episode Statistics HES: Deaths Within 30 Days of a Hospital Procedure or of an Emergency Admission to Hospital, Financial year 2010-2011. Mortality rates per 100,000 persons in England are highest amongst patients admitted for stroke (18,245.92), followed by fractured proximal femur (7,321.38), myocardial infarction (4,988.87), non-elective admissions (3,684.79), and coronary artery bypass graft (1,636.34). 

Housing LIN: Housing, Dementia and the Maintenance of Independence (PDF 535KB). This report has been updated by the ADASS Housing Policy Network and the Housing LIN. It takes a look at the emerging housing policy and practice developments in relation to supporting people with dementia. It explains that housing conditions and access to appropriate care and support can impede the ability of people with dementia to remain independent. It makes a number of thoughtful points and ends with a useful list of 10 'top tips' of things you should do.
In Focus: Innovations in housing and dementia.

Institute for Healthcare Improvement: IHI Reducing Readmissions Blog: What can we learn from relay race baton exchanges? A key component of improving care transitions is the timely transfer of relevant clinical information between care settings. In IHI’s initial work to improve communications after a patient is discharged from the hospital, they set out to learn about baton handoffs from the US Olympic Relay Teams.

Institute for Social Marketing, University of Stirling: Health first: an evidence-based alcohol strategy for the UK. This report sets out a strategic plan with key recommendations, and the evidence to underpin them, to reduce the harm from alcohol in the UK. Amongst the recommendations it makes, it includes minimum unit pricing; product labelling; reform of licensing legislation; a ban on advertising and sponsorship; and improved training for health and social care professionals.

King's Fund blogs: Time to Think Differently blog: Breaking down the boundaries in health and social care.
King's Fund blog building the narrative for integrated care.

Local Government Association (LGA): Sexual health commissioning: frequently asked questions. These FAQs have been produced by the LGA and Public Health England. They address a number of transitional issues relating to the transfer of responsibility for commissioning sexual health services to local government. In addition to these FAQs the Department of Health will publish guidance on local government’s mandatory responsibilities for sexual health.

Mental Health Foundation: Losing track of time: dementia and the ageing prison population: treatment challenges and examples of good practice. The aims of this report are to scope existing research on treating and managing male offenders with cognitive impairment to identify, and share examples of good practice employed by prisons around the globe.

Mental Health Foundation: Service users’ experiences of recovery under the 2008 Care Programme Approach. This study was set up to explore how effective service users find the 2008 Care Programme Approach in promoting recovery as they understand it, to put forward their views and recommendations about the recovery role of the approach and to produce a checklist of good practice for mental health professionals involved in this approach. Overall, data from participants indicates that, whilst there is some evidence of good practice, services provided under the 2008 Care Programme Approach are patchy in the extent to which they promote recovery as service users understand it.

National Organisation for Foetal Alcohol Syndrome UK (NOFAS-UK): Midwives survey on foetal alcohol spectrum disorder. National Organisation for Foetal Alcohol Syndrome UK (NOFAS-UK), a charity dedicated to reducing the incidence of foetal alcohol spectrum disorder (FASD), is asking for midwives to complete a survey concerning the condition, to help them focus their training in the right areas. NOFAS promotes education for healthcare professionals and raises public awareness about the risks of alcohol consumption during pregnancy. The survey is open until Friday 15 March.

NHS Confederation: The non-executive directors’ guide to hospital data. This briefing aims to help non-executive directors better understand NHS data and how it can be used to determine what is going on in their hospital. It introduces the scale of NHS activity, the range of activity, the patient pathway and the major datasets.

NHS Improvement: Cardiovascular disease outcomes strategy online survey summary report. This report summarises the feedback received from all the responses to this survey. Responses have been categorised into the following areas: prevention, acute care, long term care, and general (covering cross cutting issues). The report highlights the key issues within each category and provides further detail about specific comments made.

NHS Kidney Care: Getting it right: End of life care in advanced kidney disease. This document brings together the experiences and learning from three project groups that have been working over the last two years to implement the framework for end of life care in advanced kidney disease. It also addresses the data items that are associated with managing end of life care.

Nuffield Trust: Commissioning high-quality care for people with long-term conditions. This briefing highlights the findings of an in-depth study of commissioning, funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme. It warns that CCGs will, in a climate of financial austerity, need to prioritise collaborative discussion and service planning, as well as leaving space for transactional work such as contract specification, service review and decommissioning.

Nuffield Trust: The anatomy of health spending 2011/12: a review of NHS expenditure and labour productivity. This report examines patterns of spending and labour productivity, drawing on the accounts data of SHAs, hospital and mental health trusts, and commissioning organisations going back to 2003/04. It finds that the proportion of trusts in deficit has risen over the past four years; that there has been little improvement in hospital productivity over recent years; and that competition appears to have a small but significant negative effect on labour productivity.

Office for National Statistics (ONS): Age-Specific Mortality Rates by NS-SEC in England and Wales, 1982-86 to 2002-06. National Statistics Socio-economic Classification (NS-SEC) is a system designed to group occupations by their underlying social advantage. For example, medical doctors are grouped under the most advantaged NS-SEC class (Higher Managerial and Professional class 1) while bus drivers are grouped in the least advantaged class in work (Routine class 7). Advantage here refers to preferential reward structures, career development opportunities and greater autonomy in how the work is undertaken. "Age-specific mortality rates fell between 1982–86 and 2002–06 for both males and females: among males at ages 60 and above, the decline in the rate of death was sizeable and generally significant in both NS-SEC classes 1 and 7".

Prison Reform Trust: Turning young lives around: how health and justice services can respond to children with mental health problems and learning disabilities who offend. This briefing paper seeks to encourage effective joint working between health and wellbeing boards and youth justice services. It aims to ensure that local strategies reflect the needs of children and young people who offend, especially those with mental health problems and learning disabilities. It outlines a practical action agenda and provides examples of good practice.

Refugee Council: When maternity doesn’t matter: dispersing pregnant women seeking asylum. This report shows that the UK Border Agency's dispersal policies are putting the health of pregnant women and their babies at risk. By moving them to accommodation around the county, women are uprooted from essential healthcare and their support networks, leaving them isolated and vulnerable. It recommends that the Department of Health should facilitate data collection by NHS trusts of incidents in which UKBA dispersal and relocation practices have prevented delivery of effective maternity care, as well as facilitating communication of the data to the UKBA.

Robert Wood Johnson Foundation: Promising practices. The Robert Wood Johnson Foundation has developed a collection of ‘success stories’ from the front lines of US health care. The library includes short summaries of interventions that tackle major issues that affect health care quality and equality. (American).

Scottish Government: National Forum on Drug-Related Deaths in Scotland – annual report 2011/12/. The Forum is an independent expert group which examines trends and disseminates good practice on reducing drug-related deaths in Scotland. This is the Forum's fifth report.

Scottish Government: Responses to the recent consultation on “Recommendations for No-Fault Compensation in Scotland for Injuries Resulting from Clinical Treatment”. The documents being published are the responses (where permission to publish has been given in writing) to this recent consultation.  

World Health Organization (WHO): Building European reference networks in health care: exploring concepts and national practices in the European Union. Under the European Directive on the application of patients’ rights in cross-border health care, the development of European reference networks was promoted as one of the prime areas for cross-border cooperation among member states. This publication examines the ways in which reference networks have developed in European countries, for what kind of medical conditions or interventions, the motivations behind their establishment, the regulatory and administrative processes involved, and the financial arrangements needed.