Quality improvement updates - 8 November 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 Scotland: NHS Financial Performance 2011-2012. This report provides an overview of the financial performance of the NHS in Scotland in the last financial year, as well as financial sustainability and the challenges and cost pressures the NHS faces. All 23 health boards in Scotland broke even in 2011/12. However, this required movements in funding across the NHS during the year, and this is not clearly reported in boards’ annual accounts.

Cancer Research UK: Breast screening review. Report of an independent panel set up in response to the debate about the effectiveness of breast screening and criticism of the information given to women. The review concluded that “screening reduces breast cancer deaths but at the cost of overdiagnosis”. 

Care and Social Services Inspectorate Wales (CSSIW): Proposal to stop using categories at registration. At present categories such as old age, dementia, mental infirmity and learning disability are applied. From April 2013 CSSIW intend describing care homes as either Care homes providing personal care, or Care homes providing nursing care. The intention will be to gradually remove such conditions for existing registered services over three years from April 2013. Feedback on this is requested. 

DH: Statement on medicines and pharmacy regulation from the UK Chief Pharmaceutical Officers published. UK Chief Pharmaceutical Officers have published a statement today on exploratory work with professional and regulatory bodies in pharmacy on the balance of medicines legislation and statutory independent professional regulation. This work is linked to Medicines & Healthcare products Regulatory Agency (MHRA) work to scope a review of sanctions and penalties.

DH: Radiotherapy services in England 2012. This sets out the up to date position on the state of radiotherapy services in this country. It uses the radiotherapy dataset collection to demonstrate what the data really tells us about radiotherapy services across the country and assesses whether the metrics for radiotherapy services, established by the National Radiotherapy Advisory Group report in 2007, remain current. The report is aimed primarily at commissioners and service providers.

Healthcare Improvement Scotland: Growing pains. Update report published on pain management services in Scotland. In Scotland, 14 per cent of the population live with chronic pain, defined as pain lasting more than three months. This report looks at access to NHS pain management services across Scotland, and finds that although there have been improvements in services, there is still variation which seems to result from how services have evolved locally. Moreover, our report finds that there is also variation in referral rates to chronic pain services across Scotland.

Healthcare Improvement Scotland: Healthcare Improvement Scotland Annual Report 2012 1 April 2011 to 31 March 2012. This document sets out some of the key achievements in the first year of operation.

Healthcare Inspectorate Wales (HIW): Review of care provided to patients with a learning difficulty or mental health issue. Healthcare Inspectorate Wales have published the first of three reports following unannounced visits to twenty independent hospitals across Wales where care is provided to patients with a learning difficulty. The three reports all confirm that there was evidence of good staff interaction with patients. Areas of strength and areas requiring improvement were identified. 
News. 

Monitor: NHS foundation trusts: review of three months to 30th June 2012. This first quarterly report for 2012/13 summarises the key trends drawn from individual reports of the 144 trusts authorised up to 30th June 2012. It emphasises the focus on driving improvement for patients through effective regulation. It also considers in more detail, the reconfiguration of services.

RCN Policy and International Department: Briefing on the Trust Special Administrator’s draft report for South London Healthcare Trust and the NHS in South East London (PDF File 515.7 KB).
Short briefing on the proposals from the Trust Special Administrator and details of how to tell us what you think.

Welsh Government: Children and Families (Wales) Measures 2010, section 11, Play opportunities for children. On 2 November 2012 the Welsh Government is commencing a duty on all Local Authorities to assess the sufficiency of play opportunities for children in their areas. The legislation is intended to make Wales a country where every child has a wide range of challenging and interesting opportunities to play and enjoy their leisure time. These regulations and guidance, set out the duty on Local Authorities and the matters that they need to take into account in their assessments.
Health in Wales: Wales first in the world to legislate for play.

Guidance, innovation, tools

1000 Lives Plus: Developing a culture of ongoing improvement. ‘Improving Quality Together’ is a new framework of core skills which is being developed for NHS Wales staff and its contractors. The framework will provide a common and consistent approach to improving the quality of services in organisations across Wales.It will be based on three main levels, with an additional level for board members. 

British Association for Counselling & Psychotherapy (bacp): NHS Commissioning resources: Guidance 01. First in a suite of tools and resources to assist with engagement at local level, this guide aims to present the key NHS reforms that impact on therapy providers.

Deepening our understanding of quality improvement in Europe (DUQuE) . “Deepening our understanding of quality improvement in Europe” is a research project financed by the EU 7th Research Framework Programme. This 42-month project started in November 2009 and its end is foreseen for April 2013. It is collecting data using a cross-sectional observational study of European hospitals.  

DH: Change4Life launches smartphone drinks checker app. A new smartphone app and enhanced online drinks checker are now available to help people see the impact alcohol can have on their health, waist and wallet.  
Change4life: drinks checker app.

DH: Amendments to the high security psychiatric services directions 2012. These directions apply to the three trusts which provide high secure mental health services at Ashworth, Broadmoor and Rampton Hospitals. They should be read alongside the High Security Psychiatric Services (Arrangements for Safety and Security at Ashworth, Broadmoor and Rampton Hospitals) Directions 2011 and associated guidance.

Guardian Professional - Healthcare Network: Innovation: a lesson for the NHS from the developing world. “After a trip to Sierra Leone, one doctor reflects on what can be learned from those working in more challenging circumstances.” 

Guardian Professional – Public health hub: How pharmacies are getting men engaged in their wellbeing. "New research shows nine in 10 men don't like to trouble a doctor or a pharmacist. But there are some innovative projects across the UK which are looking at tackling this."
National Pharmacy Association: Men should take firmer grip on medicines and wellbeing, say pharmacists. 

Health Foundation: Innovative Shine project wins two awards for effective pre-pregnancy care for women with diabetes. A Health Foundation Shine project won two awards and was commended for a third for their innovative approach to effective pre-conception care (PPC) for women with diabetes. The winning project from Derby Hospitals NHS Foundation Trust, PROCEED: Preconception care for diabetes used a ‘team without walls’ model where the service user is seen in the right place, by the right person, at the right time.

Health Innovation Portal. This Health Council of Canada site reports on innovative health care practices, policies, programs and services so they can be adopted elsewhere in Canada. The site includes a searchable national database, a framework to evaluate emerging practices, and a forum for students in health fields.

Healthcare Financial Management Association (HFMA): Launching an innovation journey. “Most healthcare organizations, with the exception of research hospitals, have not traditionally had R&D budgets. This is changing as organizations launch innovation labs and appoint VPs of innovation in hopes of differentiating themselves in an evolving marketplace. To identify some key practices on this journey, we asked three healthcare innovation leaders to share their experiences”. (American).

House of Commons Library briefing: Direct payments and personal budgets for social care. This note gives a brief overview of the rules governing the provision and use of direct payments for social care and provides information on the development of personal budgets for care.

Housing LIN (Learning and Improving Network): Hospital 2 Home. A resource pack designed to support older patients returning from hospital in England has been launched. It contains information, suggestions for action, case studies and checklists for considering older patients’ housing situations in hospital discharge and transfer of care and for improving integration of housing and support into the process for discharging older people.
RCN: RCN welcomes new home care guide. The Royal College of Nursing welcomed the launch of a new cross sector guide which highlights the important role of housing in supporting an independent and healthy later life. The RCN worked on  this project with other organisations.
DH New Hospital 2 Home discharge pack. 

Nesta: Innovations in prevention. Despite recognition of the benefits of preventative investment, it remains a “marginal component” of expenditure. The first section of the paper outlines expenditure on preventative measures in the UK and discusses examples. The second section outlines stages in developing, implementing and monitoring a prevention strategy. Nesta is an independent charity “with a mission to help people and organisations bring great ideas to life”. 

Nuffield Trust: Predicting the risk of hospital readmission with PARR-30. In 2010 the Government announced that hospitals in England would not be reimbursed for some emergency hospital readmissions occurring within 30 days of discharge. The Nuffield Trust has developed an algorithm for predicting which patients are most at risk of short term readmission, designed to be used by acute hospitals.
How to implement the PARR-30 model: required data and algorithm.

Social Care Institute for Excellence (SCIE): SCIE Introduction to...adult mental health services. This updated Introduction to... briefing gives a brief overview of the adult mental health (AMH) system, and the legislation and guidance that covers the structure and delivery of services. It is aimed at people who have little or no experience in this area.

SCIE: SCIE Introduction to...children's social care. This Introduction to... briefing gives a brief overview of Children’s Social Care (CSC) and the relevant legislation and policy framework. It is aimed at people who have little or no experience in this area.

Welsh Government: Choose Well This Winter. Choose Well has been re-launched for the winter season. It has already been applauded for signposting record numbers of people towards the NHS Direct Wales website for initial clinical advice. The new Choose Well app is free to download and is available to all smart phones. 

Yorkshire & Humber Public Health Observatory (YHPHO): Diabetes Prevalence Model for local authorities updated. An updated version of the Diabetes Prevalence Model for England has been published. The model estimates the number of people in local authority areas who would be expected to have diabetes in the future if the increase in diabetes is sustained at current levels. The model also estimates the degree to which rising levels of obesity are likely to be responsible for this increase.

Practice examples and case studies

Care Quality Commission: Case study: Cancelling a manager’s registration to protect residents at a care home in the North West. The CQC is responsible for checking that services are providing care that meets standards of quality and safety set out in law. One of these standards requires people managing services to have the necessary skills to be able to do their job properly. When it became clear that the poor care being provided at a care home in the North West of England stemmed from the incompetence of the manager responsible for the service, the CQC took steps to remove them from their position.

Reports, commentary, statistics

Agency for Healthcare Research and Quality (AHRQ): Quality improvement measurement of outcomes for people with disabilities. In 2004, the AHRQ in America launched a collection of evidence reports which summarised the evidence on quality improvement strategies related to chronic conditions, practice areas, and cross-cutting priorities. This evidence report is part of a new series, Closing the Quality Gap: Revisiting the State of the Science. This report examines how health care outcomes for general medical care have been assessed for people with disabilities.

Centre for Health Economics (CHE): Hospital quality competition under fixed prices (CHE Research Paper 80). The relationship between the quality of health care and the extent of competition amongst providers has been the subject of intense policy interest and debate. This report is one of a series of related investigations being undertaken by the CHE into this relationship in the hospital sector, in primary care (general practices) and in social care.

Centre for Mental Health: Liaison psychiatry in the modern NHS. Every NHS hospital should have a liaison psychiatry service as standard, according to a new report from Centre for Mental Health and the NHS Confederation Mental Health Network. Liaison psychiatry services provide immediate access to specialist mental health support for people being treated for physical health problems, most often in general hospitals and in some cases in the community.  

Commonwealth Fund: Can sustainable hospitals help bend the health care cost curve. "As policymakers seek to rein in the nation’s escalating health care costs, one area deserving attention is the health system’s costly environmental footprint". This study undertaken in the USA examines data from selected hospitals that have implemented programmes to reduce energy use and waste and achieve operating room supply efficiencies."The analysis finds that savings achievable through these interventions could exceed $5.4 billion over five years and $15 billion over 10 years."

Department for Education: Characteristics of children in need in England 2011-2012. This publication contains final figures on the numbers of children referred to and assessed by children's social services. It includes information on the characteristics of children in need and information on children who were the subject of a child protection plan for the year ending March 2012.  

DH: Protecting people. Promoting health – a public health approach to violence prevention in England. The Department of Health commissioned the North West Public Health Observatory (NWPHO) to produce the high level report to provide information and evidence for policy makers and commissioners to use in developing preventative approaches with strategic partners. The report aims to increase awareness and strengthen commitment to prevention across government, NHS, local authorities, private and voluntary sectors as well as education, employers and other agencies.

Foundation Trust Network: Health service reconfiguration debate briefing. This briefing argues the urgent need for a full and open debate between politicians, the public and the health sector about the future of the NHS over the next ten to 15 years. It recognises the need to better engage with local populations to explain how proposals for reconfiguration and service change will improve patient care and listen to what communities say in response. 

Health and Social Care Information Centre (HSCIC): QOF Achievement, prevalence and exceptions data 2011/12. The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England and is part of the GP contract. The QOF is not about performance management, but incentivising and rewarding good practice. For 2011/12, 8,123 GP practices in England are included in the published results, covering almost 100 per cent of registered patients in England. The QOF has four main components, known as domains. Each domain consists of a set of measures of achievement, known as indicators, against which practices score points according to their level of achievement.

HSCIC: NHS Contraceptive Services - England, 2011-2012, Community contraceptive clinics. The data show that there were 2.5 million attendances at NHS community contraceptive clinics made by 1.4 million individuals. This represented a decrease of 4 per cent on the number of attendances in 2010/11 (2.6 million) but an increase of 7 per cent on the number of individuals in 2010/11 (1.3 million). 1.3 million women attended NHS community contraceptive clinics, an increase of 9 per cent on the previous year (1.2 million). 167,000 men attended NHS community contraceptive clinics, a decrease of 2 per cent on the previous year (171,000).

HSCIC: NHS hospitals: new figures suggest 11 per cent increase in procedures carried out by private sector in a year. New figures suggest that the number of hospital procedures paid for by the NHS but carried out by the private sector has increased by nearly 11 per cent in one year.

HSCIC: Episode Statistics HES (admitted patient care) England 2011-12. There were 17.5 million Finished Consultant Episodes (FCEs) recorded in 2011-12, an increase of 1.1 per cent from 2010-11. Of these episodes, 11.5 million (66.1 per cent) were ordinary episodes (inc. delivery episodes) and 5.9 million (33.9 per cent) were day cases. 59.6 per cent of FCEs involved some form of procedure or intervention, with 94.8 per cent of day case episodes involving a procedure or intervention.

Health Foundation: Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature (PDF 112.7KB). Formal evaluations of programmes are an important source of learning about the challenges faced in improving quality in healthcare and how they can be addressed. The authors identified ten key challenges and provide a range of tactics that may be used to respond to these challenges.

Health Foundation: What does good self management support look like? This newsletter looks at self management support which involves enabling people with long-term conditions to play a more proactive role in their health and healthcare. It does this by providing them with information and practical tools to help them develop skills, such as goal-setting and problem solving, and by signposting them to relevant support or activities in the wider community. 

Health Foundation: How to use agenda setting and confidence rulers. Psychological Wellbeing Practitioner Mavis Dwaah talks about two of the simple tools she uses to support people to better self manage their long-term conditions. 

Joseph Rowntree Foundation (JRF): My Home Life: promoting quality of care in care homes. 'My Home Life' is a collaborative initiative between Age UK, City University, the Joseph Rowntree Foundation and Dementia UK promoting quality of life in care homes. This report outlines the findings from this project. 

King’s Fund: Payment by Results: How can payment systems help to deliver better care? This report reviews the role and objectives of payment systems in the English NHS, focusing on Payment by Results (PbR), which accounts for around 30 per cent of the total English NHS budget. It also considers the experiences of other countries using similar payment systems and, based on findings, points to the policy implications.
King’s Fund blog: Payment by Results: time for rethink? John Appleby comments on PbR. 

Medical Care Research Unit (MRCU), University of Sheffield: Evaluation of NHS 111 pilot sites: Final report. The University of Sheffield has published its second interim report on the NHS 111 pilot sites, all of which use NHS Pathways as their clinical assessment tool. An evaluation of the new NHS 111 telephone service, conducted by researchers from the University of Sheffield, shows pilot schemes have delivered some but not all of the potential benefits one year after they were launched.

Mencap: Out of sight. This report is part of a campaign to end poor care and abuse at large, institutional-style services for people with a learning disability. 

National End of Life Care Programme: October 2012 National End of Life Care Programme newsletter. This issue includes results of the end of life care review, news of a new web tool to track user involvement, analysis of patterns of health and social are at end of life and case studies.

NHS Confederation: Integrated ambulance commissioning in the new NHS. As the NHS reforms start to become embedded over the next year, it will be vital for clinicians leading the new clinical commissioning groups (CCGs) to get involved in ambulance commissioning. The purpose of this briefing is to explain how ambulance commissioning currently works for clinical commissioners who may be new to this area.

Nuffield Trust: NHS Efficiency 2012 highlights. Videos and slideshows from the Trust’s conference on NHS hospital efficiency.

Policy Exchange: All together now: competitive integration in the NHS. “Unnecessary admissions to NHS hospitals have grown over the last 10 years, fuelled by pay incentives for doctors that fail to encourage GPs and consultants to work together in the best interests of the patient. Hospital admissions have increased by 2.79 million since 2005, largely due to the fragmented nature of the NHS”.
News: Hospital admissions increase by almost three million in seven years as patients with chronic diseases such as diabetes fill wards.

Primary Care Contracting (PCC): Commissioning Excellence Bulletin (PDF 1.34MB). The November 2012 issue of 'Commissioning Excellence' includes articles on taking the guesswork out of CCG finances and how the Staffordshire insight model and Guide paves the way for improved asthma treatment and outcomes. 

Primary Care Foundation: Urgent care centres: what works best? (PDF 489KB).This discussion paper looks at the different models for providing urgent care services and evaluates their impact. Through site visits to 15 urgent care centres and a literature review carried out by Warwick Medical School as well as the support of a reference group the report identifies some criteria that define a good service that delivers high quality, clinically appropriate and cost-effective care.

RSA (Royal Society for the encouragement of Arts, Manufactures and Commerce): Plugging the Gap.  "The UK is facing the largest public sector spending cuts since the 1970s... If citizens are expected to 'do more' we are going to need new kinds of services in order to support them to this end. As further tough policy and funding choices are made, can new forms of community engagement and social enterprise help to bridge the gap, ensuring that the most vulnerable and poorest are not left behind?" Through a series of papers ‘Plugging the Gap” will address these issues and develop ideas for practical responses to the shrinking state and cuts to services. 
Plugging the Gap – the social care challenge report (PDF 127KB).
Plugging the Gap – families with multiple problems (PDF 619KB). 

Runnymede: A sense of place: retirement decisions among older black and minority ethnic people. The report covers the wide-ranging topics that influence retirement decisions in the BME community and recommends ways in which local and national government should respond to the demographic reality of an ageing BME population. A major theme is how the government’s one-size-fits-all approach is proving inadequate to meet the needs of BME older people.

Scottish Government: A Common Understanding 2012 - Working Together For Patients. The Scottish Government is committed to ensuring that patients in Scotland receive medicines of established cost-effectiveness and therapeutic value. Medicines are an integral part of all aspects of clinical care provided in NHSScotland. The Scottish Government also recognises that effective joint-working amongst all of the stakeholders involved in contributing to the care of patients is essential to the provision of quality health care.

Scottish Government: Respite Care Scotland 2011-12. This report presents information on respite care services provided or purchased by Local Authorities in Scotland. Respite Care is a service intended to benefit a carer and the person he or she cares for by providing a short break from caring tasks.

Welsh Government: Working together to reduce harm – substance misuse annual report 2012. This reports on the progress made on the delivery of the Welsh Government’s ten year substance misuse strategy. It provides updated information on actions which are being undertaken nationally, regionally and locally to progress each of the strategy’s priority areas. 
Health in Wales: Tackling substance misuse in Wales: progress update.

World Health Organization (WHO): Atlas of Health and Climate. This document is a product of a unique collaboration between the meteorological and public health communities. It provides sound scientific information on the connections between weather and climate and major health challenges. These range from diseases of poverty to emergencies arising from extreme weather events and disease outbreaks. They also include environmental degradation, the increasing prevalence of non-communicable diseases and the universal trend of demographic ageing.