Quality improvement updates - 18 April 2013

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

DH: Health Education England Directions 2013. This document sets out Health Education England’s full operational duties and functions, and revokes the current preparatory directions 2012.

DH: Memorandum of understanding between Public Health England and the Care Quality Commission (PDF 245KB). This memorandum of understanding provides a framework for a working relationship between Public Health England and the Care Quality Commission.

DH: Local Healthwatch Organisations Directions 2013. These directions mirror those for previous Local Involvement Networks (LINks), to require that local authority contracts with independent care providers allow local Healthwatch authorised representatives to enter and view premises. This also mirrors the NHS standard contract in relation to local Healthwatch authorised representatives entering and viewing the premises of independent providers of NHS-funded care.

Healthcare Improvement Scotland: Systemic Anti-Cancer Therapy governance framework and audit tool. The purpose of this audit tool is to record compliance with CEL 30 (2012) [Revised] Guidance for the Safe Delivery of Systemic Anti-Cancer Therapy1,3,4. CEL 30 (2012) provides NHS boards with a framework for safe practice in the prescribing, preparation, administration and disposal of systemic anti-cancer therapy (SACT), and NHS boards are required to demonstrate compliance with it. The audit tool should be used by SACT services to complete self-assessment by the end of September 2013, and thereafter in line with the governance framework for Systemic Anti-Cancer Therapy services. Audit should be conducted by a multi-professional (nurse, pharmacist, and medical staff) team involved in the delivery of SACT.

Healthcare Quality Improvement Partnership (HQIP): Statutory and Mandatory requirements for clinical audit. This table provides a summary of the current statutory and mandatory requirements imposed on healthcare providers working in the NHS in England. It includes the 2013/2014 NHS Standard Contract, the introduction of the NHS provider licence by Monitor, changes to the foundation trust annual report, and the review of the NHSLA clinical negligence schemes.

HQIP: New resources from the Epilepsy12 National Audit. A new resource and interactive web tool has been provided by Epilepsy12, a collaborative UK-wide clinical audit looking at the healthcare for children and young people with suspected epileptic seizures. Based on the first national audit report (published September 2012), the new resource allows units to see how they measure against a range of key indicators and also how they compare to other units.

National Hip Fracture Database: The National Hip Fracture Database National Report 2012 - Supplement (PDF 2.9MB). This analysis shows that the overall length of NHS stay for hip fracture across 180 hospitals ranges from 12.4 to 44.5 days – more than a three-fold variation. The National Hip Fracture Database report shows that acute care for hip fracture has improved, but there are concerns about the later stages of care.

Guidance, innovation, tools

DH: Hospices Funding Breakdown. It has been announced that hospices across England have been awarded a share of £60 million of government funding to improve care environments and settings. This document provides full details of funding given to individual hospices as part of the Capital Grant Scheme.

DH: Identifying and Supporting Victims of Human Trafficking: Guidance for Health Staff. This document provides guidance and sets out actions for healthcare staff who suspect that their patient may be a victim of human trafficking. is relevant to all kinds of healthcare settings, including A&E, primary care, sexual health services and genito-urinary medicine (GUM) clinics.

DH: Attributing the costs of health and social care research. This guidance provides a framework for the NHS and its partners to identify, recover and attribute the costs of health and social care R&D (ACoRD), in a transparent, and consistent manner. It clarifies the distinction between the 3 costs of research: research costs; NHS support costs and treatment costs.

DH: NHS Primary Medical Services Directions 2013. These directions relate to the NHS Primary Medical Services Regulations which came into force on 1st April 2013. As well as being a useful resource for GPs who work under contract to the NHS, they will be of interest to patients who wish to understand the legal obligations of GPs to their patients, in line with the NHS Constitution.

DH: National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care. This guidance sets out the principles and processes of the national dramework for NHS continuing healthcare and NHS funded nursing care. It has been revised to reflect the new NHS framework and structures created by the Health and Social Act 2012, effective from the 1st of April 2013. The associated tools (a checklist, decision support tool and fast track pathway tool), which are designed to assist clinicians and practitioners with the decision making process, have also been revised accordingly. 

Department of Health, Social Services and Public Safety (DHSSPS): Guidance on Termination of Pregnancy in Northern Ireland. This new document builds on previous versions that have been subject to public consultation and consideration by Northern Ireland courts. The guidance now recommends that consultant psychiatrists should be involved in the assessment of a woman’s mental health when it is related to grounds for terminating a pregnancy. Other improvements include a section in relation to accountability and information collection in organisations. A public consultation is being held on the document from 8 April to 29 July 2013.

Guardian: Awards encourage adoption of new ideas says NHS Confederation. Mike Farrer, Chief Executive of NHS Confederation talks to the Guardian on the importance of innovation in the NHS. Mr Farrer say that to achieve better outcomes for patients with reduced resources, the NHS must get better at adopting new practices.

Healthcare Quality Improvement Partnership (HQIP): NCAPOP projects mapped to NHS Outcome Framework domains. As part of HQIP's commitment to improving its tools and guidance, the live Quality Accounts resource now includes information on NHS Outcomes Framework domains. There are five domains in total.

National Institute for Health Research (NIHR): i4i Invention for Innovation Challenge Awards 2013. Focusing on one NHS priority a year, these awards will fund disruptive technologies, which have the potential to improve outcomes for patients with either total or partial loss of hearing or sight. Applications close on 29 May 2013.

NHS Dumfries and Galloway: Communication and Mealtimes Toolkit Helping people with dementia to eat, drink & communicate. A guide for carers (PDF 7.8MB). The toolkit is in two sections, focussing on communication, and then on eating and drinking. Unsuccessful mealtimes often reflect a breakdown in communication and the way food is given and eaten can be a means of communication in its own right. The emphasis throughout the toolkit is on centring care around the person with dementia, which relies on knowing as much about them as possible. Care plan check lists are provided in each section, with examples, to help carers look at how they can put the advice in to practice with each individual.

NHS Employers: 2013/14 general medical services (GMS) contract: guidance and audit requirements for new and amended services. This guidance includes the two extended clinical directed enhanced services and other new or existing enhanced services. It provides primary care organisations with information to help support the continuation or introduction of these services. This guidance is applicable in England only.

NHS Improvement:  Managing exacerbations in COPD (PDF 1.2MB). NHS Improvement worked with a number of sites to develop alternative approaches and models of care to improve the services available to patients. This toolkit has been designed to share the learning and show how to make change happen.

Welsh Government: Responsible body guidance for the NHS in Wales. This guidance sets out who is responsible for funding an individual's treatment and care within the NHS in Wales.

Practice examples and case studies

NHS Confederation: Service resdesign case study: Providing specialist emergency care in Northumbria. This case study is part of a series designed to share good practice and lessons learned by local NHS organisations involved in major reviews of local health services. This case study features the establishment of Northumbria Healthcare NHS Foundation Trust's new urgent and emergency care facility, that culminated from several years’ strategic planning, and a comprehensive programme of engagement with staff and the local community.

SCIE Social Care TV: Working together to promote independence. This is a film showing how some of the principles of the SCIE/ NICE guidance on promoting the health and well being of looked after children are working in practice. The film focuses on two schemes for care leavers which are helping to support them in their move to independence. Two young people talk about their needs and fears of moving to independence, whilst their service managers talk about how they have organised a service which meets their requirements.

Reports, commentary, statistics

DH: DH Structural Reform Plan progress report: March 2013. This monthly update reports against objectives set out in the Department of Health’s Business Plan for 2012-15 and is part of a commitment across government to promote transparency and accountability.

DH: Department of Health equality objectives 2012 to 2016: progress update. This update outlines the progress made so far against the Department of Health's equality objectives. These objectives contribute to the six priorities of the Department of Health’s business plan and reflect a commitment to make equality integral to the day to day leadership of the health and social care system.

DH: Department of Health launches competition to designate Academic Health Science Centres. NHS providers and their university partners in England are invited to apply to become Academic Health Science Centres (AHSCs). Designation will be for 5 years from 1 April 2014, and the role of the new AHSCs will be to: increase strategic alignment of NHS providers and their university partners, specifically in world-class research, health education and patient care and improve health and healthcare delivery including through increased translation of discoveries from basic science into benefits for patients.

DH: Identifying the ordinary residence of people in need of community care services. This guidance explains how to decide where a person is ordinarily resident for the purposes of the National Assistance Act 1948 and certain other legislation. It is applicable to local authorities with social services responsibilities and sets out how to identify where responsibility lies between authorities for the funding and/or provision of care for people aged 18 and over who are assessed as needing social care services. The guidance may also be of relevance to CCGs, NHS Trusts and NHS foundation trusts which are exercising local authority health-related functions pursuant to arrangements made under section 75 National Health Service Act 2006 and the NHS Bodies and Local Authorities (Partnership Arrangements) Regulations 20001. The local authority functions which may be carried out by NHS bodies under such arrangements include functions under Part 3 of the National Assistance Act 1948, to which this guidance mainly relates.

DH: Structural reform plan monthly implementation update: March 2013. This monthly update reports against objectives set out in the Department of Health’s Business Plan for 2012-15 and is part of a commitment across government to promote transparency and accountability.

DH: NHS Primary Medical Services Directions 2013. These directions relate to the NHS Primary Medical Services Regulations, which came into force on 1 April 2013. As well as being a useful resource for GPs who work under contract to the NHS, they will be of interest to patients who wish to understand the legal obligations of GPs to their patients, in line with the NHS Constitution.

DH: Food statistics pocketbook 2012. This publication provides a concise round-up of statistics on food covering the economic, social and environmental aspects of the food we eat (excluding agriculture). It contains a mixture of National Statistics, official statistics and unofficial statistics. Unofficial statistics are used where there are gaps in the evidence base.

DH: Changes to the publication of abortion statistics in England and Wales. The Department of Health is proposing changes to the way it publishes abortion statistics for England and Wales, and is seeking the views of commissioners, clinicians, academics, other government departments and special interest groups. The aim of the consultation is to ensure that the abortion statistics remain relevant and useful to users. The consultation closes on 10 June 2013.

DH: Public Health England (PHE): Marketing plan 2013-14. This plan is an update of the public health marketing 2011-14 strategy following the transfer of the national social marketing programmes to PHE. It builds on the previous strategy and clearly defines PHE's role in the new healthcare system.

Health and Care Professions Council (HCPC): HCPC launches consultation on standards of proficiency for speech and language therapists. This consultation invites stakeholders for their views on proposed changes to the profession-specific standards of proficiency for speech and language therapists. The standards of proficiency are the threshold standards for safe and effective practice in the UK and play a key role in public protection. The consultation runs until 28 June 2013.

Health and Social Care Information Centre (HSCIC): One in 11 hospital admissions for liver disease ends in a hospital death. One in 11 (or 8.8 per cent) hospital admissions for liver disease in England (3,040 out of 34,650) resulted in a hospital death in 2012. This is higher than the overall percentage of hospital admissions that result in hospital death, which is about one in 72 admissions (1.4 per cent, or 210,170 out of 15.2 million). Provisional figures show that while there has been a 1.6 per cent (560) increase in admissions with a primary diagnosis of liver diseases, the rate of death has remained the same since 2011.

Health Foundation: Implementing shared decision-making. This learning report is based on seven improvement stories developed by the Office for Public Management (OPM) as part of their evaluation of the first phase of the programme. The stories draw on a series of interviews with clinicians and patients carried out by the evaluation team and present the experiences of both primary care and hospital-based teams. The stories explore the participants’ experiences of the MAGIC programme, and of implementing shared decision making in practice.

Health Foundation: The MAGIC programme evaluation. The Health Foundation's MAGIC (Making good decisions in collaboration) programme aims to support clinical teams in primary and secondary care to embed shared decision making with patients in their everyday practice. This independent evaluation by the Office for Public Management (OPM) covers the first phase of the programme. The evaluation shows that, while there are challenges to making shared decision making a reality, and it can be hard and slow to do, shared decision making can create positive change within health systems and to individual patients.

Health Foundation: Improving patient flow. This learning report describes the work undertaken by two NHS trusts as part of the Health Foundation’s Flow Cost Quality programme. It illustrates the problems created by poor flow that the programme was set up to address, and provides practical examples of how focusing on flow can improve quality, use available capacity effectively and save money. The report summarises key lessons from the programme and highlights important challenges for designing services and approaching change by focusing on flow.

Health Foundation: Annual review 2012: Bringing quality to light. This review looks back at the work of the Health Foundation in 2012 and sets out plans for 2013.

Implementation Science: Development of quality of care indicators from systematic reviews: the case of hospital delivery. “High-quality systematic reviews, whose conclusions clearly claim in favour or against an intervention, can be a source for generating quality indicators of delivery care. To make indicators coherent, the nuances of clinical practice should be considered. Any attempt made to evaluate the extent to which delivery care in hospitals is based on scientific evidence should take the generated indicators into account.”

Ipsos MORI: Public sector leaders: views on public services and economy. This omnibus survey of chief executives, directors and senior managers in the public sector shows that funding and budget cuts are still the top concern for leaders across the public sector. 84 per cent of leaders were shown to believe that their organisation has been affected a great deal or fair amount by cuts in public spending. Savings implemented include: working in partnership with different organisations to reduce costs; cut backs on pay increases; and a reduction in spending on managerial functions as well as back office functions.

Joseph Rowntree Foundation (JRF): Links between housing and poverty. The Joseph Rowntree Foundation has published ‘The links between housing and poverty’. This study analyses the past decade of UK evidence to explore: the relationship between housing circumstances and the experience of poverty; the relative importance of housing cost, quality and location and other factors in the impact of poverty on people’s lives; and the role of housing in enabling people to take up employment and increase income from work.

King’s Fund: Improving the allocation of health resources in England. While the principles behind resource allocation in the English NHS have changed little since the mid-1970s, the NHS has changed considerably. This paper argues that the resource allocation system needs to change accordingly. The paper explores how the health resource allocation process and the formula on which it is based have changed over time, and how it will work from April 2013. It suggests some improvements that can be made to support a more coherent health and care system.

King’s Fund: How should we pay for health care in future? To contribute to an informed public debate about both the level of future spending on health and social care, and how that spending might be funded, The King’s Fund, in collaboration with Ipsos MORI, held two deliberative events (one in London and one in Leeds) with members of the general public. Participants were asked for their views on the NHS, the challenges it faces and how it is funded. They were then given information on the funding challenges and offered possible solutions – paying for some services, means-testing or reducing the standard of care. This paper outlines and analyses the responses.

MHRA: MHRA prioritises science and research support as part of new corporate plan. The Medicines and Healthcare Products Regulatory Agency (MHRA) has announced its aim to be a leading regulator on the world stage in supporting science and research as part of its new five-year corporate plan. Alongside protecting and improving the health of millions of people every day through effective regulation of medical products.

MHRA: MHRA launches 2013-2018 corporate plan. The Medicines and Healthcare Products Regulatory Agency has launched its new five year corporate plan, its 2013-14 business plan, and the Regulatory Excellence Programme.

National Council for Voluntary Organisations (NCVO): NCVO and Serco code of practice. This code of practice aims to help improve working relationships between the private sector and the voluntary and community sector (VCS). It offers a guide to best practice in selecting partners and managing effective and sustainable relationships in the supply chain, as well as advice on delivering strong partnerships. It also provides useful principles for consortia relationships, and can help organisations build longer term partnerships, potentially spanning multiple opportunities and sectors.

National Endowment for Science, Technology and the Arts (Nesta): Doctor know: a knowledge commons in health. This paper argues that society's growing ability to mobilise knowledge from different fields and sources is beginning to show the potential of a 'knowledge commons' in healthcare: an open system of knowledge with researchers, practicing clinicians, patients, their families and communities all involved in capturing, refining and utilising a common body of knowledge in real time. It sets out what this might mean in practice, and steps that can be taken to get there.

NHS Alliance: Breaking boundaries: a manifesto for primary care by the NHS Alliance. This manifesto calls for a fundamental shift in healthcare from an acute to a primary setting, and calls for the NHS Commissioning Board (now NHS England) to commit to specific measures to implement this, including: appointing a GP or other primary care professional to work at the same level as the Chief Medical Officer or Commissioning Board Medical Director; allowing data to be shared across boundaries in different services and settings; and advocating that primary care should take a new role in orchestrating community movements which improve health and wellbeing.

NHS Alliance: A new year of Social Value in public service delivery (PDF 132KB). The NHS Alliance has published a paper urging clinical commissioners to consider ‘social value’ when commissioning community health and social care services.

NHS England: NHS England publishes generic commissioning policies. NHS England has published a number of interim generic policies, ensuring fair and consistent decision-making across its direct commissioning function. The 14 policies cover all aspects of NHS England’s direct commissioning responsibilities including specialised services, primary care, screening, military and offender health.

NHS England: Compassion in Practice implementation plans. These implementation plans are part of a wider strategy which aims to transform care in England. It aims to encourage independent living; improvement of health outcomes; working with people to provide a positive experience of care; and building strengthening leadership.

NHS England: NHS England publishes clinical access policies for specialised services. NHS England has published an agreed set of clinical access policies for specialised commissioning. For the first time ever, specialised services will be commissioned using a nationally consistent approach, meaning that patients will have equal access to high quality services, regardless of where they live. The policies, along with a number of specialised services specifications, were the subject of a short public consultation between December 2012 and February 2013.

NHS England: New Single drug fund list to bring fairer system for cancer patients. NHS England has taken action to end regional variation of access to the Cancer Drugs Fund. There will be one national list of approved fast-track drugs giving uniform access to treatment across the country. From 1 April, NHS England took on responsibility for the operational management of the Cancer Drugs Fund, creating for the first time a single national system for deciding which drugs are available and for which conditions.

NHS England: NHS Supply Chain's Customer Board bi-annual report (PDF 1.6MB). The latest bi-annual report from NHS Supply Chain’s Customer Board is now available. The report covers key focus areas and progress to date, particularly surrounding communications, knowledge management and stakeholder engagement. Clinical leaders and clinical commissioning group accountable officers may wish to review the report and consider any implications locally.

NHS Improvement: Impact of cardiac rehabilitation on readmissions. This report summarises the findings of a short study, commissioned by NHS Improvement, which models the relationship between uptake of cardiac rehabilitation and unplanned cardiac readmission rates both nationally and at commissioner level.

NHS Trust Development Authority (NHS TDA): Delivering high quality care for patients: the accountability framework for NHS Trust Boards. This framework sets out how NHS TDA will work with NHS trusts on a day-to-day basis; how it will assess the progress NHS trusts are making; and how it will provide the development support each organisation needs to meet the challenges that lie ahead.

PLoS Medicine: Changing Patterns in Place of Cancer Death in England: A Population-Based Study. Home and hospice deaths have increased since the launch of the UK National End of Life Care Programme, according to a study at the Cicely Saunders Institute published in the journal PLOS Medicine. The study analysed all cancer deaths in England collected by the Office for National Statistics during 1993-2010. The proportion of home deaths increased after 2005 whereas the proportion of hospital deaths declined. The proportion of deaths in hospices also increased over the study period.

Prescription Charges Coalition: Paying the price: prescription charges and people with long-term conditions. This report examines the impact of prescription charges on people with long-term conditions in England. It found that people with conditions such as asthma, heart disease, arthritis and HIV are having to choose between food, clothing, bills or prescription costs.  It argues that prescription charging is short-sighted as it makes it more difficult for people to manage their conditions effectively, leading to more severe health problems and extra costs to the NHS and society overall.

Royal College of Paediatrics and Child Health (RCPCH): Back to Facing the Future. Over three quarters of children see a senior paediatrician within four hours of admission, but there remains a shortage of consultants at peak times. This report presents the results of the RCPCH’s audit of acute paediatric units in the UK against the ten minimum standards set out by the College in its bold blueprint: Facing the Future two years ago.
Full report: Back to Facing the Future: An audit of acute paediatric service standards in the UK (PDF 2MB).

Scottish Government: Supporting Young People's Health & Wellbeing - A Summary of Scottish Government Policy. This document sets out a summary of the key Scottish Government policies that aim to support young people's health and wellbeing. It is a broad overview and does not attempt to describe every policy or initiative that will have an impact on the health of young people in Scotland. No single Scottish Government Directorate is responsible for policy development relating to children and young people's health and wellbeing. This paper aims to draw together the key policies into a single document.

Scottish Government: The Common-Sense Approach to Moving and Handling of Disabled Children and Young People- Easy Read. This guide is for workers and employers who work with children and young people who have moving and handling needs. It gives a common-sense, practical approach based on the current laws about children's rights, manual handling and health and safety.

Scottish Government: See Hear: A strategic framework for meeting the needs of people with a sensory impairment in Scotland. This strategic framework covers cradle to grave sensory impairment and is set against a background of increasing demand, the requirement for greater efficiency and effectiveness with available resources and Health and Social Care Integration. It has been developed in the context of a number of wider policy and practice expectations, and has been directly informed by views of a wide range of stakeholders who have contributed their views on current service provision and made suggestions for future developments.

Scottish Government: Cross Border Healthcare & Patient Mobility: Public Consultation on Scotland’s Transposition and Implementation of Directive 2011/24 EU on the Application of Patients’ Rights in Cross-border Healthcare. This consultation document sets out the Scottish Government’s approach to implementation of the EU Directive on the application of patients’ rights in cross-border healthcare. It seeks views on the detail of the implementation, and examines the effects the Directive may have on Scotland’s health system. The consultation closes 14 June 2013.

UNICEF: UNICEF report card. Report Card 11, puts the UK in 16th position in a league table of child well-being in the world's richest countries. An earlier report in 2007 put the UK at the bottom of 21 developed countries for overall child well-being, so there has been minor improvement. However there are still areas in which the UK ranks significantly low, especially among young people aged 15 to 19. Teenage pregnancy rates continue to be high, as do the numbers of young people under 19 not in education, employment or training. The UK also has one of the highest alcohol abuse rates in 11 to 15 year olds.

Welsh Government: The duty to review the Mental Health (Wales) Measure 2010 - Inception report. This report describes the proposed process and suggested sources of information, which will be used to review the Measure. An interim evaluation report will be published by 31 March 2014 and a final report before January 2016.