Quality improvement updates - 2 May 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: The Health and Social Care Act 2012 and associated secondary legislation and guidance (PDF 88KB). This document is a summary of changes to secondary legislation as a consequence of the Health and Social Care Act 2012 and is intended to highlight the relevant provisions.

Guidance, innovation, tools

Care Inspectorate: Preventing Falls: a booklet for care at home staff (PDF 549KB). The Care Inspectorate has worked with NHS Education for Scotland to develop a pocket-sized booklet for care at home staff. This highlights the steps that staff can take to help the people that they care for.  

DH: Commissioning toolkit for respiratory services. Spirometry is one of the most common diagnostic tests performed in primary care but its quality can be very variable. As a result spirometry results cannot be relied on in around a quarter of all patients on GP COPD registers.
This step-by-step guide shows clinicians how to ensure that diagnostic spirometry performed in primary care and other settings is quality assured and provides valid results for patients. It details how spirometry should be performed, the interpretation and reporting of results and methods for quality assurance. The guide also illustrates common technical errors and offers a Top Ten Tips for reporting spirometry results.

DH: Hospital accident and emergency departments: planning and design. This updated guidance provides information on how to approach a new build or redesign an A&E department. It is specifically aimed at senior emergency clinicians and designers given their important role in making a new build successful. This guidance replaces HBN 22 published in 2005.

DH: Innovation, Excellence and Strategic Development Fund: new awards 2013 to 2014. Successful candidates from the 2013 to 2014 Innovation, Excellence and Strategic Development Fund Awards (IESD) have been announced.

DH: Mental Health Act: exercise of approval instructions 2013. Guidance for approving registered medical practitioners under the Mental Health Act 1983.

DH: Guidance: Mental Health Act: Referrals to First-tier Tribunal. This guidance sets out when the Secretary of State can refer patients to the First-tier Tribunal under Section 67 of the mental health act and how to request a referral.

DH: Sourcing blood plasma for import into the UK. Guidance from the Advisory Committee on the Safety of Blood, Tissues and Organs on source countries of imported plasma for transfusion.

Monitor: Quality Governance: How does a board know that its organisation is working effectively to improve patient care? This guidance is aimed at members of boards of NHS organisations to enable them to perform their role in improving health services for patients. It is designed for use across all types of NHS providers, including existing and aspirant NHS foundation trusts in the acute, specialist, ambulance, community and mental health sectors. It may also be of use to other staff in NHS bodies, such as senior management, operational, clinical and nursing staff and those working on internal, external and clinical audits.

National AIDS Trust (NAT): Commissioning HIV testing services in England: a practical guide for commissioners (PDF 2.33MB). This toolkit and appendices are designed primarily for those with responsibility for commissioning HIV testing services. It signposts readers to data and research on HIV testing, showcases best practice and offers suggestions of how to decide what sort of services are needed in different areas. It will be refreshed when new case studies of successful HIV testing initiatives or up-to-date evidence and data come to light.

NHS Technology Adoption Centre: NTAC Publish New Adoption and Implementation Guides. NTAC has recently published three new guides on the NTAC website which look at Portable Ultrasound Bladder Scanning technology and BNP and NT-proBNP diagnostic testing technologies. These can all be found in the publications section of the website.

Royal College of General Practitioners (RCGP): RCGP commissioning guidance in end of life care (PDF 1.8MB). This guidance provides a six-step framework and overview to support the delivery of practical improvements across the health, social care and voluntary and independent sectors. It aims to ensure that the needs of dying patients and those closest to them are paramount whilst services are commissioned and developed around them. It cautions that improvements in treating long term conditions, dementia, frailty and reducing hospitalisation cannot be achieved unless end of life care is seriously considered and integrated.

Sharing Good Practice in Social Work Education Participation (SWEP): The Social Work Education Participation (SWEP) website has been designed to share good practice in the involvement of service users and carers in social work education. It was developed by a partnership of Shaping our Lives, the University of Sussex and SCIE following consultation with service users and carers currently involved in social work education. 

SCIE Social Care TV: Avoiding Unnecessary Hospital Admissions: The Headlines. This film looks at the realities behind the headlines about older people and their use of hospital beds, and considers what steps could be taken to help avoid unnecessary admissions. 

Scottish Government: Getting our priorities right. The purpose of the guidance is to provide an updated good practice framework for all child and adult service practitioners working with vulnerable children and families affected by problematic parental alcohol and/or drug use. It has been updated in the particular context of the national GIRFEC approach and the Recovery Agendas, both of which have a focus on ‘whole family’ recovery. Another key theme is the importance of services focusing on early intervention activity. That is, working together effectively at the earliest stages to help children and families and not waiting for crises – or tragedies – to occur.

Turning the world upside down: 'People living in the most disease prone and poorest countries of the world are developing new ideas and practices in health from which we can all learn, wherever we live.' Turning the World Upside Down showcases some extraordinary examples and provides the space for discussion and debate. It is an online community and platform which shares, collects and celebrates innovations in health from developing countries.
See: Three lessons from Malawi.

Practice examples and case studies

Foundation of Nursing Studies (FoNS): Embedding Excellent Nutrition Care Practices in an Acute Hospital Ward (PDF 804KB). The aim of this project was to provide a measurable improvement
in the standard and consistency of patients nutritional care and experience on one acute hospital ward.

Reports, commentary, statistics

Age UK: Agenda for later life 2013: improving later life in tough times (PDF 3.11MB). This report sets out some of the challenges facing older people in 2013. It gives a snapshot of both the over 65s and those approaching later life detailing the current challenges and opportunities facing the nation.

Care Inspectorate: Care News. The Care Inspectorate has launched a new web version of their flagship magazine, Care News. The publication, which was recently shortlisted for an industry award, helps people working in the care sector to share and signpost good practice, and to keep others up to date on issues affecting the care industry in Scotland.   

Carers UK: Joint committee on the draft Care and Support Bill. The government published its draft bill on care and support in July 2012. The draft bill introduces a new legal framework for the provision of care and support services in England. A joint committee of MPs and peers appointed to scrutinise the draft bill have now published their report and recommendations on the draft bill. This briefing examines what the committee has recommended and what this may mean for the future of social care.

DH & NHS England: Public health functions to be exercised by NHS England Variation to the 2013-14 agreement (PDF 250KB). The changes coming into force under this variation are: an amended key deliverable for children's public health services (from pregnancy to age 5) in relation to the Family Nurse Partnership (FNP) programme; updated baselines for key deliverables on screening for diabetic retinopathy, breast screening and cervical screening; certain planned new programmes and developments mentioned in paragraph A42 of the 2013 - 14 agreement; and updates to certain other service specifications within Part C of the agreement.

DH: School Health Service: briefing for local council members. The Local Government Association and the Department of Health have produced a briefing for Lead Members for Children’s Services on the School Health Service. This briefing provides advice and links to further resources.

DH: Ring fenced public health grants to local authorities. These documents provide more detail on the ring fenced public health grants which have been provided to local authorities.

DH: High Security Psychiatric Services (National Health Service Commissioning Board) Directions 2013. NHS England has a responsibility to arrange the provision of high security psychiatric services and these directions lay out how it carries out its functions in relation to these services.

DH: Health Building Note 15-01: accident & emergency departments: planning and design guidance. This updated guidance provides information on how to approach a new build or redesign an A&E department. It is specifically aimed at senior emergency clinicians and designers given their important role in making a new build successful.

DH: Mental Health Act: applications for cross-border transfer of patients. The Mental Health Act permits some patients who come under its provisions to be transferred to Scotland, Northern Ireland, the Channel Islands and the Isle of Man. The Act states that a hospital in England must obtain the authorisation of the Secretary of State for Health before it can transfer such a patient to a location in one of these jurisdictions, and these forms can be used to apply for this authorisation. 

DH: Evaluation of the Physical Activity Care Pathway London Feasibility Pilot ((PDF 2.2MB). In 2007, the Department of Health developed a draft Physical Activity Care Pathway. The Physical Activity Care Pathway involves four key steps: assessment of patients’ physical activity levels, brief intervention, signposting to local physical activity opportunities and follow-up consultations. This technical report presents the final results from the feasibility trial conducted by the British Heart Foundation National Centre for Physical Activity and Health based at Loughborough University. See also: Executive summary (PDF 344KB).
DH: Independent report: Let's Get Moving care pathway: feasibility study results. This report presents the final results from a feasibility trial conducted as part of the Physical Activity Care Pathway initiative.

DH: Policy: Improving care for people with dementia. The government wants to improve health and care services, create more dementia-friendly communities and make dementia research a priority. They want to increase diagnosis rates by: making sure that doctors give 65 to 74 year olds information about memory services as part of the NHS health check programme, and refer them for assessment if they need it; making £1 million available for innovative NHS projects to increase diagnosis rates through the Innovation Challenge Prize for Dementia (prize winners will be announced in March 2014) and by launching a new toolkit to help GPs provide better support.
DH: Will we rise to the challenge of an ageing society?

DH: High Security Psychiatric Services (National Health Service Commissioning Board) Directions 2013. Directions from the Secretary of State for Health to NHS England on how to carry out high security psychiatric services.
 
DH: Adult social care outcomes framework 2013-2014. This framework sets out the indicators for measuring adult social care outcomes in 2013 and 2014.

eHealth Insider: HSCIC creates quality indicator library. The Health and Social Care Information Centre is creating a library and repository for quality indicators to reduce duplication and improve standards.

Health and Social Care Information Centre (HSCIC): NHS Stop Smoking Services Statistics. This quarterly report presents provisional results from the monitoring of the NHS Stop Smoking Services (NHS SSS) in England during the period 1 April 2012 to 31 December 2012. This report includes information on the number of people setting a quit date and the number who successfully quit at the 4 week follow-up. It also presents in depth analyses of the key measures of the service including pregnant women, breakdowns by ethnic group, socio-economic classification as well as by intervention type and setting and type of pharmacotherapy received and regional analyses at Strategic Health Authority (SHA) and Primary Care Trust (PCT) levels.

Health Foundation: International perspectives on healthcare improvement. Healthcare providers around the world are facing increasingly similar challenges, yet they adopt a wide array of approaches to tackle them. This month the Health Foundation looks at the value of harnessing learning from the international context and adapting it to local needs, with some fresh approaches to delivering healthcare.

Health Improvement Scotland: Quality Improvement - Sustainable in any culture? The aim of the project was to explore which behaviours bring about measurable changes in clinical outcomes, and how this can be linked to the quality improvement agenda. The literature review and interview questions looked at leadership skills, embedding clinical culture and involving clinicians in the quality improvement agenda.

Health in Wales: Wales Abdominal Aortic Aneurysm Screening Programme. Men aged 65 in Carmarthenshire, Ceredigion, Pembrokeshire and through-out Wales will be invited to take part in a new screening programme launched today (May 1, 2013) by Public Health Wales.
Press release: Launch of Abdominal Aortic Aneurysm Screening Programme.

Ipsos MORI: Understanding society: how do we change behaviour? Make it simple. This issue of Understanding Society includes discussion of the role of behavioural economics and social psychology in public health, and the huge challenges for public health interventions, in the face of pervasive encouragement to act in less healthy ways. It also includes case studies of how the Ontario Ministry of Health and Long-Term Care in Canada used behavioural approaches to re-vamp their smoking cessation and free seasonal flu vaccination programmes.

IPPR: The condition of Britain. The IPPR has launched a flagship programme to better understand the everyday pressures facing people in Britain and the potential to overcome these challenges together. The programme aims to generate new insights into the 'condition of Britain' today and identify the resources and energies which could be mobilised to improve society - in the process helping to define the centrarl challenges for social policy over the coming decade.

London School of Economics and Political Science (LSE); University of East Anglia: Long-term care funding in England: an analysis of the costs and distributional effects of potential reforms (PDF 273KB). The paper provides detailed estimates of the public expenditure costs of the government’s plans. It projects that the government’s current proposals, with a cap of £75,000, would add £2 billion (2010 prices) to public expenditure by 2030. This is in contrast to a projected extra £3.3 billion cost of the Dilnot Commission’s proposals, which had recommended a cap of £35,000.

NESTA: Health for People, By People and With People. Produced by the British health charity Nesta, this report advocates changes to three important components of Britain’s healthcare system: doctor-patient consultations, service design and focus, and patient pathway design. The authors argue for a more patient-centred approach that focuses on long-term outcomes, recovery and prevention, and is applied in the context of behaviour change, improved wellbeing and social support.

NHS Confederation: Ambition, challenge, transition: reflections on a decade of NHS commissioning. This report has been produced to mark the end of a significant period of transition for NHS commissioning. It explores the achievements and challenges experienced over more than a decade of commissioning through the voices of those who lived it on the ground.

NHS England: NHS England board agrees interim equality objectives. NHS England has set three interim equality objectives for April to October 2013 which will ensure that policy making, decisions and activities comply with the public sector equality duty and provide system leadership to clinical commissioning groups and other parts of the NHS.

NHS England: Report of the external review of children’s congenital cardiac surgery service at Leeds Teaching Hospitals NHS Trust (PDF 551KB). This report is the output of the independent review team that formed part of the first stage of the review into children’s heart surgery at Leeds. It looked at systems within the unit and found that there were no immediate issues that would prevent a resumption of surgery.
NICOR investigation of mortality from paediatric cardiac surgery in England 2009–12 (PDF 293KB).
 
Nuffield Trust: Reclaiming a population health perspective: future challenges for primary care (PDF 292KB). The report, which was written by the Nuffield Trust, commissioned by the National Association of Primary Care, examines the arguments for encouraging and enabling general practices to take a much more proactive role in improving the health and wellbeing of their local populations, as well as their individual patients.
Press release: NHS funding crunch creates a challenge for GPs to improve public health.

Primary Care Commissioning (PCC): Briefing on NHS health checks for local authorities. Local authorities are now responsible for commissioning health checks. This briefing provides information about the programme. This is a national prevention programme, which is provided locally, mostly by GPs. Patients can be referred as a result of their health check to various services, many of which, such as open gyms, are run by local authorities. This briefing considers why health checks are important, what a check consists of, their cost-effectiveness and the implications for local authorities.

Public Health England: PHE Bulletin, 30 April 2013. The first edition of PHE Bulletin includes news of Public Health England’s 7 priorities and a toolkit for local authorities and businesses.

Public Health England: Public Health Outcomes Framework 2013 to 2016 and technical updates. The Public Health Outcomes Framework concentrates on: increased healthy life expectancy; reduced differences in life expectancy and healthy life expectancy between communities.

Public Health England: Public health commissioning in the NHS. The agreement sets out how NHS England is accountable for the delivery of certain public health services and gives details of arrangements for expert support from Public Health England. The service specifications provide details of the public health evidence and advice needed to support effective commissioning.

RAND Corporation: Why the rich drink more but smoke less: the impact of wealth on health behaviours. This paper seeks to explain this phenomenon by developing a theory of health behaviour, and exploiting both lottery winnings and inheritances to test the theory. It distinguishes between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. It suggests that differences in health costs may indeed provide an explanation for behavioral differences, and ultimately health outcomes, between wealth groups.

Revolving Doors Agency: Role of adult social care services for vulnerable offenders. This joint briefing paper from the Revolving Doors Agency, the Prison Reform Trust, the Centre for Mental Health and the Association of Directors of Adult Social Services (ADASS) outlines how directors of adult social services and lead members can develop co-ordinated, effective support for people with multiple needs in, or on the edge of, the criminal justice system.

Social Care Institute for Care Excellence (SCIE): Early intervention: decision making in children’s services. New SCIE research has found that local authorities understand the need to intervene early to support children and families at greatest risk of developing problems. Investing in long-term issues whilst also funding immediate needs remains a challenge. But the work indicates that the keys to effective early intervention are: providing visionary and creative local leadership; having a clear understanding of children's and families' journey through what can be a complex local system; and multi-professional working at the local level. The research was commissioned by Action for Children to inform their policy work on early interventions.

SCIE: 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. It is not a systematic research review or an exhaustive examination of published research on the topic. Rather, it aims to give an overview of the main themes of research findings which help to identify the challenges and solutions to improving choice and control for older people (including those living with dementia) through the use of personal budgets and direct payments.

SCIE: Think Local Act Personal update: Driving up quality in social care. Driving up quality in adult social care is a new set of briefings from TLAP that bring together the views of commissioners, providers, regulators, standard-setters and people who use services and their families and carers. The briefings define quality social care, the principles that underpin it and who is responsible for its delivery. They call for care where the person using it is at its centre, that enables personal outcomes to be achieved and builds relationships based on dignity and respect.

SCIE: SCIE opinion - 23 April 2013. First blog from new SCIE Chair, Lord Michael Bichard.

Scottish Government: Mental Health Strategy Easy Read. This is an Easy Read version of the Mental Health Strategy for Scotland 2012-15.

Scottish Government: Update to: A User's Guide to Self-directed Support in Scotland (2012). The information contained in the User’s Guide is still relevant and will be useful to anyone using self-directed support or thinking about trying it for the first time. The purpose of this supplementary leaflet is to give an update on some of those wider developments that are not covered in the user guide. An important change is that Self-directed Support (SDS) is more than direct payments.

World Health Organization (WHO): The changing national role in health system governance: a case-based study of 11 European countries and Australia. This study of 12 countries, including England, provides an overview of recent changes in national governments’ role in the governance of health systems, focusing on efforts to reconfigure responsibilities for health policy, regulation and management; the resultant policy priorities; and the initial impact. 'The shift in responsibilities shows little uniform direction: a number of countries have centralized certain areas of decision-making or regulation but decentralized others'. The study reviews common trends, based on the country cases, and assesses potential future developments.