1. Paul Lelliott Director Royal College of Psychiatrists Research and Training Unit

2. Royal College of Psychiatrists The professional body for psychiatrists in the UK and Ireland Nearly all senior psychiatrists are members A charity whose aims include to improve professional and service standards

3. Quality improvement programmes Common elements: Large-scale networks of services Utilise audit cycle Assume that clinical and service quality are inseparable Involve other professional bodies and user/carer groups Members include public and private providers Standards-based self and peer review Increasingly offering accreditation All moving towards funding by subscription

4. Quality improvement programmes QI Networks for: Medium secure units Child mental health inpatients units* Child mental health community services Services for people who self-harm Therapeutic communities* Accreditation for: ECT clinics Acute psychiatric wards * Also offer accreditation

5. Funding and participation 5 networks 100% funded by subscriptions Rest moving in that direction All but 2 were pump-primed Once in, almost nobody drops out There is a typical adoption curve There is a tipping point Usually front-line staff agitate to join

6. Levers for improvement Participation in self-review against standards Feedback and benchmarking Training and education Communication/networking –visits to other services as peer-reviewer, annual forum –e-mail discussion, newsletters, position statements Supported action planning Bringing outside influences to bear –accreditation (creates pressure to put things right) –letters/presentations to CEOs –Regulator receives lists of accredited services –service commissioners (setting commissioning standards)

7. Why professional bodies can do this Authority, credibility and expertise Natural source of clinical standards Can get the clinicians on board Have longevity (unlike Governments, administrations and policies) Can set an agenda based on service priorities (as opposed to political priorities)

8. Challenges Professional bodies: –are viewed as having vested interests –can be conservative and reactive –authority is inferred and not direct Appearance of collusion with members leading to dilution of credibility Collusion with regulators could dilute independence and alienate members

9. The future? Regulators/commissioners expect services to participate Accreditation becomes the benchmark Networks replace Government inspection Networks set the agenda for policy, service planning and service development For clinicians, participation linked to re- certification

10. www.rcpsych.ac.uk/ccqi