1. Commission for Health Improvement CHI: The national perspective Emilie Roberts Development Manager 10 December 2003

2. This presentation will cover Who we are and what we do A bit about the review process What are we finding? Some reflections From CHI to CHAI How it works Hints and tips

3. CHIs aim To bring about demonstrable improvement in the quality of NHS patient care throughout England and Wales

4. CHIs principles patient centred independent, rigorous and fair developmental evidence based open and accessible apply the same expectations to ourselves

5. An overview: what does CHI do? National performance ratings national NHS patient and staff surveys national clinical audit programme national reports Local clinical governance reviews investigations NSF studies

6. Clinical governance reviews What is it like to be a patient here? How good are the PCTs systems for safeguarding & improving quality of care? What is the PCTs capacity for improving? The review does not assess: the performance of individuals or individual practices

7. The review process Scheduling Data collection Meetings Site visits Report Action planning Why me? Why not me?

8. The review process Scheduling Data collection Meetings Site visits Report Action planning PCT data request Practice survey Routine data

9. The review process Scheduling Data collection Meetings Site visits Report Action planning Partner organisations Patients & public

10. The review process Scheduling Data collection Meetings Site visits Report Action planning Review manager Plus team of seconded reviewers

11. The review process Scheduling Data collection Meetings Site visits Report Action planning Publicly available

12. The review process Scheduling Data collection Meetings Site visits Report Action planning It can be put on the shelf and forgotten about. Its not an ongoing audit. No one goes back to check Trust coordinator quoted in the Daily Telegraph, 01.12.2003

13. The review process Scheduling Data collection Meetings Site visits Report Action planning It can be put on the shelf and forgotten about. Its not an ongoing audit. No one goes back to check Trust coordinator quoted in the Daily Telegraph, 01.12.2003

14. The practice surveys Example – patient and public involvement in general practice (570 practices in sample) 83% report little progress in involving patients/users Of these, half had received no advice from the PCT Almost all general practices have a policy for complaints Only 2/3 have any system for learning from compliments

15. Site visits: visiting and interviewing PCT managers, professionals & staff Focus is your experience of systems in place to improve quality and safeguard patient safety patient experience (visits include some observation of the environment)

16. Can you have confidence in the findings? Reported findings must be strongly supported by evidence Individuals and practices are not named or identified in the report CHI has serious concerns over fire risk in some practices. There was inconsistency across practices of fire exits, training, visibility of extinguishers, evidence of fire drills, procedures and signed escape routes….

17. Hints and tips Prepare wisely Tell us about your PCT Manage expectations Facilitate the site visits Shout about the things you do well, and Be honest about the areas that need improvement

18. What is CHI finding in PCTs (1) Access PCTs are generally meeting NHS plan targets for general practice but there are problems in some areas Patients having difficulty accessing NHS dentistry in some areas CHI commonly finds long waits for physiotherapy and other therapy services

19. What is CHI finding in PCTs (2) Leadership Staff generally like working in PCTs. They report that CEOs are visible and approachable But, in many PCTs the PEC does not seem to be fulfilling its role as the engine room

20. What is CHI finding in PCTs (3) Impact on local community CHI finds increasing use of extended roles PCTs are involving patients and carers in developing specific services Commissioning is underdeveloped PCTs are struggling to implement robust monitoring arrangements

21. Reflections on CHI The review team Consistency One size fits all Making a difference Regulatory burden

23. The future - CHI to CHAI April 2004 - Commission for Healthcare Audit and Inspection Aim is still improvement in patient care Activity will be targeted & proportionate Focus on organisations and services Explicit standards Greater coordination of regulation in health care

24. Inspection by outsiders (ie those who do not provide care) exerts an effect on care only through the behaviours and actions of insiders (those who do provide care). If we want inspection to affect quality, we must begin by asking how those who are inspected may affect quality Brennan and Berwick, 1996

25. Commission for Health Improvement www.chi.nhs.uk