National Quality Frameworks Jonathan Potter Clinical Director, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London BGS “Commissioning” Workshop November 25th

National Quality Framework Advice, guidance and standards Implementation and improvement support Assessment, measurement and reporting

National Quality Framework - England Advice, guidance and standards Implementation and improvement support Assessment, measurement and reporting Care Quality Commission National clinical audit – HQIP Clinical Guidelines - NICE Quality Standards - NICE Quality Metrics - IC Quality Observatories Commissioning – Best practice tariff CQINs, DES, LES Quality accounts Clinical Excellence Awards Quality Outcome Framework NPSA NHSIII National operating framework - DH Personal health accounts National Quality Board

National Quality Framework - England Advice, guidance and standards Implementation and improvement support Assessment, measurement and reporting Care Quality Commission National clinical audit – HQIP Clinical Guidelines - NICE Quality Standards - NICE Quality Metrics - IC Quality Observatories Commissioning – Best practice tariff CQINs, DES, LES Quality accounts Clinical Excellence Awards Quality Outcome Framework NPSA NHSIII National operating framework - DH Personal health accounts National Quality Board

1. To align the national system around shared goals for improving quality 2. To advise Ministers and the DoH on priority ares for improving quality 3. To oversee the development of tools and system levers to support clinical teams, providers and commissioners to achieve improvement. National Quality Board

Established Work Programme (1) Mid Staffs Review Review of systems and processes for identifying and responding to potentially serious failings in patient care Advise on Priorities for Quality Improvement System Alignment NICE Quality Standards Clinical Prioritisation Develop robust methodology and criteria for determining clinical priorities – to identify shared goals, advise Ministers, influence Operating Framework. First priorities identified by March 2010 Advise Ministers on topics for quality standards. Will aim to establish a defined list of topics (110) and apply set of criteria to determine sequencing MRSA Objective Recommendation to Ministers for new MRSA Objective to replace 50% reduction target

Established Work Programme (2) Tools & System Levers Clinical Excellence Awards Advise ACCEA on strengthening clinical quality aspects of clinical excellence awards scheme Indicators for Quality Improvement (IQI) Quality Accounts Strategic oversight of new indicator development. In process of establishing governance arrangements for new indicator development Advise DH on regulations as part of wider consultation. Accreditation Oversee the development of a core model for accreditation schemes based around Excellence. Academy of Medical Royal Colleges tasked with developing core model for consideration by Board

National Quality Framework - England Advice, guidance and standards Implementation and improvement support Assessment, measurement and reporting Care Quality Commission National clinicalLaunch Internet Explorer Browser audit – HQIPLaunch Internet Explorer Browser Clinical Guidelines - NICE Quality Standards - NICE Quality Metrics - IC Quality Observatories Commissioning – Best practice tariff CQINs, DES, LES Quality accounts Clinical Excellence Awards Quality Outcome Framework NPSA NHSIII National operating framework - DH Personal health accounts National Quality Board QIPP

Relationship between NICE quality standards and Registration requirements The quality curve shows the different mechanisms required for quality improvement. NICE quality standards takes organisations from good to excellent UnsafeSubstandardAdequateGoodExcellent Innovation Measuring for improvement Informed patient choice Commissioning (national contract) Commissioning (local contract) Regulation ( Enforcement against Registration Requirements) Regulation (Period Assessment) NICE quality standards Standard of services Proportion of services Accreditation Registration requirements

NHS Quality Framework - Scotland Advice, guidance and standards Implementation and improvement support Assessment, measurement and reporting

NHS Quality Framework - Scotland Advice, guidance and standards Implementation and improvement support Assessment, measurement and reporting Boards Health delivery plans Improvement targets Quality Improvement Scotland QIS SIGN Health Environment Inspectorate NHS Health Scotland Scottish Executive Strategic plan Information services division

1. Be a champion [ for something] 2. Get to know the national/ regional/ local levers which will drive change 3. Get to know and work with your commissioners and managers 4. Gather data to support your case and to measure change [ dashboards]. National Quality Framework What does it mean for the clinician

Conclusion

National Quality Framework - England Clinical Guidelines - NICE Quality Metrics - IC Quality Observatories Commissioning – Best practice tariff CQINs, DES, LES Quality accounts Clinical Excellence Awards Quality Outcome Framework National Quality Board Care Quality Commission National clinical audit – HQIP Quality Standards - NICE National SHAs Purchasers Providers QIPP Patients Personal Health Accounts

Established Work Programme (1) Mid Staffs Review What:Review of systems and processes for identifying and responding to potentially serious failings in patient care How: NQB Mid Staffs sub group established (Bill Moyes, Barabara Young, Ian Carruthers, Una O’Brien). Develop hypothesis and test with relevant parts of the service When: Testing in Oct. Report by end 2009 Advise on Priorities for Quality Improvement System Alignment NICE Quality Standards Clinical Prioritisation What:Develop robust methodology and criteria for determining clinical priorities – to identify shared goals, advise Ministers, influence Operating Framework How:NQB Clinical Prioritisation sub group (Bruce Keogh- Chair, Margaret Goose, Mike Rawlins, John Oldham, Paul Lelliott, Ian Kennedy, John Appelby, Jan Sobieraj) When:Engagement process live now, First priorities identified by March 2010 What:Advise Ministers on topics for quality standards How: Through clinical prioritisation sub group. Will aim to establish a defined list of topics (110) and apply set of criteria to determine sequencing When: Defined topic list to be published Jan 10. Recommendations for NICE 2010/11 work programme announced Feb 10. Initial 10 before end of 2009 MRSA Objective What: Recommendation to Ministers for new MRSA Objective to replace 50% reduction target How: NQB launched 6 week engagement on initial proposals (ended in July). NQB MRSA Sub-group chaired by Paul Lelliott considered engagement responses and made recommendation to NQB. When: Board agreed recommendation at 22 nd Sept meeting. Now advising SoS

Established Work Programme (2) Tools & System Levers Clinical Excellence Awards Advise ACCEA on strengthening clinical quality aspects of clinical excellence awards scheme ANNUAL REPORT: Progress so far: various achievements during first year Forward plans : where the NQB will be focussing over coming 12 months NQB and QIPP: narrative on how Board will support the challenge International comparisons: including the benefit of comparisons for improving quality, whole system comparisons and the validity of such comparisons Indicators for Quality Improvement (IQI) Quality Accounts Strategic oversight of new indicator development. In process of establishing governance arrangements for new indicator development Advise DH on regulations as part of wider consultation. Accreditation Oversee the development of a core model for accreditation schemes based around Excellence. Academy of Medical Royal Colleges tasked with developing core model for consideration by Board

Established Work Programme (2) Tools & System Levers Clinical Excellence Awards What:Advise ACCEA on strengthening clinical quality aspects of clinical excellence awards scheme How:Discussion at 18 th May NQB meeting When: Advice for 2009/10 awards round issued in June. NQB to consider advice on 2010/11 awards next year ANNUAL REPORT HQCfA committed to the NQB publishing an annual report. Will look at: Progress so far – various achievements during first year Forward plans – where the NQB will be focussing over coming 12 months NQB and QIPP – narrative on how Board will support the challenge International comparisons – including the benefit of comparisons for improving quality, whole system comparisons and the validity of such comparisons Indicators for Quality Improvement (IQI) Quality Accounts What: Strategic oversight of new indicator development How: In process of establishing governance arrangements for new indicator development When: Ongoing. Governance arrangements to be set out by end 2009 What: Advise DH on regulations as part of wider consultation. How: Discussion at 22 nd Sept NQB meeting. Has led to sub-group on QA assurance When: Consultation on regs went live 17 September for 12 weeks. Report to NQB on options for assurance in December Accreditation What:Oversee the development of a core model for accreditation schemes based around excellence How:Academy of Medical Royal Colleges tasked with developing core model for consideration by Board When: Consider / sign off model at December meeeting

NHS Quality Improvement Scotland (NHS QIS) A special health board working with NHS boards to help improve the quality of healthcare through: 1. Advice and guidance on effective clinical practice 2. Supporting and driving quality improvements 3. Assessing NHS performance, reporting and publishing findings.

National Quality Framework - Scotland Clinical Guidelines - SIGN Clinical Excellence Awards Quality Improvement Scotland - QIS National Providers Boards

National Quality Framework - England Clinical Guidelines - NICE Quality Metrics - IC Quality Observatories Commissioning – CQINs, DES, LES Quality accounts Clinical Excellence Awards Quality Outcome Framework National Quality Board Care Quality Commission National clinical audit – HQIP Quality Standards - NICE National SHAs Purchasers Providers

National Quality Framework - England Clinical Guidelines - NICE Quality Metrics - IC Quality Observatories Commissioning – Best practice tariff CQINs, DES, LES Quality accounts Clinical Excellence Awards Quality Outcome Framework National Quality Board Care Quality Commission National clinical audit – HQIP Quality Standards - NICE National SHAs Purchasers Providers Patients Personal health accounts