The quality agenda in the nhs
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Session slides introducing quality as policy issue
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The quality agenda in the nhs
- 1. The Quality Agenda Analysing Health Policy / Contemporary Health Policy Analysis Kate Thomson
- 2. Session overview • How has ‘quality’ been embedded in NHS reforms since 1997? ▫ What mechanisms have been used to monitor and improve quality? ▫ How has the quality agenda changed? • Have quality mechanisms been effective? • What is the meaning of quality? • What other drivers for the NHS pose a challenge to the quality agenda?
- 3. Quality – from 1997 • NICE National Institute for (Health and) Clinical Excellence • NSFs National Service Frameworks • CHI Commission for Health Improvement ( Healthcare Commission CQC). Centralised regulation, standardisation Quality, performance & accountability
- 4. Quality issues – from 1997 • Regulation of medical profession ▫ Bristol case; Shipman • Clinical governance ▫ Monitoring, audit, continuous improvement • Central monitoring & inspection (CHI) • Waiting lists • Resources & financing
- 5. What is the Quality relationship between quality and cost /investment? Striking a balance in healthcare provision Access Cost
- 6. Performance & targets • ‘traffic lights’; star rating systems; health checks • ‘earned autonomy’ & Foundation status • Increased number & coverage of targets, e.g. waiting times ▫ Increased central control – uniform standards from early 00s – less ‘control’ • QOF – quality outcomes framework in primary care • Payment By Results + patient choice – incentivising quality?
- 7. Targets/ performance indicators: ▫ Greener (2004): tightening of national regulation frameworks betrayed a lack of trust in professionals to act in the best interests of the health service. ▫ Stevens (2003) (cited in Klein 2006): they ‘undermine intrinsic motivation and produce a compliance culture in which only what gets measured gets done’. • Do you agree? • Coalition govt promised to eradicate ‘target-driven’ culture
- 8. Quality Domains (CQC) • Safety • Clinical and cost effectiveness • Governance • Patient focus • Accessible and responsive care • Care environments and amenities • Public health
- 9. Current quality context: Darzi & beyond • 2008 – Darzi High Quality Care for All ▫ Effectiveness ▫ Safety •Increased ▫ Experience cost • NHS Constitution (2009) pressures • Coalition govt: Transparency in Outcomes consultation NHS Outcomes •Shifting political Framework 2011/12 (+ Public Health / landscape Adult Social Care frameworks)
- 10. World of acronyms: Do you know what these abbreviations stand for? If not, find out. How does each relate to the quality agenda /performance management?
- 11. From: DH (2010) The NHS Outcomes Framework 2011/12 (updated frameworks & docs for each available via Moodle site).
- 12. Current quality emphasis • Access to services ▫ Primary care– times, availability ▫ Drugs & treatments ▫ Closer to home / integrated care • Patient safety ▫ Infection control ; ‘never events’ How is service user choice (of ▫ Staffing levels provider, of service • Choice & empowerment /treatment etc.) related to quality? • Value for money Do you agree? • Evidence & leadership
Hinweis der Redaktion
- NEW NHS 1997- key emph 1) health improvement, addressing inequalities; 2) efficiency & quality. - though ‘competition’ rejected as way of driving up standards, instead: Better performance measurement & threat of sanctions -central intervention – if standards not met indicators e.g. Access, effectiveness, efficiency, patient perceptions, outcomes.Led to these three being set up (1998 white paper) to emph. National standards and coherence, to address geographical variations that had been historic in NHS in fact.
- Bristol case began in court in 1997.Resources issue – commitment to Tory spending plans, this already breached with a bit more money going into NHS – followed by post 2000 pledge regarding reaching Euro average (arbitrary & controversial but led to big real increases from early 00s) Waiting lists – a political priority as perceived to be why NHS has bad rep in public, focused on by media.
- Does ‘quality’ have to be expensive? What cost pressures are there?
- Public emphasis on waiting lists maybe mistaken (Klein 2006) as they jsut seemed to get worse, and the media were watching. Doctors complained that encouraged emphasis on getting through elective surgery lits above all else – may not be real prorities in clinical terms. Also many patients were waiting longer to get first appts. Shift to re-emphasis on waiting times and focus on stages of journey – more reflective of real patient concerns (most would not know about length of waiting list) . Added to pressure on govt as v diffiuclt to succeed in own terms. Performance indicators that were first published in 1999 revealed extent of geog differences or ‘postocde lottery’.Led to increase in number of targets in specific areas, e.g. Cancer referrals, reduction in deaths from chd and stroke
- Quality Domains in assessing core standards (to 2009/10, CQC) – NHS trustsAre any of you involved in completing declaration for CQC? This is a ‘transitional’ year with a new regime coming from next year.
- Financial crisis and other political issues – need to simultaneuosly ‘ enhance quality and reduce cost’Darzi – is still referenced by the Coalition govt in the consultations relating to Jul 10 White Paper, e.g. in the one on Outcomes Framework Quality, Investment, Productivity, Prevention Outcomes Framework, for this year doesn’t set out ‘levels of ambition’ (targets) but ‘direction of travel’,, but in future level of ambition will be calculated using:the current trajectory of each indicator as the baseline; the extent to which variations are attributable to NHS actions; the cost-effectiveness of the required improvements; the timeliness of the impact of NHS actions on healthcare outcomes; achievability and affordability as a whole – the required improvements should be consistent overall with the NHS funding envelope; the variation and inequalities in health outcome indicators, taking account of equalities characteristics, disadvantage and where people live; and any potential impact on behaviour and incentives.
- “Achieving high quality care meansempowering patients to makechoices over their healthcareand giving them greater controlover their health” – does it??No matter how talented theindividual, clinicians cannot dotheir best for patients if they areunclear about what the best carelooks like. NHS Evidence, a newservice managed by NICE, ensuresthat professionals have thisknowledge at their fingertips.Launched in April this year, itbrings the world’s best evidenceand medical guidance to theconsulting room or surgery via anew online portal.