The Quality Agenda

Analysing Health Policy / Contemporary Health Policy Analysis

Kate Thomson

Session overview
How has quality been embedded in NHS reforms
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?

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?

Quality from 1997

NICE (now)National Institute for Health and Care Excellence NSFs National Service Frameworks CQC (CHI Healthcare Commission ) Outcomes Frameworks
Centralised regulation, standardisation Quality, performance & accountability

Quality issues
Regulation of medical profession
Bristol case; Shipman

Clinical governance

Central monitoring & inspection Care failures e.g. Stafford (Francis Report) Resources & financing

What is the relationship between quality and cost /investment?

Quality

Striking a balance in healthcare provision

Access

Cost

Performance & targets ( ~2000 )

traffic lights; star rating systems; health checks; earned autonomy & Foundation status Primary care targets Increased number & coverage of targets
From Increased central control uniform standards less control from early 00s

Payment By Results + patient choice incentivising quality?

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

From.. Quality Domains (CQC mid 00s)

Safety Clinical and cost effectiveness Governance Patient focus Accessible and responsive care Care environments and amenities Public health

2001-13 Changing purpose of CQC (CHI)

Learning organisation

Light touch

Regulator

Inspector

To.. Care Standards (CQC) -current

You should expect: 1. to be respected, involved in your care and support, and told whats happening 2. care, treatment and support that meets your needs. 3. to be safe. 4. to be cared for by staff with the right skills to do their jobs properly 5. your care provider to routinely check the quality of their services. > Intelligent Monitoring

From: DH (2010) The NHS Outcomes Framework 2011/12 (updated frameworks & docs for each available via Moodle site).

NHS Outcomes Framework

Quality emphases
Access to services
Acute care /diagnostics waiting times Primary care times, availability Drugs & treatments Closer to home / integrated care

Prevention
Numbers offered screening /checks

Quality emphases
Patient safety
Infection control ; never events Staffing levels

Choice & empowerment Value for money Evidence & leadership

Quality emphases: Customer satisfaction!

Button from CQC website

Friends and Family Test

'How likely are you to recommend our ward/A&E department to friends and family if they needed similar care or treatment?'

NHS England 2013:

Our guiding principle for success is receiving positive feedback from patients and NHS staff on whether they would recommend treatment at their hospital to their friends and family.
What do you think?

Discussion points:
1. What do the changing regimes and emphases tell us about policy directions and assumptions: about the relationship of the service user to professionals /organisations about the relationship of the state (or its representatives) to service providers Think about choice and autonomy

2. What is the relationship between quality monitoring /inspection, and high quality services (or quality improvements)?