Quality Mechanisms in the NHS

Question 1

Quality Mechanisms in the NHS

Answer 1

• National Quality Board (NQB)
• Health and Wellbeing Boards
• NHS Outcomes Framework
• Clinical Governance

Question 2

Regulators

Answer 2

• Care Quality Commission (CQC)
• Healthwatch England and Local Healthwatch
• NHS Improvement (Discussed in later session)
Also:
• National Institute for Health and Care Excellence (NICE)
• UK Health Security Agency and Office for Health Improvement and Disparities (Discussed in later session)

Question 3

Dimensions to Quality in Healthcare

Answer 3

Services must be:
• Well-led
• Use resources sustainably
• Equitable for all

And:
• Clinical Effectiveness
• High Quality Care 
• Patient Safety
• Positive Patient Experience

Question 4

High Quality Patient Care

Answer 4

Involves:
• Healthcare professionals
• Provider organisations
• Commissioners
• System and professional regulators
• National bodies e.g. Department of Health and Social Care

Question 5

National Quality Board (NQB)

Answer 5

• Remit to provide coordinated leadership for quality across the NHS
• Only place where national organisations tasked with safeguarding and improving quality come together
• Advises on priorities for clinical standards – informs work of National Institute for Health and Care Excellence (NICE)

Works to:
• Improve quality in all that the NHS does nationally
• Support local quality improvement with providers, commissioners, users of services
• Identify new challenges and opportunities to improve quality

Recent aims:
• support delivery of the Long Term Plan’s ambition for quality in the NHS, while encouraging high quality care for all across all of health, public health and social care
• supporting system transformation and the integration of care and outcomes
• understanding and addressing unwarranted
variation and inequalities
• supporting learning and recovery from COVID-19

Question 6

Health and Wellbeing Boards

Answer 6

Key leaders from the health and care system:
• work together to improve the health and wellbeing of their local population and reduce health inequalities
• collaborate to understand their local community’s needs, agree priorities and encourage commissioners to work in a more joined-up way

Question 7

NHS Outcomes Framework

Answer 7

• Set of indicators developed by Department of Health and Social Care to monitor health outcomes of adults and children in England
• Provides an overview of how the NHS is performing
• Enshrined in Health and Social Care Act 2012
• NHS OF will be published on an annual basis from March 2022 onwards
• Sets national outcomes that all providers of NHS-funded care should be contributing towards
• The Framework sets 5 overarching outcomes or domains which summarise what the NHS should be
aiming to achieve for patients

Question 8

Domains of the NHS Outcomes Framework

Answer 8

Effectiveness:
Domain 1
• Prevent people dying prematurely

Domain 2
• Enhancing quality of life for people with long-term conditions

Domain 3
• Helping people to recover from episodes of ill health or following injury

Patient Experience:
Domain 4
• Ensuring people have a positive experience of care

Patient Safety
Domain 5
• Treating and caring for people in a safe environment and protecting them from avoidable harm

These 5 domains try to capture what the NHS should be doing for patients, translating the definition into real terms

Question 9

Purpose of the NHS Outcomes Framework

Answer 9

• National level overview of how the NHS is performing which public and Parliament can hold Government to account for progress
• Act as an accountability mechanism between Secretary of State for Health & Social Care and NHS England
• Act as catalyst for driving quality improvement and measurement of outcomes throughout the NHS

Question 10

NHS Health Checks

Answer 10

• NHS Health Checks – available to all adults in England 40 – 74
• Assess risk of stroke, kidney disease, heart disease, type 2 diabetes or dementia
• Looks at age, gender, family history, ht, wt, BP, cholesterol
• Found to be cost effective and clinically beneficial

Question 11

Clinical Governance

Answer 11

‘a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’

Question 12

Principles of Clinical Governance

Answer 12

• Clear lines of responsibility and accountability for the overall quality of clinical care
• Comprehensive programme of quality improvement systems (clinical audit, evidence-based practice, clinical standards and guidelines, work-force planning and development)
• Education and training plans
• Clear policies aimed at risk management
• Procedures to identify and remedy poor performance

Question 13

Regulators

Answer 13

• Care Quality Commission (CQC)
• Healthwatch England and Local Healthwatch
• NHS Improvement

Care Quality Commission (CQC)
• Independent regulator of all health and social care services in England
• Role to ensure that care provided by hospitals, primary medical services, GPs (from 2013) dentists, ambulances, care homes, services in people’s own homes and elsewhere meets national standards of
quality and safety

Question 14

Rationale for developing CQC

Answer 14

• Integration of services
• One port of call for independent information on standards, safety and available provision
• Brings together best inspection and regulation methods
• Tough new powers to act on public’s behalf if services are unacceptably poor

Question 15

Priorities of the CQC

Answer 15

• Care centred on people’s needs
• Joined-up care
• Swift action to eliminate poor quality care
• Promoting high quality care
• Effective regulation

Question 16

CQC main activities

Answer 16

• Ensure care services meet fundamental standards
• Registration of care services that meet set standards
• Monitoring, inspecting and regulating care services
• Powers of enforcement – taking action if care services fail to meet fundamental standards
• Improving health and social care
• Mental Health Act visits – protecting rights of vulnerable people
• Listening to and acting on patient and public experiences
• Reporting health and social care information – performance ratings

Question 17

Healthwatch England

Answer 17

• Set up as part of NHS reforms
• An independent consumer champion for health and social care
• Specific remit to represent at a national level people using health and social services – the voice of the people
• Legal requirement for its views to be taken into account by Secretary of State, NHS England and Regulators including CQC

8 principles:
• Essential services
• Access
• A safe dignified and quality service
• Information and education
• Choice
• Being listened to
• Being involved
• A healthy environment

Question 18

Local Healthwatch

Answer 18

• There is a Healthwatch organisation covering every local authority area in England
• Have the power to enter and view
services
• Influence how services are set up and commissioned (through local Health and Wellbeing Board)
• Produce reports that will influence the way services are designed and delivered
• Produce information, support and advice about local services
• Pass information and recommendations to Healthwatch England and CQC