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Time for QualityWatch?
Martin Bardsley

23 October 2013
© Nuffield Trust and Health Foundation

© Nuffield Trust
Background
Release of the second Francis Report into mid staffs

Range of responsive studies including Keogh Reviews
Conti...
Aims
• provide an authoritative resource on the overall quality
of health and social care;
• monitor and comment on change...
Five year programme includes
 Using sets of indicators to measure changes in the
quality of care.
 Deeper analyses on sp...
© Nuffield Trust and Health Foundation
Website QualityWatch.org.uk

© Nuffield Trust and Health Foundation
Challenge of assessing quality…
Quality is multidimensional – does not easily fall into a handful
of simple indicators.
Qu...
Structuring Indicators of Quality
Numbers of existing indicators by domain and sector

Domain

Social care
provision

Prim...
Trends and blips. Diagnostic waiting times.

Proportion of tests on the waiting list over 6 or 13 weeks (January 2006 to A...
An external perspective
Life expectancy in years by country (1991 to 2011)

Source: Organisation for Economic Co-operation...
Interrelated indicators: eg Number of days delayed based
on care received by the patients (August 2011 to July 2013)

© Nu...
Regional differences: eg Proportion of adults with learning
difficulties in paid employment by region (2009/10 to 2012/13)...
Changes in staff over past decade

© Nuffield Trust and Health Foundation
Patients' responses to the question "In your opinion, were there
enough nurses on duty to care for you in hospital?" (2005...
Hiding behind the mean?

Patients' responses to the question "Overall,
did you feel you were treated with respect and dign...
Proportion of patients who said that doctors or nurses talked in
front of them as if they weren't there (2002 to 2012)

© ...
Focus on Hip Fracture
Major health issue 50,000 admissions per year
Studied over 500,000 admission from 2001-2011 –
Look a...
Trends in 30 day mortality following admission for
hip fracture

© Nuffield Trust and Health Foundation
Mortality rates higher in more deprived areas

© Nuffield Trust and Health Foundation
General Observations ….
Many access indicators ‘holding up’. Urgent care is a critical area – and
though there have been w...
Next Steps
Public release of website

Summary report due later this month
Refine existing indicators and extend them
Next ...
www.qualitywatch.org.uk

Sign-up for our newsletter
www.qualitywatch.org.uk/newsletter
Follow us on Twitter:
Twitter.com/q...
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Martin Bardsley: Introducing QualityWatch

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Transcript of "Martin Bardsley: Introducing QualityWatch"

  1. 1. Time for QualityWatch? Martin Bardsley 23 October 2013 © Nuffield Trust and Health Foundation © Nuffield Trust
  2. 2. Background Release of the second Francis Report into mid staffs Range of responsive studies including Keogh Reviews Continuing headlines of failures within care – Morecombe Bay, Whipps Cross Major organisational change within NHS Prospect of continuing years of constrained finances Critical period for quality and many organisations looking at it in new ways © Nuffield Trust and Health Foundation
  3. 3. Aims • provide an authoritative resource on the overall quality of health and social care; • monitor and comment on changes over time independently of government and the statutory bodies; • highlight where there are clear and compelling gaps between what is being achieved and what is possible in order to prompt action ; and • contribute to improving measures of quality. © Nuffield Trust and Health Foundation
  4. 4. Five year programme includes  Using sets of indicators to measure changes in the quality of care.  Deeper analyses on specific topics. First two published tomorrow  Annual overview report  Website www.qualitywatch.org.uk charts, analysis, blogs  Conferences, seminars © Nuffield Trust and Health Foundation
  5. 5. © Nuffield Trust and Health Foundation
  6. 6. Website QualityWatch.org.uk © Nuffield Trust and Health Foundation
  7. 7. Challenge of assessing quality… Quality is multidimensional – does not easily fall into a handful of simple indicators. Quality will vary between areas where services are provided, and vary over time Danger of focussing in what's measured and missing the point Time lag for change to work through the systems –good quality care may not be immediately visible Our ability to use information improving – look forward to new and better metrics © Nuffield Trust and Health Foundation
  8. 8. Structuring Indicators of Quality Numbers of existing indicators by domain and sector Domain Social care provision Primary/ community provision Ambulance, A&E and secondary/ tertiary acute care Mental health provision Population / commission ing Total Access 13 46 75 41 9 184 Safety 11 66 160 82 7 326 Effectiveness Person centred care 13 147 274 26 82 542 18 27 159 77 5 286 Capacity 30 35 47 24 1 137 Equity 0 7 10 10 1 28 Total 85 328 725 260 105 1503 © Nuffield Trust and Health Foundation
  9. 9. Trends and blips. Diagnostic waiting times. Proportion of tests on the waiting list over 6 or 13 weeks (January 2006 to April 2013) © Nuffield Trust and Health Foundation
  10. 10. An external perspective Life expectancy in years by country (1991 to 2011) Source: Organisation for Economic Co-operation and Development (OECD), Health data 2013 © Nuffield Trust and Health Foundation
  11. 11. Interrelated indicators: eg Number of days delayed based on care received by the patients (August 2011 to July 2013) © Nuffield Trust and Health Foundation
  12. 12. Regional differences: eg Proportion of adults with learning difficulties in paid employment by region (2009/10 to 2012/13) © Nuffield Trust and Health Foundation
  13. 13. Changes in staff over past decade © Nuffield Trust and Health Foundation
  14. 14. Patients' responses to the question "In your opinion, were there enough nurses on duty to care for you in hospital?" (2005 to 2012) Source: Care Quality Commission, Survey of Adult Inpatients © Nuffield Trust and Health Foundation
  15. 15. Hiding behind the mean? Patients' responses to the question "Overall, did you feel you were treated with respect and dignity while you were in the hospital?" (2002 to 2012) © Nuffield Trust and Health Foundation
  16. 16. Proportion of patients who said that doctors or nurses talked in front of them as if they weren't there (2002 to 2012) © Nuffield Trust and Health Foundation
  17. 17. Focus on Hip Fracture Major health issue 50,000 admissions per year Studied over 500,000 admission from 2001-2011 – Look at change over time - Incidence of fractures - Survival (in/out of hospital) - Operations with 24/48 hours - Readmission and bed day use - Differences by area deprivation In depth studies allow us to use range of methods to understand a particular aspect of care © Nuffield Trust and Health Foundation
  18. 18. Trends in 30 day mortality following admission for hip fracture © Nuffield Trust and Health Foundation
  19. 19. Mortality rates higher in more deprived areas © Nuffield Trust and Health Foundation
  20. 20. General Observations …. Many access indicators ‘holding up’. Urgent care is a critical area – and though there have been wobbles we are still ahead of where we were five years ago. Progress on prevention limited Activity continues to increase – nurse staffing steady, beds reduced Patient experience -paradox of surveys continuing to be positive despite failings in care within individual organisations Understanding safety still a challenge – progress from work on HAI clear in other areas measurement of harms and supporting processes still developing Effectiveness – typically very specific markers and positive findings Inequalities – stubbornly persistent © Nuffield Trust and Health Foundation
  21. 21. Next Steps Public release of website Summary report due later this month Refine existing indicators and extend them Next range of hot topics (due in Autumn) Social care spending and older people Access to emergency care Patterns of antidepressant prescribing © Nuffield Trust and Health Foundation
  22. 22. www.qualitywatch.org.uk Sign-up for our newsletter www.qualitywatch.org.uk/newsletter Follow us on Twitter: Twitter.com/qualitywatch 23 October 2013 © Nuffield Trust and Health Foundation © Nuffield Trust and Health Foundation
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