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Martin Bardsley: Quality In Austerity-Indicators of Quality


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Martin Bardsley: Quality In Austerity-Indicators of Quality

  1. 1. Quality In Austerity - Indicators ofQualityMartin BardsleyDirector of Research, Nuffield TrustMarch 2013 © Nuffield TrustTwitter: #NTSummit
  2. 2. Why is HF/NT investing in work on quality?There is no inevitable inverse relationship between finance andquality but....• Financial pressure may divert attention from quality• Search for transformational changes in delivery may have unintended consequences (good/bad) on quality• Historically success in areas like waiting times and HAI linked with significant investment• Efficiencies likely to be sought in staffing• New organisational structures everywhere• Implications of austerity on health needs © Nuffield Trust
  3. 3. There a whole lotta monitoring going on support to the Public Health England commissioners Experience Inspection Data monitoring Contract Self monitoring NHS CB NHS Outcomes Framework. monitoring National Quality Dashboard and corporate intelligence Monitor NHS TDA CCGs Data CSUsDepartment of Health Performance Performance Contract management against third party information against plan objectives Data Data (eg QRP s) and Commercial analysts Care Quality inspection / investigation Provider Commission Information from Continuous Quality of education Professional people using services monitoring of Individual competence regulators quality HealthWatch Engagement Patients User-generated content Experience NHS Ombudsman Complaints organisations © Nuffield Trust
  4. 4. What can Health Foundation and Nuffield Trust add? Provides an independent overview of how quality of care is changing over time. Offers a view across different dimensions of quality that is not linked to any one provider or sectors. Enable flexible analysis of important quality issues as they arise, and uses a range of methodologies. Develops the methods used to measure quality, including innovative analyses across linked data sets at person-level. Looks across the care system and where possible include international comparators. © Nuffield Trust
  5. 5. Quality in Austerity Programme • 5 year, multi-stranded programme • Compliment existing initiatives looking at qualityDeveloping sets of indicators… Deeper analyses on ‘hot topics’……to measure changes in thequality of care over time across …building on our capacity to usecare settings. complex information to create new approaches and new perspectives on how the quality of care is changing within the NHS. © Nuffield Trust
  6. 6. Topic: Trends in Ambulatory Care Sensitive Admissions ACS admissions have increase by 40% in the last 10 years – will they continue to grow? 300,000Emergency admissions 250,000 200,000 150,000 100,000 50,000 0 Age-standardised rates of admission for ear, nose and throat infections, 2011/12 © Nuffield Trust
  7. 7. Individual indicatorsEffectiveness Access and timeliness Capacity Safety Patientcenteredness Equity © Nuffield Trust
  8. 8. An explosion of indicators… …but some areas better covered than othersOutcomes Frameworks, NICE, QRP, QIPP, QOF, Quality Accounts, Dashboards, Thermometers, Atlases… Primary and Secondary / tertiary provision Population / community General and Mental Social care commissioner Total provision acute health provision level Effectiveness 147 274 26 13 82 542 Access and timeliness 46 75 41 13 9 184 Capacity 35 47 24 30 1 137 Safety 66 160 82 11 7 326 Patient centeredness 27 159 77 18 5 286 Equity 7 10 10 0 1 28 Total 328 725 260 85 105 1503 © Nuffield Trust
  9. 9. Even more limited outside acute trustsSome areas better populated than othersHospital admin systems - strong on activity and coverage but limited detailGeneral Practice – massive data sets with untapped potentialAcute care specialist and clinical systems – hugely variableSocial Care – tend to be local, not shared. Major problem re self fundersCommunity Care – very variableIndependent Sector Care – very limited © Nuffield Trust
  10. 10. And an external body can only see so much in a complex organisation Corporate ClinicalVisibility ofperformance(quality) Though good data Community exists in places we still rely too much on HES based © Nuffield Trust
  11. 11. Failures in quality: the holy histogram theoryREGULATOR or COMMISSIONING COMMISSIONING (enforcement) (contracting) (contracting, choice, competition…) ‘IMPROVEMENT’ ‘IMPROVEMENT’ BODIES BODIES Number of organisations Non compliant Basket Weak OK Good Excellent Quality © Nuffield Trust
  12. 12. In an ideal world, quality indicators would be built from…1. The information we need to understand Social Healthclinical quality at organisational level and Hospital care GP statusabove should flow from information collected inthe course of people doing their jobsIncluding... Patients views, PREMS and PROMS2. Data linkage between these encounters /events / episodes at patient level is important:a. To make the most of what data we haveb. To measure outcome(“change in patient health status that can be attributed toantecedent health care”) © Nuffield Trust
  13. 13. Some of the most critical areas are the most challengingeg Information from care users Care Users – Surveys, F&F, Complaints, Individual reports/stories Patient reported outcome measures Staff perceptions Quality of medical treatments – limited information Patient outcomes – difficult to assign causality Capturing qualitative intelligence Improving these will help but no guarantee of predicting future failure © Nuffield Trust
  14. 14. So what do we need to do…A. Continue developing information from patients and staffB. Fill the gaps for services that are lacunae – OOH, community, independent sectors...C. Go beyond HES into the quality of services including clinical auditsD. Integrate the quantitative and qualitativeE. Link data to make the most of what there is and to assess consequences /outcomeF. Link the information to subsequent action.... © Nuffield Trust