Driving improved quality in respiratory care - levers and tools from national policy Bronwen Thompson, Policy adviser to PCRS-UKJune 2013.

Driving improved quality in respiratory care

- levers and tools from national policy

Bronwen Thompson, Policy adviser to PCRS-UK June 2013

● Healthcare policy is ultimately aiming to improve the care patients receive

● It’s therefore not just for managers

● Policy can be a lever to driving better care, and therefore a tool for clinicians

● Clinicians need to be promoting healthcare policy actively and driving its implementation

Overview

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Levers – mechanism to achieve what you want to while minimising effort

4

Why implementing policy is the business of clinicians

‘Clinical leadership is putting clinicians at the heart of shaping and running clinical services, so as to deliver excellent outcomes for patients and populations, not as a one-off task or project, but as a core part of clinicians’ professional identity’

Clinical guidelines - developed by clinicians

Quality standards - developed by NICE

Outcomes strategy - developed by DH

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Policy levers for respiratory care

CCG outcomes indicator set, Public health outcomes framework

National NICE quality standards – COPD and asthma

COPD and asthma outcomes strategy

QOF – Quality and outcomes framework, DES

Regional CQUINS

LocalPractice quality premium, LES

NHS Outcomes Framework

6

NHS outcomes framework ● Measures how well the NHS is performing

● Organised around the 5 domains

● Relevant to respiratory disease:

● Domain 1:Mortality

Potential years of life lost

Under 75 mortality rate from respiratory disease

● Domain 2:Quality of life in LTCs

Unplanned hospitalisations for chronic ambulatory care sensitive conditions

Unplanned hospitalisations for young people

under19 due to asthma

● Domain 3: Recovery from episodes of ill health

Preventing emergency admissions in children

with LRTI

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Public health outcomes framework ● Similar format around 5 domains to address determinants of ill

health

● Some shared with NHS

● Under 75 mortality rate for respiratory disease

● Maternal smoking

● Smoking in young people and in adults

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CCG outcomes indicator set (OIS)● Focuses on the outcomes CCGs have to deliver alongside

their local priorities

● Same format as NHS outcomes framework – same 5 domains

● Some more specific opportunities in respiratory disease

● Domain 2: Improving functional ability in people with LTCs

People with COPD and MRC dyspnoea score <3 to be referred to pulmonary rehab programme

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CCG outcomes indicator set (OIS)● Focuses on the outcomes CCGs have to deliver alongside

their local priorities

● Same format as NHS outcomes framework – same 5 domains

● Some more specific opportunities in respiratory disease

● Domain 2: Improving functional ability in people with LTCs

People with COPD and MRC dyspnoea score <3 to be referred to pulmonary rehab programme

10

NICE Quality standards ● Concise set of statements drawn directly from clinical guidelines

● Plan for 150-180 – now up to 32

● Commissioning guides accompany the QS

Respiratory Quality standards ● COPD - July 2011

● Asthma - February 2013

● To follow: Smoking cessation – August 2013, and Idiopathic pulmonary fibrosis (IPF), pneumonia, obstructive sleep apnoea, bronchiolitis

New Structure of NHS in England – April 13

211 Clinical Commissioning Groups (CCGs)

19 Commissioning Support Services/Units

Department of Health

NHS Trusts

NHS England~~~~~~~~~~~~

4 outposts

AreaTeams27

N SME L

Primary care practices

12

COPD Quality standard● Statement 6. People with COPD meeting appropriate criteria

are offered an effective, timely and accessible multidisciplinary pulmonary rehabilitation programme.

New Structure of NHS in England – April 13

211 Clinical Commissioning Groups (CCGs)

19 Commissioning Support Services/Units

Department of Health

NHS Trusts

NHS England~~~~~~~~~~~~

4 outposts

AreaTeams27

N SME L

Primary care practices

14

COPD Quality standard

● Statement 7. People who have had an exacerbation of COPD are provided with individualised written advice on early recognition of future exacerbations, management strategies (including appropriate provision of antibiotics and corticosteroids for self-treatment at home) and a named contact.

● Statement 9. People with COPD receiving long-term oxygen therapy are reviewed in accordance with NICE guidance, at least annually, by a specialist oxygen service as part of the integrated clinical management of their COPD.

● Statement 12. People admitted to hospital with an exacerbation of COPD are reviewed within 2 weeks of discharge.

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Asthma Quality standard

● Statement 8. People aged 5 years or older presenting to a healthcare professional with a severe or life-threatening acute exacerbation of asthma receive oral or intravenous steroids within 1 hour of presentation.

● Statement 10. People who received treatment in hospital or through out-of-hours services for an acute exacerbation of asthma are followed up by their own GP practice within 2 working days of treatment.

● Statement 11. People with difficult asthma are offered an assessment by a multidisciplinary difficult asthma service.

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CQUINS and discharge bundles ● Regional level incentives

www.copdcarebundle.com

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NW asthma CQUIN in children

The childhood asthma CQUIN payment framework enables commissioners to reward excellence by linking a proportion of healthcare providers’ income to achievement of local quality improvement goals. Since the first year of the CQUIN framework (2009/10), many CQUIN schemes have been developed and agreed.

Introduction to Care Quality and Innovation (CQUIN)

Pennine Acute hospitals NHS Trust, Manchester

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Policy levers for respiratory care

CCG outcomes indicator set, Public health outcomes framework

National NICE quality standards – COPD and asthma

COPD and asthma outcomes strategy

QOF – Quality and outcomes framework, DES

Regional CQUINS

LocalPractice quality premium, LES

NHS Outcomes Framework

19

Quality premium – CCGs – 2013/14

Four national measures • Reducing potential years of lives lost through amenable mortality: the

overarching objective for Domain 1 of the NHS Outcomes Framework; 12.5%

• Reducing avoidable emergency admissions: a composite measure drawn from four measures in Domains 2 and 3 of the NHS Outcomes Framework; 25%

• Ensuring roll-out of the Friends and Family Test and improving patient experience of hospital services, based on one of the overarching objectives for Domain 4 of the NHS Outcomes Framework; 12.5%

• Preventing healthcare associated infections, based on one of the objectives for Domain 5 of the NHS Outcomes Framework. 12.5%

Three local measures based on local priorities

62.5%

37.5%

PCRS-UK supports the implementation of policy

NHS England~~~~~~~~~~~~

4 outposts

211 Clinical Commissioning Groups (CCGs)

19 Commissioning Support Services/Units

AreaTeams27

Department of Health

N SME L

Public Health

England

NHS Trusts

Primary care practices

PCRS-UK supports the development of levers to drive policy uptake

NHS England~~~~~~~~~~~~

4 outposts

211 Clinical Commissioning Groups (CCGs)

19 Commissioning Support Services/Units

AreaTeams27

Department of HealthN S

ME L

Public Health

England

NHS Trusts

Primary care practices

NICE

● There is a range of policy levers to drive improvement in clinical practice locally

● Clinicians have a key role to play in driving implementation of policy

● PCRS-UK supports its members in identifying and exploiting the policy levers that exist to drive improvements in respiratory disease locally

Summary