Transcript The new driving force for improvement in the NHS

National Peer Review Programme
Specialist Palliative Care
Ruth Bridgeman / Julia Hill
Programme Director/ Deputy
Programme Director
Session 1:
Introduction and
Welcome
Aims of Today
To promote an understanding of then national peer review process
and specialist palliative care in the new healthcare environment
To feedback the evaluation of the peer review self-assessment
round 2012/2013.
To discuss and agree national core principles for specialist palliative
care services
To enable teams to cascade to others within their organisations
Sessions 2:
Background and Context of the
Specialist Palliative Care Measures
The National Peer Review Programme
• Hosted by NHS England as part of the Delivery Team within
NHS Improving Quality (NHSIQ).
• Positive support to retain the programme and expand the
remit to other disease types including Paediatric Diabetes,
Paediatric Neuroscience and Stroke Services
• A long term host will be confirmed in the summer.
• It is agreed it will be hosted by the NHS IQ until a suitable
host is agreed
How Peer Review Fits in the New
Health Environment
NHS England
National Peer Review
Programme
The Benefits of the Peer Review
Programme
•
Provision of disease specific information across the country together with
information about individual clinical teams which has been externally
validated
•
A catalyst for change and monitoring of service improvement
•
Provision of a directory of services
•
Speedy identification and resolution of immediate risks and serious
concerns to patients and or staff each year
The Benefits of the Peer Review
Programme
•
Engagement of a substantial number of front line clinicians in reviews
(3,143)
•
Rapid sharing of learning between clinicians
•
Better understanding of the key recommendations in the NICE guidance,
NICE standards or National Standards.
•
Provision of timely national benchmarked data, trend analyses and reports
that provide accessible public information about the quality of cancer
services www.mycancertreatment.nhs.uk;
The Scope of Peer Review
• all cancer services:
– 2011/12 2507 teams reviewed
– 1841 clinical teams and services
– Additional cross cutting services
– Networking groups
• other disease types and this years business plan covers:
– Roll out of a National Programme for Paediatric Diabetes Services Approx. 170 services
– Development of a National Programme for Stroke Services
– Development of a National Programme for Paediatric Neuroscience
Outcomes of Peer Review
Confirmation of the quality of services
Speedy identification of major shortcomings in the quality of services so
rectification can take place
Published reports that provide accessible public information about the quality
of services
Timely information for local commissioning (CCGs) as well as for specialist
commissioners (ATs)
Valid information which is available to other stakeholders
History and Context of Specialist
Palliative Care Peer Review
The revised Specialist Palliative Care (SPC) Measures are based on the requirements for SPC in
Chapter 9 of the NICE Guidance: Improving Supportive and Palliative Care for Adults with
Cancer (2004).
The measures have been revised from the previous SPC measures (2004) to take a number of
factors into account:
– the subsequent developments in SPC practice and network organisation
– developments in general supportive care which have been incorporated generically
into all site specific cancer measures
– the National End of Life Care Strategy 2008 and the NICE EOLC Quality Standard 2011
– strengthening the SPC multidisciplinary team (SPC MDT) so that each one has a
requirement for two consultants in palliative medicine as core members
– These changes have been undertaken in consultation with the national cancer peer
review SPC reference group, and subjected to national consultation.
Peer Review for SPC 2012/2013
This data presents a national overview of the findings from the Specialist Palliative
Care Review Programme in 12/13.
A total of 282 teams were included in the assessment for this period, comprising of
171 acute hospital MDTs and 111 hospice MDTs.
208 teams chose to complete a self-assessment (SA) only, whilst 34 teams chose to
complete both a self-assessment and an internal validation (IV).
40 (14%) teams did not complete an assessment (37 hospices and 3 Trusts).
Number of
teams
282
Number
Reviewed
242
SA
208
% compliance
(Median)
IV
34
77%
% compliance
(Mean)
75%
IR
5 (2%)
SC
15 (5%)
Peer Review for SPC 2012/2013
There were a number of high performing teams in 2012/2013;
•
11 teams (4%) achieved 100% compliance
•
126 teams (45%) achieved ≥ 80% compliance
However, there were also a small number of low performing teams;
•
11 teams (4%) had compliance of 50% or under
Peer Review for SPC 2012/2013
Sessions 3: Findings and
Recommendations from Self
Assessment 2012/2013
Vicki Morrey – External Consultant
Support to Networks and Providers
Purpose of visits and consultations:
• Clarify peer review requirements
• Establish a shared understanding
• Identify an agreed way forward for 2012/13
• Support SPC providers to agree an acceptable
definition of the MDT
• Highlight the benefits and advantages of
participation in the Peer Review process
Summary of Support Provided
29 visits were made across 22 Cancer Networks
Network visits included:
• Attendance at Network SPCG meetings
• Facilitated workshops
• Discussion groups
• Presentations
• One to one discusssion
Introduction to the Report
Aim of the report is to provide feedback and
make recommendations
Main focus is on the Service provider
Organisation and SPC MDT measures
All respondents remain anonymous
Introduction to the Report cont.
The report recommendations take account of:
• Emerging themes from Self assessment
narrative, workshops and discussions
• Identification of the core aims of SPC services
• Characteristics of SPC practice
• Impact of new NHS arrangements
• Shift of SPC from cancer to a more generic
focus
Introduction to the Report cont.
• The position of SPC in the End of Life Care
Pathway
• Appointment of National Director for End of
Life Care as an important point of reference
NB There was little or no evidence of resistance
towards the principle of Peer Review for SPC.
Many examples of creative and inspiring
practice
Key Findings
1. Configuration of Services
Overwhelming evidence of multi-professional
approach across all SPC services.
Different configurations in various settings
either as a consequence of limited resources
(e.g. hospital teams) or as indicated by need
(e.g. day services)
Key Findings cont.
The Peer Review Measures required:
• All SPC in-patient services in the network
should be covered by one SPC MDT
• All out-patient/community care services
should be associated with one SPC MDT
• All consultants in palliative medicine should
be core members of a SPC MDT
Key Findings cont.
This understanding of MDT created most
controversy
Two clear interpretations of a SPC MDT emerged
Self Assessment descriptions reveal either a
local (i.e. individual service) or a locality ( also
called co-ordinating or super)
A Locality team into which others refer is not the
usual model of practice
Key Findings cont.
No evidence of locality SPC MDTs in 12 networks
Only 1 network achieved locality wide MDTs
across all organisations
Remaining networks demonstrated a mix of
service configuration
Majority had been established in response to
the Peer Review requirements
Advantages of Locality SPC MDT
• Promoting increased integration
• Improved understanding of the function of
various providers across an area
• Providing an educational opportunity
• Sharing of knowledge and expertise
• Review of complex patients
• Wider MDT opinion/clinical challenge
Advantages of Locality SPC MDT cont.
• Improved team working
• Support for difficult decisions
• Enabled regular AHP involvement
Challenges of the Locality MDT
• Inconsistent interpretation of referral criteria –
inappropriate referrals
• Reluctance to refer - benefits not readily
understood – low referrals
• Unconvinced of need or usefulness
• Inadequate IT and administration
• Practical requirements onerous
• Staff time and additional workload considered
burdensome
• Effort outweighed benefit
Summary
• All services show commitment to multiprofessional care
• Existence of SPC MDT in all units across all
services
• Self- Assessment reports demonstrate two
distinct interpretations of the SPC MDT
• Majority of organisations have measured
against a local single service MDT
Summary cont.
• Majority of Locality MDTs have been
established in response to the peer Review
requirements
• Most Locality MDTs have been in existence a
short period only and are yet to be evaluated
Contentious Measures
• Attendance at Advanced Communications
National Training Programme
• The SPCMDT should produce a report at least
annually on clinical trials
• The core team specific to specialist palliative
care should include two consultants in
palliative medicine
Emerging Themes
•
•
•
•
•
•
I.T. Requirements
Lack of Focus on Outcomes
Cancer MDT Association and References
Workforce Issues
Core Aims of SPC Services
Changes to the role of the Network
Recommendations
1. The report recommended that the following
measures be removed or allow increased
flexibility in the supporting evidence of
compliance.
• Attendance at Advanced Communications
Training Programme
• The SPC MDT should produce a report at least
annually on clinical trials1
Recommendations cont.
• The core team specific to SPC should include
two consultants in palliative medicine
• MDT agreement to Network 24hr telephone
advice service and 7 day visiting service
specifications
Recommendations cont.
2. SPC MDT
This is central to SPC practice
There needs to be greater consistency and
shared understanding of the definition and
model of practice
Recommendations cont.
3. Specialist Palliative Care Core Aims
SPC Peer Review measures would benefit from a
clearer statement of the core aims or principles
of SPC practice. Suggested as
• The management of patient care to be agreed
through a multi-professional approach,
including team discussion prior to decision
making
Recommendations cont.
• An integrated approach to care and robust
system of communication between care
settings
• Provision of an equitable out of hours service
Management of complexity is also a defining
characteristic of the SPC practitioner
Recommendations cont.
4. NHS Reforms
The SPC Peer Review Measures need to be
aligned with the new NHS framework and to
recognise the position of the National Director
for End of Life Care as an important point of
reference
Recommendations cont.
5. The position of Voluntary Hospices
Hospice participation should be encouraged but
to acknowledge their limitations with regard to
the required level of resource and capacity
6. Focus on Outcomes
Revision of the SPC Peer Review Measures
should adopt an outcome focused approach
Session 4:
Review of the Core Principles
SPC Advisory Group
Considerations
• The majority of clinicians support the concept of peer
review and welcome the opportunity to demonstrate
excellence in practice.
• The peer review process is also generally regarded as a
constructive mechanism for service development.
• The report of Mid Staffordshire NHS Foundation Trust
Public Inquiry (Robert Francis Jan 2013) pointed out
that the creation of a caring culture would be greatly
assisted if all those involved in the provision of
healthcare are prepared to learn lessons from others
and to offer up their own practices for peer review.
• The current lack of SPC service specification
SPC Advisory Group
Recommendations
• Further revision of the measures
• Services agreement to Core Principles
• Maintain momentum for service development
by encouraging teams to continue to self
assess focussing on measures and statements
that support the core principles
• Work with NCD for EOLC to support the
development of service specification
Core Principles
Specialist palliative care services are invited to
agree to core principles that underpin the
delivery of specialist palliative care services.
Core Principles
1. Receive care that is safe, effective and
responsive delivered by a multi-professional
team who are specialists in palliative care.
Core Principles
2. Experience care that is coordinated and
integrated across all settings, with robust
handover arrangements and communication
between generalist and specialist professionals,
involving them in decision making about their
care.
Core Principles
3. Be confident of receiving an equitable
specialist service appropriate to their needs
both during working hours and out of hours.
Discussion of the Core Principles
Group Work
Feedback on the core Principles
• Each table to feedback on each of the
principles
• Completion of the core principles form
Session 5: Next steps
Cancer Peer Review Programme
• The Peer Review programme will work with the
National Clinical Director for End Life Care
• The Peer Review Measures will be revised during
2013 in light of the evaluation and national policy
• SPC services will be able to self assessment against
the core principles if they wish
• No External Verification will take place in
November/December 2013.
Thank You
Any Questions?