Transforming Community Services The Quality and Productivity Agenda

Tim Curry – Policy Department Kellie Norris – Eastern Region Kim Manley – Learning & Development Institute Ross Scrivener – Learning & Development Institute Linda Watterson - Learning & Development Institute

February 2010

What does productivity mean?

 It is the relationship between inputs and outputs  Usually expressed as labour cost per minute  It is relatively easy to measure staff time (an input) and the production of an item (an output)  However it is more problematic when focusing on the

quality

of what is produced  More so in a situation where relationship between inputs and outputs is unclear such as healthcare

What is the quality and productivity agenda about?

 NHS funding has risen from 37 billion in 2001 to 109 billion  Overall staff numbers have increased (inputs) but the number of patients treated (outputs) has not risen proportionately  This does not suggest people are not working as hard (or harder)  Complaints, readmissions, HAIs, and errors remain unacceptably high* although inpatient satisfaction is relatively high^  The quality/productivity agenda is about more effective use of existing inputs to produce more outputs (people treated) but with better outcomes ( ↑health status, ↓complication rates and errors). * Leatherman & Sutherland (2008) Quest for Quality: Refining the NHS Reforms. Nuffield Trust.

^ Picker Institute (2009) Key Findings Report for 2008 Inpatient Survey

Key quality and productivity issues

 This requires a revolution in the planning, funding and delivery of health services 

Effectiveness

– disinvest from low value interventions and ensure care provided is of benefit 

Safety

– extend strategies impacting on HAIs and other adverse events 

Transform care for people with Long Term Conditions

management and ways to prevent sudden deterioration – focus on self 

Ill health prevention

– implement measures for healthier communities 

Incentives

– reward quality, efficiency and long term care outside hospital and encourage competition on elective care, discourage rise in emergency care

How does the quality and productivity agenda affect me?

 Delivering on this agenda will involve radical changes to practice  Roles may change as well as the context of care  With change comes opportunity as it will be impossible to deliver the scale of change without staff and creating opportunities for innovation and creativity  But conversely some services will change completely or be made obsolete

What is the RCN doing?

 Politically and professionally the RCN has shaped the quality/productivity agenda  Focus on patient-centred care delivered by high quality nursing staff  RCN is involved in developing, commissioning and accrediting evidence for practice  RCN works closely with NICE, SIGN and GAIN in appraising new technologies and defining evidence-based practice  Locally the RCN builds links with providers and commissioners and is working hard to ensure the NHS makes the most of its staff

How can I show that I am productive?

 That depends on what you do and how much autonomy you have in practice  Be aware of: – national and mandatory targets – local targets  Sources of this kind of intelligence probably already exist e.g. increased patient numbers linked to complaints and or reported errors  Clinical coding depts, clinical governance teams, trust board reports, finance reports etc. can provide this kind of information.

How can I measure my productivity?

 Lowest level of measurement will be at team or service level although specialist nurses may require some individual measure of effectiveness  You may find a range of tools in use to show a picture of quality/productivity e.g. clinical dashboards  You will need to communicate the story in the figures by combining the different measures into one narrative  Keep it simple – the focus should be efficiency and patient health gain  Find out who is leading on this agenda where you work and find out how you can contribute positively to it  end point, improving the quality of care is Remember measurement is not the

What is the RCN saying about productivity?

 We should aspire to be a more productive health service  But it must retain a person centred approach aimed at delivering high quality care for all  Slash and burn policies make short term savings at the cost of damage to service delivery  Sustainable change is required

What is an outcome?

 …the end result of a process, series of events or steps  Outcomes are often measured by evaluating a series of events to deliver  The pattern that emerges gives a better understanding of whether an intended outcome is being achieved  Abertawe used an intervention called a SKIN bundle to reduce the risk of pressure ulcers and has achieved positive results

What is a Quality Account?

 A Quality Account is a publicly available report on the quality of services provided  From April 2010 all providers (acute, mental health, learning disability and ambulance services) will be required to produce one annually  Primary care and community services will follow

What is CQUIN?

 CQUIN stands for Commissioning for Quality and Innovation  Launched in April 2009 and makes a proportion of providers’ income conditional on achievement of quality and innovation standards  This amounts to about 5% of their income but will increase in time  This is the first incentive to focus on quality and may increasingly become a catalyst for change

Haven’t we been here before?

 The NHS has always been faced with the challenge of delivering high quality care within a predetermined budget  The current situation is unique and not solely due to economic pressures  Greater access to information about quality of services means closer scrutiny of public spending  Public have high expectations for service standards  The RCN believes that the current climate offers an opportunity to demonstrate the value and effectiveness of high quality nursing care

Further RCN online resources

 Clinical governance resource http://www.rcn.org.uk/development/practice/clinical_governance  Sign up for the clinical governance e-Bulletin http://www.rcn.org.uk/development/practice/clinical_governance/updates  Patient safety resource http://www.rcn.org.uk/development/practice/patient_safety  Learning Zone content (patient safety, clinical audit, preventing HAI etc.) http://www.rcn.org.uk/development/learning/learningzone  Watch out for public facing resources on: – Measuring for quality – Staffing and workforce issues – Implementation of evidence-based practice

Further online resources

NHS Institute for Innovation and Improvement provides further information on the following:  Quality, Innovation, Productivity and Prevention (QIPP) agenda http://www.institute.nhs.uk/cost_and_quality/qipp/cost_and_quality_homepage.html

 The Productive Ward http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html

 Productive Community Services http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_community_servi ces.html