Transforming Community Services The Quality and Productivity Agenda

1. Transforming Community ServicesThe 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

2. 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

3. 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

4. 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 – focus on self management and ways to prevent sudden deterioration • 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

5. 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

6. 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

7. 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.

8. 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 • Remember measurement is not the end point, improving the quality of care is

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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_services.html