commission for health improvement chi: the national perspective emilie roberts development manager...
TRANSCRIPT
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Commission forHealth Improvement
CHI: The national perspective
Emilie RobertsDevelopment Manager
10 December 2003
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This presentation will cover1. Who we are and what we do
2. A bit about the review process
3. What are we finding?
4. Some reflections
5. From CHI to CHAIHow it works
Hints and tips
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CHI’s aim
To bring about demonstrable improvement in the quality of NHS patient care throughout England and Wales
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CHI’s principles patient centred independent, rigorous and fair developmental evidence based open and accessible apply the same expectations to
ourselves
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An overview: what does CHI do?
National performance
ratings national NHS
patient and staff surveys
national clinical audit programme
national reports
Local clinical
governance reviews
investigations
NSF studies
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Clinical governance reviews What is it like to be a patient here?
How good are the PCT’s systems for safeguarding & improving quality of care?
What is the PCT’s capacity for improving?
The review does not assess: the performance of individuals
or individual practices
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The review process1. Scheduling
2. Data collection
3. Meetings
4. Site visits
5. Report
6. Action planning
Why me?
Why not me?
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The review process1. Scheduling
2. Data collection
3. Meetings
4. Site visits
5. Report
6. Action planning
PCT data request
Practice survey
Routine data
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The review process1. Scheduling
2. Data collection
3. Meetings
4. Site visits
5. Report
6. Action planning
Partner organisations
Patients & public
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The review process1. Scheduling
2. Data collection
3. Meetings
4. Site visits
5. Report
6. Action planning
Review manager
Plus team of seconded ‘reviewers’
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The review process1. Scheduling
2. Data collection
3. Meetings
4. Site visits
5. Report
6. Action planning
Publicly available
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The review process1. Scheduling
2. Data collection
3. Meetings
4. Site visits
5. Report
6. Action planning
“It can be put on the shelf and forgotten about. It’s not an ongoing audit. No one goes back to check”
Trust coordinator quoted in the Daily Telegraph, 01.12.2003
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The review process1. Scheduling
2. Data collection
3. Meetings
4. Site visits
5. Report
6. Action planning
“It can be put on the shelf and forgotten about. It’s not an ongoing audit. No one goes back to check”
Trust coordinator quoted in the Daily Telegraph, 01.12.2003
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The practice surveysExample – patient and public involvement in
general practice (570 practices in sample)
83% report little progress in involving patients/users Of these, half had received no advice from the PCT
Almost all general practices have a policy for complaints Only 2/3 have any system for learning from
compliments
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Site visits: visiting and interviewing PCT managers, professionals & staffFocus is
your experience of systems in place to improve quality and safeguard patient safety
patient experience (visits include some observation of the environment)
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Can you have confidence in the findings?
Reported findings must be strongly supported by evidence
Individuals and practices are not named or identified in the report
“CHI has serious concerns over fire risk in some practices. There was inconsistency across practices of fire exits, training, visibility of extinguishers, evidence of fire drills, procedures and signed escape routes….”
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Hints and tips Prepare wisely
Tell us about your PCT
Manage expectations
Facilitate the site visits
Shout about the things you do well, and
Be honest about the areas that need improvement
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What is CHI finding in PCTs (1)Access
PCTs are generally meeting NHS plan targets for general practice but there are problems in some areas
Patients having difficulty accessing NHS dentistry in some areas
CHI commonly finds long waits for physiotherapy and other therapy services
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What is CHI finding in PCTs (2)Leadership
Staff generally like working in PCTs. They report that CEOs are visible and approachable
But, in many PCTs the PEC does not seem to be fulfilling its role as the ‘engine room’
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What is CHI finding in PCTs (3)Impact on local community
CHI finds increasing use of extended roles
PCTs are involving patients and carers in developing specific services
Commissioning is underdeveloped
PCTs are struggling to implement robust monitoring arrangements
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Reflections on CHI The review team
Consistency
One size fits all
Making a difference
Regulatory burden
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The future - CHI to CHAI
April 2004 - Commission for Healthcare Audit and Inspection
Aim is still improvement in patient care Activity will be targeted &
proportionate Focus on organisations and services Explicit standards Greater coordination of regulation in
health care
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“Inspection by outsiders (ie those who do not provide care) exerts an effect on care only through the behaviours and actions of insiders (those who do provide care).
If we want inspection to affect quality, we must begin by asking how those who are inspected may affect quality”
Brennan and Berwick, 1996
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Commission forHealth Improvement
www.chi.nhs.uk