SCRUTINY: AN INTEGRAL PART OF IMPROVEMENT

• the Scottish context• Quality Strategy• external confidence and assurance at a time of financial constraint and rising expectations• shifting balance in power between health professionals and patients• integration of care - regulation & scrutiny with fewer boundaries

CONTEXT

MID STAFFORDSHIRE

INTEGRATED CYCLE OF IMPROVEMENT

TIMELINE

6th June 2011Cabinet Secretary announcement directing HIS to undertake inspections of care of older people in acute care

29th November 2011Scottish Parliament Health and Sport Committee Report published on Inquiry into the Regulation of Care for Older People

1st December 2011Letter to Chair HIS setting out the policy context from Director General

TIMELINE

October – January 20126 test inspections completed

3rd February 2012Letter to Chief Executive, HIS asking for the formal programme of inspections to commence as swiftly as possible

6 INSPECTIONS UNDERTAKEN• Western Infirmary 21st February• Hairmyres Hospital 5th March• Royal Alexandra Hospital 14th March• Western General Hospital 11th April• Glasgow Royal Infirmary 2nd May• Wishaw General Hospital 28th May

Reports published with improvement action plans

INTEGRATED CYCLE OF IMPROVEMENT

• Inspection of Older People’s Services in acute care

• Learning from other reports

• Improving Older People’s Care in Acute Hospital programme

• Key themes adapted to other work

• Local self assessment • Local inspection report• Older People in Acute

Care Clinical Standards • National Care Standards• Review of literature:

CAAP process (April 2012)

• Relevant reports eg Audit Scotland

AREAS OF STRENGTH• Caring behaviours of staff, taking account of privacy,

dignity and respect

AREAS OF IMPROVEMENT

• Staff don’t always act to safeguard the best interests of patients with dementia, their families and carers(legal and ethical implications)

• Food, fluid and nutrition• Pressure ulcer care

BUILDING THE IMPROVEMENT PROGRAMME

USING THE EVIDENCE

• Patient and User feedback• Observation in the ward• Research and evidence • Reports and Reviews• Standards of practice and care• Common Sense

• We know the size of the problem

• We know where we want to get to

• What are the few things which we know will make a difference ?

• How do we bring them together ?

WHAT NEXT ?

BUILDING THE IMPROVEMENT PROGRAMME

Research and Development. Driven by need

PrototypeIdeas shaped by small scale tests of change

Spread Good practice supported by Quality Improvement

Sustainability Part of normal workingensured by Scrutiny

Admission and Assessment

In-patient care Transitions

ContinenceDementia Falls

Nutritional care

Tissue Viability

Inspection Themes

1

2

3

Improving care for older people in acute hospital Integration of Scrutiny and Improvement

Improvement Plan

Local NHS board test

sites

Improving care for older people in acute hospital Integration of Evidence and Improvement

Nutritional care

MUST screen in 24 hours

Assistance at meal times

Hydration

Improving care for older people in acute hospital Integration of Evidence and Improvement

Falls

Environmental issues

Falls PreventionAssessment

THANK YOU

Any Questions ?

QUESTIONS

• What are the challenges/opportunities  in integrating inspection and improvement ?

• What opportunities do you see in integrating inspection and improvement of older people?

• How do you ensure the patient/carer is central to all scrutiny and improvement work?