© Nuffield Trust and Health Foundation © Nuffield Trust
23 October 2013
Time for QualityWatch?
Martin Bardsley
© Nuffield Trust and Health Foundation
Background
Release of the second Francis Report into mid staffs
Range of responsive studies including Keogh Reviews
Continuing headlines of failures within care – Morecombe Bay, Whipps Cross
Major organisational change within NHS
Prospect of continuing years of constrained finances
Critical period for quality and many organisations looking at it in new ways
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Aims
• provide an authoritative resource on the overall quality of health and social care;
• monitor and comment on changes over time independently of government and the statutory bodies;
• highlight where there are clear and compelling gaps between what is being achieved and what is possible in order to prompt action ; and
• contribute to improving measures of quality.
© Nuffield Trust and Health Foundation
Five year programme includes
Using sets of indicators to measure changes in the quality of care.
Deeper analyses on specific topics. First two published tomorrow
Annual overview report
Website www.qualitywatch.org.uk charts, analysis, blogs
Conferences, seminars
© Nuffield Trust and Health Foundation
© Nuffield Trust and Health Foundation
Website QualityWatch.org.uk
© Nuffield Trust and Health Foundation
Challenge of assessing quality…
Quality is multidimensional – does not easily fall into a handful of simple indicators.
Quality will vary between areas where services are provided, and vary over time
Danger of focussing in what's measured and missing the point
Time lag for change to work through the systems –good quality care may not be immediately visible
Our ability to use information improving – look forward to new and better metrics
© Nuffield Trust and Health Foundation
Structuring Indicators of Quality Numbers of existing indicators by domain and sector
Domain Social care
provision
Primary/
community
provision
Ambulance,
A&E and
secondary/
tertiary acute
care
Mental
health
provision
Population /
commission
ing Total
Access 13 46 75 41 9 184
Safety 11 66 160 82 7 326
Effectiveness 13 147 274 26 82 542
Person centred
care 18 27 159 77 5 286
Capacity 30 35 47 24 1 137
Equity 0 7 10 10 1 28
Total 85 328 725 260 105 1503
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Trends and blips. Diagnostic waiting times. Proportion of tests on the waiting list over 6 or 13 weeks (January 2006 to April 2013)
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An external perspective Life expectancy in years by country (1991 to 2011)
Source: Organisation for Economic Co-operation and Development (OECD),
Health data 2013
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Interrelated indicators: eg Number of days delayed based on care received by the patients (August 2011 to July 2013)
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Regional differences: eg Proportion of adults with learning difficulties in paid employment by region (2009/10 to 2012/13)
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Changes in staff over past decade
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Patients' responses to the question "In your opinion, were there enough nurses on duty to care for you in hospital?" (2005 to 2012)
Source: Care Quality Commission, Survey of Adult Inpatients
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Hiding behind the mean? Patients' responses to the question "Overall,
did you feel you were treated with respect and dignity while you were in the hospital?" (2002 to 2012)
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Proportion of patients who said that doctors or nurses talked in front of them as if they weren't there (2002 to 2012)
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Focus on Hip Fracture
Major health issue 50,000 admissions per year
Studied over 500,000 admission from 2001-2011 –
Look at change over time
- Incidence of fractures
- Survival (in/out of hospital)
- Operations with 24/48 hours
- Readmission and bed day use
- Differences by area deprivation
In depth studies allow us to use range of methods to understand a
particular aspect of care
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Trends in 30 day mortality following admission for hip fracture
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Mortality rates higher in more deprived areas
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General Observations ….
Many access indicators ‘holding up’. Urgent care is a critical area – and
though there have been wobbles we are still ahead of where we were
five years ago. Progress on prevention limited
Activity continues to increase – nurse staffing steady, beds reduced
Patient experience -paradox of surveys continuing to be positive
despite failings in care within individual organisations
Understanding safety still a challenge – progress from work on HAI
clear in other areas measurement of harms and supporting processes
still developing
Effectiveness – typically very specific markers and positive findings
Inequalities – stubbornly persistent
© Nuffield Trust and Health Foundation
Next Steps
Public release of website
Summary report due later this month
Refine existing indicators and extend them
Next range of hot topics (due in Autumn)
Social care spending and older people
Access to emergency care
Patterns of antidepressant prescribing
© Nuffield Trust and Health Foundation
www.qualitywatch.org.uk
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© Nuffield Trust and Health Foundation
23 October 2013
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