Paul Lelliott

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Paul Lelliott

• Director
• Royal College of Psychiatrists Research and
  Training Unit

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Royal College of Psychiatrists

• The professional body for psychiatrists in the
  UK and Ireland
• Nearly all senior psychiatrists are members
• A charity whose aims include to improve
  professional and service standards

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Quality improvement programmes

• Common elements
• Large-scale networks of services
• Utilise audit cycle
• Assume that clinical and service quality are
  inseparable
• Involve other professional bodies and user/carer
  groups
• Members include public and private providers
• Standards-based self and peer review
• Increasingly offering accreditation
• All moving towards funding by subscription

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Quality improvement programmes

• QI Networks for
• Medium secure units
• Child mental health inpatients units
• Child mental health community services
• Services for people who self-harm
• Therapeutic communities
• Accreditation for
• ECT clinics
• Acute psychiatric wards
• Also offer accreditation

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Funding and participation

• 5 networks 100 funded by subscriptions
• Rest moving in that direction
• All but 2 were pump-primed
• Once in, almost nobody drops out
• There is a typical adoption curve
• There is a tipping point
• Usually front-line staff agitate to join

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Levers for improvement

• Participation in self-review against standards
• Feedback and benchmarking
• Training and education
• Communication/networking
• visits to other services as peer-reviewer, annual
  forum
• e-mail discussion, newsletters, position
  statements
• Supported action planning
• Bringing outside influences to bear
• accreditation (creates pressure to put things
  right)
• letters/presentations to CEOs
• Regulator receives lists of accredited services
• service commissioners (setting commissioning
  standards)

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Why professional bodies can do this

• Authority, credibility and expertise
• Natural source of clinical standards
• Can get the clinicians on board
• Have longevity (unlike Governments,
  administrations and policies)
• Can set an agenda based on service priorities (as
  opposed to political priorities)

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Challenges

• Professional bodies
• are viewed as having vested interests
• can be conservative and reactive
• authority is inferred and not direct
• Appearance of collusion with members leading to
  dilution of credibility
• Collusion with regulators could dilute
  independence and alienate members

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The future?

• Regulators/commissioners expect services to
  participate
• Accreditation becomes the benchmark
• Networks replace Government inspection
• Networks set the agenda for policy, service
  planning and service development
• For clinicians, participation linked to
  re-certification

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• www.rcpsych.ac.uk/ccqi