PCT Director of Finance Development Programme

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Clinical quality standards accreditation
systems for service providers Robert
Sloane International Advisor
DH International
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Seven Principles of Public Life

• Selflessness
• Integrity
• Objectivity
• Accountability
• Openness
• Honesty
• Leadership

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50 Years of the NHS

• 1946 NHS Act
• 1948 NHS Formed
• 1962 Hospital Plan for England and Wales
• 1974 Major Structural Change
• 1984 Introduction of General Management
• 1989 Working for Patients (introduction of the
  internal market)
• 1997 The New NHS

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The NHS in England from April 2003
Department of Health
Strategic Health Authorities
NHS Trusts
Primary Care Trusts
-----------
-------------- Commissioning _________ Statutory
relationship
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NHS Trust Governance Model (Illustrative)
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Accountability Framework

• Six Key Functions
• Effective financial stewardship
• High standards of corporate and clinical
  governance
• Appoint, appraise and remunerate senior
  executives
• Set the strategic direction
• Monitor performance against objectivity
• Develop local partnerships

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Changing Context of Healthcare
Historical
Primary Care
Community Care
Secondary Care
Tertiary Care
Patient / Client
Emerging
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Policy context - Quality Assurance
Clear standards of service
National Institute for Clinical Excellence
National service frameworks
Dependablelocaldelivery
Professionalself-regulation
Clinicalgovernance
Lifelonglearning
Patient public involvement
Healthcare Commission National performance
framework National patient and user survey
Monitoredstandards
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The Health Quality Service
An independent charity which assists health care
organisations to continuously improve the quality
of their services, through the application of
relevant, achievable, measurable standards HQS
provides the means for independent evaluation and
accreditation
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Accreditation

• Based on peer review system of external audit
• The peer reviewers all experienced senior
  healthcare professionals
• All undergo selection and training
• Process aims to maximise added value of sharing
  experience not just assessment

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World-wide movement

• No longer enough to be confident of good clinical
  services
• We must be able to demonstrate that services are
  high quality through meeting standards targets
  
• There is a requirement to show that continual
  improvement is taking place.

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The accreditation approach

• Explicit standards are the basis of the framework
• Implementation period involving
• self assessment
• action planning
• development
• External assessment by peer review
• Accreditation award by independent committee

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Accreditation assessment is carried out by peer
review

• Peer
• An equal in terms of role, expertise and
  understanding

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Accreditation system based on standards

• Clarity among health providers and assessors of
  what is to be achieved
• Works to counter individual bias of assessors
• More that one way to achieve the standard
• Written report against each standard measures
  level of achievement

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The scope of standards

• Specific to health sector
• Customised to national law
• Cover
• professional practice
• the facilities where services are delivered
• the community experience of the service (patient
  and public)

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Type of standards

• Initially Structure and Process standards
• Organisational systems
• management structure, reporting lines, committee
  structures
• Documented processes for delivery
• policies, procedures, planning documents,
  content of training sessions

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Accreditation Key Activities
Establish the project
Standards distribution
Baseline assessment and action plans
Develop services
Internal audit
Pre-survey documents completed
Documentation review
Survey
Survey report
Further action
Accreditation and monitoring
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Standards Development Cycle
Issue to field
Research
Initial draft
Comments queries
Consult with Working Group
Survey against criteria
Revisions
Second Draft
Wider Consultation
Evaluate
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British experience

• Accreditation has been a useful tool to establish
  quality systems
• One third of hospitals signed up for voluntary
  accreditation
• An evolutionary stage to mandatory reviews and
  inspections by government agencies
• Evidence that organisations with accreditation
  are better prepared for inspection