Title: Commission for Health Improvement
1Commission forHealth Improvement
- CHI The national perspective
- Emilie RobertsDevelopment Manager
- 10 December 2003
2This presentation will cover
- Who we are and what we do
- A bit about the review process
- What are we finding?
- Some reflections
- From CHI to CHAI
- How it works
- Hints and tips
3CHIs aim
- To bring about demonstrable improvement in the
quality of NHS patient care throughout England
and Wales
4CHIs principles
- patient centred
- independent, rigorous and fair
- developmental
- evidence based
- open and accessible
- apply the same expectations to ourselves
5An 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
6Clinical governance reviews
- What is it like to be a patient here?
- How good are the PCTs systems for safeguarding
improving quality of care? - What is the PCTs capacity for improving?
- The review does not assess
- the performance of individuals or individual
practices
7The review process
- Scheduling
- Data collection
- Meetings
- Site visits
- Report
- Action planning
8The review process
- Scheduling
- Data collection
- Meetings
- Site visits
- Report
- Action planning
- PCT data request
- Practice survey
- Routine data
9The review process
- Scheduling
- Data collection
- Meetings
- Site visits
- Report
- Action planning
- Partner organisations
- Patients public
10The review process
- Scheduling
- Data collection
- Meetings
- Site visits
- Report
- Action planning
- Review manager
- Plus team of seconded reviewers
11The review process
- Scheduling
- Data collection
- Meetings
- Site visits
- Report
- Action planning
Publicly available
12The review process
- Scheduling
- Data collection
- Meetings
- Site visits
- Report
- Action planning
It can be put on the shelf and forgotten about.
Its not an ongoing audit. No one goes back to
check Trust coordinator quoted in the Daily
Telegraph, 01.12.2003
13The review process
- Scheduling
- Data collection
- Meetings
- Site visits
- Report
- Action planning
It can be put on the shelf and forgotten about.
Its not an ongoing audit. No one goes back to
check Trust coordinator quoted in the Daily
Telegraph, 01.12.2003
14The practice surveys
- Example 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
15Site visits visiting and interviewing PCT
managers, professionals staff
- Focus is
- your experience of systems in place to improve
quality and safeguard patient safety - patient experience (visits include some
observation of the environment)
16Can 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.
17Hints 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
18What 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
19What 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
20What 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
21Reflections on CHI
- The review team
- Consistency
- One size fits all
- Making a difference
- Regulatory burden
22(No Transcript)
23The 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
24Inspection 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
25Commission forHealth Improvement