Transforming Community ServicesThe Quality and Productivity Agenda

Tim Curry – Policy Department

Kellie Norris – Eastern Region

Kim Manley – Learning & Development Institute

Ross Scrivener – Learning & Development Institute

Linda Watterson - Learning & Development Institute

February 2010

What does productivity mean?It is the relationship between inputs and outputsUsually expressed as labour cost per minuteIt is relatively easy to measure staff time (an input) and the production of an item (an output)However it is more problematic when focusing on the quality of what is producedMore so in a situation where relationship between inputs and outputs is unclear such as healthcare

What is the quality and productivity agenda about?

NHS funding has risen from 37 billion in 2001 to 109 billion Overall staff numbers have increased (inputs) but the number of patients treated (outputs) has not risen proportionately This does not suggest people are not working as hard (or harder) Complaints, readmissions, HAIs, and errors remain unacceptably high* although inpatient satisfaction is relatively high^ The quality/productivity agenda is about more effective use of existing inputs to produce more outputs (people treated) but with better outcomes (↑health status, ↓complication rates and errors).

* Leatherman & Sutherland (2008) Quest for Quality: Refining the NHS Reforms. Nuffield Trust.

^ Picker Institute (2009) Key Findings Report for 2008 Inpatient Survey

Key quality and productivity issues This requires a revolution in the planning, funding and delivery of health services Effectiveness – disinvest from low value interventions and ensure care provided is of benefit Safety – extend strategies impacting on HAIs and other adverse events Transform care for people with Long Term Conditions – focus on self management and ways to prevent sudden deterioration Ill health prevention – implement measures for healthier communities Incentives – reward quality, efficiency and long term care outside hospital and encourage competition on elective care, discourage rise in emergency care

How does the quality and productivity agenda affect me?

Delivering on this agenda will involve radical changes to practice Roles may change as well as the context of care With change comes opportunity as it will be impossible to deliver the scale of change without staff and creating opportunities for innovation and creativity But conversely some services will change completely or be made obsolete

What is the RCN doing?

Politically and professionally the RCN has shaped the quality/productivity agenda Focus on patient-centred care delivered by high quality nursing staff RCN is involved in developing, commissioning and accrediting evidence for practice RCN works closely with NICE, SIGN and GAIN in appraising new technologies and defining evidence-based practice Locally the RCN builds links with providers and commissioners and is working hard to ensure the NHS makes the most of its staff

How can I show that I am productive?

That depends on what you do and how much autonomy you have in practice Be aware of:

– national and mandatory targets

– local targets Sources of this kind of intelligence probably already exist e.g. increased patient numbers linked to complaints and or reported errors Clinical coding depts, clinical governance teams, trust board reports, finance reports etc. can provide this kind of information.

How can I measure my productivity? Lowest level of measurement will be at team or service level although specialist nurses may require some individual measure of effectiveness You may find a range of tools in use to show a picture of quality/productivity e.g. clinical dashboards You will need to communicate the story in the figures by combining the different measures into one narrative Keep it simple – the focus should be efficiency and patient health gainFind out who is leading on this agenda where you work and find out how you can contribute positively to it Remember measurement is not the end point, improving the quality of care is

What is the RCN saying about productivity?

We should aspire to be a more productive health service But it must retain a person centred approach aimed at delivering high quality care for all Slash and burn policies make short term savings at the cost of damage to service delivery Sustainable change is required

What is an outcome?

…the end result of a process, series of events or steps Outcomes are often measured by evaluating a series of events to deliver The pattern that emerges gives a better understanding of whether an intended outcome is being achieved Abertawe used an intervention called a SKIN bundle to reduce the risk of pressure ulcers and has achieved positive results

What is a Quality Account?

A Quality Account is a publicly available report on the quality of services provided From April 2010 all providers (acute, mental health, learning disability and ambulance services) will be required to produce one annually Primary care and community services will follow

What is CQUIN?

CQUIN stands for Commissioning for Quality and Innovation Launched in April 2009 and makes a proportion of providers’ income conditional on achievement of quality and innovation standards This amounts to about 5% of their income but will increase in time This is the first incentive to focus on quality and may increasingly become a catalyst for change

Haven’t we been here before? The NHS has always been faced with the challenge of delivering high quality care within a predetermined budget The current situation is unique and not solely due to economic pressures Greater access to information about quality of services means closer scrutiny of public spendingPublic have high expectations for service standards The RCN believes that the current climate offers an opportunity to demonstrate the value and effectiveness of high quality nursing care

Further RCN online resources Clinical governance resource

http://www.rcn.org.uk/development/practice/clinical_governance

Sign up for the clinical governance e-Bulletinhttp://www.rcn.org.uk/development/practice/clinical_governance/updates

Patient safety resourcehttp://www.rcn.org.uk/development/practice/patient_safety

Learning Zone content (patient safety, clinical audit, preventing HAI etc.)http://www.rcn.org.uk/development/learning/learningzone

Watch out for public facing resources on:– Measuring for quality– Staffing and workforce issues– Implementation of evidence-based practice

Further online resourcesNHS Institute for Innovation and Improvement provides furtherinformation on the following:

Quality, Innovation, Productivity and Prevention (QIPP) agendahttp://www.institute.nhs.uk/cost_and_quality/qipp/cost_and_quality_homepage.html

The Productive Wardhttp://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html

Productive Community Serviceshttp://www.institute.nhs.uk/quality_and_value/productivity_series/productive_community_services.html