Safe, high quality care for all – the importance of accreditation Fiona Carragher @DepCSOFiona Deputy Chief Scientific Officer Apr 2017

The push for Quality We are what we repeatedly do. Excellence, then, is not an act, but a habit. Aristotle “Transparency about quality has helped care improve” NHS Five Year Forward View

The drivers of change in healthcare Demographics Scientific Advance Expectations Social, political, economic, environmental Service models Care & Quality Gap Health & Wellbeing Gap Finance & Efficiency Gap Utilising technology & information Improving integration New models of Care Multiprofessional working Carter efficiency review (2016) Introducing and sustaining minimum quality standards will address these gaps. Doing so will give assurance to: Local and specialised commissioners – services are being delivered to appropriate quality standards Patients and carers – standards are the same wherever they receive their care Organisations – standardisation to improve effectiveness and reduce inefficiencies.

The value of accreditation With accreditation, services can demonstrate that they: meet performance standards sustainably & support continuous improvement deliver clinical and administrative practices professionally focus on patient safety and high quality of care have appropriate resources, facilities and workforces Accreditation provides: Commissioners - independent assurance of quality and safety Patients - drives care quality of care for patients, Services - delivers efficiency and productivity Informs commissioning decision-making, secures quality assurance knowledge & is increasingly uses in service assessment & contracting

Accreditation schemes A 25 year track record of NHS experience in using accreditation to assure standards and drive improvement HOWEVER Uptake still variable Much more scope to collaborate & share good practice ACCREDITATION SCHEMES JAG GI Endoscopy CEPSS Engineering & Physical Sciences Others POCT, Med Devices IQIPS Physiology ISO 15189 Medical Labs (Path & Genetics) ISAS Imaging

Why isn’t uptake happening faster? Attitude to & appetite for accreditation Interest vs influence to make it happen Engagement - Barriers Identified through a ‘deep-dive’ of accreditation initiatives country-wide Attitude towards and appetite for accreditation Of the 34 stakeholders consulted everyone was positive that accreditation is a good thing as a benchmark of quality and all wanted to work towards it or achieve it. It is perceived as a badge or mark of quality for the services they provide. Interest versus influence to make it happen Of the people that were interested in their services being accredited they had no or very little influence to make it happen and required executive engagement to mobilise the internal resources and support. Support required for implementation and accreditation There are three levels of support required, national, regional and local. It was perceived that much more can be done to reduce the process and administrative burden at all levels. A range of support recommendations were identified and ranged from greater transparency and ease of access to the organisations and teams going through accreditation, to developing networks nationally regionally and locally for support. The creation of shared portals to house a repository of case studies and examples of documents or procedures that could be shared and then localised. It was also proposed that the timescales for completion of the process are too long and nurture change fatigue. Perceived benefits Support required for implementation

Driving uptake of accreditation A number of leading trusts have secured board-level support for accreditation programmes: University Hospitals Birmingham (UHB) and Imperial Healthcare Trust (London) for comprehensive trust-wide accreditation. Cambridge Hospitals for trust-wide IQIPS. Key role for Lead Healthcare Scientists Major initiatives – eg NHS Genomic Medicine Centres are driving accreditation across hospital networks

Crucial for inspection and patient assurance Accreditation now forms a cornerstone of the evidence gathered by the CQC as part of their inspection regime: “We will look at how we can work more effectively with our partners by using each other’s information, such as accreditation schemes” CQC, Shaping the future 2016-2021: What our strategy means for the health and adult social care services we regulate “We believe that… all services need to meet recognised and independently assessed standards that ensure provision is fit for purpose… To give parents of deaf children the assurances they need about the quality of provision, all services should be accredited.” National Deaf Children’s Society, Lessons from accredited paediatric audiology services, 2015

Why accreditation? Develops culture of quality and reflection Improves care standards and outcomes Reduces cost to system & patients of unwarranted variation Commissioning push – becoming a contractual obligation Inspection requirement Staff morale External improvement support Productivity/ Sustainability – STPs & Carter VISION: All scientific & diagnostic services accredited to support safe, high quality care for all Providers: encourage all services to achieve accreditation & improve quality Commissioners: uses accreditation to identify & select high quality services

The push for Quality Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skilful execution; it represents the wise choice of many alternatives. War hero William A Foster (after John Ruskin)