Driving improved quality in respiratory care - levers and tools from national policy Bronwen Thompson, Policy adviser to PCRS-UKJune 2013

●Healthcare policy is ultimately aiming to improve the care patients receive ●It’s therefore not just for managers ●Policy can be a lever to driving better care, and therefore a tool for clinicians ●Clinicians need to be promoting healthcare policy actively and driving its implementation Overview

Levers – mechanism to achieve what you want to while minimising effort 3

Why implementing policy is the business of clinicians 4 ‘Clinical leadership is putting clinicians at the heart of shaping and running clinical services, so as to deliver excellent outcomes for patients and populations, not as a one-off task or project, but as a core part of clinicians’ professional identity’ Clinical guidelines - developed by clinicians Quality standards - developed by NICE Outcomes strategy - developed by DH

Policy levers for respiratory care 5 CCG outcomes indicator set, Public health outcomes framework National NICE quality standards – COPD and asthma COPD and asthma outcomes strategy QOF – Quality and outcomes framework, DES Regional CQUINS Local Practice quality premium, LES NHS Outcomes Framework

NHS outcomes framework ●Measures how well the NHS is performing ●Organised around the 5 domains ●Relevant to respiratory disease: ●Domain 1:Mortality Potential years of life lost Under 75 mortality rate from respiratory disease ●Domain 2:Quality of life in LTCs Unplanned hospitalisations for chronic ambulatory care sensitive conditions Unplanned hospitalisations for young people under19 due to asthma ●Domain 3: Recovery from episodes of ill health Preventing emergency admissions in children with LRTI 6

Public health outcomes framework ●Similar format around 5 domains to address determinants of ill health ●Some shared with NHS ●Under 75 mortality rate for respiratory disease ●Maternal smoking ●Smoking in young people and in adults 7

CCG outcomes indicator set (OIS) ●Focuses on the outcomes CCGs have to deliver alongside their local priorities ●Same format as NHS outcomes framework – same 5 domains ●Some more specific opportunities in respiratory disease ●Domain 2: Improving functional ability in people with LTCs People with COPD and MRC dyspnoea score <3 to be referred to pulmonary rehab programme 8

CCG outcomes indicator set (OIS) ●Focuses on the outcomes CCGs have to deliver alongside their local priorities ●Same format as NHS outcomes framework – same 5 domains ●Some more specific opportunities in respiratory disease ●Domain 2: Improving functional ability in people with LTCs People with COPD and MRC dyspnoea score <3 to be referred to pulmonary rehab programme 9

NICE Quality standards ●Concise set of statements drawn directly from clinical guidelines ●Plan for – now up to 32 ●Commissioning guides accompany the QS Respiratory Quality standards ●COPD - July 2011 ●Asthma - February 2013 ●To follow: Smoking cessation – August 2013, and Idiopathic pulmonary fibrosis (IPF), pneumonia, obstructive sleep apnoea, bronchiolitis 10

New Structure of NHS in England – April Clinical Commissioning Groups (CCGs) 19 Commissioning Support Services/Units Department of Health NHS Trusts NHS England ~~~~~~~~~~~~ 4 outposts AreaTeams 27 N S MEME L Primary care practices

COPD Quality standard ●Statement 6. People with COPD meeting appropriate criteria are offered an effective, timely and accessible multidisciplinary pulmonary rehabilitation programme. 12

New Structure of NHS in England – April Clinical Commissioning Groups (CCGs) 19 Commissioning Support Services/Units Department of Health NHS Trusts NHS England ~~~~~~~~~~~~ 4 outposts AreaTeams 27 N S MEME L Primary care practices

COPD Quality standard ● Statement 7. People who have had an exacerbation of COPD are provided with individualised written advice on early recognition of future exacerbations, management strategies (including appropriate provision of antibiotics and corticosteroids for self-treatment at home) and a named contact. ● Statement 9. People with COPD receiving long-term oxygen therapy are reviewed in accordance with NICE guidance, at least annually, by a specialist oxygen service as part of the integrated clinical management of their COPD. ● Statement 12. People admitted to hospital with an exacerbation of COPD are reviewed within 2 weeks of discharge. 14

Asthma Quality standard ● Statement 8. People aged 5 years or older presenting to a healthcare professional with a severe or life-threatening acute exacerbation of asthma receive oral or intravenous steroids within 1 hour of presentation. ● Statement 10. People who received treatment in hospital or through out-of-hours services for an acute exacerbation of asthma are followed up by their own GP practice within 2 working days of treatment. ● Statement 11. People with difficult asthma are offered an assessment by a multidisciplinary difficult asthma service. 15

CQUINS and discharge bundles ●Regional level incentives 16

NW asthma CQUIN in children 17 The childhood asthma CQUIN payment framework enables commissioners to reward excellence by linking a proportion of healthcare providers’ income to achievement of local quality improvement goals. Since the first year of the CQUIN framework (2009/10), many CQUIN schemes have been developed and agreed. Introduction to Care Quality and Innovation (CQUIN) Pennine Acute hospitals NHS Trust, Manchester

Policy levers for respiratory care 18 CCG outcomes indicator set, Public health outcomes framework National NICE quality standards – COPD and asthma COPD and asthma outcomes strategy QOF – Quality and outcomes framework, DES Regional CQUINS Local Practice quality premium, LES NHS Outcomes Framework

Quality premium – CCGs – 2013/14 19 Four national measures Reducing potential years of lives lost through amenable mortality: the overarching objective for Domain 1 of the NHS Outcomes Framework; 12.5% Reducing avoidable emergency admissions: a composite measure drawn from four measures in Domains 2 and 3 of the NHS Outcomes Framework; 25% Ensuring roll-out of the Friends and Family Test and improving patient experience of hospital services, based on one of the overarching objectives for Domain 4 of the NHS Outcomes Framework; 12.5% Preventing healthcare associated infections, based on one of the objectives for Domain 5 of the NHS Outcomes Framework. 12.5% Three local measures based on local priorities 62.5% 37.5%

PCRS-UK supports the implementation of policy NHS England ~~~~~~~~~~~~ 4 outposts 211 Clinical Commissioning Groups (CCGs) 19 Commissioning Support Services/Units AreaTeams 27 Department of Health N S MEME L Public Health England NHS Trusts Primary care practices

PCRS-UK supports the development of levers to drive policy uptake NHS England ~~~~~~~~~~~~ 4 outposts 211 Clinical Commissioning Groups (CCGs) 19 Commissioning Support Services/Units AreaTeams 27 Department of Health N S MEME L Public Health England NHS Trusts Primary care practices NICE

●There is a range of policy levers to drive improvement in clinical practice locally ●Clinicians have a key role to play in driving implementation of policy ●PCRS-UK supports its members in identifying and exploiting the policy levers that exist to drive improvements in respiratory disease locally Summary