SAMPLE TITLE WHY MEASURING QUALITY IS IMPORTANT Hilary Cass President Elect, RCPCH PATRON HRH The Princess Royal

SAMPLE TITLE NEXT STAGE REVIEW "We must have an unwavering, unrelenting, unprecedented focus on quality” Secretary of State, Rt Hon Alan Johnson, 30 June 2008.

SAMPLE TITLE DEFINITION OF QUALITY – NEXT STAGE REVIEW Term used with different meaning within the NHS and covers many aspects of service provision including Waiting times for treatment Convenience and accessibility Cleanliness of facilities Patient involvement Quality and effectiveness of clinical care LORD DARZI’S DEFINITION Care which is "clinically effective, personal and safe"

SAMPLE TITLE NHS INFORMATION CENTRE 2008 Survey of indicators in common use in secondary care Total number of indicators = 469 Number specific to children and maternity = 9 Number specific to child mental health = 2 Number specific to specialist paediatric care = 0 Number specific to general / neonatal paediatric care = 4 Of which - number strongly endorsed as useful = 3 (QoF – only 2 indicators relevant to children) CLINICAL INDICATORS SURVEY REPORT

SAMPLE TITLE A SERVICE WITH A QUALITY CHALLENGE How much is process a quality measure when outcomes are difficult to measures?

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CEMACH REPORT 2008 (ENGLAND) 26% of deaths - “identifiable failure in the child’s direct care” 43% of deaths – “potentially avoidable factors” Errors by staff with inadequate paediatric training or supervision especially commo n

SAMPLE TITLE All cause mortality in children aged 0-14 ©2011 by British Medical Journal Publishing Group: Wolfe I et al. BMJ 2011;342:bmj.d1277

SAMPLE TITLE FIRST ACCESS CARE 50% children with meningococcal disease sent home at first primary care consultation £20 million legal settlements Thompson Lancet 2006 Medical Defence Union

SAMPLE TITLE FIRST ACCESS CARE 75% asthma admissions preventable with better primary care Cost: over £7 million pa

SAMPLE TITLE PROBLEMS AT MACRO LEVEL Inconsistent expertise and diagnostic resources The primary- secondary care gap Overwhelmed with acute & minor illness, services for LTC fitting around acute care

SAMPLE TITLE SYSTEMIC ISSUES Current system design does not favour paediatric care!

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Current service configuration not sustainable Standards drawn up on clinical consensus Workforce arguments will not win hearts and minds of public Public understand but don’t accept financial arguments Case must focus on true quality indicators WINNING HEARTS AND MINDS

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DATA FROM USA US children received less than 50% overall indicated care in outpatients Paediatricians used more than 100 guidelines, but no single guideline except asthma used by more than 27% of paediatricians Majority of quality indicators based on routine OP care, but 40% of paediatric healthcare costs attributable to inpatient care Few indicators developed for children with special healthcare needs Kavanagh L, Adams W, Wang C. ADC 2009; 94:458-63

SAMPLE TITLE Identifying and tackling unwarranted variations in healthcare will improve both the quality and efficiency of the care provided, and deliver the best possible health outcomes for all children and young people. Dr Sheila Shribman National Clinical Director for Children, Young People and Maternity Services

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THE CLINICIAN – MANAGER STEREOTYPE DEFENDER OF CLINICAL QUALITY Instead of systems to improve the quality and reduce the cost of care, we will establish systems to improve the value of care. Helen Bevan Instead of systems to improve the quality and reduce the cost of care, we will establish systems to improve the value of care. Helen Bevan

SAMPLE TITLE THE END GAME QUALITY COST

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TRAINING EFFECTIVE IN DEVELOPING CLINICAL SKILLS

SAMPLE TITLE INCREASING EMPHASIS ON LEADERSHIP AND COMMUNICATION SKILLS

SAMPLE TITLE PROPOSAL: PEP MODEL FOR QI

SAMPLE TITLE QI MUST BE EMBEDDED ACROSS ALL COLLEGE DEPARTMENTS

SAMPLE TITLE SHARING AND ACTING ON POOR QUALITY Risk register remains unseen System being designed on the hoof Clinicians defending service variation and deficits must do so on sound QIs Strong mechanisms needed for sharing of information between local / regional services and College Lobbying must be on basis of evidence from front line

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