1. Dr Ian Barnes Cellular Pathology NEQAS Birmingham Tuesday 29 th October 2013

2. Video at: http://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-englandhttp://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england

4.  Clinical effectiveness, patient experience, safety  Professionalism, leadership and governance  “make quality our primary concern”  Transparency, sharing intelligence, data and insight  Incident reporting, lesson learning  Interrogation of assurances of quality

5.  Learning and sharing are key drivers for quality improvement  Quality should be embedded in career plans from the first stages  Reducing unwarranted variation  “values and behaviours of staff” – culture and governance  Clarity of roles and responsibilities  Set out a Quality Framework

6.  Expectation of transparency both in terms of lab and staff performance and behaviour  Changing culture and governance by modifying values and behaviours  Clarity of roles and responsibilities  Strong leadership  A clear quality framework

8. “To identify whether there are any issues within quality assurance frameworks and governance at a national level in pathology services, and to make recommendations for addressing them.”

9.  Commissioned by the National Medical Director in response a localised Trust issue in immunohistochemistry  Board first met Jan 2013  Investigation through three workstreams, led by expert chairs, looking at tiers of the system: ◦ Individual responsibilities ◦ Provider and trusts responsibilities ◦ Whole-system responsibilities  Interim Report to Prof Sir Bruce Keogh in August 2013  Final report due late 2013

10. Stakeholder Engagement & Communications Pathology Quality Assurance Review Board Chair: Dr Ian Barnes Pathology Quality Assurance Review Board Chair: Dr Ian Barnes Review Management Team Project management Review Management Team Project management Professional Development Quality Assurance and Governance NHS National System NHS England NHS Medical Director, Prof Sir Bruce Keogh NHS England NHS Medical Director, Prof Sir Bruce Keogh Report any Clinical & Safety concerns to SofS

11.  Concise and focussed  Around 10 recommendations  “Reliable, Robust and Responsive”  Crafted to align and support NHS direction of travel  To be launched late 2013/early 2014

12.  A pragmatic definition of quality based on - Reliability, robustness, and responsiveness  Reliable: given the right question, services will provide the right answer  Robust: services will continually improve processes in the light of experiences  Responsive: capable of adjusting to varied needs of patients and clinical users, and of changing in response to demand, to user feedback and to developing technology and service requirements

13.  Oversight of pathology quality assurance  Commissioning  Governance of QA within Trusts  Transparency  Measures of performance  Education, training, roles  Information technology and management

14.  What exists already?  What is lacking?  Interrogation of data, management by exception

15.  Transparency?  Integration?  Verification?  Oversight?  Sanctions? SUIs SHOT MHRA CCGs Internal Governance Internal Assurance EQA Schemes CPA JWG (via NQAAPS) CQC

16.  Include requirements in the National Contracts  Highlight responsibilities of commissioners, “duty of care”  Access to data to assure themselves of the quality of the services purchased  Commissioning for high quality 7-day services

17.  Enhance the mechanism by which trusts assure themselves of the quality of the services they provide  Link this to commissioners responsibility for services purchased  Creates a push-pull requirement for focus on quality

18.  Francis defines transparency as “allowing information about the truth about performance and outcomes to be shared with staff, patients, the public and regulators”  What data is meaningful to patients/commissioners/trust boards/users/ GPs/CQC/CPA etc?  How to pull this from existing data and present  Oblige trusts to publish their own QA data?  Creates flow for oversight scrutiny  Personal performance data

19.  IQC  EQA schemes ◦ Process ◦ Individual  Accreditation  College KPIs  Error reporting ◦ Internal ◦ External: SUI, MHRA, SHOT  Other – benchmarking, Atlas of Variation

20.  Individual and lab performance  Monitoring for persistent poor performance  Referral and sanctions  Data streaming to national dashboard  Harmonisation  Minimum standards for EQA  Minimum standards for labs eg workload thresholds

21.  Internal ◦ Department ◦ Pathology Directorate ◦ Hospital management  External ◦ Commissioners (purchasers) ◦ UKAS (accreditation) ◦ EQAS (scheme oversight) ◦ Error reporting ◦ National Dashboard No anonymity, available for public scrutiny, regulatory bodies assured of quality

22.  Postgraduate curricula  Quality training in core modules  Additional training for leadership and management roles  Include in CPD  Key roles and responsibilities for pathology quality  Survey of ~2500 staff…

23.  Recommendations will require multiple ownership  Enhancement of existing systems to ◦ Exploit existing data streams ◦ Involve existing organisations ◦ Deliver change through better integration of existing structures  Professionalism and a change of culture will be key requirements

24.  i.barnes@nhs.net