1. Transforming Community Services The 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

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

3. What is the quality and productivity agenda about? u NHS funding has risen from 37 billion in 2001 to 109 billion u Overall staff numbers have increased (inputs) but the number of patients treated (outputs) has not risen proportionately u This does not suggest people are not working as hard (or harder) u Complaints, readmissions, HAIs, and errors remain unacceptably high* although inpatient satisfaction is relatively high^ u 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

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

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

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

7. How can I show that I am productive? u That depends on what you do and how much autonomy you have in practice u Be aware of: –national and mandatory targets –local targets u Sources of this kind of intelligence probably already exist e.g. increased patient numbers linked to complaints and or reported errors u Clinical coding depts, clinical governance teams, trust board reports, finance reports etc. can provide this kind of information.

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

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

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

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

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

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

14. Further RCN online resources u Clinical governance resource http://www.rcn.org.uk/development/practice/clinical_governance u Sign up for the clinical governance e-Bulletin http://www.rcn.org.uk/development/practice/clinical_governance/updates u Patient safety resource http://www.rcn.org.uk/development/practice/patient_safety u Learning Zone content (patient safety, clinical audit, preventing HAI etc.) http://www.rcn.org.uk/development/learning/learningzone u Watch out for public facing resources on: –Measuring for quality –Staffing and workforce issues –Implementation of evidence-based practice

15. Further online resources NHS Institute for Innovation and Improvement provides further information on the following: u Quality, Innovation, Productivity and Prevention (QIPP) agenda http://www.institute.nhs.uk/cost_and_quality/qipp/cost_and_quality_homepage.html u The Productive Ward http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html u Productive Community Services http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_community_servi ces.html