1. Quality and Safety in Cancer Care - the view from NHS QIS Dr Frances Elliot & Hilary Davison Chief Executive & Director of Guidance and Standards 13 November 2009 www.nhshealthquality.org

2.  Better Health, Better Care (2007)  Better Cancer Care (2008)  Living and Dying Well (2008)  Scottish Government Quality Strategy (2009) Strategic context

4.  Special Health Board established by the Scottish Parliament in 2003  independent in our advice, assessments and recommendations NHS QIS

5. Our vision and purpose To lead the use of knowledge to promote improvement in the quality of healthcare for the people of Scotland To deliver internationally recognised excellence in quality improvement To lead the use of knowledge to promote improvement in the quality of healthcare for the people of Scotland To deliver internationally recognised excellence in quality improvement

6. What we do We :  provide advice and guidance on effective clinical practice, including setting standards  drive and support implementation of improvements in quality  assess the performance of the NHS, reporting and publishing the findings  Increasingly we do this as an integrated approach

7. NHS QIS Key Activity Advice, guidance and standards Implementation and improvement support Assessment, measurement and reporting Local improvement cycles Assurance Accountability

8. Implementation  Scottish Patient Safety Programme  New Directorate of Improvement and Implementation Support  Networks Clinical Practice development  Clinical governance support  Scottish Patient Safety Programme  New Directorate of Improvement and Implementation Support  Networks Clinical Practice development  Clinical governance support

9. Changing Role  NHSScotland Quality Strategy  Healthcare Improvement Scotland - a new body responsible for scrutinising health services, including independent healthcare - retains and emphasises current functions of NHS QIS in relation to quality improvement  NHSScotland Quality Strategy  Healthcare Improvement Scotland - a new body responsible for scrutinising health services, including independent healthcare - retains and emphasises current functions of NHS QIS in relation to quality improvement

10. The future  Integrated improvement programmes  Based on a robust analysis of the evidence base  Will include a package of advice and guidance for the service  Integrated improvement programmes  Based on a robust analysis of the evidence base  Will include a package of advice and guidance for the service

11. The future  “Care bundle” approach with appropriate improvement tools for the service to enable implementation  Support from QIS and partners to make it happen  Key quality indicators to enable local self- assessment and reporting on progress, with proportionate external quality assurance  “Care bundle” approach with appropriate improvement tools for the service to enable implementation  Support from QIS and partners to make it happen  Key quality indicators to enable local self- assessment and reporting on progress, with proportionate external quality assurance

12. Quality Performance Indicator Development Process Preparatory work (QIS Knowledge Management Team) Consultation (Regional Cancer Networks) Finalisation (NHS QIS, QPI development core group) Publication (NHS QIS) Indicator Development (QPI development group) Scoping (QPI development group, NHS QIS KMT) QPI Development Group Launch Meeting (QPI development group) Cancer Taskforce Ratification of QPI’s (Scottish Cancer Taskforce) 6 - 8 Months Preparatory work (QIS Knowledge Management Team) Consultation (Regional Cancer Networks) Finalisation (NHS QIS, QPI development core group) Publication (NHS QIS) Indicator Development (QPI development group) Scoping (QPI development group, NHS QIS KMT) QPI Development Group Launch Meeting (QPI development group) Cancer Taskforce Ratification of QPI’s (Scottish Cancer Taskforce) 6 - 8 Months Preparatory work (QIS Knowledge Management Team) Consultation (Regional Cancer Networks) Finalisation (NHS QIS, QPI development core group) Publication (NHS QIS) Indicator Development (QPI development group) Scoping (QPI development group, NHS QIS KMT) QPI Development Group Launch Meeting (QPI development group) Cancer Taskforce Ratification of QPI’ (Scottish Cancer Taskforce) 6 - 8 Months

13. QPI Development Group Launch Meeting  Agree scope of preparatory work  Define criteria for QPI development  Inaugural meeting March 2010  Secretariat?  Agree scope of preparatory work  Define criteria for QPI development  Inaugural meeting March 2010  Secretariat?

14. Preparatory Work (2 months)  NHS QIS Knowledge Management Team  Assess current guidance/evidence (AGREE)  Suggest scope for indicator development  Develop scope of indicators – background and need  NHS QIS Knowledge Management Team  Assess current guidance/evidence (AGREE)  Suggest scope for indicator development  Develop scope of indicators – background and need

15. Scoping (1 – 2 months)  NHS QIS knowledge management team and QPI development group  Briefing paper  Overview of preparatory work  Summarise key information  Recommendations for draft QPI’s  Filter recommendations using agreed criteria/framework  NHS QIS knowledge management team and QPI development group  Briefing paper  Overview of preparatory work  Summarise key information  Recommendations for draft QPI’s  Filter recommendations using agreed criteria/framework

16. Indicator Development Group (1-2 months)  Review briefing paper and consider proposed draft QPI’s  Create short list (?10)  Define numerators, denominators and exclusions for each draft QPI  Review briefing paper and consider proposed draft QPI’s  Create short list (?10)  Define numerators, denominators and exclusions for each draft QPI

17. Draft Indicators Ratified  Draft QPI’s presented to SCTF for approval prior to wider consultation

18. Consultation (1 – 3 months)  Consultation via regional networks  Local, regional and national  Who should we consult with?  For what purpose?  Level of user involvement?  Consultation via regional networks  Local, regional and national  Who should we consult with?  For what purpose?  Level of user involvement?

19. Finalisation (2 months)  NHS QIS, QPI Development Group  Collate feedback from consultation  Refine QPI’s including numerators, denominators, exclusions  Final ratification by SCTF  Publication and dissemination to Boards  NHS QIS, QPI Development Group  Collate feedback from consultation  Refine QPI’s including numerators, denominators, exclusions  Final ratification by SCTF  Publication and dissemination to Boards

20. Involvement  SCTF  Agree proposed QPI development process and final sign off  NCQSG  Advise on tumour sites to be addressed and sequencing  SCTF  Agree proposed QPI development process and final sign off  NCQSG  Advise on tumour sites to be addressed and sequencing

21. Involvement  Quality Performance Indicators Development Group  Short life group  clinical experts  Review information on topics referred from NCQSG  Draft QPI’s  Definitions  Quality Performance Indicators Development Group  Short life group  clinical experts  Review information on topics referred from NCQSG  Draft QPI’s  Definitions

22. Involvement  NHS QIS  Review of evidence  Prepare briefing paper  Quality assurance, consistency checking, advice on implementation  ISD  Alignment with national datasets  Ensure measurability  Input to definitions  NHS QIS  Review of evidence  Prepare briefing paper  Quality assurance, consistency checking, advice on implementation  ISD  Alignment with national datasets  Ensure measurability  Input to definitions

23. For Consideration and Discussion  Ownership of the process  Ownership of the final output  How do we “badge”  How do we address tumour sites with little or no evidence  Generation of the evidence base  Ownership of the process  Ownership of the final output  How do we “badge”  How do we address tumour sites with little or no evidence  Generation of the evidence base