Ensuring corporate quality assurance

Commissioners should ensure that the services they commission represent value for money and offer the best possible outcomes for patients. Commissioners need to set clear specifications for monitoring and assuring quality in the service contract.

Commissioners should ensure that they consider both the clinical and economic viability of the service, and any related services, and take into account patients' views, the views of parents or carers and those of other stakeholders when making commissioning decisions.

A service for the diagnosis and management of adults with attention deficit hyperactivity disorder (ADHD) and young people in transition needs to:

• be effective and efficient
• be responsive to the needs of patients and parents or carers
• provide treatment and care based on best practice, as defined in NICE clinical guideline CG72 on ADHD
• deliver the required capacity
• be integrated with other elements of care for people with ADHD
• define agreed criteria for referral, local protocols and the care pathway for people with ADHD
• be person-centred and provide equitable access, ensuring that people with ADHD are treated with dignity and respect, are fully informed about their care and are able to make decisions about their care in partnership with healthcare professionals
• audit outcomes for people with ADHD to ensure appropriate access and transition from child and adolescent mental health and paediatric services to adult mental health services, and the diagnosis and treatment of ADHD
• demonstrate how it meets requirements under equalities legislation
• demonstrate value for money.

Local quality assurance

Any mechanisms for quality assurance at a local level are likely to refer to the following.

• Service and performance targets, including estimated activity levels and case mix, waiting and referral-to-treatment times (ensuring that people with ADHD and parents or carers do not experience unnecessary delays), and complaints procedures. Transition: getting it right for young people states that children's and adult health services should agree the best way of measuring the effectiveness of transition arrangements, and whether agreed policies and protocols are being implemented. One example of an indicator used to do this is the measurement over time of the ‘did not attend' (DNA) rate for young people at their second adult service appointment.
• Clinical governance arrangements, including incident reporting.
• Clinical quality criteria: appropriateness of referral, consenting procedures, clinical protocols.
• Audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms; arrangements should include auditing the proportion of eligible people with ADHD who are provided with care, and monitoring of patient outcomes. For further information see audit support (adults) for NICE clinical guideline CG72 on ADHD
• Health, safety and security: infection control, waste management, confidentiality procedures, legislative requirements.
• Equipment: testing and calibration.
• Accreditation requirements: for some or all elements of the service, the premises and/or staff.
• Patient satisfaction: people with ADHD and parent or carer perspective and perception of service provision, complaints.
• Outcomes for people with ADHD: increase the number of adults with ADHD who received a confirmed diagnosis and treatment, improved quality of life, reducing inequalities in the referral rates for different ethnic groups.
• Staff competencies: individual and team baseline requirements, monitoring and performance. The National Collaborating Centre for Mental Health document on Diagnosis and management of ADHD in children, young people and adults identifies competencies that might be useful in an ADHD service for adults.
• Information requirements, including both people-specific information (NHS number, referring GP, provision of high-quality information to people with ADHD/carers) and service-specific information (referral-to-treatment times, workload trends, number of complaints).
• The process for reviewing the service with stakeholders, including decisions on changes necessary to improve or to decommission the service.
• Achieving targets associated with equalities legislation.

Further information

General information on quality and corporate assurance can be obtained from the following sources:

• The National Patient Safety Agency (NPSA) oversees the implementation of a system to report and learn from adverse events and near misses occurring in the NHS. The publication ‘Seven steps to patient safety' provides an overview of patient safety and gives updates on the tools that the NPSA is developing to support patient safety across the health service.
• NHS Alliance online resources. NHS Alliance is the representational organisation of primary care and primary care trusts, and provides them with an opportunity to network and exchange best practice. The alliance supports its members with an open-access helpline, in-house and joint publications and briefings, internal newsletters and a website.
• The DH commissioning framework provides guidance on the commissioning process in the context of the NHS reform agenda.
• Delivering the 18 week patient pathway provides a range of resources to support the key NHS objective to deliver an 18 week patient pathway from GP referral to the start of treatment by the end of 2008.
• NHS Institute for Innovation and Improvement support for commissioners, includes Commissioning for Health Improvement products to accelerate the achievement of world class commissioning; The Productive Leader programme to enable leadership teams to reduce waste and variation in personal work processes, and Better care, better value indicators to help inform planning, to inform views on the scale of potential efficiency savings in different aspects of care, and to generate ideas on how to achieve these savings
• 10 Steps to your SES: a guide to developing a single equality scheme. This guidance has been developed to assist NHS organisations that have a duty, as public authorities, to comply with the race, disability and gender public sector duties, and in anticipation of new duties in relation to age, religion and belief, and sexual orientation.

Specific information on quality and corporate assurance for a service for the diagnosis and management of attention deficit hyperactivity disorder in adults and young people in transition can be obtained from the following sources:

• Better metrics is a pragmatic project that provides clinically relevant measures of performance to support the development of measurable local targets and indicators for local quality improvement projects. See metrics for mental health (notably 9.04 transition to adult services, 9.06 access to appropriate services, 9.09 reducing inequalities, social exclusion and stigma, 9.16 responding to the needs of carers).
• The Quality and outcomes framework (QOF) is a voluntary quality incentive scheme that rewards general practices for implementing systematic improvements in the quality of patient care.
• Skills for health works with employers and other stakeholders to ensure that those working in the sector are equipped with the right skills to support the development and delivery of healthcare services. See details of the mental health competence framework