Ensuring corporate and 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 view of parents or carers and those of other stakeholders when making commissioning decisions.

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

• be effective and efficient
• be responsive to the needs of children and young people and their 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 children and young people with ADHD
• define agreed criteria for referral, local protocols and the care pathway for children and young people with ADHD
• be patient-centred and provide equitable access, ensuring that children and young people and their parents or carers 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
• consider and respond to recommendations arising from any audit, serious untoward or patient safety incidents
• 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 children and young people and their parents or carers do not experience unnecessary delays), complaints procedures.
• Clinical governance arrangements, including incident reporting.
• Clinical quality criteria: appropriateness of referral, consenting procedures, clinical protocols and ensuring that the child and adolescent mental health services (CAMHS) minimum data set is completed.
• Audit arrangements: define audit requirements, frequency of reporting, reporting route and format, and dissemination mechanisms; arrangements, and monitoring of patient outcomes.
• Health, safety and security: infection prevention, 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 and service user experience: using the national patient survey; taking into account perspectives and perception of service provision to help shape services; engagement to inform commissioning decisions; complaints.
• Process measure and patient outcomes: proportion of children and young people who receive medication and/or other evidence-based treatments, for example the proportion of parents or carers who are offered a parent-training/education; impairment reduction measured by the children's global assessment scale; symptom reduction measured through a standardised rating scale, for example Connors' scale. Establishing outcome measures is likely to be an iterative process, especially where services are not well developed and commissioners may wish to agree trajectories for outcomes as part of the quality payments for providers. Process outcomes such as the conversion rates for the diagnosis of ADHD and/or the expected level of symptom reduction may also be a useful indicator. Commissioners may wish to consider using outcomes across service areas, for example the proportion of children and young people with ADHD in full-time education.
• Staff competencies: individual and team baseline requirements, which are described in the full guideline Diagnosis and management of ADHD in children, young people and adults, and monitoring and performance.
• Information requirements, including both patient-specific information (NHS number, referring GP, provision of high-quality information to patients/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 environment must comply with the requirements of the National service framework for children, young people and maternity services and in particular Standard 9: the mental health and psychological well-being of children and young people.
• The You´re welcome quality criteria self-assessment toolkit enables service providers and commissioners to see what to do to make health services ‘young people friendly'.
• 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 Department of Health commissioning framework provides guidance on the commissioning process in the context of the NHS reform agenda.
• 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, and Experience-based design, which brings staff and patients together to improve care and shape the redesign of services.
• 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 ADHD in and young people can be obtained from the following sources:

• The CAMHS outcome research consortium supports children and adolescent mental health services in outcome evaluation.
• 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 the children and maternity metric, which is currently being updated.
• 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 children´s services competence framework.