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 and those of other stakeholders when making commissioning decisions.

An anticoagulation therapy service needs to:

• define the agreed criteria for referral, local protocols and the care pathway for patients requiring anticoagulation therapy
• be patient-centred and provide equitable access
• audit safety indicators to ensure the service is safe, and that any system risks are addressed
• be involved in the planning of changes to service provision and capacity, together with local stakeholders, in line with expected changes in need
• 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 targets: estimated caseloads, complaints procedures
• audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms
• clinical quality criteria: appropriateness of referral, screening tests, waiting times, consenting procedures
• equipment: testing and calibration
• patient satisfaction: patient perspective and perceptions
• patient outcomes: level of therapeutic control, incidence of adverse outcomes
• staff competence: baseline requirements and training
• information requirements: including both patient-specific information (NHS number, referring GP) and service-specific information (referral-to-treatment times, workload trends, number of complaints)
• the process for reviewing and changing 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.
• 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.
• The DH commissioning framework provides guidance on the commissioning process in the context of the NHS reform agenda.
• 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 anticoagulation therapy services can be obtained from the following sources:

• UK National External Quality Assessment Service (NEQAS) provides objective information and advice to clinical laboratories on the quality of their analytical and interpretative performance to facilitate optimal patient care.
• The National Patient Safety Agency published a Patient Safety Alert 'Actions that can make anticoagulant therapy safer' in March 2007 and signposts a range of support materials to help with risks associated with anticoagulants and reduce the risks of patients being harmed in the future.
• British Committee for Standards in Haematology (BCSH) provides up to date advice on the diagnosis and treatment of haematological disease through the production of evidence-based guidelines, including safety indicators for inpatient and outpatient oral anticoagulant care produced jointly with the NPSA in August 2006.
• 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. The document includes indicators for heart disease and stroke.
• 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 coronary heart disease framework.