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.
A bariatric surgical service needs to:
- be effective and efficient
- be responsive to the needs of patients
- provide treatment, care and follow-up based on best practice, as defined in NICE clinical guideline CG43 on obesity
- deliver the required capacity
- be integrated with other elements of care for people with severe obesity
- define agreed criteria for referral, local protocols and the care pathway for people with severe obesity requiring bariatric surgery and long-term follow-up
- be patient-centred and provide equitable access, ensuring that patients are treated with dignity and respect, are fully informed about their care and are able to make decisions about their care in partnership with the multidisciplinary team
- 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 patients do not experience unnecessary delays), complaints procedures.
- Clinical governance arrangements, including incident reporting.
- Clinical quality criteria: appropriateness of referral, consenting procedures, clinical protocols.
- Audit arrangements: arrangement for prospective audit should be made, so that the outcomes and complications of different procedures, the impact of quality of life and nutritional status, and the effect of comorbidities can be monitored in both the short and the long term. (See audit criteria for NICE clinical guideline CG43 on obesity for further information).
- Health, safety and security: infection control, waste management, confidentiality procedures, legislative requirements.
- Equipment: including scales, theatre tables, Zimmer frames, commodes, hoists, bed frames, pressure-relieving mattresses and suitable seating.
- Patient satisfaction: patient perspective and perception of service provision and access to follow-up, support and plastic surgery if required.
- Patient outcomes: reduced incidences of morbidity and mortality associated with severe obesity, including a reduction in type 2 diabetes and hypertension, increased number of appropriate referrals, improved quality of life and weight loss post-surgery, and reduction in numbers of people requiring revisional surgery.
- Staff competencies: surgeons should undertake a relevant supervised training programme and have specialist experience in bariatric surgery. Other members of the bariatric surgery multidisciplinary team should be able to demonstrate competence through attending study days, conferences and on-the-job training.
- 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.
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 bariatric surgical service 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 diabetes metric 4.01 ‘Overweight and obesity prevalence strategies'.
- ‘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 perioperative care support competencies.
- ‘Specialist certification of obesity professional education (SCOPE)' membership acknowledges clinicians working with obese and overweight patients who have undertaken continuing professional development in the field of obesity management.
- ‘Association for the Study of Obesity' provides training to health professionals and others involved in the prevention and treatment of obesity, and offers an ongoing forum for the sharing of scientific expertise and clinical practice through the provision of high quality scientific and educational meetings.
This page was last updated: 02 March 2012
- Bariatric surgical service
- Commissioning a bariatric surgical service for the treatment of people with severe obesity
- Specifying a bariatric surgical service for the treatment of people with severe obesity
- Determining local service levels for a bariatric surgical service for the treatment of people with severe obesity
- Assumptions used in estimating a population benchmark
- The commissioning and benchmarking tool
- Ensuring corporate and quality assurance