Ensuring corporate and quality assurance

Commissioners should ensure that the services they commission represent value for money and offer the best possible outcomes for women and their babies. 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 service user views and those of other stakeholders when making commissioning decisions.

A peer-support programme for women who breastfeed needs to:

• be effective and efficient
• be responsive to the needs of women and their babies
• provide support and care based on best practice, refer to NICE public health guidance PH11 on maternal and child nutrition and NICE clinical guideline CG37 on postnatal care
• deliver the required capacity
• be integrated with other elements of care for women requiring support for breastfeeding
• define agreed criteria for referral, local protocols and the care pathway for women requiring support for breastfeeding
• be family-centred and provide equitable access, ensuring that women 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
• 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 breastfeeding initiation to meet local delivery plan targets, maintenance of breastfeeding following transfer to health visitor to be measured and increased by 2 percentage points year-on-year from baseline, prevalence of breastfeeding at 6-8 weeks, number of women contacted by peer supporter within 48 hours of giving birth.
• Clinical governance arrangements, including incident reporting.
• Audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms; arrangements should include auditing the proportion of women requiring support for breastfeeding, and monitoring of client outcomes and complications (see audit support for NICE public health guidance PH11 on maternal and child nutrition for further information).
• Health, safety and security: infection control, waste management, confidentiality procedures, legislative requirements, staff safety/security on home visits.
• Accreditation requirements: implementing the BFI in hospital and community settings.
• Maternal satisfaction: women's perspectives and perceptions of service provision; complaints.
• Outcomes: number of women breastfeeding at 6-8 weeks; number of women aged under 25 initiating breastfeeding; number of women seeing a peer supporter at the bedside; number of women receiving telephone support only; number of women receiving a home visit; age of baby when weaning starts.
• Staff competencies: individual and team baseline requirements to be in line with the recommendations in NICE public health guidance PH11 on maternal and child nutrition; monitoring and performance.
• 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.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 peer-support programme 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 Public Health and Health Inequalities metric 6.Modernising maternity care -a commissioning toolkit for primary care trusts in England.
• 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 Maternity and care of the newborn competence framework.