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' and carers' views and those of other stakeholders when making commissioning decisions.

A service providing cognitive behavioural therapy (CBT) for the management of common mental health problems needs to:

• Be effective and efficient.
• Be responsive to the needs of patients and carers.
• Provide treatment and care based on best practice, as defined in the following NICE clinical guidelines: CG22 on anxiety, CG90 on depression, CG26 on post-traumatic stress disorder (PTSD), CG31 on obsessive-compulsive disorder (OCD); and the NICE technology appraisal TA97 on computerised CBT.
• Deliver the required capacity
• Be integrated with other elements of care for people with moderate to severe depression, anxiety, OCD and PTSD.
• Define agreed criteria for referral, local protocols and the care pathway for people requiring CBT for common mental health problems.
• 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 healthcare professionals
• Demonstrate how it meets requirements under equalities legislation
• Demonstrate value for money. See the NHS Purchasing and Supply Agency framework agreement for the purchase of NICE approved computerised CBT software packages.

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, and waiting and referral-to-treatment times. The Improving Access to Psychological Therapies (IAPT) programme identified that best practice sites are working towards achieving maximum waiting times of ten working days from referral to treatment for people with mild or moderate conditions. When estimated levels of activity have been determined for the local population requirements, commissioners may wish to monitor actual against planned activity levels and to develop local strategies for the early identification and appropriate referral of people with depression and anxiety.
• Clinical quality criteria: appropriateness of referral, clinical protocols.
• Audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms. This should include auditing the proportion of eligible people requiring CBT who are provided with care, and monitoring of patient outcomes. See the IAPT programme outcome framework and data collection tool. The IAPT programme also recommends that services begin to monitor the delivery of waiting times at key points on the care pathway - from referral to treatment at each level of the stepped care model.
• Health, safety and security: waste management, confidentiality procedures, legislative requirements.
• Equipment: testing.
• Accreditation requirements: for some or all elements of the service, the premises and/or staff.
• Clinical governance arrangements, including incident reporting.
• Patient satisfaction: patient and carer perspective and perception of service provision, complaints.
• Staff competences: individual and team baseline requirements, 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 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 providing CBT 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 mental health metric 9.
• The IAPT implementation plan has produced curricula for workers of low-intensity and high-intensity therapies. It provides strategic health authorities, primary care trusts, training providers and service providers with an overview of what is needed to implement the IAPT plan.
• ‘The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders' identifies the activities associated with the delivery of high-quality cognitive and behavioural therapy and the competences required to achieve these. See the detailed descriptions of the competences associated with each of these activities.
• The ‘Quality and outcomes framework (QOF)' was designed to deliver substantial financial rewards for high-quality care. The framework sets out a range of national standards based on the best available research evidence.
• ‘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 competency framework and of psychological therapies competencies.