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 service for the accurate diagnosis of the epilepsies in adults needs to:

• be effective and efficient
• be responsive to the diverse needs of patients, including those with learning disabilities
• manage the diagnosis and offer treatment and care based on best practice, as defined in NICE clinical guideline CG20 on the epilepsies
• deliver the required capacity
• be integrated with the general management and care of people with epilepsy
• have local defined criteria for referral, protocols and a care pathway for people with a recent onset unprovoked seizure, which are agreed by local stakeholders and led by a nominated clinician
• 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
• audit improvement in patient outcomes
• 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, complaints procedures.
• Clinical governance arrangements, including incident reporting.
• Clinical quality criteria: for example, appropriateness of referral for diagnostic investigations, consenting procedures, clinical protocols, standards of communication between primary and secondary care healthcare professionals, number of people with a recent onset suspected seizure seen within 2 weeks by a specialist, and number of individuals requiring electroencephalogram (EEG) or magnetic resonance imaging (MRI) having the test performed within 4 weeks of it being requested. See appendix D of NICE clinical guideline CG20 on the epilepsies for detail on criteria for audit.
• Audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms.
• Health, safety and security: infection control, 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 satisfaction: patient perspective and perception of service provision, number of people with a diagnosis of epilepsy who understand their diagnosis, type of epilepsy and management of their condition, complaints.
• Patient outcomes: improved seizure control, quality of life and reduced risk of sudden death from seizures (SUDEP), fewer epilepsy-related injuries. Proportion of people with epilepsy supported to be independent and in control of their condition - see NHS operating framework vital signs; access to personalised and effective care.
• Staff competencies: individual and team baseline requirements, monitoring and performance, continuing professional development.
• 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 priority programmes, including Care outside hospital; No delays and the No delays achiever, an integrated service improvement tool to help providers reduce delays in services; and Quality and value, including 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 for the accurate diagnosis of the epilepsies in adults 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 long-term neurological conditions metric 7.05 'prompt recognition of symptoms, diagnosis and treatment'.
• 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 competence framework on long-term conditions - neurological care.