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 foot care service for people with diabetes needs to:

• be integrated with other elements of care for people with diabetes
• define the agreed criteria for referral, local protocols and the foot care pathway for people with diabetes
• be patient-centred and provide equitable access
• audit the number of foot ulcers and amputations - see Appendix D of the NICE clinical guideline CG10 on type 2 diabetes - foot care
• be involved in the planning of changes to service provision and capacity in line with expected changes in the need for clinical services
• 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; this should include auditing the proportion of eligible people with diabetes who are provided with foot care and monitoring
• clinical quality criteria: appropriateness of referral, waiting times, consenting procedures
• patient satisfaction: patient perspective and perceptions
• patient outcomes: reduced incidence of foot ulcers, complications and amputations and associated hospital admissions. See also the outcomes identified in putting feet first: commissioning specialist services for the management and prevention of diabetic foot disease in hospitals
• staff competence: individual and team baseline requirements, monitoring and performance
• information requirements, including both patient-specific information (NHS number, referring GP) and service-specific information (workload trends, number of complaints)
• the process for reviewing the service with stakeholders, including decisions on necessary changes 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 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 foot care service for people with diabetes can be obtained from the following sources:

• NHS Diabetes supports healthcare professionals to implement the Diabetes National service framework standards. The website contains a range of service examples and other resources.
• National diabetes audit (NDA) The National Diabetes Audit is developed and delivered by NCASP, which is part of The Information Centre.
• ‘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. To indicate the effectiveness of long-term clinical management of diabetes and of long-term complications, see metric 4 for indicators on diabetes, and specifically 4.07 in relation to foot ulceration.
• 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 diabetes competency framework. Specifically the competencies Diab DF 01 - 03 relating to a diabetes foot care service.
• The ‘National minimum skills framework for commissioning foot care services for people with diabetes' has been developed by Foot in Diabetes UK, in collaboration with Diabetes UK, the Association of British Clinical Diabetologists, the Primary Care Diabetes Society and the Society of Chiropodists and Podiatrists. It aims to support local service providers to deliver high quality foot care services for people with diabetes by ensuring health care professionals have the appropriate skills.