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 the views of patients, parents and carers, and those of other stakeholders when making commissioning decisions.
An insulin pump therapy service needs to:
- be effective and efficient
- be responsive to the needs of people with type 1 diabetes, their parents and carers
- provide treatment and care based on best practice, as defined in NICE clinical guideline CG15 on type 1 diabetes
- deliver the required capacity by providing insulin pump therapy for everyone who meets the criteria in NICE technology appraisal TA151 on insulin pump therapy
- be integrated with other elements of care and services for people with type 1 diabetes
- define agreed criteria for referral, local protocols and the care pathway for people with type 1 diabetes
- 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 the provision of insulin pumps
- monitor the number of patients on insulin pump therapy
- demonstrate how it meets requirements under equalities legislation.
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, parents and carers do not experience unnecessary delays), complaints procedures.
- Clinical governance arrangements, including incident reporting.
- Clinical quality criteria: appropriateness of referral, consenting procedures, clinical protocols and individualised care plan
- Audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms; arrangements should include auditing the proportion of eligible people requiring insulin pump therapy who are provided with care, and monitoring of patient outcomes and complications (see audit criteria for NICE technology appraisal TA151 on insulin pump therapy for further information).
- Health, safety and security: infection control, waste management, confidentiality procedures, legislative requirements.
- Equipment: testing and calibration of insulin pumps and consumables in line with manufacturer instructions.
- Accreditation requirements: for some or all elements of the service, the premises and staff.
- Patient satisfaction: patient and carers perspective and perception of service provision, complaints.
- Patient outcomes: improved quality of life.
- Staff competencies: 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.
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.
- NHS Institute for Innovation and Improvement support for commissioners, includes 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.
- NHS Diabetes provides support to healthcare professionals to implement the Diabetes National service Framework standards.
Specific information on quality and corporate assurance for an insulin pump therapy 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 metrics for diabetes, notably: NCHOD; 03/04 emergency admissions for diabetic ketoacidosis and coma; 4.03 patient experience and engagement; 4.04 HbA1c effectiveness; 4.05 macro-vascular risk; 4.06 micro-vascular complications; 4.09 patient education and empowerment; 4.10 staff education; 4.11 diabetic emergencies; 4.12 annual review/care planning.
- The Quality and outcomes framework (QOF) is a voluntary quality incentive scheme that rewards general practices for implementing systematic improvements in the quality of patient care.
- 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 competence framework, specifically the competencies Diab IPT01 - IPT06 inclusive relating to insulin pump therapy.
- Insulin pump services: report of the Insulin Pumps Working Group.
- The Diabetes Education Network provides resources to help diabetes teams across the UK provide high quality structured education programmes for people with type I diabetes.
- The Department of Health and Diabetes UK Patient Education Working Group report sets out the requirements for developing a high-quality patient education programme.
- The Diabetes commissioning toolkit describes how to carry out a health needs assessment for a local diabetes population and provides a generic specification for diabetes care; signposting recognised quality markers and suggesting key outcomes for the service.
- Diabetes UK provides a range of resources, education and share examples of current practice.
This page was last updated: 03 April 2012