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 memory assessment service 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 NICE-SCIE clinical guideline CG42 on dementia
• deliver the required capacity
• be integrated with other elements of care for people requiring memory assessment services; see ‘Everybody´s business. Integrated mental health services for older people: a service development guide'
• define agreed criteria for referral, local protocols and the care pathway for people requiring memory assessment services
• 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.

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 and carers do not experience unnecessary delays), and complaints procedures. When estimated levels of activity have been determined for the local population requirements, commissioners may wish to monitor actual against planned activity levels and develop local strategies for the early identification and appropriate referral of people with suspected dementia.
• Clinical quality criteria: appropriateness of referral, consenting procedures, clinical protocols, length of time from assessment to treatment.
• Audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms. This should include auditing the proportion of eligible people requiring a memory assessment service who are provided with care, and monitoring of patient outcomes and complications. Patient outcomes may include quality of life, independence including mobility, and number of people with integrated care. See audit criteria for NICE-SCIE clinical guideline CG42 on dementia for further information.
• Health, safety and security: infection control, waste management, confidentiality procedures, legislative requirements.
• Equipment: testing and calibration.
• Patient satisfaction: patient and carer perspective and perception of service provision, including access to written information (see audit arrangements above) and to counselling; complaints.
• Staff competencies: individual and team baseline requirements, monitoring and performance. The NICE-SCIE clinical guideline CG42 on dementia recommends that staff involved in the care of older people in the healthcare, social care and voluntary sectors have access to dementia-care training (skill development) that is consistent with their roles and responsibilities. The implementation advice for NICE clinical guideline CG42 on dementia suggests that a sustained programme of training, education and awareness raising for all staff, including GPs, would help to improve the recognition, detection and diagnosis of dementia.
• 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.
• Implementation advice for NICE clinical guideline CG42 on dementia
• ‘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 memory assessment 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 mental health metric 9.16 ‘Responding to the needs of carers', mental health metric 9.18 ‘Appropriateness of treatment for people with dementia', and older age metric 10.07 ‘Population health and well-being'.
• 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. See ‘QOF Business Ruleset' for guidance relating to the technical requirements for correctly recording QOF information.
• ‘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.
• ‘Skills for care' supports employers in improving standards of care provision through training and development, workforce planning and workforce intelligence.