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 children and their parents or carers and those of other stakeholders when making commissioning decisions.

A service for the surgical management of otitis media with effusion (OME) in children needs to:

• be effective and efficient
• be responsive to the needs of children and their parents and carers
• provide treatment and care based on best practice, as defined in NICE clinical guideline CG60 on surgical management of OME
• deliver the required capacity for the assessment and management of children with OME
• be integrated with other elements of health and social care for children with OME
• define agreed criteria for referral, local protocols and the care pathway for children with OME
• be child-centred and provide equitable access, ensuring that children and their parents or carers are treated with dignity and respect, are fully informed about their or their child's care, and are able to make decisions about their child's care in partnership with healthcare professionals
• audit surgical management of OME to ensure 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, waiting and referral-to-treatment times (ensuring that children and their parents or carers do not experience unnecessary delays), complaints procedures.
• Clinical governance arrangements, including incident reporting.
• Clinical quality criteria: appropriateness of referral, consenting procedures, clinical protocols.
• Audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms; arrangements should include auditing the proportion of eligible children with OME who are provided with care, and monitoring of patient outcomes and complications (see audit support for NICE clinical guideline CG60 on OME for further information).
• Health, safety and security: prevention of infection, infection control, waste management, confidentiality procedures, legislative requirements.
• Equipment: must be calibrated at least annually using acceptable methods. Calibration should meet national standards (BSA 2000). It is suggested that equipment should not be more than 5 years old. Audiology testing must be performed in soundproofed accommodation to ISO 8253-1 (1987) and ISO 8253-2 (1992) standards for acoustic test methods suitable for children and conform to standards outlined in the Department of Health Building Note (1994). It is possible to provide tympanometry in a GP surgery but equipment will require calibration and the service should be integrated with the local ear, nose and throat service and paediatric audiology service.
• Accreditation requirements: for some or all elements of the service, the premises and/or staff.
• Patient satisfaction: child and parent or carer perspective and perception of service provision, complaints.
• Patient outcomes: such as improved hearing, reduced ear pain, reduced infection and improved reported speech and language development. Reduced number of adjuvant adenoidectomies.
• Staff competencies: state registration requirements should be met for staff working in paediatric audiology services. Staff should also be specifically trained to work with children and have fully compliant child protection training and CRB screening.
• Information requirements, including both patient-specific information (NHS number, referring GP, provision of high-quality information to patients/parents/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 for the surgical management of OME in children can be obtained from the following sources:

• Transforming services for children with hearing difficulty and their families: a good practice guide describes the indicators of high quality care and notes that audiology assistants and associate audiologists can undertake some of the less expert, routine clinical tasks, with appropriate training.
• Quality standards in paediatric audiology - guidelines for the early identification and the audiology management of children with hearing loss.
• The Care Quality Commission report Improving services for children in hospital, which emphasises the standards needed for children's services including anaesthesia.
• Surgery for children - delivering a first class service contains recommendations aimed at improving the quality of service, training, individual and team performance in children's surgery.
• 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 children and maternity metric, which is currently being updated.
• 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 children's services competence framework.