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 and productivity in the service contract.
Commissioners should ensure that they consider both the clinical and cost effectiveness of the service, and any related services, and take into account the views of clinicians and of children and young people and their parents or carers, and those of other stakeholders, when making commissioning decisions.
A paediatric continence service needs to:
- be effective and efficient
- be responsive to the needs of children and young people, and their parents or carers
- provide treatment and care based on best practice, as defined in NICE clinical guidelines CG99 on constipation in children and young people and CG111 on nocturnal enuresis
- deliver the required capacity and outcomes
- be integrated with other elements of care for children and young people with continence problems
- ensure a coordinated approach is taken to promoting the quality of care across all pathways spanning more than one provider
- define agreed criteria for referral, local protocols and the care pathway for children and young people with continence problems
- be patient-centred and provide equitable access, ensuring that children and young people, and their parents or carers, are treated with dignity and respect, are fully informed about care and are able to make decisions about care in partnership with healthcare professionals
- consider and respond to recommendations arising from any audit, serious untoward incidents or patient safety incidents
- 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 young people, 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, including: prescribing practices, outpatient referrals to paediatrics or gastroenterology, hospital admissions for urinary tract infections or constipation, numbers of children and young people using continence products, inappropriate referrals to CAMHS, referrals to safeguarding services, and monitoring of patient outcomes (see audit support for NICE clinical guidelines CG99 on constipation in children and young people and CG111 on nocturnal enuresis for further information).
- Health, safety and security: infection prevention, 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 and service user experience: using the national patient survey; taking into account perspectives and perception of service provision to help shape services; engagement to inform commissioning decisions; complaints.
- Outcomes: length of time children and young people are clean and dry; improvement during treatment and after discharge; improved quality of life for children and young people and their parents or carers.
- 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 children and young people and their parents or 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.
- Compliments and complaints.
- Achieving targets associated with equalities legislation.
General information on quality and corporate assurance can be obtained from the following sources:
- 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.
Specific information on quality and corporate assurance for a paediatric continence service can be obtained from the following sources:
- 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 continence care competence framework.
- BMJ Learning is an online service provided to support continuing professional development requirements and to develop knowledge in key areas. See modules on nocturnal enuresis in children and functional recurrent abdominal pain in children.
This page was last updated: 02 March 2012