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 pulmonary rehabilitation service needs to:

• be responsive to the needs of patients
• monitor the number of eligible patients offered, received and declined pulmonary rehabilitation
• audit service availability for all who need it, including patient outcomes
• 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 benefits and targets: reducing the length of hospital stays, estimated caseloads, complaints procedures
• audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms
• clinical quality criteria: appropriateness of treatment, waiting times, consenting procedures
• patient satisfaction: developing and improving support in the community
• patient outcomes: improving health related quality of life, patients' functional and maximum exercise capacity, and reducing dyspnoea
• 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 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 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 COPD/ a pulmonary rehabilitation 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 clinical health skills CHS72, 74, 78 & 79.
• The Chartered Society of Physiotherapy is the professional, educational and trade union body for the country's chartered physiotherapists, physiotherapy students and assistants. It aims to support its members and help them to provide the highest standards of patient care.
• 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.
• ‘British Thoracic Society' is a society of health professionals committed to improving care for patients with lung diseases, through education, research and improving standards.
• ‘European Respiratory Society' is an international medical organisation that produces a number of publications, contributes to the coordination of educational activities in respiratory medicine across Europe, and is actively involved in lobbying for the provision of better lung health.
• ‘General Practice Airways Group' is an independent charity representing primary care health professionals interested in delivering the best standards of respiratory care.
• ‘Global Initiative for Chronic Obstructive Lung Disease (GOLD)' works with health care professionals and public health officials around the world to improve prevention and treatment of COPD.