Ensuring corporate and quality assurance
Commissioners should ensure that the services they commission represent value for money and offer the best possible outcomes for pregnant women who smoke. 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 clinicians', and service users' views and those of other stakeholders when making commissioning decisions.
Services for quitting smoking in pregnancy and following childbirth need to:
- be effective and efficient
- be responsive to the needs of pregnant women who smoke and their partners and families
- provide treatment and support based on best practice, as defined in NICE public health guidance PH26
- deliver the required capacity and outcomes ensuring that all pregnant women who smoke are identified, referred and have access to ongoing and intensive support throughout pregnancy and beyond from specialist stop-smoking advisers
- be integrated with maternity services and other public, community and voluntary services offering elements of care for pregnant women and for women following childbirth
- ensure a coordinated approach is taken to promoting the quality of care and support across all pathways spanning more than one provider (for example maternity services, other services and NHS Stop Smoking Services)
- define agreed criteria for referral, local protocols and the care pathway for pregnant women who smoke to ensure that opportunities are maximised for pregnant women who smoke to be identified and referred for specialist support
- be client-centred and provide equitable access, ensuring that women and their partners are treated with dignity and respect, are fully informed about their care and support, and are able to make decisions in partnership with healthcare professionals
- consider and respond to recommendations arising from any audit, serious untoward or patient safety incidents
- demonstrate how they meet requirements under equalities legislation, are providing responsive and targeted services to meet the needs of the locality, and are reaching and supporting women from black and minority ethnic groups and routine and manual occupations
- demonstrate value for money
- consider where the barriers are for implementation before considering Commissioning for Quality and Innovation payment framework (CQUIN) as a lever for change.
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 waiting times (ensuring that pregnant women who smoke and their partners do not experience unnecessary delays), complaints procedures.
- Clinical governance arrangements, including incident reporting.
- Clinical quality criteria: appropriateness of referral, clinical protocols.
- Audit arrangements: refer to NHS stop smoking services: service and monitoring guidance 2010/11 for specific information. Arrangements should include monitoring of outcomes and complications (see audit support for NICE public health guidance PH26 on Quitting smoking in pregnancy and following childbirth for further information).
- Health, safety and security: infection prevention, waste management, confidentiality procedures, legislative requirements.
- Equipment: testing and calibration according to local and manufacturer protocol. Capacity and capability to comply with CO monitoring requirements (under core contracts and Service Level Agreements [SLAs]).
- 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 and patient-reported outcome measures (PROMS); taking into account perspectives and perception of service provision to help shape services, engagement to inform commissioning decisions, complaints. See also client satisfaction survey tool developed by the smoking cessation service research network. Commissioners should note that all CQUIN schemes should include a patient experience element and providers should meet agreed patient satisfaction goals on a service-by-service basis.
- Outcomes: numbers of pregnant women who smoke have been identified, referred to and followed up by NHS Stop Smoking Services, and have received specialist support to stop smoking. Numbers of pregnant women who have successfully stopped smoking during pregnancy and are not smoking at time of delivery.
- Staff competencies: individual and team baseline requirements, monitoring and performance.
- Information requirements: including both patient-specific information (NHS number, referring GP or other professional, provision of high-quality information to women and their families) and service-specific information (see also NHS stop smoking services: service and monitoring guidance 2010/11 for further information).
- 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:
- 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 Department of Health 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 quitting smoking in pregnancy and following childbirth services can be obtained from the following sources:
- NHS stop smoking services: service and monitoring guidance 2010/11 provides best practice guidance relevant to the provision of all NHS stop-smoking interventions and sets out fundamental quality principles for the delivery of services, which can be used to inform the development of local commissioning arrangements.
- The NHS Centre for Smoking Cessation and Training (NCSCT) national training standards are the official benchmark of quality training for stop-smoking personnel in England. Standards have now been mapped to the knowledge and skills framework. The core training provided by the NCSCT will be free of charge until April 2012. See also Learning outcomes for training stop smoking specialists.
- 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 Maternity and care of the newborn, Public health, Psychological therapies.
- Midwifery 2020, The future of the profession is a project commissioned by the Chief Nurses of England, Northern Ireland, Scotland and Wales to set the direction for midwifery and identify the changes needed to the way midwives work, and to their roles, responsibilities and training and development requirements. The Midwifery 2020 project will end in 2010 with a report setting out the vision for 2020.
This page was last updated: 02 March 2012
- Quitting smoking in pregnancy and following childbirth
- Commissioning services for quitting smoking in pregnancy and following childbirth
- Specifying services for quitting smoking in pregnancy and following childbirth
- Determining local service levels for quitting smoking in pregnancy and following childbirth
- Assumptions used in estimating a population benchmark
- The commissioning and benchmarking tool
- Ensuring corporate and quality assurance