Ensuring corporate and quality assurance
Commissioners should ensure that the services they commission represent value for money and offer the best possible outcomes for people with schizophrenia and their carers. 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 service user's views and carer's views and those of other stakeholders when making commissioning decisions.
A schizophrenia service needs to:
- be effective and efficient
- be responsive to the needs of people with schizophrenia and their carers
- provide treatment and care based on best practice, as defined in NICE clinical guideline CG82 on schizophrenia
- deliver the required capacity
- be integrated with other elements of health and social care for people with schizophrenia
- define agreed criteria for referral, local protocols and care pathways for people with schizophrenia at different phases of the condition. The care programme approach should be used to help ensure effective collaboration with other care providers during transfer between services and should include details of how to access services in times of crisis.
- be client-centred and provide equitable access, ensuring that people are treated with dignity and respect, are fully informed about their care and treatment and are able to make decisions about their care including advance decisions and advance statements in partnership with health and social care professionals.
- consider and respond to recommendations arising from any audit, serious untoward 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 service users and carers do not experience unnecessary delays), complaints procedures.
- Clinical governance arrangements, including incident reporting.
- Clinical quality criteria: appropriateness of referral, consenting procedures in line with the code of practice that accompanies the Mental Capacity Act clinical protocols.
- Audit arrangements: frequency of reporting, reporting route and format, and dissemination mechanisms; arrangements should include developing and using practice case registers in primary care to monitor the physical and mental health of people with schizophrenia, and organisations should ensure that services providing psychological interventions routinely and systematically monitor a range of outcomes across relevant areas (see NICE clinical guideline CG82 on schizophrenia audit support for primary care, audit support for organisational criteria, audit support for clinical criteria and audit support for pharmacological interventions for further information).
- Health, safety and security: of staff and service users, full risk assessment, infection prevention, waste management, confidentiality procedures, legislative requirements.
- Accreditation requirements: for some or all elements of the service, the premises and/or staff. Arts therapies should be provided by Health Professions Council (HPC) registered arts therapist, with previous experience of working with people with schizophrenia.
- 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.
- Patient outcomes: see Health of the Nation Outcome Scales (HoNOS), include clinical, patient reported and social outcomes
- Staff competencies: trusts should provide access to training that equips healthcare professionals with the competencies required to deliver the psychological therapy interventions recommended in NICE clinical guideline CG82 on schizophrenia
- 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.
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.
- 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 schizophrenia 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 adult mental health metric 9.06-9.17
- 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.
- National mental health development unit provides national support for implementing mental health policy
- Delivering race equality dashboard is a tool designed to support the measurement of key priorities within race equality and mental health
- 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 mental health competence framework.
This page was last updated: 02 March 2012
- Commissioning a service for the treatment and management of schizophrenia in adults
- Specifying a schizophrenia service
- Determining local service levels for a service for the treatment and management of schizophrenia in adults
- Assumptions used in estimating a population benchmark
- The commissioning and benchmarking tool
- Ensuring corporate and quality assurance