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´ and carers´ views and those of other stakeholders when making commissioning decisions.

A urinary continence service needs to:

• be effective and efficient
• be responsive to the needs of women and their carers
• provide treatment and care for women based on best practice, as defined in NICE clinical guideline CG40 on urinary incontinence
• deliver the required capacity
• be integrated with other agencies caring for people with incontinence and work to common evidence based policies, procedures, guidelines and referral pathways
• define agreed criteria for referral, local protocols and the care pathway for women requiring a urinary continence service
• be person-centred and provide equitable access, ensuring that women are treated with dignity and respect, are fully informed about their care and are able to make decisions about their care in partnership with health 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 and performance targets, including estimated activity levels and case mix, waiting and referral-to-treatment times (ensuring that patients and 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; this should include auditing the proportion of eligible people with UI who are provided with care, and monitoring patient outcomes and complications. See audit criteria for NICE clinical guideline CG40 on urinary incontinence.
• Health, safety and security: infection control, waste management, confidentiality procedures, legislative requirements.
• Equipment: testing and calibration of ultrasound scan, electrical stimulation equipment, biofeedback equipment.
• Accreditation requirements: for some or all elements of the service, the premises and/or staff.
• Patient satisfaction: patient and carer perspective and perception of service provision, complaints.
• Patient outcomes: number of patients with improved quality of life. See implementation advice for NICE clinical guideline CG40 on urinary incontinence for examples of quality of life tools.
• Staff competencies: individual and team baseline requirements, monitoring and performance. Number of primary care staff trained; numbers of staff competent to carry out initial assessments, catheterisations and vaginal examinations; number of staff competent to teach pelvic floor exercises; number of specialists completing further education in continence care courses.
• 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.

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 urinary continence 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 older people metric 10.05 ‘reducing falls' and primary care nursing metric 12.2.
• The RCP National audit of continence care for older people provides a tool that enables health professionals to check the current status of local services and progress against national standards, and a template continence policy that covers competencies, governance and audit.
• The essence of care: patient-focused benchmarking for health care practitioners offers benchmarking tools for the fundamentals of nursing care, including continence, bladder and bowel 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 continence services. See details of the continence care competency framework.
• British Society of Urogynaecology provides training and guidelines, and sets standards in conjunction with the Royal College for Obstetricians and Gynaecologists.
• The Chartered Society of Physiotherapy provides training and guidelines, and sets standards for physiotherapy practice in conjunction with the Association of Chartered Physiotherapists in Women's Health and Chartered Physiotherapists Promoting Continence.