NICE Quality Standards for End of Life Care and Dementia were used as frameworks to conduct service reviews as part of our CQUIN. For both reviews, we triangulated information from patient stories, stakeholder events and hard data sources to form a picture of current services and to make recommendations for change. The Quality Standards (QS) provided an independent, evidence based definition of high quality services against which we could evaluate our service provision.
- End of life care for adults (QS13)
Aims and objectives
Reasons for implementing your project
The reviews, which were both structured around the NICE Quality Standards, showed that there were areas of excellence in both services, but that provision was inconsistent in different areas of the county. Our recommendations, agreed jointly between providers, covered areas including: improved co-ordination between providers; investment in training and telehealth to improve services; systematic adoption of best practice in identifying patients and using care pathways to ensure optimum care; and provision of improved and consistent information for patients, carers and professionals.
How did you implement the project
The brief for the patient stories, the data collection exercises and the design of the stakeholder workshops were all structured around the Quality Standard statements. This provided a common, accepted, evidence based definition of best practice, to benchmark our performance.
The QS statements were also used as the structure for the reports, giving a clear pathway through the review, and enabling us to triangulate the data from the three sources, draw conclusions and make recommendations for action.
1) regarding use of the Quality Standard:
There was some confusion about the QS versus the existing NICE Guidance. Staff were all aware of, and working to the Guidance, but didn't understand what the QS was for. Using this as the framework for the review has helped to make this clear, and makes explicit to commissioners exactly where each of the provider organisations is contributing to delivering the relevant outcomes.
2) regarding the need to improve services:
The major challenge is in agreeing joint action plans between organisations. For dementia this has included two acute trusts, a pharmacy service that supports the PCT and ourselves and social care and third sector partners. We had a working group where this kind of discussion was intended to happen, but attendance had been poor from some organisations (including commissioners). The ad hoc meetings arranged to discuss the results of this review were found to be useful, and have resulted in re-forming the Dementia Implementation Group with representation from three NHS Trusts, CCG, social care, public health, third sector and service users.
The End of Life county wide group was more functional and well attended. The final report was presented to this group, which has accepted responsibility for carrying forward the action plan.
Both reports are to be submitted to Joint Operational Groups - where commissioners and providers of NHS, social care and third sector services all meet - with recommendations that the Operational Groups are asked to approve. Actions for our own Trust will be followed up and implemented, and the Operational Groups provide a forum to decide how jointly owned actions will be taken forward.
Key learning points
Using the QS consistently as the framework for data collection speeded up the report writing; helped to make reviewing the reports by managers and clinicians a quick and helpful process and identified recommendations which were hard to contest.
The QS are very comprehensive, and it was challenging to find data from all three sources to populate every statement - but this, in itself, is a useful way to identify where we need to be more methodical, or to change the ways we collect data.
The qualitative views from patient stories and stakeholder workshops added validity to what the hard data was telling us, and produced reports that were valued by providers and commissioners.
We would recommend using NICE Quality Standards, and the triangulation of patient, stakeholder and hard data, as a useful methodology for reviewing services.