Commission forHealth Improvement

CHI: The national perspective

Emilie RobertsDevelopment Manager

10 December 2003

This presentation will cover1. Who we are and what we do

2. A bit about the review process

3. What are we finding?

4. Some reflections

5. From CHI to CHAIHow it works

Hints and tips

CHI’s aim

To bring about demonstrable improvement in the quality of NHS patient care throughout England and Wales

CHI’s principles patient centred independent, rigorous and fair developmental evidence based open and accessible apply the same expectations to

ourselves

An overview: what does CHI do?

National performance

ratings national NHS

patient and staff surveys

national clinical audit programme

national reports

Local clinical

governance reviews

investigations

NSF studies

Clinical governance reviews What is it like to be a patient here?

How good are the PCT’s systems for safeguarding & improving quality of care?

What is the PCT’s capacity for improving?

The review does not assess: the performance of individuals

or individual practices

The review process1. Scheduling

2. Data collection

3. Meetings

4. Site visits

5. Report

6. Action planning

Why me?

Why not me?

The review process1. Scheduling

2. Data collection

3. Meetings

4. Site visits

5. Report

6. Action planning

PCT data request

Practice survey

Routine data

The review process1. Scheduling

2. Data collection

3. Meetings

4. Site visits

5. Report

6. Action planning

Partner organisations

Patients & public

The review process1. Scheduling

2. Data collection

3. Meetings

4. Site visits

5. Report

6. Action planning

Review manager

Plus team of seconded ‘reviewers’

The review process1. Scheduling

2. Data collection

3. Meetings

4. Site visits

5. Report

6. Action planning

Publicly available

The review process1. Scheduling

2. Data collection

3. Meetings

4. Site visits

5. Report

6. Action planning

“It can be put on the shelf and forgotten about. It’s not an ongoing audit. No one goes back to check”

Trust coordinator quoted in the Daily Telegraph, 01.12.2003

The review process1. Scheduling

2. Data collection

3. Meetings

4. Site visits

5. Report

6. Action planning

“It can be put on the shelf and forgotten about. It’s not an ongoing audit. No one goes back to check”

Trust coordinator quoted in the Daily Telegraph, 01.12.2003

The practice surveysExample – patient and public involvement in

general practice (570 practices in sample)

83% report little progress in involving patients/users Of these, half had received no advice from the PCT

Almost all general practices have a policy for complaints Only 2/3 have any system for learning from

compliments

Site visits: visiting and interviewing PCT managers, professionals & staffFocus is

your experience of systems in place to improve quality and safeguard patient safety

patient experience (visits include some observation of the environment)

Can you have confidence in the findings?

Reported findings must be strongly supported by evidence

Individuals and practices are not named or identified in the report

“CHI has serious concerns over fire risk in some practices. There was inconsistency across practices of fire exits, training, visibility of extinguishers, evidence of fire drills, procedures and signed escape routes….”

Hints and tips Prepare wisely

Tell us about your PCT

Manage expectations

Facilitate the site visits

Shout about the things you do well, and

Be honest about the areas that need improvement

What is CHI finding in PCTs (1)Access

PCTs are generally meeting NHS plan targets for general practice but there are problems in some areas

Patients having difficulty accessing NHS dentistry in some areas

CHI commonly finds long waits for physiotherapy and other therapy services

What is CHI finding in PCTs (2)Leadership

Staff generally like working in PCTs. They report that CEOs are visible and approachable

But, in many PCTs the PEC does not seem to be fulfilling its role as the ‘engine room’

What is CHI finding in PCTs (3)Impact on local community

CHI finds increasing use of extended roles

PCTs are involving patients and carers in developing specific services

Commissioning is underdeveloped

PCTs are struggling to implement robust monitoring arrangements

Reflections on CHI The review team

Consistency

One size fits all

Making a difference

Regulatory burden

The future - CHI to CHAI

April 2004 - Commission for Healthcare Audit and Inspection

Aim is still improvement in patient care Activity will be targeted &

proportionate Focus on organisations and services Explicit standards Greater coordination of regulation in

health care

“Inspection by outsiders (ie those who do not provide care) exerts an effect on care only through the behaviours and actions of insiders (those who do provide care).

If we want inspection to affect quality, we must begin by asking how those who are inspected may affect quality”

Brennan and Berwick, 1996

Commission forHealth Improvement

www.chi.nhs.uk