Martin Bardsley: Introducing QualityWatch

© Nuffield Trust and Health Foundation © Nuffield Trust

23 October 2013

Time for QualityWatch?

Martin Bardsley

© Nuffield Trust and Health Foundation

Background

Release of the second Francis Report into mid staffs

Range of responsive studies including Keogh Reviews

Continuing headlines of failures within care – Morecombe Bay, Whipps Cross

Major organisational change within NHS

Prospect of continuing years of constrained finances

Critical period for quality and many organisations looking at it in new ways


Aims

• provide an authoritative resource on the overall quality of health and social care;

• monitor and comment on changes over time independently of government and the statutory bodies;

• highlight where there are clear and compelling gaps between what is being achieved and what is possible in order to prompt action ; and

• contribute to improving measures of quality.


Five year programme includes

Using sets of indicators to measure changes in the quality of care.

Deeper analyses on specific topics. First two published tomorrow

Annual overview report

Website www.qualitywatch.org.uk charts, analysis, blogs

Conferences, seminars

http://www.qualitywatch.org.uk/


Website QualityWatch.org.uk


Challenge of assessing quality…

Quality is multidimensional – does not easily fall into a handful of simple indicators.

Quality will vary between areas where services are provided, and vary over time

Danger of focussing in what's measured and missing the point

Time lag for change to work through the systems –good quality care may not be immediately visible

Our ability to use information improving – look forward to new and better metrics


Structuring Indicators of Quality Numbers of existing indicators by domain and sector

Domain Social care

provision

Primary/

community

provision

Ambulance,

A&E and

secondary/

tertiary acute

care

Mental

health

provision

Population /

commission

ing Total

Access 13 46 75 41 9 184

Safety 11 66 160 82 7 326

Effectiveness 13 147 274 26 82 542

Person centred

care 18 27 159 77 5 286

Capacity 30 35 47 24 1 137

Equity 0 7 10 10 1 28

Total 85 328 725 260 105 1503


Trends and blips. Diagnostic waiting times. Proportion of tests on the waiting list over 6 or 13 weeks (January 2006 to April 2013)


An external perspective Life expectancy in years by country (1991 to 2011)

Source: Organisation for Economic Co-operation and Development (OECD),

Health data 2013


Interrelated indicators: eg Number of days delayed based on care received by the patients (August 2011 to July 2013)


Regional differences: eg Proportion of adults with learning difficulties in paid employment by region (2009/10 to 2012/13)


Changes in staff over past decade


Patients' responses to the question "In your opinion, were there enough nurses on duty to care for you in hospital?" (2005 to 2012)

Source: Care Quality Commission, Survey of Adult Inpatients


Hiding behind the mean? Patients' responses to the question "Overall,

did you feel you were treated with respect and dignity while you were in the hospital?" (2002 to 2012)


Proportion of patients who said that doctors or nurses talked in front of them as if they weren't there (2002 to 2012)


Focus on Hip Fracture

Major health issue 50,000 admissions per year

Studied over 500,000 admission from 2001-2011 –

Look at change over time

- Incidence of fractures

- Survival (in/out of hospital)

- Operations with 24/48 hours

- Readmission and bed day use

- Differences by area deprivation

In depth studies allow us to use range of methods to understand a

particular aspect of care


Trends in 30 day mortality following admission for hip fracture


Mortality rates higher in more deprived areas


General Observations ….

Many access indicators ‘holding up’. Urgent care is a critical area – and

though there have been wobbles we are still ahead of where we were

five years ago. Progress on prevention limited

Activity continues to increase – nurse staffing steady, beds reduced

Patient experience -paradox of surveys continuing to be positive

despite failings in care within individual organisations

Understanding safety still a challenge – progress from work on HAI

clear in other areas measurement of harms and supporting processes

still developing

Effectiveness – typically very specific markers and positive findings

Inequalities – stubbornly persistent


Next Steps

Public release of website

Summary report due later this month

Refine existing indicators and extend them

Next range of hot topics (due in Autumn)

Social care spending and older people

Access to emergency care

Patterns of antidepressant prescribing


www.qualitywatch.org.uk

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23 October 2013

Martin Bardsley: Introducing QualityWatch

Health & Medicine

Transcript of Martin Bardsley: Introducing QualityWatch