Commission for Health Improvement

1
Commission forHealth Improvement

• CHI The national perspective
• Emilie RobertsDevelopment Manager
• 10 December 2003

2
This presentation will cover

• Who we are and what we do
• A bit about the review process
• What are we finding?
• Some reflections
• From CHI to CHAI

• How it works
• Hints and tips

3
CHIs aim

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

4
CHIs principles

• patient centred
• independent, rigorous and fair
• developmental
• evidence based
• open and accessible
• apply the same expectations to ourselves

5
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

6
Clinical governance reviews

• What is it like to be a patient here?
• How good are the PCTs systems for safeguarding
  improving quality of care?
• What is the PCTs capacity for improving?

• The review does not assess
• the performance of individuals or individual
  practices

7
The review process

• Why me?
• Why not me?

• Scheduling
• Data collection
• Meetings
• Site visits
• Report
• Action planning

8
The review process

• Scheduling
• Data collection
• Meetings
• Site visits
• Report
• Action planning

• PCT data request
• Practice survey
• Routine data

9
The review process

• Scheduling
• Data collection
• Meetings
• Site visits
• Report
• Action planning

• Partner organisations
• Patients public

10
The review process

• Scheduling
• Data collection
• Meetings
• Site visits
• Report
• Action planning

• Review manager
• Plus team of seconded reviewers

11
The review process

• Scheduling
• Data collection
• Meetings
• Site visits
• Report
• Action planning

Publicly available
12
The review process

• Scheduling
• Data collection
• Meetings
• Site visits
• Report
• Action planning

It can be put on the shelf and forgotten about.
Its not an ongoing audit. No one goes back to
check Trust coordinator quoted in the Daily
Telegraph, 01.12.2003
13
The review process

• Scheduling
• Data collection
• Meetings
• Site visits
• Report
• Action planning

It can be put on the shelf and forgotten about.
Its not an ongoing audit. No one goes back to
check Trust coordinator quoted in the Daily
Telegraph, 01.12.2003
14
The practice surveys

• Example 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

15
Site visits visiting and interviewing PCT
managers, professionals staff

• Focus is
• your experience of systems in place to improve
  quality and safeguard patient safety
• patient experience (visits include some
  observation of the environment)

16
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.

17
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

18
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

19
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

20
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

21
Reflections on CHI

• The review team
• Consistency
• One size fits all
• Making a difference
• Regulatory burden

22
(No Transcript)
23
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

24
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
25
Commission forHealth Improvement

• www.chi.nhs.uk