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Policy responses and statements
- Name of organisation:
- Scottish Government
- Name of policy document:
- The Healthcare Quality Strategy for Scotland:
Draft Strategy Document
- Deadline for response:
- 16 December 2009
Background: The NHSScotland Quality Strategy reflects
the shared ambitions of everyone in Scotland whether a patient, a carer,
or whether working for NHSScotland in a community, primary or acute
care setting. This is to create high quality person-centred, clinically
effective and safe healthcare services and to be recognised as being
world-leading in our approach. Many of the things we are already doing
in primary care, in health improvement, in hospitals and in other healthcare
environments are the right things, so the Quality Strategy can build
on a strong foundation. However, we also need to focus on some new
things, to do some things differently, and to reflect the changing
cultures, expectations, needs and context for healthcare service delivery
so that future generations can also enjoy the same high-quality healthcare
services.
Pursuing this ambition for the NHS in Scotland will ensure that we
simultaneously maximise our shared responsibly for contributing to
the wider Purpose of the Scottish Government to create sustainable
economic growth and opportunities for everyone in Scotland to flourish.
The Quality Strategy will have a direct and positive impact on these
goals through the improvements it will support in ensuring everyone
in Scotland can expect to live longer healthier lives, to participate
more productively both economically and socially, and through the increased
effectiveness and efficiency of the NHS, there will be a resultant
increase in productivity of the health sector in Scotland – a
significant and direct contribution to economic growth.
The aim is for everyone in Scotland to work together to ensure better
health and higher quality healthcare services which are flexible and
reactive to each individual circumstance. The Scottish Government wants
to ensure:
- Caring and compassionate staff and services
- Clear communication and explanation about conditions and treatment
- Effective collaboration between clinicians, patients and others
- A clean care environment
- Continuity of care
- Clinical excellence
To do this, the Scottish Government will continue to pursue the health
improving activities NHSScotland is already undertaking in partnership
with other bodies through the implementation of our health improvement
strategies, including Equally Well. It will focus on making the changes
and supporting the shift in culture required to one which is personcentred
and focussed on clinical excellence and patient safety, supported by
an optimum balance between continuous improvement and performance management.
The Scottish Government will do this by setting out a number of key
drivers and priority areas for action across NHSScotland. It will begin
the process of implementation by agreeing the specific interventions
required to make progress in each of these areas.
COMMENTS ON
SCOTTISH GOVERNMENT
THE HEALTHCARE QUALITY STRATEGY FOR SCOTLAND:
DRAFT STRATEGY DOCUMENT
The Royal College of Physicians of Edinburgh is pleased to respond
to the Scottish Government on its draft strategy document
on The Healthcare Quality Strategy for Scotland.
The College welcomes the emphasis on building a national quality infrastructure,
adopting a systematic approach to measuring and improving quality and
reducing the number of “initiatives”. The
emphasis on integrating quality measures with existing HEAT and other
targets is also welcome, as is the recognition that the balance of
performance management should shift from activity to patient safety
and quality of care.
The document would benefit from being referenced to the evidence cited
in support of the chosen direction of travel, for example, cross referencing
to progress reports for the Scottish Patient Safety Programme (SPSP)
to support the endorsements of Don Berwick.
The following comments reflect a secondary care perspective and raise
a number of issues for the hospital service, given the current emphasis
within the strategy document on evidence and experience from primary
and community care:
- A new emphasis on standards in clinical care will be necessary
to support the development of robust audit and outcomes data. The
College has a strong track record in this respect and welcomes the
opportunity to contribute using the expertise within our professional
clinical networks.
- The College supports the emphasis on developing effective clinical
data systems to measure and monitor quality and looks forward to
contributing to the various work streams that will progress this
work. Physicians are committed to improving the quality of
clinical data in Scotland, which can be inaccurate and damages confidence
in the output. The definition of and methodology for deriving quality
measures will be critical to the success of the strategy and in securing
the confidence of patients and doctors.
- There will be a need to establish a well resourced audit infrastructure
across Scotland to allow clinical teams to undertake clinical effectiveness
work in support of local quality improvement projects. Participation
in relevant clinical effectiveness projects is also a key component
of specialist recertification for all consultants, and the College
welcomes the synergy in this aspect of the Quality Strategy. Time
will have to be created in consultant job plans for this essential
work.
- A strategy for audit in physicianly medicine has been a high priority
for the College for many years, and it has proved difficult to get
agreement to fund pilots to begin this essential work. The
College welcomes the opportunity to make progress through the proposed
Healthcare Quality Strategy.
- The College notes the references to including CARE measures in
clinical appraisal and revalidation of doctors, and understands that
these were developed by and for Primary Care and that there is limited
evidence of their direct application to Secondary Care. The
College is aware of one published study in a single UK hospital outpatient
facility, a related study with consultant anaesthetists and some
work in Germany and would be keen to hear of other evidence demonstrating
the validity of this approach in Secondary Care (1,2,3,4).
- The College notes the move towards a trained doctor service and
agrees there is significant evidence in support of clinical quality
improvement resulting from rapid access to senior clinical opinion,
particularly for the sickest patients and those presenting as emergencies(5). Similarly,
evidence is emerging that supports the cost effectiveness of consultant
delivered care.
- Effective workforce planning will be critical to secure a sustainable
consultant delivered service, particularly given the emerging quality
issues of patient continuity and outpatient capacity resulting from
the European Working Time Regulations (EWTR) changes. A recent
survey undertaken by the Scottish Academy shows that over 70% of
Scottish Consultants believe that the EWTR has had a negative impact
on patient safety with many qualitative statements citing poor continuity
of care and rota gaps as the main drivers.
Finally, the College looks forward to working with colleagues across
NHS Scotland on the development and delivery of the Quality Strategy
as part of the Quality Alliance.
References
1. S.W. Mercer, D.J. Hatch, A. Murray, D.J. Murphy, K.W. Eva. Capturing
patients' views on communication with anaesthetists: the CARE Measure. Clinical
Governance, 2008 vol 13, issue 2, 128-137
2. Mercer SW, McConnachie A, Maxwell M, Heaney D and Watt GCM. Relevance
and practical Use of the Consultation and Relational Empathy (CARE)
Measure in general practice. Family Practice 2005; 22: 328-334.
3. Mercer SW, Murphy DJ. Validity and reliability of the Care
Measure in secondary care. Clinical Governance, 2008 vol 13
issue 4, 269-283.
4. Neumann
M, Wirtz
M, Bollschweiler
E, Mercer
SW, Warm
M, Wolf
J, Pfaff
H. Determinants and patient-reported long-term outcomes of
physician empathy in oncology: a structural equation modelling approach. Patient
Educ Couns. 2007 Dec;69(1-3):63-75. Epub 2007 Sep 11.
5. NCEPOD Report; Deaths in acute hospitals: Caring to the End? 2009
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[16 December 2009]
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