-
December 2008/January
2009:
1. Work is in progress to
further develop IFQO webpages as part of the College website.
That will hopefully include systematic monthly updates on all of
the key projects in each country. This report covers the main
developments I am aware of for the time being.
2. Senior College officers
and staff have held preliminary discussions with Dr Joe McDonald
(National Clinical Lead for Mental Health for the National
Programme for IT in England) about the idea of setting up a small
RCPsych Informatics Unit early in 2009. The work should
benefit mental health informatics in general, not just psychiatric
aspects and not just in England. A key role initially would
be to assist with projects developing the content of electronic
care records. A meeting: ‘Mental Health, Rising to the Informatics
Challenge’ is planned for 27 March.
(contact: Joe.Mcdonald@nhs.net or Dr Martin
Elphick)
3. Department for Children,
Schools and Families: Improving Information Sharing and
Management (IISaM) Programme
IISaM
will enable alignment of delivery across:
- Information Sharing – enabling co-operation between local
agencies
- ContactPoint – the quick way to find out who else is working
with the same child or young person (previously known as the
information sharing index)
- the electronic enablement of the Common Assessment Framework
(eCAF)
- Integrated Children’s System (ICS) for looked-after children
and
- the Client Caseload Information System (CCIS) for the
Connexions service
- Every Child
Matters website
With links to specific project related information and
publications:
Guidance and training materials for integrated
working processes and tools – also go to Child's Workforce Development
Council
(College contact: Richard Burton)
4. NHS Connecting for Health:
Content Requirements for Mental Health Services
The purpose of this (internal) document, on
which the College has provided input, is to describe at a high
level the generic content required by Mental Health Services for
use in all NPfIT systems. It is intended that these
requirements form the baseline for an external procurement of such
content with a view to this being made available as the standard
set provided in NPfIT systems for MH Services. It is hoped
that the College will also have a role to play in quality assurance
of the project.
(College contact: Martin Elphick/Richard
Burton)
In the meantime we gather that CSE Servelec
(provider for the Lorenzo system for the ‘northern’ part of NPfIT)
has agreed to adopt the same NHS clinical content for MH that has
been developed so far for RiO in London and the South. This
may offer Lorenzo the chance to move forward more quickly in terms
of being clinically useful (and possibly improve compatibility of
data structures across the country).
5. Department of Health:
Developing the Quality and Outcomes Framework (for Primary Care):
Proposals for a new, independent process.
This is a public consultation document setting
out proposals for how a new independent and transparent
process for recommending Quality Outcome Framework (QOF) indicators
led by NICE should work. The DH will publish the responses and
publish a report on how the consultation process influenced the
development of policy.
Department of Health Consultations webpage
6. Department of Health,
Sainsbury Centre for Mental Health, RCPsych: Key Outcomes
Seminar
A seminar is being planned in meetings between
the above three agencies for mid March to identify a number of
candidate population-level outcomes metrics that might be used in
setting Public Service Agreement targets for local government, to
further the government’s Social Inclusion agenda.
(College Contact: Richard Burton)
7. Information Centre for
Health and Social Care: Clinical Quality Indicators Survey
‘High Quality Care for All, the final report of the NHS Next
Stage Review, defined quality in the NHS as safe and
effective care of which the patient's whole experience is positive.
Soon
you will be able to measure the quality of the care you deliver
using a range of
indicators. Some will be specific to your organisation and region
and some will be national
measures but both sets will be developed by the people who will use
them – NHS staff. This will allow you to benchmark
your work against outcomes across the country and will
give
you insights into how to improve the quality of care you give. Our
goal is to support local efforts to
improve quality by developing useful and meaningful
measures.’
Clinical quality indicators survey
Addendum: Please see Briefing
Paper below for an overview of this development.
8. College
Education and Training Centre: Medical Manager’s Conference
on Revalidation
The IFQO initiative was presented at a College
conference in Belfast on 20th November, with a focus
upon the possible use of clinical outcomes measures in the
re-validation of psychiatrists. As yet, these measures are
not routinely collected and it would be impossible to assess an
individual’s performance in the absence of comparative data in a
number of similar treatment settings). The attention of the
assembled medical managers was drawn to the recently published
Outcomes Compendium. The principle that clinical outcome
should be one of a range of factors taken into account was
generally accepted but there is a need for a lot more time,
training and technology if routine outcome measures are to be
employed.
9. Academy
of Royal Colleges Standards on record structures and content.
These should apply equally to MH records as to
those used in acute services.
Academy of Medical Royal
Colleges (2008) A clinician’s guide to record structures:
Part 1. Why standardise the structure and content of medical
records?
A Clinicians guide to record structures (1)
Academy of Medical Royal
Colleges (2008) A clinician’s guide to record structures:
Part 2. Standards for the structure and content of medical
records when patients are admitted to hospital.
A Clinicians guide to record structures (2)
10. The Payment by
Results Factsheet (no 7)
This provides amongst other
things a link to the presentations made at a big September PBR
conference on Mental Health, updates on costings methodology (or
the sub-project to develop a method to be used), and latest
timelines.
Payment by Results
If you have a special interest I could forward
on request a copy of minutes of the last Expert Reference Panel
which includes ‘ update presentations’ on the PBR project, and also
a National Audit survey of Finance Director’s views about PBR and
their readiness for implementation (December 1st).
M Elphick 2/01/09
Measuring for Quality Improvement in Mental Health: A
briefing paper
From what I am picking up, the recent widely-
circulated paper Measuring for Quality Improvement seems
to benefit from further clarification so far as mental health
services are concerned. By chance I have heard about it
separately over the last fortnight from senior figures in my SHA,
Trust, the RCPsych, Connecting for Health, CSIP, the Information
Centre and Dept of Health (MH Branch). I don’t claim to know
about everything that is going on but the following may be
useful. There is no point in trying to paraphrase the
document itself but here are some answers to questions I have heard
as to ‘how it all fits together’:
What are the Quality
Indicators/Measures/Metrics that will be used in Quality
Accounts?
We don’t yet know. Different ones may be
used at different organisational levels for various purposes.
They may be deliberately changed from year to year, or between
contracting cycles to prevent incentives being unbalanced.
Local decisions will be taken as to which are most relevant to
local quality issues, and we must engage in that process
particularly with SHAs and through the Care Pathways (‘Darzi’)
groups. There will be a core of common measures determined at
a national level, and a ‘menu’ of approved, quality-assured
measures for use at local levels. Those are the ‘Clinical
Quality Indicators’ that can be found (with some difficulty
apparently) on the Information Centre website. They are still
under consultation. If you go to the consultation survey site you
can find, as well as the list of measures, a diagram in Annexe 1 of
the ‘pyramid of quality’ illustrating the different uses and
‘products’ at each organisational level.
Clinical Quality Indicators Survey
NB Besides the CQ indicators that are listed
under Mental Health, the following numbers are also relevant:
CF 2-3; MR 12-14,31 and 33; PE 1-92 (possibly excluding those
relating to Choice); PS 1-3, 17-24, 26-33, 35-40; RA 2, 11-12,
16-17, 21-22.
When will all of this
happen?
Most of it is planned to happen for Mental
Health at the same time as for Acute services – measures need to be
identified and ‘in place’ by April 2009, for Quality Accounts to be
published in 2010 (Source: DH MH Branch). But it is not
planned for MH provider’s contracts to be affected immediately by
CQUIN (the Commissioning for Quality Initiative, in which money is
held back if quality targets are not achieved). That will be
delayed by a year because the new MH standard contract format has
only just been introduced and needs to bed down first.
How does this fit with Payment by
Results?
PBR for MH will also require new data
collection. It will necessitate allocation by clinicians of
each service user to one of a smallish discrete number of care
packages (note there is a distinction between care pathways and
care packages). The numbers of each type of package provided
will be used to calculate the resource allocation (but not
necessarily by using a fixed national tariff as is the case with
PBR in the Acute sector). Clinical allocation is being done
in the pilots by using a modified version of HoNOS (which of course
was originally designed as an outcome rather than an assessment
measure). Therefore it may be possible to use the same data
both for quality and activity measures.
NB: It seems likely that Information
Standards Board approval of the care packages used for PBR in MH
will not be gained, and therefore a DSCN be sent out, until mid
2009. That would still just allow implementation of PBR
within 2010 as indicated in the Next Stage Review (Source: NHS
Information Centre).
What about other quality
metrics?
The DH has recently commissioned Sainsbury
Centre for Mental Health to work with the College on some quality
metrics on Social Exclusion. A seminar is to be held on that
early next year to identify possible metrics for population-level
use, perhaps even to be used in Public Service Agreements (between
Central and Local Government). There is obvious potential for
using compatible measures with the above.
NB: It has already been decided that MH
MDS data will be used to support a PSA on employment of people with
mental health problems (Source: NHS Information Centre).
What about IT support?
There will have to be an emphasis at first
upon measures that are already potentially ‘available’ – ie data is
supposed to collected (eg in data returns) even if it is not
currently aggregated, analysed or used. Obviously part of the
consultation and continuing development process will involve going
beyond that to develop new measures that span the full range of
quality parameters, for all our services.
What is the College
doing?
- The College logo appears with others on the Information Centre
website for CQIs though I personally do not know who represented
the College.
- The CRTU has an established history and reputation in this
area.
- There is currently a large number of new informatics
initiatives requiring a consensus response by clinicians, including
work (in England) on the content of electronic clinical records,
PBR, quality and outcomes measures, risk recording, an
interventions list/classification, etc. Similar cohorts of
projects are underway in Scotland and to some extent also in Wales
in N Ireland. Discussions are underway to set up a College
Informatics Unit.
- The ‘Information-based Funding, Quality and Outcomes
Initiative’ is already under way, but has very limited
resources. An initial Statement of Principles with
answers to common questions can be found on the College Website,
and a more user-friendly website is to be set up next month,
including updates on as many projects as we can manage to
track.
Snippets:
- There seems to be an intention within the Department of Health
to standardise data items between RAP (LA Social Services) returns
and Health returns, and even for NHS providers to be able to make
RAP returns themselves.
- Other clinical outcomes measures than HoNOS may be included in
MH-MDS (incl HoNOS 65+, PHQ9).
M Elphick 12/12/2008
(Specialist Adviser, Information-based
Funding, Quality and Outcomes)