1. Time for QualityWatch?
Martin Bardsley
23 October 2013
© Nuffield Trust and Health Foundation
© Nuffield Trust

2. 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
© Nuffield Trust and Health Foundation

3. 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.
© Nuffield Trust and Health Foundation

4. 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
© Nuffield Trust and Health Foundation

5. © Nuffield Trust and Health Foundation

6. Website QualityWatch.org.uk
© Nuffield Trust and Health Foundation

7. 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
© Nuffield Trust and Health Foundation

8. 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
Person centred
care
13
147
274
26
82
542
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
© Nuffield Trust and Health Foundation

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

10. An external perspective
Life expectancy in years by country (1991 to 2011)
Source: Organisation for Economic Co-operation and Development (OECD),
Health data 2013
© Nuffield Trust and Health Foundation

11. Interrelated indicators: eg Number of days delayed based
on care received by the patients (August 2011 to July 2013)
© Nuffield Trust and Health Foundation

12. Regional differences: eg Proportion of adults with learning
difficulties in paid employment by region (2009/10 to 2012/13)
© Nuffield Trust and Health Foundation

13. Changes in staff over past decade
© Nuffield Trust and Health Foundation

14. 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
© Nuffield Trust and Health Foundation

15. 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)
© Nuffield Trust and Health Foundation

16. Proportion of patients who said that doctors or nurses talked in
front of them as if they weren't there (2002 to 2012)
© Nuffield Trust and Health Foundation

17. 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
© Nuffield Trust and Health Foundation

18. Trends in 30 day mortality following admission for
hip fracture
© Nuffield Trust and Health Foundation

19. Mortality rates higher in more deprived areas
© Nuffield Trust and Health Foundation

20. 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
© Nuffield Trust and Health Foundation

21. 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
© Nuffield Trust and Health Foundation

22. www.qualitywatch.org.uk
Sign-up for our newsletter
www.qualitywatch.org.uk/newsletter
Follow us on Twitter:
Twitter.com/qualitywatch
23 October 2013
© Nuffield Trust and Health Foundation
© Nuffield Trust and Health Foundation