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QualityWatch: Closer to critical 1 Nov 2016

'We can only be sure to improve what we can actually measure' wrote Lord Darzi in High Quality Care for All. I was reminded of it this week when QualityWatch hosted a conference to coincide with the release of its third annual statement 'Closer to Critical?'

QualityWatch is a remarkable collaboration between the Nuffield Trust and The Health Foundation. In its own words: “Quality of care is a complex, multidimensional concept and can be viewed through many different lenses. The QualityWatch team uses an extensive range of indicators to assess the quality of health and social care services in England. This range of indicators continues to develop over time to provide an increasingly broad assessment of quality (see www.qualitywatch.org.uk/indicators)”

For child health, indicators used by QualityWatch include:

• teenage pregnancy
• birth weight
• obesity
• dental caries
• vaccination coverage
• admissions for mental health
• unplanned admissions for long term conditions

At Connecting Care for Children we’ve reflected before on the challenges and the importance of measures and recognise that we often measure what is measurable, rather than what is important. I am mindful that the earliest lesson in medicine is to ’first do no harm’ and if we paraphrase Lord Darzi’s quote as ‘you deliver what you measure’ then there is certainly scope for doing harm by choosing the wrong metrics.

QualityWatch is rightly concerned that the current financial squeeze poses a serious risk to healthcare quality and have chosen three topics of concern to focus on this year:

1. how easily patients can access care
2. how engaged and motivated the workforce is
3. how well we look after the health of children and young people

This resonates strongly. Connecting Care for Children’s Child Health GP Hub model improves access and supports workforce development. It goes without saying that our work is all about children and young people.

People deliver healthcare, so getting the right staff with the right training matters. In the session on building a high-quality workforce, Professor Martin Roland and Dr Hilary Cass painted a picture of the future – these quotes from Martin’s report on 'The Future of Primary Care' are superb:

• 'We regard it as outdated that GPs and specialists are unable to communicate freely by email or by electronic messaging. Although some areas have commissioned services that enable GPs to email specialists for advice, these remain the exception rather than the rule. Often people need to be referred to hospital just for a simple query to be answered. At a time when there is so much focus on integration of care, it seems bizarre to us that provision is not made within the job plans and contracts of both GPs and specialists to encourage this basic level of communication.'
• 'We think it will soon look outdated that, in an age where so much communication occurs by email, few people can email their GP or practice nurse. In contrast, 86 per cent of GPs in Denmark (see box) and 46 per cent in the Netherlands use email regularly to communicate with patients.'

I am so glad we have provision for this in the Child Health GP Hub and have shared our insights both through a blog and in a letter published in the Archives of Disease in Childhood.

Hilary’s important message ‘we need to stop the hospital being the happening place to be’ was picked up by Twitter. The more I see, the more I recognise how much the GP practice is already the happening and the trusted place to be.

The highlight of the day for many will have been the uplifting example from Northumbria where they have been improving quality and reducing costs.

The clear message, as David Evans, their recently appointed chief executive (and previous medical director) explained, was to focus on safety and quality and these will deliver the cost savings. A simple example was their ability to expand the number of orthopaedic surgeons through savings made by standardising the types of implants used. All staff at the Trust participate in quality improvement and patients are deeply involved. Undoubtedly this patient participation is a key strength, and as Ben Holden writes, it might be medicine’s next big breakthrough. Interesting too, that by being far away from Whitehall David Evans said they were able to get on and do things ‘without permission’.

So what hope is there for us, based in London? Can we possibly make the radical changes across the whole system that enable high-quality care for children and young people? Well perhaps we will be fine: so often I hear despondency about Whitehall leaving children’s services alone. Perhaps we should be pleased about that, after all.