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Achieving better outcomes for musculoskeletal (MSK) conditions – Roland Valori

In this blog, Roland Valori takes a closer look at some of the attempts to reduce variation in clinical outcomes and improve productivity of services for musculoskeletal conditions and diseases. These include using techniques such as ‘Audit and Feedback’, demonstration projects, whole service redesign and a variety of other quality improvement initiatives at local and national level.

The impact of these approaches varies and even when change is achieved, it is often difficult to sustain. Accreditation will help achieve a more sustained approach to improvement in quality. It supports and enhances these varied approaches providing a quality mark for patients and commissioners.

Some accreditation schemes such as the endoscopy and audiology schemes are linked to commissioning. The CQC is using information from accreditation schemes to inform its inspections and has indicated it would like to see more widespread accreditation of clinical services.

The development of schemes thus far has been unplanned. As a result there is considerable variation in approach that leads to unwarranted burden on scheme providers, provider organisations and clinical teams.

The Clinical Services Accreditation Alliance (CSAA), whose work is currently housed with the Healthcare Quality Improvement Partnership, was created in 2013 to develop consistency and quality to the approach, and to reduce burden and costs.

At the core of the approach is a framework for clinical services that is designed to provide a roadmap to follow, and against which services can be assessed for the purposes of accreditation. The framework was created in collaboration with the British Standards Institution (BSI) and was published in August 2016. The framework is a standard product of BSI methodology and is called a Publicly Available Specification (PAS1616). In time it could develop into a British Standard (BS).

For those living with MSK conditions this is a significant step forward as the framework is patient focussed and will put patients at the centre of care. It is also designed to achieve better value for money through an integrated approach: the intention is that clinical services will be assessed across the whole patient pathway, not just in hospitals.

A generic approach could be developed because the CSAA discovered that current accreditation schemes were using very similar standards. The framework brings consistency and common language, but it has also been created in such a way that it can be customised for individual services.

The first phase of the project work has been completed. Liver services have been piloting a process based on the principles of the CSAA.  Clinical teams on 12 sites have used a draft generic standard framework to structure quality improvement. Six of these have been assessed against the requirements of the framework. The pilot has demonstrated the process can be applied successfully and there has been excellent feedback from patient groups and health professionals. Liver services are now planning to role out the approach across the country using PAS1616 in place of the draft framework. The CSAA is looking for other clinical services that wish to be early adopters of the process.

MSK services are well ahead of many other clinical specialities and therefore perfectly placed to be an early adopter in the development of service based accreditation.

Roland is presenting a webinar  as part of the MSK knowledge Network Series Webinars on Friday 18 November, 2016,12:00-13:00; Titled Clinical Service Accreditation: achieving better value for MSK services.  Register for the webinar. Once you have registered you will be sent a calendar invite containing details on how to join.


Roland qualified as a doctor in 1976. He has been a Consultant Gastroenterologist in Gloucestershire since 1993. He has had an interest in achieving better value for money of health care services for 20 years. In 1999 he wrote an MSc thesis on implementing best care across the primary/secondary care interface

Roland was National Clinical Director for Endoscopy from 2003 to 2013. In recognition of impact he was awarded ‘NHS Change Leader of the Year’ in the first National NHS Leadership Awards (2009). He was the National Clinical Advisor to the English Bowel Cancer Screening Programme from 2006 to 2013.

In 2011 Roland was appointed Clinical Director for Service Accreditation in the Royal College of Physicians of London. He currently leads the Clinical Services Accreditation Alliance, a coalition of medical and other health professional organisations developing a strategy for more widespread accreditation of clinical services.

Roland has been a user of MSK services on several occasions during the last 11 years.

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