Commissioning for quality: views from commissioners

A new interactive web resource has been launched to support CCGs on commissioning high quality services that deliver improved outcomes for patients. Dr Paul Husselbee, Chief Clinical Officer of NHS Southend CCG gives his view:

High quality care for all, now and for future generations – This is the very least the public deserves from our NHS. But how can we, as commissioners, make this vision a reality?

Clinical Commissioning Groups have a duty to ensure the continuous improvement in the quality and outcomes of the services they commission.

CCGs should be identifying the quality improvements they wish to secure and use the commissioning process to drive it through. At the same time CCGs must also assure themselves of the quality of services that they commission.

NHS England as commissioners will also be looking to ensure the quality of the services they commission from general practice, local dentists and providers of specialist services.

We should ask ourselves: what do we mean by “quality”?

A single definition of quality in the NHS was first set out in “High Quality Care for All ” (2008), following the NHS Next Stage Review led by Lord Darzi. This definition has since been embraced by staff throughout the NHS.

This definition sets out three dimensions to quality, all three of which must be present in order to provide a high quality service:

  • Clinical effectiveness– quality care is care which is delivered according to the best evidence as to what is clinically effective in improving an individual’s health outcomes;
  • Safety– quality care is care which is delivered so as to avoid all avoidable harm and risks to the individual’s safety;
  • Patient experience– quality care is care which looks to give the individual as positive an experience of receiving and recovering from the care as possible, including being treated according to what that individual wants or needs, and with compassion, dignity and respect”. (Quality in the new health system – National Quality Board January 2013).

So, we have our definition but how do we go about testing this against the services we are commissioning?

To assist commissioners in this task, the Quality Working Group of the Commissioning Assembly has co-produced a resource – “Commissioning for Quality: Views from Commissioners” – which sets out five key messages which have emerged from the analysis of a number of CCG quality frameworks and strategies as well as other relevant literature.

These five key messages, when applied together, should make a significant impact on the quality of services:

  1. Listen to the voices of patients and the public
  2. Triangulate data and intelligence
  3. Make use of the levers available
  4. Walk the service – look and see
  5. Share concerns and take action

These messages are not standalone actions, but are interconnected. For example, the information and intelligence gained from listening to the voices of patients and the public can be triangulated with the findings from announced (and unannounced) visits to services to see them in action. This triangulation of data and intelligence enables a holistic picture to emerge about a given service.

In the past, perhaps too much emphasis was placed upon hard, statistical data without going to see the service in action – walking the service in the patients’ shoes.

As commissioners, we must continually ask ourselves – would I be happy for my family to use this service? If not, then why not and what do I need to do to improve the quality of the service?

It is also important to recognise two other important factors:

  1. Ensuring quality is complex and systemic. It is not the sole responsibility of any one organisation but a “collective endeavour requiring collective efforts and collaboration at every level of the system.” (Quality in the new health system – National Quality Board January 2013).

There are a number of organisations in the system with a role to play in ensuring quality and it is important they work together to share intelligence and take action where needed.

  1. To undertake the tasks set out in the five key messages requires certain skills as well as capacity within commissioning organisations. We need robust analytical skills not only to know where to go to get data but also to be able to interrogate it and draw conclusions. Assertiveness skills are required to challenge poor quality services with provider organisations along with a sound knowledge and understanding of the NHS Contract and how to apply levers when necessary.

We hope Commissioning for Quality – Views from Commissioners will be a practical resource where commissioners can see for themselves what three CCGs are doing about “walking” their services and can download templates and other useful tools to help them commission for quality,

Paul Husselbee

Dr Paul Husselbee is Chief Clinical Officer (CCO) of NHS Southend CCG and has been a GP in Southend for 23 years, having been born and brought up in the town.

He is also co-chair of the Quality Working Group of the NHS Commissioning Assembly, was a member of the Keogh Review Board and sits on the Quality and Clinical Risk committee, a sub-committees of the Board of NHS England.

He has been CCO in Southend since October 2012 – a small CCG with around 180,000 patients, co-terminus with Southend Unitary Local Authority and served by a single acute hospital. He has always had a keen interest in the managerial side of the health service, previously being GP advisor to Southend University Hospital, then Co-Chair of the PEC of Southend PCT.

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  1. Leon Spender says:

    Why do CCG’s operate without a team of Governors? Most British public services who are keen to bring forward public opinion, do so by having governors, preferably elected.

    • NHS England says:

      Dear Leon,
      Every CCG must have a governing body. The main function of the governing body is to ensure that CCGs have appropriate arrangements in place to ensure they exercise their functions effectively, efficiently and economically and in accordance with accepted principles of good governance. The membership of CCG governing bodies must include at least two lay people. One should have knowledge about the CCG’s area, so as to enable them to express informed views about the discharge of the CCG’s function – which would encompass a lead role in championing patient and public involvement. The other lay member should have qualifications, expertise or experience so as to enable them to express informed views financial management and audit matters – which would give rise to a lead role in overseeing key elements of governance such as audit, remunerations and managing conflicts of interest.
      Kind regards,
      NHS England