Unwarranted variation programmes

Work is underway on a number of programmes where nursing, midwifery and care staff are taking the lead in addressing unwarranted variation in areas that straddle the NHS, independent care sector and local authorities. The intention is to encourage similar efforts in other areas, such as in care homes where staff can use the approach for both small scale projects and large ones.

Wound care

A project is looking at a national approach to wound care management which aligns to a specific component such as diabetes care.

A useful resource is now available for nursing and care staff to highlight what an ideal wound care pathway looks like, particularly in primary and community nursing.

In this example, using the framework for nursing, midwifery and care staff: Leading Change, Adding Value, unwarranted variation in wound care has been identified. Betty’s story provides a valuable resource to highlight how using the framework can address all three outcomes of the triple aim: better experiences, better use of resources and better outcomes. Nursing, midwifery and care staff have a direct opportunity to decrease variation. Decreasing variation will reduce the health and wellbeing gap, the care and quality gap and the funding and efficiency gap to deliver better outcomes through improved wound care. This document been produced in conjunction with the RightCare programme team.

Midwifery supervision

Following a review of statutory supervision in 2015 the recommendations were made that the Nursing and Midwifery Council (NMC) should have direct responsibility and accountability solely for the core functions of regulation.

By spring 2017, a new model of supervision will be developed that will: support the provision of woman centred safe care that improves outcomes for women and their families and supports a framework of sustainable clinical supervision for midwives in England.

The development of the new model of supervision will specifically look to identify and address unwarranted variation.

Maternity – Improving outcomes in maternity care

Contributing to the Government’s national ambition to halve the rates of stillbirths, neonatal and maternal deaths and intrapartum brain injuries by 2030 sets out five high-level themes which are known to make care safer.

Maternity – Continuity of Carer

TheNational Maternity Review’ (2016) set out wide-ranging proposals designed to make care safer and give women greater control and more choices, to be implemented over the next five years.

It will enable women to choose a provider based on their maternity offer, for example, continuity of carer throughout pregnancy, birth and postnatal care. Improving continuity is linked to improving quality of care and is expected to reduce unwarranted variation.

Safeguarding – ‘Looked after Children’ (LAC) annual health assessments

Guidance is available that sets out the requirements of assessments that are undertaken in relation to ‘Looked After Children’. These measures alongside those set out within statutory guidance and aligned tariff arrangements should be used to ensure a quality assessment for all LAC.

Variation has been identified in relation to both quality and payment processes and there is an opportunity to identify whether this is unwarranted variation and should be addressed.

Continuing healthcare (CHC) in health and care settings

NHS Continuing Healthcare (NHS CHC) is a package of care for adults aged 18 or over which is arranged and funded solely by the NHS. In order to receive NHS CHC funding individuals have to be assessed by Clinical Commissioning Groups (CCGs) according to a legally prescribed decision making process to determine whether the individual has a ‘primary health need’.

It is proposed that there may be differentials in approaches to commissioning and application of the framework and this may be unwarranted variation.

Mental health – Improving the physical health and wellbeing of people with mental health problems

The ‘Five Year Forward View for Mental Health’ (2016) highlighted that people with mental health problems have poorer physical health than the general population and are often unable to access the physical healthcare they need, contributing to avoidable health inequalities. People with severe mental illness are particularly at risk and die on average 15-20 years earlier than the general population.

Learning disabilities – Premature mortality in individuals with learning disabilities

The Confidential Inquiry into the Premature Deaths of People with Learning Disabilities’ (CIPOLD), published in March 2013, set out the extent of the health inequalities suffered by people with a learning disability and showed, through case studies, how annual health checks would have made a difference. The Mencap report ‘Death by Indifference’ also included case studies showing where health checks might have contributed to preventing premature deaths. Using the NHS RightCare approach, the new focus will be to improve the quality of care to reduce premature deaths in the following key areas: epilepsy, diabetes, cancer and heart disease.