The King’s Fund has urged the Department of Health to work with other national bodies to “develop a clear road map for radically improving quality measurement in community services.”
In a short report issued this morning, the think-tank says assessing and managing the quality of community services is hampered by a lack of metrics and data; which is caused, in part, by a lack of IT to collect information.
The researchers behind the report on ‘Managing quality in community health services’, say half of their interviewees felt their organisations were doing well, and that two thirds felt they had the data they needed to improve quality.
However, they comment that: “Given the overall paucity of both data and quality metrics for the community services sector, it is questionable whether this level of confidence is warranted.”
They also add: “It is possible that the system is collectively setting its thresholds for quality measurement in community services lower than other sectors that have better systems and support.”
The report notes that community health services – including health visiting, school nursing, community nursing, physio and other therapy, and end of life services – are used by millions of people every year and account for around £10 billion of the NHS budget.
Despite this, it notes that the sector has been more subject to reorganisation than almost any other part of the NHS, with the most recent shake-up triggered by the Transforming Community Services programme.
This ordered primary care trusts to divest themselves of their community arms, so they could concentrate on commissioning (before they were themselves abolished in favour of clinical commissioning groups).
Community services were reconstituted as trusts, merged with acute and mental health trusts, or transferred to the private and voluntary sectors; leading to a big increase in NHS spending on non-NHS providers.
Community services are now seen as vital to the present reform agenda of more person-centred, co-ordinated advice and care, delivered in people’s homes.
But, the report argues, “there is relatively little national policy focus on quality in community healthcare”, only “limited national data on quality”, relatively “under-developed” IT and infrastructure, and lots of block contracting that “does not incorporate quality standards.”
Interviewees told the King’s Fund team lead by Catherine Foot that the indicators they had available to them included the NHS Safety Thermometer, incident reports, workforce information, complaints data, patient reported outcome measures and their own patient feedback.
But the report argues that more is needed, starting with the completion of work on a Community Information Data Set (CIDS), the maternity and children’s data set, and the children and young people’s data set.
It also argues that it is essential for non-NHS providers to collect and report on this information; and that they invest in the IT systems necessary.
In the IT context, the report also notes that community health services often have problems accessing patient records and sharing information with other organisations. “There is an urgent need for clarification of policies, guidance and sharing of good practice in relation to information governance for data-sharing,” it says.
The report argues that better IT and data would make it easier for organisations to address some of the more basic problems that community health services have in delivering quality.
These include demand pressures, the difficulty of planning, finding, and managing an appropriate workforce, block contracting, and patchy relationships with other parts of the system.
However, it argues that policy makers and regulators should take action to address some of these directly, for example by developing better workforce plans and creating better pricing and contracting models.
“The community services sector is a diverse and complex part of our healthcare system…. That has for too long remained poorly understood, under supported nationally, and perhaps also undervalued,” it concludes.
“Now, more than ever, it is time that we became serious about quality in community services.”