1. National Cancer Quality Programme
Better Cancer Care 1 states that a wide ranging approach to quality improvement is required to ensure that services improve performance across all dimensions of quality. The NHS Scotland Healthcare Quality Strategy 2 (launched in May 2010) further expands upon this by articulating three quality ambitions:
- Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.
- No avoidable injury or harm from the healthcare they receive, and that they are cared for in an appropriate, clean and safe environment at all times.
- The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation.
The quality strategy aims to put quality at the very heart of the NHS, building upon the excellent foundations already in place. A quality measurement framework has been developed which sets out measures and targets which will be used to monitor, challenge, manage and report progress towards the three quality ambitions. This framework also allows for supplementary national indicators that will underpin progress towards the quality ambitions 2 .
Under the auspices of the Scottish Cancer Taskforce, National Cancer Quality Performance Indicators ( QPIs) have been developed to drive continuous quality improvement in cancer care across NHSScotland. The QPIs are small sets of cancer-specific outcome focussed, evidence based indicators. These are underpinned by Patient Experience QPIs that are applicable to all, irrespective of cancer type. QPI implementation ensures that activity is focussed on those areas that are most important in terms of improving survival and patient experience whilst reducing variance and ensuring the most effective and efficient delivery of care.
A QPI is defined as a proxy measure of quality care. QPIs are kept under regular review and are responsive to changes in clinical practice and emerging evidence.
1.1 Quality Assurance and Continuous Quality Improvement
The ultimate aim of the programme is to develop a framework, and foster a culture of, continuous quality improvement, whereby real time data is reviewed regularly at an individual Multi Disciplinary Team/Unit level and findings actioned to deliver continual improvements in the quality of cancer care. This is underpinned and supported by a programme of regional and national comparative reporting and review.
NHS Boards are required to report against QPIs as part of a mandatory, publicly reported, programme at a national level. A rolling programme of reporting is in place, with approximately three national tumour specific reports published annually. National reports include comparative reporting of performance against QPIs at Board/Multi Disciplinary Team level across NHSScotland, trend analysis and survival. This approach helps to overcome existing issues relating to the reporting of small volumes in any one year.
In the intervening years tumour specific QPIs are monitored on an annual basis through established Regional Cancer Network and local governance processes, with analysed data submitted to Information Services Division ( ISD) for inclusion in subsequent national reports. This approach ensures that timely action is taken in response to any issues that may be identified through comparative reporting and systematic review.