Healthcare Improvement in Scotland

On 1 April 2011, Healthcare Improvement Scotland was launched as a new health body, marking a change in the way the quality of healthcare in Scotland is supported nationally. The purpose of Healthcare Improvement Scotland is to improve the quality and safety of healthcare for the people of Scotland by:

• Providing evidence-based advice and guidance
• Supporting innovation and improvement with patients, their families and the public at the centre of all activities
• Scrutinising services to provide public assurance
• Influencing national policies

With these objectives, Healthcare Improvement Scotland builds on past work done by NHS Quality Improvement Scotland (NHS QIS) and the Care Commission. The Healthcare Environment Inspectorate (HEI),

Scottish Intercollegiate Guideline Network (SIGN), Scottish Health Council, Scottish Medicines Consortium (SMC), Scottish Patient Safety Programme and the Scottish Health Technologies Group (SHTG), all previously components of NHS QIS, are now part of Healthcare Improvement Scotland. However, the shape and focus of activities to improve the quality of healthcare have evolved. The integrated cycle of improvement has been developed to explain how the organisation’s activities are organised to deliver its objectives.

Evidence
Healthcare Improvement Scotland collaborates with national and international experts to identify, create, synthesise and share evidence for improvement. It provides advice and guidance on effective clinical practice by developing national standards, evidence notes, health technology assessments and systematic reviews. Healthcare Improvement Scotland assesses new technologies in healthcare through the SHTG and advises on the cost effectiveness of newly licensed medicines through the SMC.

All evidence is accessible to healthcare professionals to support them in providing safe and effective care, and to the public to inform them of the quality of care they can expect to receive.

Currently, the evidence on postnatal depression is being revisited to update the SIGN guideline on postnatal depression. Aspects of the guideline undergoing revision include diagnosis, screening, pharmacological and psychological interventions. The updated guideline and an associated patient version will be available in spring 2012.

Improvement
Healthcare Improvement Scotland facilitates improvements in healthcare practice and patient safety through use of evidence; offers clinical governance support; and encourages NHS boards to promote public involvement and equal opportunities.

Many of the organisation’s improvement initiatives that are currently ongoing stem from the reproductive, maternal and child health work programme. As part of its core continuous work, this programme co-ordinates the assessment of maternal deaths in

Scotland and thus contributes to the triennial Saving Mothers’ Lives Report which is overseen by the Centre for Maternal and Child Enquiries (CMACE). The most recent report containing data from 2006- 2008 was published in March this year.

In June, Healthcare Improvement Scotland, in collaboration with NHS Education and NHS Health, held a series of roadshows to launch the Scottish Antenatal Parent Education Pack. The pack was developed to prepare professionals to deliver consistent parent education, which respects and reflects the individual needs of pregnant women and their partners. It includes a national syllabus, a resource pack and a training element.

In November last year, a revised Scottish Woman-Held Maternity Record (SWHMR) was published following evaluation in 2010 and taking account of feedback from a national consultation. The SWHMR is an innovative development led by Healthcare Improvement Scotland on behalf of the Scottish Government. Scotland was the first of the UK countries to have a single national unified handheld record for women during their maternity care.

Scrutiny
HEI inspects the NHS to ensure hospitals are safe and clean, assesses the performance of NHS and independent healthcare services, and publishes findings. Healthcare Improvement Scotland also scrutinises compliance with national standards. The national standards for sexual health services were published in March 2008 and peer review visits to each NHS board in Scotland to assess performance against these standards will be complete this summer. An overview of national performance will be published later this year.

A new model for scrutiny is being developed that will apply to both the independent sector and the NHS in future years.

Measures of success
The effectiveness of Healthcare Improvement Scotland will be judged on the following criteria:

• Public involvement and confidence in services;
• Improvement in the measures of qualityindicators;
• Reduced variation in practice
• Greater use of what is known to beclinically and cost effective
• Less use of what is not effective
• Reduction in harm to patients
• Reduction in legal or disciplinary action taken against health professionals or organisations

Conclusion
There are several factors that will help the new health body improve the quality of care and experience of every patient in Scotland every time they access healthcare. The

Healthcare Improvement Scotland work programme supports Scottish Government priorities, particularly those arising from the Healthcare Quality Strategy.

The organisation also has the freedom to determine how it works and publishes it findings and recommendations. Within the organisation there is a wealth of knowledge, including senior staff with extensive experience in leading change to improve services at all levels of the NHS. However it is only by working in partnership with patients, the public and health professionals and maintaining strong links with UK regulatory and professional bodies, and other UK organisations that Healthcare Improvement Scotland will ensure its work has credible clinical quality and is robustly evaluated.

In this way, Healthcare Improvement Scotland will strive to build a reputation as a centre of excellence for healthcare quality improvement. Further information is available at www.healthcareimprovementscotland.org.

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