REPORT ON CLINICAL SERVICES ACCREDITATION ALLIANCE LAUNCH MEETING: NOVEMBER 2016

Dr Jill Swift

On November 25th 2016 I attended a meeting of the Clinical Services Accreditation Alliance (CSAA), on behalf of WAGE, held at the Royal Pharmaceutical Society in London. This was to launch a recently published document entitled ‘Provision of Clinical Services Standards – BSI-PAS 1616’ . This is a ‘Publicly Available Specification (PAS), sponsored by the Royal College of Surgeons on behalf of the CSAA. The meeting was chaired by Dr Ian Bullock from the Royal College of Physicians and Chair of the CSAA.

Members of WAGE will be aware of the GRS for endoscopy, the first national service to undergo accreditation. Dr Roland Valori, currently Clinical Lead for the CSAA, spoke about the process in setting up the GRS and the impact it has had on endoscopy services not only in the UK but also in Canada and some European Countries. A similar process is now in place to assess and accredit further clinical services in the UK. Work commenced in 2013 and their ambition is to have all clinical services engaged in the process to provide ‘best patient experience within current, and future, financial limits’. Any clinical service can use the PAS1616 ‘both to review its current level of provision and as a roadmap for improvement’. It is designed to provide a framework to follow for new or existing services with the long term aim of raising standards and improving quality within the Health Service.

It covers aspects of clinical service provision including:

  • Clinical service planning and clinical service definition
  • Leadership,strategy and management
  • Person-centred treatment and/or care
  • Risk and safety
  • Clinical effectiveness
  • Clinical service users with complex needs
  • Staffing a clinical service
  • Improvement, innovation and transformation
  • Educating the future workforce

Of particular interest to some WAGE members will be the proposed accreditation of Hepatology services (Liver QuEST). Debbie Johnston presented data from 15 pilot sites ranging from DGHs to transplant centres (7 of whom had pilot site visits) who have been involved so far. Eight standards have been proposed including, leadership, patient education, prevention, quality and safety. It is proposed that all liver centres will participate and be rated from step 1- superlight, step 2-light and step 3- full PAS accredited, over the next 1-2 years.

Dr Neil Haslam and Dr Paul Fitzgerald from Royal Liverpool and Broadgreen University Hospitals spoke of their experience of leading a pilot of PAS 1616 in unscheduled care as a ‘Care Group’ Project involving Care of the Elderly, Haematology, Palliative care and Stroke medicine. The ‘GRS’ was used as a basis for tools for improvement indicators; each service agreed what it should provide and what services patients should expect. Working through key domains and setting objectives quickly identified strengths and weaknesses of the service, supported efficiency and effectiveness and identified specialty development needs. From this, KPIs and dashboards were generated for individual care groups and the Trust . They felt that the process and results have already had a significant impact on improving quality of clinical services.

Dr Simon Fletcher presented the Anaesthesia Clinical Services accreditation(ACSA) which is a voluntary, peer-reviewed process run by the Royal College of Anaesthetists. Standards for service provision were initially drawn from a long-standing compendium of Best Practice in Anaesthesia. There has been a very positive response with 84 units currently registered (out of 224 units country-wide), 13 accredited, and 20 visits booked for 2017. Welsh Government wants full engagement in Wales.

Patient participation in accreditation was stressed by all speakers and by patient representatives at the meeting. Mr Andrew Langford of the British Liver Trust stated that patients provide a strong expert voice and should be involved with planning and organisation, governance, public relations and encouraging participation in clinical trials, reviews and accreditation. This has already been achieved in HIV, MS and some mental health services. The patient voice is important for a mutually respectful relationship and should be seen as supportive and not as a threat.

This was highlighted by Mr Richard Driscoll (a former patient representative for the IBD audit) who is now Chair of the Healthcare Quality Improvement Partnership. (HQIP). This was set up in 2008 as an independent organisation in partnership with Professionals and Patients. HQIPs role is to drive improvement in patient outcomes and patients' experience. They are currently looking to create a faculty of expertise that can support clinicians and services to develop accreditation schemes, with the potential to develop a consultancy approach.

The role of accreditation is to improve patient care. Many other agencies are involved in monitoring or assessing standardsand it is important to avoid duplication of assessments. Sir Michael Richards, Chief Inspector of Hospitals, CQC, spoke of the 5 key questions asked by the CQC –

Are services 1. Safe 2 Effective 3.Caring 4.Responsive and 5. Well-led?

Four priorities of the CQC to achieve their strategic ambition are to:

  • Encourage improvement, innovation and sustainability
  • Deliver intelligence-driven approach to regulation
  • Promote a single shared view of quality
  • Improve efficiency and effectiveness.

The CQC has an ongoing relationship with the CSAA and is a stakeholder and member of the project board. In future, if services achieve PAS 1616 accreditation, the CQC will accept that the service has achieved an acceptable level of quality and safety and not inspect it separately.

The main concerns of NHS Trusts were outlined by Chris Hopson, Chief Executive of NHS Providers. These are how the NHS will manage more with less money, how to manage clinical risk, how to eliminate unwarranted variation, how to continuously improve quality of treatment and care whilst making maximal use of limited resources.

In summary, accreditation of clinical services is set to expand. Many of us have already had experience of GRS with its challenges and hard work but overall, benefits to patients and the endoscopy service. PAS 1616 published by the British Standards Institution provides a specification to support clinical services and is intended to be used by any clinical service to review its current provision and provide a roadmap for improvement. Patient involvement is seen as a key factor with clinicians and patients working in partnership to ensure quality improvement within the Health Service.

Further information is available at