Qua-li-ty

This is looking like it will be increasingly problematic for private providers like Medequip and those in the voluntary, community and social enterprise sector who supply goods and services to health and social care.

Whilst we are promised further details, the Budget headlines on increased National Insurance contributions for employers, the increase in the Living Wage, and alongside an increase that many believe is too small, the requirement for the NHS to find further efficiency savings, suggest to me that we have some very difficult conversations ahead of us. The Local Authority and NHS contracts that we sign are simply not equipped to deal with these sorts of increases. Neither in the detail of the price increase mechanisms in the documents, nor the organisational decision making, nor the cultural shifts necessary to enable significant change in models of contract delivery during the life of a contract.

That’s before we consider what quality means to the people who use services.

There is a school of thought that quality simply equates to compliance with expressed requirements. As the advert says “it does what it says on the tin”.

But from my experience, and through the work we are doing with people who use equipment services, I am coming to the conclusion that any work on defining quality has to be more firmly based on what makes the most difference to people, and that this has to encompass the whole connection of organisations that impact their lives.

I’m not against counting things, but I don’t think we’ll find the answers in the Key Performance Indicators measuring activity of the separate organisations involved, or in the data collected in aggregate from across the networks, places, Local Authorities or Integrated Care Systems.

Whilst the data can provide some structure, it’s peoples’ experiences and narrative that make for a compelling story.

But let’s go back a bit to see what’s in place to monitor quality. Let’s start at the top.

How does anyone know that their local Council and NHS services are well run and delivering efficient and effective services?

NHS England has an evolving Quality Assurance and Improvement framework, and I’m told, plans for annual assessment of Integrated Care Boards. The NHS also has a reputation for the collection and reporting of data.

Local Authority social care for children and families has been inspected by OFTED for a while and more recently the Care Quality Commission, as well as inspecting registered providers has been inspecting Local Authority arrangements for the provision and commissioning of adult social care. I know they have had some difficulties recently but I’m assuming they’ll sort that out.

The Directors of Adult Social Services also submit a range of data to DHSC, who also regularly survey, and Local Authorities more generally have to be transparent and accountable to Government, as well as their local population.

Getting closer to home, like most community equipment suppliers Medequip is a member of CECOPS – a not-for-profit organisation that sets standards, accredits and inspects assistive technology and equipment services.

We also use ISO 9001, the well-known and widely used and often required, quality management system ensuring business improvement.

Alongside these we have various legal requirements and industry standards we adhere to in health and safety, data security, recruitment and sustainability.

Building on these, we are increasing our transparency by working alongside local Healthwatch organisations to collect feedback from people and to report back to them on what we have changed as a result.

We are also developing our relationships with and reporting to people using equipment services, through our co-production group, Equipment Matters.

So, broad brush, if the money’s too tight to mention and there are other Quality Assurance processes in place, shouldn’t the joint effort of providers and commissioners be on understanding and ensuring quality from the perspective of the person using the equipment?

Our most productive conversations with commissioners on cost, price and outcomes have been when there is a focus on the big picture and how we work together.

Whilst it’s always important to get the detail right, starting and ending with it won’t radically change how things are done, how quality is demonstrated and how outcomes are achieved.

For many years the starting point for specifications for equipment services seems to have been the current service. Purchase, store, distribute, maintain, repair, collect, recycle.

Repeat.

At the same time, the demands on the NHS and Local Authorities have resulted in a procurement and contract monitoring landscape that sometimes feels like a race to the bottom, with little value placed on relationships between organisations, and between organisations and people.

If it sounds like I’m asking for a unified theory of everything it’s because I think that’s what’s needed.

That would look like everyone involved in agreeing how we should frame the issue of people needing different levels of support, technology and equipment to live their lives at home.

Then those most affected being involved in the discussions with a variety of types and sizes of organisations and groups to develop and deliver solutions.

And most importantly, the people drawing on that support then deciding what quality looks and feels like, and keeping an on-going eye on things to make sure that happens.

I know in my bones that we are going to have to have those difficult conversations about performance and cost.

My hope is that, if we can all focus on quality as it’s experienced and defined by people who use services, at least one of those conversations starts with “what can we all do differently”?

So, if you see me on the Medequip stand at NCASC in Liverpool, why not stop by and try that line on me and my colleagues.