National Clinical Audit of Psychosis

The contract is expected to initially be delivered for NHS-funded care in England and Wales for a period of 3 years, at a maximum total budget of up to £1,269,360 GBP excluding VAT. Bids exceeding this limit will be rejected. There is potential to extend the contract for up to two additional years as well as the option to include other Devolved Nations and/or Crown Dependencies.

The maximum budget ‘core’ value is £1,269,360 GBP excluding VAT. This excludes the potential two year extension and aspirational intent which will be included in the service specification at point of tender. Due to the unknowns in advance of holding the premarket engagement session, it is currently expected that the extension value will be a 2 year pro rata of the core 3 year funding, estimated at £846,240 excluding VAT.

Further to this funding, the final specification will contain a list of aspirational measures which will be expected to be modified into the contract should the need and funding become available. The aspirational intent value is unknown at point of drafting this notice, so an estimated value of £7,000,000 is applied. This aspirational intent has the potential to be invoked fully, partially, or not at all, and the Authority cannot guarantee that the successful provider will be required to do any of the aspirational measures that will be listed in the final specification.

The role of a national clinical audit is to stimulate healthcare improvement through the provision of timely and high quality information on the organisation, delivery and outcomes of healthcare, together with tools and support to enable healthcare providers and other audiences to make best use of this information. Outcomes are benchmarked against national guidance and standards e.g. quality standards from the National Institute for Health and Care Excellence (NICE), and those from other established professional and patient sources.

The overarching aim of this audit is to stimulate improvements in care that NHS Mental Health Trusts in England and Health Boards in Wales provide to people with psychosis by measuring and reporting variations in quality of care and patient outcomes. During this contract period, the successful tenderer will need to build on the achievements of the audit so far, and enhance the ability for the audit to be used for healthcare improvement. To do this, the supplier will need to engage with clinicians, patients and commissioners (both local and national) and regional networks.

Successful national audits are those where the individuals providing the data are also in a position to improve the system, and where there is a shared understanding of what good care looks like. Data is most useful locally for healthcare improvement when its provision to clinical teams is timely, the data is refreshed regularly, and appropriate tools, support and guidance accompany the data outputs. The intent is for all of these features to be implemented and improved during the period of this future contract.

Some proposed expectations of the audit are to:

•Facilitate all psychosis care teams to become quality improvement teams meaning that they engage with the data and resources to improve patient outcomes, e.g. through collaborative care planning, supervision and service improvement

•Reduce the wide variations in care between different providers and increase the proportion of patients who take up the recommended package of Early Intervention in Psychosis (EIP) care

•Reduce the persistent inequalities in access to care, especially among ethnic minority service users

•Increase the number of people identified with at-risk-mental-state (ARMS) who have access locally to appropriate interventions

•Increase the number of service users who are offered physical health monitoring and who take up relevant interventions

•Increase the number of people with psychosis moving into employment and/or educational or occupational activities

•Increase access to and take up of psychological therapies, namely cognitive behavioural therapy (CBT) for psychosis

•Promote the recording of clinical outcome measures for every patient at the start and end of treatment and throughout care

The audit supplier will work with commissioners and funders to create a coherent strategy for how the improvement goals listed above, or similar, will be achieved.

•Support improvements in the Mental Health Services Data Set (MHSDS) data by driving compliance with national coding standard and quality indicators so that it can be used more widely for the audit, e.g. give feedback, identify gaps in the data

•Indicate to healthcare providers where assessing and recording of patient outcomes is lacking and drive increased recording of outcome measures in local patient records

•Identify and notify outlier organisations using the appropriate guidance so that they have the opportunity to put interventions in place

•Share best practice and quality improvement examples, and signpost to resources available

•Adapt quality improvement priorities in line with new evidence based practice and guidance

•Develop quality improvement resources for use by providers

•Develop a robust, high quality audit designed around key quality indicators likely to best support local and national quality improvement

•Achieve, articulate and maintain close alignment with relevant NHS England and Improvement and NICE national guidance and quality standards throughout the audit, as appropriate

•Enable improvements through the provision of timely, high quality data that compares providers of healthcare, and comprises an integrated mixture of named Trust or Health Board, commissioner, multi-disciplinary team, possibly consultant or clinical team level and other levels of reporting

•Engage service users and families in a meaningful way, achieving a strong patient voice which informs and contributes to the design, functioning, outputs and direction of the audit

The scope of this national clinical audit programme comprises a prospective audit of key measures on the processes and outcomes of care provided by Early Intervention in Psychosis (EIP) teams to people with psychosis in England and Wales.

As with all our contracts, HQIP prioritises the minimisation of local data entry/submission burden and the impact of data flows on patient privacy, and the maximisation of quality, timeliness and cost-efficiency of reporting of data. To avoid burden on the healthcare system, the audit will use electronic patient record data and/or routine data (e.g. hospital episode statistics (HES) and Mental Health Services Data Set (MHSDS)) whenever available, rather than collect bespoke data. Where data items are collected from providers/services, these must be directly aligned with the audit quality improvement intent in order to minimise collection burden.

Further details of the existing audit can be found at: www.rcpsych.ac.uk/improving-care/ccqi/… ↗