Services for people with chronic obstructive pulmonary disease

This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg43

7 Further information

National priorities and initiatives relevant to commissioning services for people with COPD include those detailed in table 6.

Table 6 Relevant national policy relating to COPD

Document	Author	Year	Significance
NHS Outcomes Framework 2012/13	Department of Health	2012	Includes measures to enhance quality of life for people with long term conditions
A strategy for services for chronic obstructive pulmonary disease (COPD) in England	Department of Health	2011	Identifies the best ways to improve care and outcomes for those with COPD and to reduce the overall prevalence of the disease
Quality, innovation prevention and productivity (QIPP)	Department of Health	2011	The workstreams on long term conditions and end-of-life care are of particular relevance when commissioning services for people with COPD
Liberating the NHS: legislative framework and next steps	Department of Health	2011	Describes in detail how reforms of the NHS will be put into practice, including the development of NICE quality standards
Healthy lives, healthy people: our strategy for public health in England	Department of Health	2011	Sets out plans for improving public health in England and the creation of Public Health England
Transparency in outcomes: a framework for quality in adult social care	Department of Health	2011	Sets out plans for a new approach to quality and outcomes in adult social care
No Health without Mental Health: a cross-government mental health outcomes strategy for people of all ages, including supporting document on the economic case of improving efficiency and quality in mental health	Department of Health	2011	Sets out six shared objectives to improve the mental health and well-being of the nation, and to improve outcomes for people with mental health problems through high quality services
Using the Commissioning for Quality and Innovation (CQUIN) payment framework – a summary guide	Department of Health	2010	Makes a proportion of providers' income conditional on quality and innovation
End of Life Care Strategy - promoting high quality care for all adults at the end of life	Department of Health	2008	Recommends a whole systems approach both for commissioning services and for delivery of integrated care for individuals

Additional resources

Commissioners may also find the resources in table 7 useful when commissioning services for people with COPD.

Table 7 Additional resources for commissioning COPD services

Document or web page	Source	Year	Significance
COPD commissioning pack	Department of Health	Due 2011	A tool to help commissioners improve the quality of services for patients, through clearly defined outcomes that help drive efficiency by reducing unwarranted variation in services
Chronic obstructive pulmonary disease pathway	NICE	2011	Provides a visual representation of NICE guidance on COPD
NHS Improvement: lung	NHS Improvement	Various	The workstream aims to support clinicians, commissioners, providers and patients to deliver effective clinical practice through service improvement and redesign
Deaths from respiratory disease: implications for end of life care in England	National end-of-life care intelligence network and National end-of-life care programme	2011	Analyses data on place of death for those with respiratory disease and how this varies with gender, age, socioeconomic deprivation and place
Video on pulmonary rehabilitation	NHS choices	2011	A respiratory nurse specialist and patients explain pulmonary rehabilitation and how exercise can improve the symptoms of COPD
Respiratory disease competence framework	Skills for Health	2011	Describes the knowledge, skills and attitudes that are needed to deliver patient centred respiratory care

Useful sources of information for developing a service specification may include:

The standard NHS contracts for acute hospital, mental health, community and ambulance services
NHS Evidence: provides free access to clinical and non-clinical information and includes a QIPP library with case studies
NHS networks, including commissioning for long-term conditions section and commissioning zone
The NICE shared learning database offers examples of how commissioners and service providers have used NICE guidance to create innovative and effective local implementation programmes for service improvements.
Implementation support for NICE clinical guideline 101.

General information on quality and corporate assurance can be obtained from the following sources:

Indicators for Quality Improvement Programme from the NHS Information Centre. A resource of robust indicators to help local clinical teams select indicators for local quality improvement and a source of indicators for benchmarking.
NHS Alliance online resources. NHS Alliance is the representational organisation of primary care and primary care trusts, and provides them with an opportunity to network and exchange best practice. The alliance supports its members with an open-access helpline, in-house and joint publications and briefings, internal newsletters and a website.
NHS Institute for Innovation and Improvement support for commissioners, including the productive series to enable NHS teams to redesign and streamline the way they manage and work, and Better care, better value indicators to help inform planning, to inform views on the scale of potential efficiency savings in different aspects of care, and to generate ideas on how to achieve these savings.
The Quality and outcomes framework (QOF) is a voluntary quality incentive scheme that rewards general practices for implementing systematic improvements in the quality of patient care.
Skills for health works with employers and other stakeholders to ensure that those working in the sector are equipped with the right skills to support the development and delivery of healthcare services.

Sources of further information to help you in assessing local health needs and reducing health inequalities include:

Disease prevalence models produced by the Association of Public Health Observatories provide prevalence estimates for COPD for GP practices, primary care trusts or local authorities.
The atlas of variation, a tool for reducing unwarranted variation to increase value and improve quality, including COPD bed days. The InstantAtlas version allows individual PCTs to see their own indicator data.
Department of Health Delivering quality and value – focus on benchmarking.
NICE Health equity audit – learning from practice briefing.
NHS Comparators provides comparator data for NHS commissioning and provider organisations to enable users to investigate aspects of local activity, costs and outcomes.
The Disease management information toolkit (DMIT) is a good-practice tool for decision-makers, commissioners and deliverers of care for people with long-term conditions, which presents data on conditions that contribute to high numbers of emergency bed days. It models the effects of possible interventions that may be commissioned at a local level and helps users to consider the likely impact of commissioning options.
PARR (Patients at risk of rehospitalisation) is a risk-prediction system for use by primary care trusts to identify patients at high risk of hospital readmission.
PRIMIS+ provides support to general practices on information management, recording for, and analysis of, data quality, plus a comparative analysis service focused on key clinical topics.
SHAPE (strategic health asset planning and evaluation) application provides support to strategic health authorities and primary care trusts on strategic planning across a whole health economy including key policy initiatives such as QIPP, JSNA and Transforming Community Services.