Clinical Service Accreditation is a system of self-assessment and external peer assessment used to accurately assess levels of performance in relation to established standards and to implement ways to continuously improve.
The CQC, led by Professor Sir Mike Richards (CQC Chief Inspector since 2013) have been looking at models of CSA since 2009, working with HQIP and the Academy of Royal Colleges.
The RCS is working with other Colleges, non-medical health professionals and patients to develop a uniform methodology for the accreditation of clinical services. The goal is to have more widespread accreditation, whilst actually reducing the burden of meeting standards through alignment of standards, shared processes for assessing them and by bringing together other compliance requirements into one process.
There is also an ambition to inspect and assess services beyond traditional boundaries to make accreditation more focused on patients, rather than hospitals and their departments. This work will be completed in the next 12 months during which time the RCS will begin conversations with service leaders interested in developing schemes.
So what is the point of all this? Dr Roland Valori, charged by the RCP to lead CSA and work with the CQC says:
‘Accreditation empowers service leads to ensure members of their team perform to acceptable standards and their organisation to provide them with the resources and support required to deliver the service. This leverage is particularly powerful if accreditation is linked to drivers such as CQC inspection and/or commissioning. The CQC recognises nine accreditation schemes that currently inform its hospital inspections.
'The CQC is supportive of more widespread accreditation, providing the process itself meets certain standards. JAG (Joint Advisory Group for Endoscopy) accreditation of endoscopy services has been a requirement for bowel cancer screening and failure to achieve JAG accreditation leads to a 5% tariff penalty for symptomatic referrals – at least in England.’
HQIP has led on the development of a set of criteria to assess the suitability of accreditation schemes to provide robust and reliable information for consideration ahead of and during CQC inspections.
The CQC has set up a panel to consider each scheme against these criteria, led by deputy chief inspector of hospitals (lead for mental health) and former Chair of HQIP Dr Paul Lelliot.
So what will be the impact? At first sight accreditation seems an over burdensome process – the pain may appear to outweigh the gain. Providing evidence of achieving standards is undoubtedly a burden; however, the vast majority of effort expended in achieving accreditation is actually related to doing the things necessary to improve the quality of the service.
Quality improvement activities feel burdensome when they are not explicit in the job plan, even when there might be an implicit assumption that they are part of SPA allocation. Accreditation, by raising the profile and value of quality improvement work, will ensure that such work becomes a more explicit part of job plans.
My view? I have had long experience on the receiving end of CSA as an endoscopist subject to the rigours of JAG accreditation. While the processes required to meet JAG requirements for CSA can be burdensome, I have felt the continuous need to maintain good skills in this particular area of my practice and I have seen improvements in the service provided to patients in my NHS endoscopy unit in Plymouth. I therefore think that surgeons should engage with CSA as participants and advocates.
Mr Mark Coleman has been a Consultant Surgeon at Derriford Hospital and The Nuffield Hospital, Plymouth since 2001. He has been the National Lead Clinician of theLapco National Training Programme in laparoscopic colorectal surgery since September 2008.