Special measures for quality improvement and challenged providers

RSET evaluates the impact of improvement interventions in NHS trusts.

Project

Published: 15/06/2021

Project status: Completed

This is a RSET project (Rapid Service Evaluation Team), a collaboration between the Nuffield Trust and UCL and funded by NIHR.

The Special Measures for Quality regime (SMQ) provides NHS trusts with increased support and oversight from NHS Improvement (NHSI) following a Care Quality Commission (CQC) inspection that has rated as inadequate the leadership and one other domain. There is also a ‘watch list’ of challenged NHS providers at risk of going into SMQ that receive support (this list is not in the public domain). According to NHSI, trusts in SMQ and those on the ‘challenged providers’ list can receive a combination of three main interventions to tackle quality problems: 1) Improvement Director, 2) buddying, and 3) access to central funding. These might be delivered in conjunction with other interventions and are often within a context of leadership changes at board level.  
There is currently limited knowledge about whether, and how, targeted interventions from NHSI drive improvements in quality, how much they cost, and whether the current improvement regime strikes the right balance between support and scrutiny. There is also interest in understanding why some trusts become sufficiently resilient and avoid re-entering special measures or exit the regime sooner than others.
Therefore, this study will evaluate the responses of NHS providers to the SMQ and challenged providers’ regimes. The aim is to determine how trusts respond to the various SMQ interventions and how they may impact on organisations' capacity to achieve and sustain quality improvements over time.
Following a scoping exercise which included the types and characteristics of trusts subject to the special measures regime since 2013, as well as a survey of the literature to identify key themes and concepts relevant to this evaluation, a set of research questions and design methods have been developed.
Potential outputs from this evaluation will include:

  • Lessons for trusts on responding to interventions in SMQ/challenged providers regimes, such as what to prioritise and the organisational capabilities found to support quality improvement
  • Lessons for the Department of Health and Social Care and NHSI on how to support challenged providers and those in the SMQ regime in light of the varied internal and external contexts of health care organisations facing performance difficulties
  • Recommendations on the use of routine, quantitative data to track quality improvements, including at system level, and the potential costs and benefits of interventions of the SMQ regime
  • A conceptual framework to help evaluate the SMQ regime and challenged providers programme in future.

Full study protocol for this evaluation

Evaluation slide deck

Outputs
  • Special measures for quality: a Q&A on the impact of improvement interventions in NHS trusts

  • Fulop N, et. al. (2019) Special Measures for Quality Improvement and Challenged Providers: Study Protocol for Evaluating the Impact of Improvement Interventions in NHS Trusts. International Journal of Health Policy and Management. doi: 10.15171/ijhpm.2019.100 (Link)
  • Vindrola-Padros C, et al. The implementation of improvement interventions for ‘low performing’ and ‘high performing’ organisations in health, education and local government: a phased literature review. International Journal of Health Policy and Management. doi: 10.34172/ijhpm.2020.197 (Link)
  • Fulop N, et. al. (2020) Rapid Evaluation of the Special Measures for Quality and Challenged Provider Regimes: A Mixed-Methods Study, Health Services and Delivery Research. doi: 10.3310/hsdr-tr-129663 (Link)
  • Fulop N, et. al. (2020) Rapid Evaluation of the Special Measures for Quality and Challenged Provider Regimes: A Mixed-Methods Study – Executive Summary (Link)
Presentations
  • Naomi Fulop and Chris Sherlaw-Johnson presented emerging findings to the Acute Care and Provider Team, Department of Health and Social Care on the 9th December 2019.
  • Naomi Fulop and Chris Sherlaw-Johnson presented emerging findings to the Joint Strategic Oversight Group (JSOG) meeting chaired by Ted Baker (Chief Inspector of Hospitals, CQC) and Steve Powis (National Medical Director, NHS England) on the 29th January 2020. Attendees included over 30 senior representatives from NHS Improvement, NHS England, CQC, HEE and GMC.
  • Naomi Fulop and Chris Sherlaw-Johnson gave a presentation on findings at the NHSE/I Intensive Support conference, a national conference organised by the NHSE/I Intensive Support teams on the 5th February 2020. Attendees included over 120 senior staff from Trusts receiving intensive support, senior representatives from NHS Improvement, NHS England and CQC.
  • Naomi Fulop (Chair), Jean Ledger and Chris Sherlaw-Johnson recorded a remote interactive workshop (online) drawing on findings for the Health Services Research UK (HSRUK) conference, June 2020. Workshop title: Addressing failure and turnaround in health care organisations: a review of current approaches and experiences across NHS providers. (Link to watch the session)
  • Naomi Fulop and Chris Sherlaw-Johnson presented findings to the NHS Improvement Directors’ meeting, 13th July 2020. Attendees included over 20 improvement directors.
  • Naomi Fulop and Chris Sherlaw-Johnson pre-recorded a presentation on the findings for the BMJ Leaders in Healthcare Conference in Nov 2020. Workshop title: Improving organisations and the role of medical directors.
  • Naomi Fulop and Chris Sherlaw-Johnson gave an online presentation on the findings to Department of Health and Social Care on the 24th August 2020. Attendees included Helen Beazer (Interim Deputy Director, DHSC) and staff in CQC sponsorship, Quality, Patient Safety and Investigations and Strategic Finance.
Conference Posters
  • Fulop N, Sherlaw-Johnson C, & Ledger J. (2020, February). Special Measures for Quality and Challenged Providers: Evaluation of the Impact of Improvement Interventions in NHS Trusts. Poster session presented at the NHSI/E Intensive Support Conference, London, UK.
Project team
  • Naomi Fulop (project lead)
  • Chris Sherlaw-Johnson
  • Jean Ledger
  • Cecilia Vindrola
  • Mel Hill
  • Jonathan Spencer
  • Lucina Rolewicz
  • Laura Schelpper
  • Sonila M. Tomini
  • Steve Morris
  • Estela Capelas Barbosa
  • Pei Li Ng
  • Christine Taylor

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