Scotland's answer to CHI publishes its first set of findings this week. But its remit is rather different to that of its English equivalent. Jennifer Trueland reports
Hospitals in Scotland will today be coming to terms with their first report cards, drawn up by the newest quality assurance watchdog on the block.
The Clinical Standards Board for Scotland was due to publish its findings yesterday on how 38 hospitals nationwide measure up in secondary prevention of heart attack. It is the first area to be judged by the organisation, which was formed two years ago to set standards and monitor trusts' performance against them.
Unlike the Commission for Health Improvement, which is looking at issues across individual trusts, CSBS is setting standards in specific clinical areas across the health service as a whole. Initially, it is focusing on the priorities of heart disease, cancer and mental health.
So how well have the hospitals done - and how has the CSBS itself been received?
'We know the process has involved a lot of work for trusts, but the feedback is that they know it hasn't only been for our benefit, ' says Dr David Steel, CSBS chief executive. 'It is work they feel they need to do themselves. It is something they feel is worthwhile and something they would have to do for clinical governance.'
Standards were set in six main areas: immediate management following heart attack; prophylactic medication; risk factors;
cardiovascular status; rehabilitation; discharge.
There are sub-categories described as 'essential' - for example that discharge is planned and all relevant information is communicated at the appropriate time. And 'desirable', for example, that full discharge summaries reach the patient's GP within seven working days.
The standards published in December 2000, following extensive consultation and visits involving professionals and lay people, were carried out in the 37 acute hospitals which provide cardiac care, and one specific rehabilitation unit.
Each hospital was judged against each standard as having 'met', 'not met' or 'not met (insufficient evidence)', which applies either where no evidence was offered or it was not enough to form a judgement. There is no league table or star system and, though the three categories could translate to the English stars system, there are no plans to do this.
'We hope our reports will become a focus for change, ' says Dr Steel. 'We do not want to inhibit innovation - We are trying to disseminate information about good processes where they are working well, so people in other trusts see what can be done and do not have to reinvent the wheel.Good information is key to this.'
The report highlights some near-universal areas for concern.
For example, while all hospitals consider patients for the clotbusting treatment thrombolysis, only 10 out of the 37 meet the target for time from admission to the administration of treatment (50 per cent of eligible patients within 30 minutes of arrival). 'The board is concerned that most hospitals do not meet this standard, ' says the report, adding that admission arrangements should be reviewed.
The other main area where hospitals fall down is in the use of information.Though most (34 out of 37) are gathering data in some format (often paper-based and time-consuming, says the report), only 21 regularly audit it. The report adds: 'Without robust data collection, it is not possible to audit performance and then improve standards where necessary.
'The board recommends that systems and support be put in place to ensure reliable and sustainable data collection and audit.'
The report also highlights inconsistency in methods of recording risk-factor information, which again makes audit more difficult; delays and variation in access to tests to determine cardiovascular status; and an over-reliance on staff goodwill and short-term projects for cardiac rehabilitation.
While the national report does not 'name and shame' hospitals that did not meet the standards, separate documents have been produced for each local health board area detailing how each hospital performed. Importantly, next to each judgement is a commentary describing practice and explaining any reasons behind a success or failure and the steps taken to make improvements.
For example, Ninewells Hospital in Dundee does not meet the 'desirable' requirement for regular audit of rehabilitation. But the report adds: 'Plans are in place to introduce a more standardised database package, produced by the British Heart Foundation, to collect cardiac rehabilitation information.'
Apart from issues of data collection and audit, most hospitals come out of the process pretty well. So far, there have been no Milburn-esque calls for managers' heads on a platter.
But CSBS chair Lord Patel warns that, while trying to avoid a blame culture, the organisation is no Mr Nice Guy. If a dangerous service is found, for example, the Scottish Executive will take action, which could involve closing the service down.
If the trust does not take the action it has promised, the CSBS will not let it go. 'This is the first report, ' says Lord Patel. 'In year one, we can accept that the service doesn't quite make the standard. In years two and three and so on, if they're still not meeting the standard, we'll want to know why.'