The National Quality Board sub-group are keen to understand the issues involved in patient safety and making a recommendation that will drive improvement and tackle variation in MRSA performance in the NHS, and eliminating preventable infections. The External Reference Group meeting was convened to hear the views of the expert reference group. MRSA Action UK joined experts from the Health Protection Agency, Department of Health and Infection Prevention Society to advise the National Quality Board sub-group, who had been set up to consider the responses to the stakeholder engagement exercise and make a recommendation to the NQB on the new MRSA Objective.

 

Key Questions:

 

Trust with low rates and / or low numbers of MRSA

How to set an Objective for this group?

What further improvements in performance can they deliver?

 

Our response:
Trusts with low rates should be expected to maintain this level of performance. Use of route cause analysis for any infection should be evidenced. It would be reasonable to assume that Trusts who have achieved good control over preventable infections will have an ethos of zero tolerance to preventable infections and good monitoring systems in place. Therefore these Trusts could be used to extend the MRSA reduction to other sites, such as urinary or catheter infections, surgical site infections as collected by the Health Protection Agency. This would be a natural progression and have a significant impact on patient quality, since research has shown that bacteraemias account for around only 6.8% of healthcare associated infections.

 

Trusts that have not attained the National Target set by John Reid must be made to do so.  Twinning with Trusts who had achieved and maintained improvement was a suggested way of sharing best practice; some Trusts who were not doing so well were in the same Strategic Health Authority area as Trusts that were the best.

 

The Objective and MRSA in the wider health community

For the first time Primary Care Organisations will have an MRSA Objective which affects the whole of their health economy, not just acute hospitals. What are the challenges to addressing MRSA in the wider health community?

 

How can we incentivise primary and secondary care to work together on this?

 

Our response:
Patient choice should act as a catalyst to providing an incentive for primary and secondary care to work together. Doctors discussing MRSA rates with patients should be second nature, if a patient needs surgery one of the things a GP could expect to be asked is where is the best place to go with minimal risk of contracting an infection, a hospital that has higher rates of infection would not be such an attractive proposition for any patient.  Therefore infections rates should be published at hospital level so that GPs can give well informed recommendations to patients. Hospital level data should be published on the NHS Choices scorecard. Dialogue and systems to address this data would bring the commissioners and providers closer together. A carrot and stick approach may be needed, using Payment by Results tariffs may be necessary.

 

Local area agreements can be used by local authorities in social care.  Metrics used in care homes assessing care plans that include residents' infection status, antibiotic prescribing, all link in with the CQC registration requirements.  The Improvement Foundation has a range of metrics that can be used to drive improvement and improve dialogue between social care, primary care and hospital trusts.  This is a particularly important area to consider with people leaving hospital with more complex care needs.

 

Measure of improvement

 

Alongside the measure of performance (how a Primary Care Organisation / trust has performed against the Objective) the sub-group are considering a measure of improvement which would show how a trust has improved across a year.  What are your views on this?

 

Our response:
Time series analysis and trend information is essential to be able to show sustained improvement, some Trusts have not shown consistent improvement since John Reid's target was introduced. Trusts should be using this trend analysis as part of their performance management system. If you don't measure over time then you can't demonstrate improvement. The improvement should be shown on the NHS Choices scorecard.

 

Perception of the Objective

How will patients and the public perceive this Objective?

 

Our response:
Without knowing what the Objective looks like this is impossible to answer at this stage. However, if the system is clear and transparent and patients and the public have better access to information on healthcare infections when they need it, this will only serve to improve public confidence. Moving from the terminology of 'target' as opposed to 'objective' will undoubtedly bring questions. The Department of Health research on public and patient opinion on healthcare associated infection may give some insight into this.  It is a shame it hasn't been published yet.

 

Derek Butler

Chair

MRSA Action UK

19^th August 2009