Health Service Focus

28.09.14

Infection prevention and control: the role of commissioners

Source: National Health Executive September/October 2014

NHE talks to Rose Gallagher, Royal College of Nursing adviser for infection prevention and control, and Debbie Wright, assistant director of infection prevention and control at Aintree University Hospital NHS FT and a representative of the Infection Prevention Society, about a new ‘toolkit’ for commissioners.

No person should be harmed by a preventable infection – this is a vision shared by both the Infection Prevention Society (IPS) and the Royal College of Nursing (RCN), who have worked together to review infection control guidelines for commissioners following the NHS reforms.

The revised guidelines are aimed at both commissioners and providers, especially CCG leads on infection prevention and control (IPC), specialist IPC nurses supporting commissioners, directors of IPC at provider organisations and their teams, plus local authorities.

In his foreword to the guidance, Mike Durkin, director of patient safety at NHS England, says: “NHS England is pleased to support resources, such as this guidance, for providers and commissioners of care that will help them to establish a health care associated infection (HCAI) reduction plan, which reflects local and national priorities.”

‘We are the envy of Europe’

Rose Gallagher, IPC adviser at the RCN, helped lead the revision of the guidance following the changes to commissioning under the Health & Social Care Act 2014.

She told NHE: “We’ve come a tremendous way in the NHS across the UK in reducing some infections. The focus has been on MRSA andC. difficile, and we achieved that because we had the support of governments, we had leadership, we had investment in resources, and we had a suite of tools to support healthcare workers and provider organisations make those changes.

“We really are the envy of Europe insofar as what we’ve managed to do in reducing infections, but of course those are only two infections caused by two organisms. There’s an awful lot more work needs to be done and we’ve started that process: applying what we’ve learnt from MRSA and C. diff to other infections.

“We need to capitalise on that learning and continue to move forward – the job is not done.”

A separate briefing paper from October 2013 explaining where IPC fits into the complex and varied new commissioning landscape is also currently being updated.

Gallagher said: “That recognises that things change and that some improvements have been made – for example, the de minimis limit for MRSA has been removed, but we still have it for C. diff for foundation trusts. But a different set of language is used for non-foundation trusts.”

Support for commissioners

Debbie Wright was another of the main authors of the revised guidance. She is now assistant director of IPC at Aintree University Hospital NHS FT, but was for many years responsible for IPC at Central Lancashire PCT, so is familiar with the issue from both a commissioner and provider viewpoint. In that role, she was a lead for the IPS/RCN Commissioning Network.

She said: “It is an important issue for commissioners. There’s differing levels of support available to commissioners in terms of IPC.”

She added that the NHS reforms did create initial confusion and concern about the future for IPC, because it was felt that some expertise would be “lost” as the structures changed: “It wasn’t clear where that function should fit with the commissioners. For example, some of the IPC commissioning expertise went directly into CCGs, some went to local authorities (that’s where my former post ended up), and some just weren’t appointed.

“At that time there was a real lack of clarity about IPC and commissioning. But I do think it’s settled down slightly, and people are now reviewing what they actually need,” Wright said.

C. difficile was a case in point, she said. “It took us a long time to get CCGs to be held to account for C. diff. We’ve always held acute trusts to account for C. diff numbers, and now that’s gone, so I did wonder whether there was going to be a change of focus or not as much drive from the CCGs on that.”

Gallagher explained how this document is just one in a series that the RCN and IPS have been producing in recent years to raise awareness of IPC issues.

“It’s been about maintaining the profile of IPC, but also about trying to support organisations to make sure they have either their own expertise or sufficient access to specialist IPC expertise to support their commissioning.”

Because not all CCGs and CSUs have such specialist advice, the newly-updated toolkit is a vital resource.

“The commissioning nurse workforce for infection control had effectively been dismantled from their positions in the commissioning arms of PCTs. We knew they were now in a number of organisations and therefore there was significant variation in access to and support for local authorities, CSUs, CCGs and so on – and we did lose some posts as a result of those changes as well.”

Gallagher said it was important that both commissioners and providers have a ‘zero tolerance’ policy, never accepting that infections are “inevitable”.

Antimicrobial resistance

Antimicrobial resistance, and the consequences of use of antibiotics to treat HCAIs, is another big factor, Gallagher said. “We’re in a very different position to where we were in 2006-07. We’ve really got to keep up this focus on infection prevention, particularly with antimicrobial resistance becoming an increasing threat and challenge to modern medicine.

“We have to take what we’ve learnt and expand it to thinking differently about how we prevent, track, and manage urinary tract infections, pneumonia, and other conditions that all carry significant morbidity and mortality. Many may be preventable, but not all, and all will certainly use antibiotics – which is further driving resistance.”

Indicators to choose from

Gallagher and Wright explained how the current toolkit is essentially a ‘bridging document’ ahead of a bigger piece of work coming later.

The bulk of this version of the toolkit is a basket of suggested indicators – additions to the national indicators that commissioners can pick and choose from according to local conditions, data and intelligence.

The document notes: “Commissioning organisations will hold providers to account for their performance, and assess their contribution to sustained improvement in IPC practices that reduce HCAIs and antimicrobial resistance.

“To achieve this they will evaluate local objectives systematically across the organisations they commission services from. They will ensure that there is proportionality to risks associated with different care settings. Commissioning teams will review surveillance data so that they can monitor progress against nationally set objectives for specific organisms, other agreed indicators and learning identified from post-infection reviews (PIR) or root cause analysis of incidents.”

Wright said: “The guidance does need to be used appropriately and reflect local need. Commissioners need to understand their providers and work with them on areas for improvement – it should be used jointly, not ‘we’re going to do this to you’. Working together produces much stronger results.”

Commissioners need to ensure they pick from the basket of indicators in a sensible way – and not try to use all of them.

Gallagher added: “It’s not ‘one size fits all’ across the country. Many elements will be common to NHS hospitals or community providers, but there is enough room there for people to select what’s a priority for them to influence through commissioning. It’s really down to local need and local intelligence.”

The future

Gallagher continued: “In ‘version 3’, at the request of our members, we are now looking to create indicator specific tables for different care settings. So, rather than having one big indicator basket, we’re looking at one for primary care, one for social care, one for mental health and one for secondary care. That will hopefully help direct the thinking of the different provider organisations to be able to pick out more easily what potential indicators might be beneficial for them.

“We’re also challenging some of the thinking behind ‘100% compliance with all elements’ as well, because we recognise that it’s about improvement over time, working towards full compliance – but that we won’t achieve full compliance overnight.

“Moving forward with ongoing revisions, our aim is to try to build an evidence base around how commissioning helps support outcomes through infection prevention. We’re doing it in the absence of any existing evidence base, so we’re really keen to learn from this work and to work towards improving and supporting at all levels of commissioning.”

Maintaining the visibility of infection prevention

The toolkit references all the other key documents and requirements that commissioning organisations need to adhere to, and it assumes compliance with the code of practice for infection control that all provider organisations have to have for CQC registration.

Gallagher said: “Just because they are compliant with the code of practice doesn’t mean that further improvement can’t be made.”

The only two mandatory objectives in the national outcomes framework are on MRSA and C. difficile infection – “but clearly there is a lot of other work that needs to go on behind that to improve the IPC generally”, Gallagher said.

“We need to maintain its position and visibility in the expanding improvement landscape, because IPC is now only one of a number of improvement areas, alongside things like falls, pressure ulcers, and so on.

“There is also an increasingly close relationship with public health and wellbeing, to try to keep people well in order to keep them away from hospitals to reduce the number of interventions. Anything that affects health affects IPC, and antimicrobial resistance sits alongside that.

Considering that she has seen how IPC works at both commissioning and provider organisations, we asked Wright how this has influenced her perspective.

She said: “It’s quite interesting; I’ve moved into a very different culture from where I was. I was the lead commissioner for quite a few hospitals and we had a very collaborative view on how we were going to work.

“The acute trusts know what their issues are and want to improve – it must be about support from commissioners, not putting additional burdens into the system.

“We need to work together to be able to be able to improve patient safety and infection protection.”

The full document, ‘Infection prevention and control commissioning toolkit: Guidance and information for nursing and commissioning staff in England’ is available here

Tell us what you think – have your say below, or email us directly at opinion@nationalhealthexecutive.com

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

Kindness is key to overcoming Covid-19 crisis

26/05/2020Kindness is key to overcoming Covid-19 crisis

Nuno Albuquerque, Group Treatment Lead, UK Addiction Treatment Group, explains why your mental health is just as important as washing your hands ... more >
UK study to examine Covid-19 impact on blood cancer patients

26/05/2020UK study to examine Covid-19 impact on blood cancer patients

A new UK study is being launched by IMPACT to examine how patients receiving stem cell transplants for blood cancers and blood disorders react to... more >
Pre-diabetes: a hidden healthcare problem

26/05/2020Pre-diabetes: a hidden healthcare problem

Dr Russell Muirhead, Clinical Director of Living Well, Taking Control A third of adults in England have pre-diabetes, according to research pu... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us th... more > more last word articles >

the scalpel's daily blog

Pre-diabetes: a hidden healthcare problem

26/05/2020Pre-diabetes: a hidden healthcare problem

Dr Russell Muirhead, Clinical Director of Living Well, Taking Control A third of adults in England have pre-diabetes, according to research published in The BMJ. The study also found that, over eight years, the number of people diagnosed with pre-diabetes tripled. By 2025, it is estimated that five million people will have diabetes in the UK – 90% of which is Type 2 diabetes. Pre-diabetes is related to increasing rates of obesi... more >
read more blog posts from 'the scalpel' >

comment

NHS England dementia director prescribes rugby for mental health and dementia patients

23/09/2019NHS England dementia director prescribes rugby for mental health and dementia patients

Reason to celebrate as NHS says watching rugby can be good for your mental health and wellbeing. As the best rugby players in the world repr... more >
Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Creating the Cardigan integrated care centre

10/06/2019Creating the Cardigan integrated care centre

Peter Skitt, county director and commissioner for Ceredigion Hywel Dda University Health Board, looks ahead to the new integrated care centre bei... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >

interviews

Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >