Recommendation 143

Metrics relevant to quality of care and patient safety

Metrics need to be established which are relevant to the quality of care and patient safety across the service, to allow norms to be established so that outliers or progression to poor performance can be identified and accepted as needing to be fixed.

A range of metrics are collected and published across the health sector that relate directly to the quality of patient care.  This includes data on infection control (Public Health England), safety incidents (NHS England), Summary Hospital-level Mortality Indicator (Health and Social Care Information Centre) and, patients’ feedback reported on NHS Choices among other sites.

The Health and Social Care Information Centre publishes performance information and statistics, using transparent calculations, so that they can be used across the health and care system to review performance and identify concerns. The Health and Social Care Information Centre’s Indicator Portal for national quality indicators extend this service.

In addition, from November 2013 NHS England will begin to extend NHS Choices so that it will bring together the most reliable and relevant data from national web services and act as a ‘front door’ to the best information on health and social care on the internet.

Details of how this information will be used by Care Quality Commission as part of its new inspection regime is outlined in recommendation 20.

NHS England and Care Quality Commission are committed to working together to develop a shared and agreed approach to measuring safety in the NHS, both for regulatory and improvement purposes.

NHS England is currently in discussion with Care Quality Commission about which patient safety measures, including incident reporting, are best suited for use in their surveillance model, and how NHS England can contribute to their interpretation.

This includes providing Care Quality Commission with access to the relevant patient safety expertise to inform how they use patient safety data in their surveillance and inspection processes, including what ‘good’ looks like and what data should be considered a cause for concern. Care Quality Commission will be setting out its new surveillance and inspection model and NHS England will be setting out its safety measurement framework in due course.


As of June 2014, NHS Choices is publishing more in-depth and detailed information about the safety of hospitals that allows for scrutiny of services and identification of variations between similar services.

The new safety section includes an NHS Choices rating of hospitals against six safety indicators and information on safe nurse staffing levels. From April 2014, NHS England began publishing data monthly about any trusts who failed to declare compliance with stage one, two, or three National Patient Safety Agency alerts by their set due date, and since June 2014 patients and the public can view this information as part of the set of key indicators on the NHS Choices safety website. In addition, from June 2014, two ‘harms’ that are measured by the NHS Safety Thermometer can now be viewed on the NHS Choices website.

NHS England and the Care Quality Commission have worked jointly to ensure a shared view of patient safety data (and what it means) is developed and that this is reflected in the new Care Quality Commission’s surveillance model for acute and specialist NHS Trusts.

The Care Quality Commission now has free and unfettered access to all incident reporting information collected by the National Reporting and Learning System and through the Strategic Executive Information System. The Care Quality Commission and NHS England’s Patient Safety Domain regularly meet to share information, review and co-develop initiatives to improve patient safety. For example, NHS England and the Care Quality Commission have co-developed the indicators that are used in the Care Quality Commission’s Intelligent Monitoring system. In March and July 2014, the Care Quality Commission also updated its surveillance model for acute and specialist NHS trusts.

The Care Quality Commission has put in place a system of Intelligent Monitoring to help decide when, where and what to inspect. This draws information and data from a range of sources to identify providers and services where there may be a greater risk of providing poor care. The evidence from the Intelligent Monitoring system is used to prioritise which providers will be inspected and the lines of enquiry during an investigation. The system triggers a response, for example, where there are a statistically significant number of severe harm incidents or avoidable deaths at a provider. “Never events” trigger an automated elevated risk in Intelligent Monitoring which inspectors follow up individually. The data it looks at includes information from:

  • staff
  • patient surveys
  • mortality rates
  • hospital performance information such as waiting times and infection rates

In October 2013 the Care Quality Commission began a pilot of its Intelligent Monitoring programme for acute and specialist NHS trusts. The pilot looked at more than 150 different sets of data (indicators), which related to the five key questions the Care Quality Commission asks of all services – are they safe, effective, caring, responsive, and well-led? Using this data, the Care Quality Commission grouped all acute NHS trusts into six priority bands for inspection. In March and July 2014, the Care Quality Commission updated its surveillance model for acute and specialist NHS trusts.

In November 2014, the Care Quality Commission published Mental Health Intelligent Monitoring reports, which display the results of its analysis of Tier 1 indicators for all Mental Health NHS trusts. Each trust will receive an individual report and banding, similar to those for acute hospitals. The bandings ranges from one to four.

In November 2014 the Care Quality Commission published its first round of Intelligent Monitoring for GPs. Draft Intelligent Monitoring models for the Adult Social Care sector have been in place since October 2014, with separate sets of indicators for residential, community and hospice services.

The Care Quality Commission has always used important information in statutory notifications as an indicator of quality and safety in the adult social care sector, alongside other information about safeguarding alerts and information provided by others such as people who use services, staff and the public.

The Care Quality Commission does not have a lot of quantitative data consistently collected across the sector but it is taking steps to improve this. With a new, more thorough model the Care Quality Commission intends to use all the available information to check whether there is a risk that services do not provide either safe or quality care.

The Care Quality Commission is currently developing the set of indicators for adult social care services. There are limitations in the coverage of national datasets, but the Care Quality Commission will start by making better use of the indicators it is developing, and then determine how it will improve this over time. The Care Quality Commission will be carrying out additional testing and engagement to determine the most useful indicators to inform its work.