Introduction

Fundamentally the work of Excellence in Care (EiC) is about enabling and providing evidence to support the best and highest standards of care to those who use our health and social care services. There is no doubt that the pandemic has taught us much about the use of technology in supporting patients and staff. But equally we know that in recent times our ability to deliver the highest standards of care has been challenged. Going forward we need to ensure that the conditions to enable safe and effective care can be met and that we can measure these improvements and sustain them. To achieve that ambition our workforce need to be supported to do so, that is where this EiC framework and other improvement programmes will play a vital role.

 - Professor Alex McMahon, Chief Nursing Officer, Scottish Government

 

Delivery of high-quality care is fundamental for nursing and midwifery practice and is an important consideration as we recover from the impact of the pandemic. The EiC framework provides front line nurses and midwives and their managers with the tools to manage, lead and continuously improve care with people who use our services. Nurse Directors across all boards in Scotland support and endorse the approach.

 - Ann Gow, Director of Nursing, Midwifery and Allied Health Professionals, Healthcare Improvement Scotland and Chair of Scottish Executive Nurse Directors

 

Background

Excellence in Care (EiC) is a national approach which aims to ensure people have confidence that they will receive a consistent standard of high-quality of care no matter where they receive treatment in NHS Scotland.

Commissioned by the Scottish Government in response to the Vale of Leven Hospital Inquiry recommendations (1), EiC seeks to improve, integrate and coordinate the way nursing and midwifery services are delivered.

Prior to the Vale of Leven Inquiry report, there was an increasing emphasis on healthcare to assure the quality of its provision following the recommendations from the Francis Report (Feb, 2013)(2); Keogh Report (July, 2013)(3) and the Rapid Review of the Safety and Quality of Care for Acute Adults in Territorial Health Boards (Dec, 2013)(4).

Scotland’s national approach to assuring and improving nursing and midwifery care was requested by the Cabinet Secretary for Health and Sport and agreed at a National Meeting in 2015. The programme is supported by the Chief Nursing Officer (CNO) and Scottish Executive Nurse Directors. The programme will deliver the following four key objectives:

• identify and/or develop a nationally agreed set of clearly defined key measures/indicators of high-quality nursing and midwifery care,
• provide a framework document that outlines key principles/guidance to NHS boards and Integrated Joint Boards on development and implementation of EiC,
• design and deliver a local and national infrastructure, and ‘dashboard’, that enables effective and consistent reporting ‘from Ward (point-of-care) to board’, and
• design a set of NHS Scotland record keeping standards and guiding principles that drive shared decision making and support professional judgement whilst taking a proportionate and appropriate response to risk.

In addition to delivering the four key objectives EiC is integral to the duties outlined within the Health and Care (Staffing) (Scotland) Act 2019(5).

EiC and the Health and Care (Staffing) (Scotland) Act 2019 share a common purpose to ensure the provision of safe and high-quality health care and that the health and wellbeing of staff and patients is supported through a framework of continual improvement and assurance.

The EiC programme has been established since 2016 as a multi-agency collaboration between Scottish Government, Healthcare Improvement Scotland, NHS National Services Scotland, NHS Education for Scotland and public partners. Funding has been made available to ensure a senior nurse/midwife and data specialist from each board has dedicated time to support national and local delivery of the approach. An initial focus of the programme has been the development of the Care Assurance and Improvement Resource (CAIR) dashboard and a suite of quality measures. The measures were co-developed with nurses, midwives and clinical experts and informed by research to provide organisation and public assurance and confidence in the consistent delivery of quality person-centred care across Scotland.

In March 2020, EiC was paused due to the COVID-19 pandemic where it remained in hiatus until it was remobilised in May 2021. The COVID-19 pandemic has had, and continues to have, a profound impact on the delivery of healthcare throughout Scotland. In January 2022, the number of confirmed COVID-19 cases surpassed 1 million in Scotland and had resulted in the deaths of 9,890 people following a positive test, however, it is widely recognised that the full extent of the direct and indirect impact of COVID-19 on public health is still relatively unknown. In addition, the continuation of the pandemic has provided significant challenges to the health and wellbeing of staff, ultimately having significant impact on the capacity and ability of the workforce to deliver the expected quality of care highlighting the importance of assurance and improvement within health and care.