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QRS Annual Report 2019 - 2020

Stan Silverman,
Chair, QRS

QRS are pleased to welcome Stan Silverman as Chair of QRS. Stan was appointed following a national recruitment programme in September 2019 and brings a wealth of experience from the NHS and independent organisations. He is a vascular surgeon by clinical background and is currently the Secondary Care Clinician on the Governing Body of NHS Birmingham and Solihull CCG.

Foreword: It’s with great pleasure and some trepidation that I write this foreword to the 2019/20 QRS Annual Report. When I was appointed as QRS Chair last year, it was clear that 2020/21 would be a pivotal year for the organisation but no one could have predicted how much things would change in such a short time.

Not only do we now face challenges in terms of adjusting to a possible new funding model, but given the impacts of the pandemic on health services, we need to understand how we can better use our expertise to support improvement. The ways in which many services are now delivered have changed radically in a matter of weeks and we need to reflect on how we need to change too.

What is clear, however, is that when clinicians have been given permission to go ahead and make changes locally to service delivery to deal with the pandemic, this has been far more successful than the outcome of decisions made centrally. This speaks to the very essence of our core business, peer review, and making use of real-life experience of clinicians, managers and service users to spread good practice and identify areas where improvements can be made. We must not lose sight of this as we look to reset and restart after the worst of the pandemic.

To everyone who has contributed to a review, worked with the QRS team and added value to patient care across the NHS, thank you - we could not have done it without you!

Our New Wesbite

In September 2019, we launched our new website. Please take a few minutes to browse through our reports, standards and other content.


Any feedback or how we can improve is welcomed,
please email: qrs@nhs.net

Our Offer

The Quality Review Service Offer

QRS have a strong national reputation in providing standards based peer review. We have a range of clinical standards published and can also use other professional standards.

Where standards are not appropriate, formative peer reviews are able to help organisations with difficult clinical quality and service delivery questions.

Interactive workshops and programmes using peers from other organisations to support enhancing quality and outcomes provide another approach to improving care.

Our strength is in those clinicians who work with us in an open, supportive dialogue with teams on their improvement journey.

Our philosophy is learning for all.

About Our Board

QRS are governed by a Board comprising senior NHS leaders from healthcare providers and commissioning along with patient/service user representatives.

Meet our Board here.The Board is representative of those organisations who use the QRS programme and

lay members. Members do not just speak for their own organisation at the Board.

The Board meets at least three times per year and has oversight of the quality and governance of QRS.

The Quality Assurance Group (QAG)

All reports from a QRS review and all standards are reviewed by the Quality Assurance Group. The role of QAG is to ensure reports are fair, consistent, focused on improvement and of a high quality. Meet the QAG members here.

QAG meet usually about 10 times per year and have a strong clinical and operational focus amongst the membership. The Chair of QAG is always a patient/service user representative to ensure the patient voice is strongly reflected in all the QRS reports.

Inherited and Acquired haemophilia and other Bleeding Disorders (IABD) Programme

In 2019/20 QRS completed a review programme on behalf of the UK Haemophilia Centre Doctors’ Organisation (UKHCDO) of providers of care for patients with inherited and acquired haemophilia and other bleeding disorders (IABD). Bleeding disorders are rare conditions in which one of the clotting factor proteins, which are an important part of how blood clots, is either partly or completely missing. Haemophilia is the most widely recognised.

In the UK, patients with bleeding disorders are cared for by staff with specialist skills in treating and managing these conditions. Care is provided by Haemophilia Comprehensive Care Centres (CCCs) which usually provide care for at least 40 severely affected patients. CCCs provide 24-hour specialist treatment, including 24-hour advice and support to smaller Haemophilia Centres (HCs) with which they are linked.
Although Centres had previously been audited, this was the first time that they had undergone a peer review of their services.

In total, 182 haemophilia Centre staff were trained in peer review for this programme and 131 members of staff (37 Consultants, 39 Nurses, 25 Physiotherapists, 3 Social Workers, 4 Psychologists, 5 Managers, 3 BMS and 15 patients/carers) took part in the programme as a reviewer.

In total, 37 sites were visited for this programme: all 28 Comprehensive Care Centres (CCCs) in England, Wales, Scotland and Northern Ireland, and nine of the Haemophilia Centres (HC’s). All visits were led by Dr Anne Yardumian and Rachael Blackburn.

The purpose of the visits was to review compliance with the Quality Standards for Inherited and Acquired haemophilia and other Bleeding Disorders (V1 July 2018), which were developed by the UKHCDO peer review working group and QRS.

There were seven immediate risks identified during the course of the programme. In addition, there were 358 items of good practice, 89 concerns and 384 issues for further consideration.

Following the visit, each Centre received a detailed report of the findings and these reports are now available at https://qualityreviewservicewm.nhs.uk/reviews

In addition, an overview report summarising the themes and trends, good practice and recommendations has also been produced which is now available at https://qualityreviewservicewm.nhs.uk/latest-updates

Haemoglobin Disorders (HD) Programme

This is the fourth programme commissioned by the UK Forum on Haemoglobin Disorders since 2010. The programme was overseen by the UKFHD Steering Group and facilitated by QRS. This programme piloted a new approach of using a risk profiling methodology to identify services who would be selected for a peer review visit.

A total of 65 services providing care for people with the haemoglobin disorders sickle cell and/or thalassaemia across the UK and Eire submitted a self-assessment against the Quality Standards for Health Services for people with Haemoglobin Disorders V4 (October 2018) and relevant evidence for 17 key standards in February 2019. Each submission was reviewed by a multidisciplinary panel from the UKFHD Steering Group and a decision made to review based on the level of compliance achieved for each service.

All services who met < than 50% of the key standards were selected for a review visit. A percentage of services who met 50% – 75% and greater that 75% of the key standards were also selected for a review. In total, 25 review visits took place across a range of adult, children and young people services between July 2019 and March 2020.
The review programme was expected to complete in April 2020; however this has been ended early because of the NHS response to the Covid 19 pandemic.

The review visit days were led by Clinical Leads appointed by the UK Forum on Haemoglobin Disorders, Dr. Subarna Chakravorty and Dr. Mark Velangi for children and young people and Dr. Emma Drasar and Dr. Rachel Kesse-Adu for adults and supported by Sarah Broomhead, QRS Assistant Director.

The contribution of all to this programme is gratefully acknowledged and could not have taken place without the support of many people and organisations: the UK Forum on Haemoglobin Disorders, the UK Thalassaemia Society, the Sickle Cell Society, the commitment and dedication of the Programme’s Clinical Leads, cooperation of the teams which were reviewed, the willingness of reviewers to give their time and expertise and their employing organisations to release them.

Reports of the review visits can be found on the QRS website. https://qualityreviewservicewm.nhs.uk/reviews/

An evaluation of the risk based process used for this programme, and overview of the review programme findings is being produced.

Other Programmes

Self-Improving Teams Programme

Raising quality smaller teams such as community nursing locality teams is highly important.
QRS have developed a methodology to train locality teams in peer review skills and equip them with the tools and framework to review each other.

Spread over two sessions, it teaches locality teams the skills of peer review, how to share good practice and how to use standards effectively. This programme gives teams the skills and tools to use peer review as a self-improvement and learning tool.

Risk Profiling

QRS has developed an effective tool for creating a risk profile across a system using a comprehensive set of quality standards. This works most effectively across national programmes or larger numbers of local providers. This is the basis for the HD programme described above.

A steering group selects a subset of standards (approx. 10) that are deemed critical to effective outcomes.

Services submit a self-assessment against all standards and evidence in support of the critical ones. A panel of peers validates the self-assessment, and those scores are processed through the QRS risk tool. This allows a system to see where the challenges lie and where to best focus resources in an evidence driven way. This can then drive a targeted peer review programme.

QRS Reporting

Review Activity

Internal Standards

Reviewers Trained

Evaluation of QRS Reviews


My Experience of being a Reviewer

My experience of being reviewed

Reflections on 2019/20

What went well

  • In summer 2019, QRS launched its new brand and website. We consulted widely on design and logo; thank you to everyone who took part. It has been well received and gives the website and programme a fresh new look. Our partners at Gough Bailey Wright have helped design and develop this for us.
  • In 2019, QRS concluded a project with Hestia; a London based charity providing support for those experiencing domestic abuse, victims of modern slavery and people with mental health needs. Hestia were keen to expand their offer to include additional services for those people that they support. QRS helped Hestia develop a quality governance framework to underpin their approach to providing more clinically focussed care and support.
  • The QRS presence on social media is developing well as a platform to reach out to those who use and might use our services. @review_quality has over 250 followers.
  • QRS now has around 750 reviewers who have been trained and are willing to undertake peer reviews with QRS. This includes the 84 we added in 2019/20. Reviewers gain a significant amount from being part of a QRS led review programme.
  • A service lead from a recent review this year told us that the QRS led review had ‘led to a funding increase of over £300,000 to the service which will allow the service to finally operate to its full potential’. This will lead to significant improvements in patient care.
    In another programme, a reviewer told us ‘The peer review instituted many changes in our own and other centres visited that had a positive impact, whether; governance arrangements, information given to patients, increased staffing, improvements of rota’s etc’.
  • The Inherited and Acquired Bleeding Disorder Review programme and the Haemoglobin Disorder Review Programmes went well in 2019/20. Feedback was very positive. Along with this, QRS undertook a number of other individual service peer reviews. Additionally, a number of workshops (Breast Cancer, End of Life Care and Eye Care) were delivered. The support to the Local Eye Health Network in Shropshire involved a number of clinicians and clinical teams working together to describe an opportunity to improve the health care of patients with sight loss and visual impairment.
  • Feedback from peer reviewers and those who have had a peer review remains high. There is significant support in the clinical communities for the model of peer review that QRS offers.

What could have gone better

  • The work to update the QRS standards was not completed in 2019/20 as planned. Some standards are now past the date that was set for a refresh of the content. This must have a strong focus in 2020/21
  • More work needs to be done on the QRS profile and brand awareness. QRS is still not achieving the wider awareness in the NHS of the benefits and assurance that a peer review can deliver. This could impact on financial viability if not properly addressed.
  • QRS is not yet well embedded in each STP. Greater focus in 20/21 on engaging at an STP level will be an important step.
  • A Good practice sharing event was planned for 2019. This did not happen as themes from the individual programmes were not seen to be beneficial to other clinical areas and teams. It is hoped this may happen for the IABD and HD programme in 2020/21.
  • Regional review programmes were agreed late in the year, leading to crowding of the QRS programme at the end of 2019/20. This can be improved by earlier agreement of work programmes in the year. Focus must be given to discussing with commissioner and provider leaders at an earlier stage.

2019/20 in numbers


Additional Reviewers


During 2019/20 QRS teams spent 53 days on review.


As part of the self-improving teams programme, 7 locality teams were trained in the use of peer review skills for them to implement their own programme.


Since it was launched; 2651 people have used the new QRS website with 3,617 sessions on the site.


The QRS reviewers found 9 areas of immediate risk to clinical safety or clinical outcome that were reported directly to the Chief Executive for immediate action.


Reports considered by HD Steering Group.


During the 2019/20 review programme, QRS reviewed 78 clinical teams.


41 NHS provider organisations across the UK were part of a review programme with QRS.


259 Clinicians, managers, patients and service users joined a QRS review, shared their experiences and took learning back to their host Trust.


The QRS Quality Assurance Group reviewed 42 reports of peer reviews. This added quality and governance oversight ensuring reports are fair, proportionate and high quality.


Reviewers offered 479 areas of Further Consideration.

These are ideas for improvement and opportunities for teams to enhance the care they provide.


The teams found 209 areas of concern that were fed back to the clinical leads and identified in the report.


QRS Reviewers reported on 422 examples of Good Practice that the clinical teams had achieved.