Continuous Quality Improvement Framework Reviews

The Forensic Network are committed to promoting quality improvement throughout forensic mental health services and to supporting Services to further their development and delivery of care, this is achieved through the Continuous Quality Improvement Framework Reviews (CQIF Reviews).

These reviews are conducted across the estate on a three year cycle and the process involves definition of appropriate quality standards, measurement of performance against these quality standards (via self assessment and peer review) and the development of an agreed action plan by the service to further increase quality of care. The review cycle is followed with a national conference to share good practice, spread learning and provide an opportunity for further professional development.



The CQIF Reviews provide services with an opportunity to be involved in a consistent estate wide approach to service development, allowing for benchmarking and development across the Scottish forensic mental health estate and a clear way of meeting the requirements of NHS CEL (2007). The framework covers the full range of levels of security (high, medium, low and community), for Forensic Mental Health and Learning Disabilities Services. The Framework is organised around six key themes:

  1. Assessment, care planning & treatment
  2. Physical health
  3. Risk
  4. Management & prevention of violence
  5. Physical environment
  6. Teams, skills & staffing

For further information about the Continuous Quality Improvement Reviews or the review process, please contact Nicol Shadbolt, at or 01555 842018

Development of the Framework

The Continuous Quality Improvement Framework was developed in conjunction with Healthcare Improvement Scotland following a presentation by Frances Elliot, then Chief Executive of NHS QIS, at the Forensic Network Conference ‘Forging the Future’ in 2009. The presentation outlined ideas for Quality Improvement in Forensic Mental Health and how NHS QIS (now NHS HIS) might support services in the development of a quality agenda.

These ideas were welcomed by the conference audience and the enthusiasm for the project reflected requests from colleagues across Scotland for support from the Forensic Network in benchmarking and auditing across the estate. Indicators were suggested by delegates at the conference and these were combined with the Secure Care Standards, which were developed for Medium Secure Services and formed part of the NHS HDL (2006) 48, to develop a framework for quality assurance. The framework was then further developed through consultation across the estate to cover the full range of levels of security (high, medium, low and community) and Forensic Learning Disabilities Services.

The aim of this continuous quality improvement framework is to use a multi-disciplinary approach to share good practice and support learning across the Forensic Network, through a culture of openness and facilitated enquiry. The review process is not about finding fault but rather working with services to identify any potential gaps in practice and support the service’s work to improve their delivery of care and achieve their identified aims.

Throughout 2011 to 2013, the Forensic Network supported services in conducting these Self-Assessments and facilitated Peer Reviews, empowering services to develop local action plans to progress their services in line with the Secure Care Standards. The first round reviews were well received and the general view was that they were important in providing an opportunity for services to identify areas of good practice and areas of improvement through a supported process. The review cycle was followed with a national conference which provided opportunities for sharing experiences between services, for wider communication of areas of achievement or improvement, and a platform for disseminating innovative solutions which are arising across the Scottish estate

The model agreed across the Forensic Network requires that the reviews are carried out every three years, reviewing and increasing the quality standards with each round of reviews in order to raise the quality of delivery. As the framework is owned by Scottish Forensic Services for Scottish Forensic Services, this allows for a review process that focuses on relevant and emerging areas for development and improvement in Scotland.