Delivering Quality through Effective Commissioning 2014 - 2018

NHS North West Surrey CCG Quality Strategy

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NHS North West Surrey Clinical Commissioning Group Quality Strategy THIS STRATEGY WILL BE APPROVED BY THE NHS NORTHWEST SURREY CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY, AND WILL HAVE EFFECT AS IF INCORPORATED INTO THE CONSTITUTION AS PART OF THE SCHEME OF DELEGATION.

Target Audience

Governing Body members, sub-committee members and all staff working for, or on behalf of, the CCG

Brief Description (max 50 words)

This strategy sets out the framework by which the CCG will oversee and manage the delivery of the quality agenda.

Approved: Review date: Document Information: Title /Version Number/(Date)

North West Surrey CCG Quality Strategy

Document Status (for information/ action etc)and timescale

For implementation

Accountable Executive

Director of Quality and Innovation

Responsible Post holder/Policy Owner

Chief Nurse/ Head of Quality

Date Approved

July2014

Approved By

CCG Governing Body

Publication Date Review Date

Annual Review

Author

Clare Stone Chief Nurse/ Head of Quality

Stakeholders engaged in

NHS North West Surrey CCG Quality Strategy

1. Quality and Performance Committee members 2. Clinical Executive members Page 2

development or review

3. Operational Leadership Team 4. Senior Management Team 5. NWS Stakeholder Event: Providers, Patients and Public

Equality Impact Assessment

EQUALITY IMPACT ASSESSMENT This document has been assessed for equality impact on the protected groups, as set out in the Equality Act 2010. This Policy is applicable to the Governing Body, every member of staff within the CCG irrespective of their age, disability, sex, gender reassignment, pregnancy, maternity, race (which includes colour, nationality and ethnic or national origins), sexual orientation, religion or belief, marriage or civil partnership, and those who work on behalf of the CCG

Contact details for further information

Clare Stone Chief Nurse/ Head of Quality

Version

Date

Reviewer Name(s)

Comments

Version 15

January 2014

Version 16

February 2014

Version 17

February 2014

Version 18

February 2014

Incorporated comments by Richard Barnett Incorporated comments by Sally Bassett Incorporated comments by Naila Kamal

Version 19

March 2014

Quality and Performance Committee Quality and Performance Committee Quality and Performance Committee Quality and Performance Committee Quality and Performance Committee

Glossary Term

Definition

Accountable Executive

CCG Executive accountable for development, implementation and review of the policy

Policy Owner

Post holder responsible for the development, implementation and review of the policy

NHS North West Surrey CCG Quality Strategy

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Document definitions

Section

These are provided in Section 1

Contents

Foreword One Our Vision, Strategic Objectives, Commissioning Principles and Values Two Our Culture Three Core Objectives of the Quality Strategy Four Developing our Quality Strategy: •Methods used to develop our strategy •Patient and public engagement •Testing our ambitions •Key stakeholder messages •A Graphic Record of our Workshop Five Our Three Ambitions for Quality: 1. Patient Experience: Ensure excellent patient experience and best outcomes for all the people in North West Surrey 2. Patient Safety: Eliminate avoidable harm and reduce variation in healthcare 3. Clinical Effectiveness: Consistently commission evidence based best practice Six Quality Governance: • NHS North West Surrey CCG Quality and Safety Governance Framework • The ‘Who’ • The Role of Quality Seven Quality Assurance: •The Role of the Quality Team •Steps to ensuring Quality: The ‘How’ •How do the CCG collect and use information: the ‘What’ •Quality Monitoring and Assurance of Providers Eight Managing and Escalating Risks to Quality and Safety Nine Next Steps and summary statement Appendices Appendix 1: References and Bibliography Appendix 2: Relevant Documents Appendix 3: Clinical Commissioning for Quality Appendix 4: Sources of Assurance Appendix 5: Quality Workshop Attendees Appendix 6: Equality Impact Assessment

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14 15 17 17 18 19 20 20 21 22 23 23 25 27 29 30 31 34 35

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Foreword NHS North West Surrey Clinical Commissioning Group (CCG) has a clear vision for the local NHS: Our key focus area for 2014 - 2018 is to demonstrate our commitment to clinical commissioning and to give a clear signal to the local health economy, our community and all current and future providers of NHS care, our ambitious drive for commissioning high quality services. To enable all North West Surrey people to enjoy the best possible health we are dedicated to serving our local population and will ensure they receive safe, committed, compassionate and caring services. The patient is at the centre of everything we do and we will seek out and listen to what they are telling us about what they need and if it is affordable. As the commissioner and local system leader of the NHS, on behalf of our population, we will continue to develop a clear focus on quality within all our contracts. This will serve to drive quality improvement on behalf of the population we serve. This commitment will be demonstrated across the whole commissioning cycle, from the development of quality schedules within the contracting framework through to the development of newly procured and commissioned services. In summary, we will ensure that the services we commission for patients are safe, in line with best practice and clinical evidence, in order to achieve the best outcomes and experience for patients. During the delivery of integrated and holistic healthcare, patients and their families will be treated with dignity and respect and involved in care decisions. Our Quality Strategy underpins our Operating Plan and our Strategic Commissioning Plan and our ambitions will be embedded in our six strategic change programmes to ensure effective delivery: 1. 2. 3. 4. 5. 6.

Targeted communities Urgent Care Planned Care Frailty and Integrated Care Children and Young People Mental Health, Learning Disabilities

Liz Lawn Clinical Chair, NHS North West Surrey CCG

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SECTION ONE NHS North West Surrey CCG Vision, Strategic Objectives, Commissioning Principles and Values NHS North West Surrey CCG was formally established on 1st April 2013 and is responsible for commissioning healthcare services for a population of 350,000 across the boroughs of Elmbridge (West), Runnymede, Spelthorne and Woking, a very small number of our population also live within Guildford and Surrey Heath. The CCG’s membership includes 42 practices working across three localities: • Thames Medical • Stanwell, Ashford, Staines, Shepperton and Egham (SASSE) • Woking During its first year, with involvement from members, health and social care partners, patients and public, the CCG developed a vision and strategy for how health services will look in the future; a five-year Strategic Commissioning Plan. The seven major priorities identified genuinely reflect the needs of patients. There is progress to be made to be more effective in managing frail elderly patients in the community, supporting them to stay as healthy and independent as possible so that they don’t end up in hospital unnecessarily. This includes supporting people as they approach the end of life, so they can die in the place of their choice with the right people around them. The CCG needs to target specific communities in areas of deprivation where the health of the population is significantly worse than in other parts of North West Surrey, and work with them to improve their health outcomes.

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Development of the Plan has supported the development of a shared organisation wide aim and establishment of the CCG as credible healthcare system leaders. Clinical leadership is central to the development of NHS North West Surrey CCG as a strong leader of the local health system, ensuring that commissioning plans and decisions are both clinically-focused and patient-centred. The CCG’s Council of Members holds the organisation’s Governing Body to account for adherence to the NHS Constitution, including clinical leadership and engagement. The Council also approves the CCG’s strategic plans and votes on other matters as required. The CCG has a clear clinically-led vision for the local NHS and is committed to ensuring that all providers share an ambitious drive for commissioning high quality services. The patient is at the centre of everything the CCG does and the CCG actively seeks out and listens to what they are told about their experiences and needs. During the last year the CCG has aimed to ensure that all North West Surrey people enjoy the best possible health and receive safe, committed, compassionate and caring services when they make contact with the NHS and have reaffirmed the core values and beliefs set out in the newly revised NHS Constitution.

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It is the CCG’s expectation that when patients are ill they will receive care that is safe, based on the right clinical evidence to ensure the best outcomes and delivered in an integrated and holistic way by staff that treat people with dignity and respect. As the commissioner and local leader of the NHS, the CCG has developed a clear focus on quality within all provider contracts, with the expectation that this drives quality improvement on behalf of the population. Innovation is key to work at the CCG, with the development of projects that are new to North West Surrey and in some cases, new to the NHS. Quality is the organising principle underpinning the current programme of NHS reforms. The continuous need to drive improvement in services and outcomes for patients is clearly reflected in the landmark reports published during 2013, the first year of operation for CCGs, visibly and sometimes painfully outlining where the NHS has failed in the past and where lessons must be learnt for the future. The regulation of health and social care process were also reviewed and changed. The CCG recognise that this significant system change has created a rare opportunity to transform NHS cultures at every level of the sector. An opportunity to change top-down hierarchies into engaged, participative, learning organisations; to change from punitive inspection regimes to cultures of appreciative inquiry which focus on diffusing and absorbing good practice; to encourage innovation at every level; to move to a system where problems are dealt with effectively and compassionately in the interests of patient care and staff wellbeing. The culture within the CCG sets the tone and implicit social behaviours of the people who work within it.

SECTION TWO Our Culture The CCG know the adverse impact that a negative organisational culture has on good patient care. Quality is central to every member of the CCG, and all employees are responsible for ensuring that clinical quality and patient safety requirements are embedded in everything they do. Cultural change happens for the better when people help everyone they interact with to feel good about themselves, provide clear instructions, allow autonomy, extend genuine trust and act fairly. For cultural change to be sustainable these behaviours must be evident at all levels; individual, across professions and multidisciplinary teams, and at the very top of each health care organisation with the board being a genuine mirror image of the culture it wishes to lead. The CCG have embraced the opportunity to build on the forces for change released by Francis, Keogh and Berwick to nurture cultures where quality and safety are the top priority; where there are clear goals for improvement at every level; where patient engagement and voice are truly enabled; where staff are engaged in developing their organisation; where staff are supported, respected, valued and developed; where team-working is not undermined by status and professional subcultures; and where NHS North West Surrey CCG Quality Strategy

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there is integrity of purpose across the organisation. Every member of staff within the CCG takes responsibility and accountability to bring about transformational change in NHS culture that the service now requires and communities deserve. The 6Cs were launched in December 2012 as part of Compassion in Practice, the Vision and Strategy for Nurses, Midwives and Care Staff, as the values and behaviours essential to the delivery of high quality compassionate care. The 6Cs are values and behaviours (shaped by staff, patients and their carers) of Care, Compassion, Competence, Communication, Courage and Commitment. Many Trusts have signed up and rewritten their organisational strategy around the 6Cs. Other health professionals have adopted the 6Cs into their practice across the NHS and social care so that they belong to all health and care staff from nurses, midwives, doctors, porters, care staff, physiotherapists, dieticians and managers both clinical and non-clinical, to executive Boards and commissioning Boards. The 6Cs have support and sign-up from statutory and regulatory bodies. NHS North West Surrey CCG supports the 6Cs initiative and the diagram below reflects how the behaviour of the CCG contributes to this significant social movement of cultural change across the NHS and social care to improve the way care is commissioned and provided.

We are committed to ensuring our healthcare system delivers and maintains the best possible care and will align current system drivers and processes to quality improvement

• • • • • •

Care Compassion Commitment Communication Courage Competence

We understand the impact of what we say and do. We want to understand the patient experience and will listen to feedback; we see the person in every patient. We have a responsibility to commission high quality, compassionate care We are clear on our accountability for the rigorous delivery of change and to transparent measurement and evaluation for continuous improvement

To truly understand the impact of what we want to do, we need to build networks & relationships to engage and mobilise for improvement

We are not afraid to lead innovation and change to improve quality; we will seek to challenge sceptics and overcome barriers

We will ensure our providers have the right staff, with the right skills, in the right place at the right time

SECTION THREE Core Objectives of the Quality Strategy NHS North West Surrey CCG Quality Strategy

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The CCG Quality Strategy is built around a single, concise definition of quality: “Safe, effective care providing the best possible health outcomes and patient experience”. The CCG has clearly defined its vision and values in the five year plan and this Quality Strategy sets out four core quality objectives that should be addressed at every stage of the strategic commissioning and procurement cycle: •To put patients and their assessed needs at the centre of commissioning and procurement decisions to ensure they are safe, personal and effective

•To ensure the right mechanisms are in place, the standards of patient safety and quality are understood, met and effectively demonstrated •To monitor commissioned services to ensure that patient safety and quality outcomes are being realised, provide a positive experience and to recommend action if the safety and quality of commissioned series is compromised at any stage •To establish robust leadership and governance arrangements to exceed statutory requirements and responsibilities, striving for consistently high quality innovative care promoting continuous improvement in the safety and quality of commissioned services

Commissioning of high quality and safe care is at the forefront of the NHS Reforms. Decisions relating to commissioning and procurement of services are imperative to maintaining a safe high quality service. Every CCG is required to develop the most appropriate systems to discharge duties around quality and safety to meet their local needs. NHS North West Surrey CCG are committed to managing and delivering on important agendas included in the NHS Constitution such as quality of care, equality and diversity, safeguarding and choice. The CCG understands existing national and local governance, systems and processes of quality assurance, and aim for this strategic approach to give a firm foundation on which to build improvement, including the appropriate systems and processes to manage the quality agenda and hold providers to account.

SECTION FOUR Developing our Quality Strategy By establishing a shared understanding of quality, and a commitment to place it at the heart of everything we do, the Quality Strategy represents a unique and important opportunity for all commissioners and providers to work together to our mutual benefit to make our NHS even better, for everyone, now and into the future.

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Methods used to develop our strategy This strategy has been developed over the period of the last year and the diagram below outlines the breadth of methods adopted:

Patient and Public Engagement

The CCG public and patient engagement infrastructure ensures people’s views are incorporated at every level; each practice has an active Patient Participation Group and the three Locality Patient Reference Groups meet quarterly with local practice leads, district/borough councils and other locality stakeholders. The CCG have a Patient and Public Engagement (PPE) Forum which meets quarterly, chaired by the CCG Lay Member for PPE. A representative of the Forum sits on the Governing Body. NHS North West Surrey CCG Quality Strategy

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As well as the traditional verbal and written feedback methods, the CCG also uses social media to reach more local people. Testing our Ambitions On 10th June 2014, the CCG held a Quality Workshop to test draft ambitions for quality and safety with stakeholders. The workshop was attended by over 40 people with representation from local providers, patients and public. The diagram below outlines the focus of the workshop, the three draft ambitions and the questions for consideration. Ensure excellent patient experience and best outcomes for all the people in North West Surrey

Eliminate avoidable harm and reduce variation in healthcare

What are we doing? o Hear an overview on our approach to quality o Listen to our priorities

Consistently commission evidence based best practice

Do we have the right priorities? Do they fit with your views on quality and what is important?

What are our providers doing? o See how they approach quality What would good/ improvement look like? o Ask them questions on their Key stakeholder messages Local peopleservices fully supported and shared the CCG ambitions and priority areas but also had clear message they wanted to be heard and the CCG will ensure these are integral to priority area and actions.

A graphic record of our workshop The CCG also had a Graphic Recorder at the workshop who listened to group discussions and conversations, capturing key messages and themes NHS North West Surrey CCG Quality Strategy

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SECTION FIVE Our Three Ambitions for Quality Patient Experience NHS North West Surrey CCG priorities for improving patient experience are based on the National Quality Board Framework and adapted by the people of NW Surrey: • Co-ordination and integration of care. Professionals talking to each other through documentation or face to face (rated most important) • Proactively seeking the views of the patient (and when agreed by the patient) the full involvement of family and friends • Respect of patient centred values, preferences and expressed needs • Clear direction and simple process which helps people access the right care at the right time • Improving the physical comfort of patients in hospital, such as making sure they are warm, positioned well in bed • Emotional support and alleviation of fear

Ambition One

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Ensure excellent patient experience and best outcomes for all the people in NW Surrey Priority Areas

Actions and Approaches we will take

Learning from Complaints

•

• Sharing best practice

• •

Friends and Family

• • • •

Live feedback

• • •

Providers will demonstrate improvements in responding to complaints, publishing reports of themes and trends and demonstrating evidence of learning We will review complaints for quality and consistency in responses We will align our CCG quality and communication team approaches to patient and public engagement We will work with other agencies and CCGs to identify and share areas of good practice We will ensure providers roll out the programme in line with national requirements We will support the Area Team to roll out the programme in Primary Care We will work with providers to improve response rates We will ensure providers demonstrate improvement as a result of responses We will continue to develop the Talk to Us (electronic soft intelligence gathering tool) feedback from GPs We will carry out visits to our providers: walk rounds to meet staff and patients – increasing soft intelligence gathered We will increase public engagement in service re-design, supporting and attending locality groups

Staff experience and satisfaction

• •

We will work with providers to support improving staff responses to surveys We will ensure providers use staff feedback to improve staff experience and satisfaction

Workforce assurance and planning

•

We will continue to develop our monitoring framework integrating contractual requirements and best practice We will review monthly sickness absence, vacancy rates and staffing numbers We will work with providers to ensure compliance with Hard Truths through publication and transparency of staff information We will carry out six monthly reviews of all workforce assurance indicators e.g. training, appraisal and personal development, recruitment processes We will ensure alignment with the Local Education and Training Board work on provider 5 year workforce plans

• • • •

Compassion in Practice

• •

We will ensure we embed core principles of the nursing, midwifery and caring strategy into all commissioned and re-designed services and ‘live our values’ We will incorporate local implementation of the philosophy behind the national nursing strategy to drive the national agenda and clinical leadership across the whole local health and social care economy

Patient Safety NHS North West Surrey CCG Quality Strategy

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NHS North West Surrey CCG has identified core priorities to keep patients safe and free from harm which the people of North West Surrey expect the CCG to address and uphold: • Prevent avoidable harm, such as pressure damage, falls, healthcare acquired infections • Protect vulnerable adults and children from harm or abuse • Ensure mortality rates are at a level which could be expected when compared to similar health economies • Proactively identify and manage risk • Drive improvements in fundamental and enhanced standards of care in line with national and local priorities

Ambition Two Eliminate avoidable harm and reduce variation in healthcare Priority Areas

Actions and Approaches we will take •

Learning from Incidents • Sharing best Practice

• •

Safe Care

• • • • •

Safeguarding children and adults

• • • • •

Infection prevention

•

North West Surrey Serious Incident Scrutiny Panel in place from April 2014 to monitor and scrutinise investigations and management plans and approve closure We will review all incidents and identify themes and trends We will support co-ordination of 6 monthly county wide sharing of learning events We will identify and encourage sharing of best practice examples We will lead a whole system campaign to reduce avoidable harm, specifically to falls and pressure ulcers We will ensure issues relating to medicines management are included in investigations into serious incidents We will ensure regular reviews for patients on poly pharmacy (more than 10 medications) We will ensure provider compliance to WHO checklist We will work with our providers to improve the recognition and management of the deteriorating patient We will have CCG specific policies and procedures in place from April 2014 for CCG and providers We will have nominated leads for safeguarding in the CCG and all GP practices We will engage fully in multi-agency county wide Board and sub groups We will ensure minimum reporting requirements are embedded in contracts for 2014/15 and actively monitor any action plans We will aim for full compliance of actions within required timescales against the national response to Winterbourne View but ensure any delays are in the patients best interest We have a Zero tolerance approach to MRSA bacteraemia

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and control

•

•

Improving mortality

• •

Quality Surveillance

• •

We will focus on reducing all avoidable Clostridium Difficile infections through improved understanding of more resistant organisms by carrying out patient level analysis for community infections to support whole system reduction We support the use of a Sepsis bundle to reduce harm from severe sepsis We will monitor and benchmark all neonatal deaths to improve understanding of issues We will jointly review with our providers all in patient deaths to identify any areas of avoidable harm We will actively participate in the Area Team Quality Surveillance Group We will develop a North West Surrey multi agency Quality Surveillance Group to improve quality in care homes and primary care

Clinical Effectiveness NHS North West Surrey CCG questions every procurement and commissioning decision as to whether it is having the desired result, continuously maintaining and improving to practice. The challenge is based on evidence of what is effective in order to improve clinical practice, patient care, service delivery and experience. Clinical effectiveness is about doing the right thing, in the right way, for the right patient, at the right time.

Ambition Three Consistently commission evidence based practice Priority Areas Measurement and transparency

Actions and Approaches we will take • We will ensure use of accurate, useful and relevant information • We will ensure provider performance reports are robust • We will benchmark and publish data • We will ensure clear plans are available from providers via development and monitoring of Quality Accounts

Clear evidence base – links with clinical networks

• • • •

•

Clinical Audit

• •

We will ensure national standards and guidance are implemented fully where appropriate We will build on links with clinical networks to strengthen SCP work streams and provider monitoring and assurance We will continue our focus on maternity and neonatal care pathway to ensure safe effective services are commissioned and provided We will continue to review stroke services and ensure appropriate access at all stages of the pathway from hyper acute to care after stroke We will ensure research and evaluation is integral to service development and improvement We will review and monitor clinical audit programmes through Quality Account requirements We will commission additional audits for assurance if required

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Clinical leadership at all levels

• • • •

Risk management and escalation

• •

Clear standards

•

• • •

Outcome focus

•

We will continue to hold executive to executive meetings We will continue to hold 2:2 meetings with Medical and Nursing Leads from providers We will be visible through a programme of scheduled and unscheduled visits We will ensure clinical engagement in the contracting cycle at all stages We will continue to develop and build robust clear early warning systems through triangulation of information to identify ‘hot spots’ We will ensure escalation is timely, appropriate and effectively managed We will ensure fundamental standards are met and develop enhanced quality improvement goal with rigorous and robust means of monitoring and enforcing We will identify and manage risks or areas for improvement through remedial action plans We will ensure specific local key quality requirements are monitored via monthly Clinical Quality Review Meetings We will continue to improve clinical debate and challenge within the contracting process We will develop a robust integrated performance dashboard to improve monitoring and reporting of quality and safety related outcomes

SECTION SIX Quality Governance Clinical Quality requires a governance framework to ensure that systems and processes are in place across the CCG for maintaining, improving and safeguarding the quality of care it commissions and that this is encouraged and supported. NHS North West Surrey CCG has clear lines of responsibility and accountability for the overall quality of clinical care, a comprehensive programme of quality improvement activity and clear policies and procedures aimed at managing risk and identifying and improving performance. The CCG also has a systematic approach which supports staff in identifying strengths and weaknesses and in readily sharing learning with others. NHS North West Surrey GGC Quality and Safety Governance Framework

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Member Practices

Area Team Assurance MONITOR and CQC

Quality and Performance Committee

Clinical Executive

ASSURANCE

Governing Body

Contract Meetings

Clinical Quality Review Meetings

Service developments and business cases

Compliments and complaints "Talk to Us"

KPIs and CQUIN

Clinical Leads intelligence

NWS SI Panel

Safeguarding events

The ‘Who’ There is a national governance structure for assuring that quality is at the core of all service and pathways improvements and that quality is assured within commissioned services. This framework encourages co-production at all levels but also local clinical ownership of measures and indicators. The National Quality Board (NQB): The National Quality Board (NQB) is a multistakeholder board established to champion quality and ensure alignment in quality throughout the NHS. The Board is a key driver of work throughout the NHS that focuses on delivering high quality care for patients. The CCG will work closely with the National Commissioning Board (NHS England) in gaining support for the CCG to ensure that its commissioning processes and monitoring of providers is effective, in having a collaborative approach toward the improvement of quality and safety in primary care services and in NHS England’s responsibilities for commissioning specialist services on behalf of the CCGs population.

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NHS England (through national, regional and local area teams): Formerly established as the NHS Commissioning Board in October 2012, NHS England is an independent body, at arm’s length to the government. Its main role is to improve health outcomes for people in England. It will ensure the new architecture is fit for purpose and provides clear national standards and accountability. The Board will lead the delivery of improvements against the NHS Outcomes Framework and of more choice and control for patients: • provide national leadership for improving outcomes and driving up the quality of care • oversee the operation of clinical commissioning groups • allocate resources to clinical commissioning groups • commission primary care and specialist services The CCG: The Health and social Care Act 2012 states that - “Each clinical commissioning group must exercise its functions with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness”. Member Practices: Member practices will receive monthly reports benchmarking their performance on key quality, performance and financial measures. The CCG will routinely survey and monitor patient experiences of using member practices. Practice patient participation groups will be essential in capturing patient experiences to feed into the early warning processes and quality review meetings with providers. The CCG’s Council of Members holds the organisation’s Governing Body to account but delegates responsibility for delivery. Governing Body: Governing Body has overall responsibility for delivery of high quality services and ensuring there is a robust framework in place to monitor and performance manage the quality of service delivery Quality and Performance Committee: The Quality and Performance Committee monitors the quality of commissioned services through establishment of a quality framework whereby providers are held to account and continuous improvement is assured. This framework takes into account nationally set outcomes, and standards, but also includes additional requirements based on local priorities, including key performance indicators. Performance is monitored against these quality standards. The Clinical Executive Committee: The Clinical Executive Committee provides a source of clinical advice to Governing Body and is responsible for delivery of the strategic commissioning work streams and the QIPP plan. The Committee also oversees development of the clinical strategy including review and performance of CQUINS, along with supporting the NHS Commissioning Board to improve quality within Primary Care. The Role of Quality in the CCG This Quality Strategy combines all the relevant key current initiatives relating to safety and quality into a single approach. To enable this, the core key themes and specific objectives have been taken from various programmes and projects. Implementation of this framework will not take place in isolation of other major programmes, it is intended to underpin, feed into and enhance existing work streams as outlined in the diagram below.

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SECTION SEVEN Quality Assurance NHS North West Surrey CCG demonstrates strategic leadership, oversight and decision making responsibilities for clinical quality and patient safety. The CCG holds providers to account in relation to these elements and decides the impact on commissioning decisions. The CCG also collates soft intelligence, including patient experience data, from practices, public and patient engagement forum and wider stakeholder feedback. The Role of the Quality Team The CCG Quality Team is responsible for the co-ordination and delivery of the following:

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Governance: Providing reports to the Quality and Performance Committee, the Clinical Executive Committee and Governing Body as required and any other subgroups regarding providers’ compliance against the quality of patients care requirements in NHS Provider contracts; Ensuring reports to the National Reporting and Learning System is undertaken by providers, on behalf of the CCG and the development of Early Warning Systems Partnership Working: Working in partnership with local, regional and national networks/ regulators to deliver the quality agenda locally, for example Health watch, Monitor, CQC and NHS England Leadership: Using clinical expertise and experience to synthesise qualitative and quantitative quality information from a broad spectrum of sources, in relation to the quality of services provided from local healthcare providers; Establishing relationships with local providers with regard to quality performance; Agreeing in year trajectories in line with emerging national and local guidance to ensure providers are measuring and meeting set trajectories, enabling peer review, where possible; Setting contractual arrangements to ensure clinical quality systems and processes are specified for each provider: systems and processes include monthly clinical quality review meetings with each provider to address under-performance against quality requirements as appropriate Assure Quality: Meeting monthly with all providers to specifically review provider clinical quality performance against agreed quality contract requirements; Monitoring and challenging providers to demonstrate learning and understanding when serious incidents occur which require a root cause analysis and investigation; managing day to day reporting and co-ordination, ensuring timeframes and deadline submissions are met and ensure learning is disseminated; Working within the Operating Framework, Better Care Better Value metrics and NHS Outcomes Framework; Drawing on clinical guidance from national bodies alongside setting local priorities to ensure that providers are delivering against the latest guidance/best practice Improve Quality: Working with providers to ensure continued patient safety and risk management processes are in place so that risk of harm for patients is reduced to a minimum; Overseeing provider documenting and highlighting of themes and lessons from incidents and evidence of embedding these lessons into service developments and improvement. Steps to assuring Quality: The ‘How’ The Quality Framework was developed from the seven steps to quality identified by Lord Darzi in ‘The Next Stage Review: High Quality Care for All’ (DH 2008) and continues to underpin the national approach to quality assurance and improvement. This framework has been used to inform and structure the CCG approach to Commissioning for Quality and demonstrates the steps the CCG will take to ensuring quality is central: 1. The CCG will Bring Clarity to Quality......by being clear about what high quality care looks like in all specialities through building robust quality requirements and patient outcomes, that are reflected consistently, when setting fundamental standards and quality indicators in specifications and contracts. The CCG will work collaboratively with other CCGs to ensure a consistent approach to quality standards across health care economies, particularly when working with large health care providers. NHS North West Surrey CCG Quality Strategy

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2. The CCG will Measure Quality......by gathering and using robust information that shows providers where they most need to improve on key measures and enables the CCG to ensure appropriate actions are in place to address them and track the effect of changes that they implement via clinical quality reviews and contract monitoring. A continuous focus will be to drive improvement and reduce unwarranted variation in practice. 3. The CCG will Publish Quality......by routinely making data available so that patients and their carers can make better informed choices, and to enable commissioners and providers to agree priorities for improvement, by using the information from the Quality Observatory, Quality Accounts and reports to the CCG Governing Body. 4. The CCG will Reward and Recognise Quality......by ensuring the right incentives are in place to support quality improvement by using CQUIN and local incentive schemes. Incentives will also be linked to whole system achievement of Quality Premiums. 5. The CCG will strengthen Leadership for Quality......by increasing clinical leadership and engagement in commissioning, strategic planning, service development and redesign. The CCG will do this by using stronger clinical engagement with localities, member practices and through clinical and professional networks. The CCG will put in place a systematic process to enable hearing the voice of service users, partnership working and building results into commissioning and investment decisions. These decisions will be clearly articulated. 6. The CCG will Innovate and Champion for Quality......by using incentives and QIPP programmes to deliver better outcomes & improved services, increase effectiveness and enhance the patient experience. The CCG will maximise innovation opportunities through partnerships and networks. The CCG will create a robust horizon scanning function to ensure as a commissioner, that they are up to date with best practice, evidence and innovation in health care. The CCG will utilise quality improvement programmes, continuing to drive and prioritise work for safe, effective care. 7. The CCG will Safeguard Quality......by using early warning systems to alert of potential serious safety failures, ensuring investigations of serious failures are robust and lessons learned are shared to reduce the risk of recurrence. The CCG will promote and incentivise the implementation of organisational schemes that reduce and prevent avoidable harm in health care. In collaboration with key partners, the CCG will ensure that arrangements for safeguarding children and vulnerable adults are robust to reduce the risk of harm to the most vulnerable members of the population. How does the CCG collect and use information: The ‘What’ Quality is systemic: that is, it depends upon many different individuals, inputs, process and organisations. It is also, to a degree, subjective. The data required to assess quality, therefore, needs to be drawn from many different sources, to ensure that relevant information is captured on the three domains of quality: effectiveness, safety and patient experience. Quality data and knowledge is captured for acute, non-acute settings, including primary care, independent sector, ambulances, mental health services, screening programmes and offender health. In order to ensure that NHS North West Surrey CCG Quality Strategy

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themes and trends are captured, information and intelligence is gathered and triangulated. Intelligence may be hard data, or evidence, or it may be soft intelligence gathered through feedback. The diagram below demonstrates how the CCG collect information and provide assurance.

Quality Monitoring and Assurance of Providers Appendix 4 outlines the breadth and complexity of the CCG provider landscape, the forums the CCG has with each provider, various sources of assurance and methods used by the provider to demonstrate evidence of effectiveness. These difference sources enable the CCG and the provider to highlight risk areas for specific discussion such as infection control, safeguarding, incident reporting and patient experience and these topics are standing agenda items at the Clinical Quality Review Meetings. This forum also receives presentations on a rolling programme agreed between the provider and the CCG and also shares learning and best practice examples.

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• Qualitative and quantitative • How and what is reported • Frequency of reporting • How do they know what patients think

• Locally within their organisation and compared to other local providers,

Do you know how good you are?

Do you know where variation exists?

Do you know your rate of improvement over time?

Do you know where you stand relative to the best?

• What are they measuring • How are they measuring • Who is measuring

• Compared to national best practice

For areas requiring Improvement, the following questions are considered: • Is there a plan? • Is it working at the rate expected? • Is corrective/ mitigating action being taken? • Does it need to be escalated/ does the Board know?

SECTION EIGHT Managing and Escalating Risks to Quality and Safety NHS North West Surrey CCG proactively seeks intelligence to help identify concerns and emerging themes early. These sources of intelligence are regularly monitored. When a theme is emerging which requires attention, a process is followed to determine whether the concern needs to be escalated and the action that will be expected will be formally agreed with providers.

How do NHS North West Surrey manage quality and safety related risks and issues?

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What can we learn from this and can we prevent it happening again?

SECTION NINE Next Steps In terms of integrated reporting and environmental scanning, the CCG is taking a more structured approach to environmental scanning supported by meaningful NHS North West Surrey CCG Quality Strategy

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analytical products. Information will be categorised, assessed, prioritised and analysis will be developed to address each of the domains of the CCG Assurance Framework. Analytical products will be flexible enough to present information at all levels, from CCG to Provider and to GP Practice. This analysis will be supported by tailored reports which will be disseminated to appropriate forums such as the Quality & Performance Committee and the Governing Body to support informed decisionmaking. The current reporting format is changing as this capacity and ability develops and the CCG will be assured that the information escalated is more robust and actions more explicit. There is growing awareness among healthcare providers of how industrial quality improvement approaches can benefit healthcare providers. It is also important that the CCG has an understanding of these methods to ensure we exercise our role in contracting for quality and ensuring quality improvement approaches are being using to improve services (Appendix 3). This includes: • • • • • •

Putting the emphasis on assuring quality and safety in evaluating current and potential providers Looking at governance and leadership on these issues, rather than merely policies and procedures Building measures of quality and safety into commissioning specifications and, where appropriate, penalties for significant breaches Putting in place performance management regimes that assess quality and patient safety processes Assessing for ourselves how care is provided on the ground, and how the culture and values of the organisation are expressed in behaviour Using CQUIN as a route to reward providers for quality improvement

The CCG is systematically reviewing progress to date and identifying gaps and areas for improvement. This strategy will be underpinned by a clear timetable of actions and specific outcome measures, aligned with the Strategic Commissioning Plan work streams, to demonstrate the drive and improvement in high quality care over the next 4 years. Metrics will be developed which compliment work already being undertaken through the contract schedules and the CQUIN framework. These measures will focus on all aspects of NHS care and the CCG will begin to develop and implement the processes across the independent and third sector. The core quality team will support the strategic change programmes in the CCG Strategic Commissioning Plan to ensure that the quality strategy and respective national requirements are fully embedded into the thinking behind any service redesign and planning.

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Summary Statement: NHS North West Surrey is committed to enabling all North West Surrey people to live longer and enjoy the best possible health: The CCG will ensure that patients receive safe, committed, compassionate and caring services delivered by providers constantly striving to improve. The CCG will actively seek out and listen to what our population is telling them about their health needs. Patients and their families will be treated with dignity and respect and involved in decisions about their care. By focussing on effective quality systems and processes, the CCG will enable providers to deliver great outcomes.

APPENDIX 1 References 1. Equity and Excellence: Liberating the NHS (2010) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/ 213823/dh_117794.pdf

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2. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. February 2013 http://www.midstaffspublicinquiry.com/report 3. The Berwick Report: A promise to Learn- a commitment to act: Improving the safety of patients in England. August 2013 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/ 226703/Berwick_Report.pdf 4. Compassion in Practice: Nursing, Midwifery and Care Staff – our Vision and Strategy. December 2012 http://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-inpractice.pdf 5. Review into the Quality of Care and Treatment provided by 14 Hospital Trusts in England: An Overview Report. July 2013 http://www.nhs.uk/NHSEngland/bruce-keoghreview/Documents/outcomes/keogh-review-final-report.pdf 6. Raising Standards: Putting People First. April 2013 http://www.cqc.org.uk/content/our-strategy-2013-2016-0 7. Equality Act 2010 http://www.legislation.gov.uk/ukpga/2010/15/contents Bibliography •

• • •

•

• •

A promise to learn– a commitment to act: Improving the safety of patients in England August 2013 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/ 226703/Berwick_Report.pdf A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture October 2013 https://www.gov.uk/government/publications/nhshospitals-complaints-system-review HOW TO: Maintain Quality during the Transition: Preparing for handover National Quality Board 2012 http://www.dh.gov.uk/health/files/2012/05/Preparing-for-Handover.pdf Review of Early Warning systems in the NHS National quality Board February 2010 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ ps/documents/digitalasset/dh_113021.pdf The Cavendish Review: An Independent Review into Healthcare Assistants and Support Workers in the NHS and social care settings July 2013 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/ 236212/Cavendish_Review.pdf The Operating Framework for the NHS in England 2012/13. DH 2011. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/di gitalasset/dh_131428.pdf The Patient Safety First Campaign for Englandwww.npsa.nhs.uk/nrls/improvingpatientsafety/nhs-patient-safety-campaign/ Inspiring Leaders: Leaders for quality. DH 2009.

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•

Using the Commissioning for Quality and Innovation (CQUIN) payment framework-for the NHS in England 2009/10. DH 2008. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAn dGuidance/DH_091443

APPENDIX 2 Relevant Documents

NHS North West Surrey Operating Plan NHS North West Surrey CCG Quality Strategy

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NHS North West Surrey Strategic Commissioning Plan NHS North West Surrey Risk Management Strategy NHS North West Surrey Policies: • Management of Serious Incidents • Safeguarding Vulnerable Adults and Children • Customer Care • Whistleblowing • Recruitment • Infection Control • Information Governance

APPENDIX 3 Clinical Commissioning for Quality

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Safe

Effective

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Experience

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APPENDIX 4: Sources of Assurance: Provider Landscape

Host Commissioner providers Type of provider

Provider

Acute

Ashford and St Peters Hospital NHS Foundation Trust

Links/ forums    

Community

Virgin care limited Surrey

 

Independent Hospitals

BMI Runnymede Nuffield Health Woking

     

Sources of assurance  

Clinical Quality Review Meeting, Joint operational performance review meetings A&E, 18 weeks. 2:2 nursing/ medical Director meetings CCG participation engagement in provider internal forums e.g. safeguarding steering group, Clinical Outcomes Forum, walkabouts Engagement in Quality Account workshops Robust CQUINs to promote quality innovation and improvements

    

Clinical Quality Review Meeting, Joint operational performance review meetings 1:1 nursing and quality meetings Quality walkabouts. Engagement in Quality Account process Robust CQUINs to promote quality innovation and improvements

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Performance and quality dashboards. National data sources e.g. Safety Thermometer , Unify Evidence from data validation, audits Walkabouts/ quality visits CQC/ other external inspections Talk to us Complaints/PPI forum feedback

Evidence of effectiveness 



Increased levels of patient/ user /staff satisfaction ( FFT, Compliance with national quality KPI requirements Demonstration of robust commissioner/ provider communications and processes.

Ambulance services

Patient transport service Surrey 999/ 111 services Surrey

   

Out of Hours

Care UK

Voluntary sector / hospices

Sam Beare / Woking Hospice

Nursing / Care homes

NWS providers



Clinical Quality Review Meetings Commissioner to commissioner forums Surrey Quality Leads forum Surrey Collaborative

Engagement with Nursing/ care home providers and social care through the NWS Care home forum

Third Party Commissioner providers Type of provider Acute

Provider     

Royal Surrey County Hospital Foundation Trust Kingston NHS Foundation Trust Epsom and St Helier NHS Foundation Trust Frimley Park NHS Foundation Trust

Links/ forums 

  

Sources of assurance

Feedback from host commissioners on Clinical Quality Review Meeting outcomes, Commissioner to commissioner forums Surrey Quality Leads forum Surrey Collaborative

     

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Performance and quality dashboards. National data sources e.g. Safety Thermometer , Unify Walkabouts/ quality visits Talk to us Complaints/PPI forum feedback Health watch forums

Evidence of effectiveness 





Increased levels of patient/ user /staff satisfaction ( FFT, Compliance with national quality KPI requirements Demonstration of robust commissioner/ provider communications and processes. Positive assurance from external inspections / CQC./ Health watch

Specialist acute services

St Georges /Kings College/ Barts/ Guys and Thomas / Royal Marsden

Mental Health

Surrey and Borders Partnership NHS Foundation Trust

Mental Health

IAPT services

Independent hospital

BMI Princess Margaret

Primary Care

GP Surgeries



Engagement with Area Team

Community Pharmacies



Engagement with Area Team

Dental Services



Engagement with Area Team

Optometry Services



Engagement with Area Team

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APPENDIX 5: Quality Workshop Attendees 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

Attendees June 10 Quality Strategy Event First Name Surname Role Representing Paul Smith Taxi PPG Roy Wernham Heathcot Medical Practice PPG PPG Charles Stewart Friends of Pirbright Surgery. PPG Mike Smallwood Louise Clubley PPG Bob Angell PPG Studholme Ashford & Member of SASSE CCG Patient Locality Group Dorothy Farrant PPG - (Councillor Woking) Janet Sleep PPG PPG St David's Stanwell Charlotte Chatwin Assistant Manager Concern and Help for East Elmbridge Retired (CHEER) Steve McCarthy CCG Patient Rep CHEER - local charity Charlotte Atkinson Assistant Manager Paul Thompson Acting Chair PPG PPG Sunbury Health Centre Solette Sheppardson Voluntary Support North Surrey Joanne Jones Community Development Manager Spelthorne Council Christine Jones Grants and Fundraising Co-ordinator TALK Fiamma Pather Operations Manager Your Sanctuary Sarah Priestley GP Carer Awareness Adviser Samantha Lamb Governor ASPHFT Governor ASPHFT Keith Bradley Steve Pursglove Team Leader Richmond Fellowship - Making Recovery Reality John Cox Jamieson McLean Business Devolopment Manager British Red Cross Hampshire Isle of Wight & Surrey Moira James Patient John James Patient Pat Notton Rik Sandom Chairman Voluntary Diabetes Group St Peter's Chertsey & District Branch Aidan C Hopkins Service Manager Alzheimer's Association Linda Cornelia PPG Thames Medical Jill Turk Spelthorne Tony Docker Patient Judith Moore Charity representative Voluntary Action In Spelthorne Nicola Cheung Plus One Charity representative Voluntary Action In Spelthorne Paul Davis Sue Stagg Maurice Cohen Jill Juttner ASPH Samantha Lamb Rowena Smith Smith Apologies Apologies Director Prevent Plc Elaine Laidler Laidler Gillian Harvey-Bush Apologies Leanda Hargreaves Apologies Tony Fishlock Apologies Apologies Surrey County Council Paul Coleing Kathy Peat PPG Hillview Medical Centre, Woking Claire Craigie Service Manager for Independent Living British Red Cross

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APPENDIX 6 Equality Analysis NWS CCG Quality Strategy Equality Analysis Checklist An equality analysis is a review of a policy, function or service which establishes whether there is a negative or positive impact on particular protected characteristic groups. In turn this enables the organisation to demonstrate it does not discriminate and, where possible, it promotes equality. This check list is a way to help staff think carefully about the likely impact of their work on equality groups and take action to improve services and projects for local people where it has a positive or negative impact. Name of the policy / function / service Briefly describe its aims and objectives:

NW Surrey CCG Quality Strategy: Delivering Quality through Effective Commissioning 2014-2018

• •

To enable all North West Surrey people to enjoy the best possible health To transform service delivery, focussed on better outcomes for patients, with decisions being taken by GPs and listening to the voices of our patients and stakeholders

The organisation has made a commitment regarding quality that states ‘we are committed to serving our local population and will ensure they receive safe, committed, compassionate and caring services. The patient is at the centre of everything we do and we will seek out and listen to what they are telling us and what they need’. There is recognition of the national context and key policy drivers regarding quality of care and safeguarding, following publication of the Francis Report, the Keogh Report, the Cavendish and Berwick Reviews which all highlight areas for improvement and the centrality of compassion in the care provided. Alongside this is a key, very important theme, which recognises the importance of working with local providers, stakeholders and partners as well as the public and patients, with an emphasis on compassion, care and being responsive to people’s needs and good patient experience. There is a commitment to being community focused, engaging local people and communities throughout the commissioning cycle and prioritising the needs of patients and the public. The Quality Strategy sets out the expectations on provider organisations, the standards of care 36

that the CCG expects from its providers and how this will be monitored and measured as part of the commissioning process. The Quality Strategy states that ‘we will ensure that the services we commission for patients are safe, in line with best practice and clinical evidence, in order to achieve the best outcomes and experience for patients. During the delivery of integrated and holistic healthcare, patients and their families will be treated with dignity and respect and involved in care decisions’. The core objectives of the strategy are; • • •

Consultation and engagement:

To put patients and their assessed needs at the centre of commissioning decisions Monitor commissioned services to ensure they are safe, effective and provide a positive experience To establish robust leadership and governance arrangements to not only meet statutory requirements and responsibilities, but strive for consistently high quality innovative care The CCG’s public and patient engagement infrastructure is in place to ensure that people’s views are incorporated at every level; •

Every practice has an active PPG

•

Locality Patient Reference Groups meet quarterly with local practice leads, district/borough councils and other locality stakeholders

•

The CCG-wide PPE Forum meets quarterly, chaired by the Lay Member for PPE

•

A representative of the Forum sits on the Governing Body

•

Using social media to reach more local people

The CCG used a range of methods in developing the strategy which included a number of meetings and workshop, e mail and telephone, questionnaires and circulation of the draft versions of the document for comment and input. An event was held on 10th June at Silvermere Golf Club from 4-6 pm. There was good representation from patients themselves, patient groups and the voluntary sector as well as local authorities and provider organisations. Providers were asked to bring displays and information about their services for a market place opportunity. Following an introductory presentation about the strategy and the purpose of the workshop participant were invited to work in groups to discuss three key elements of the strategy.

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• Patient experience • High quality care • Keeping patients safe National frameworks for each of the above were used to set out the key elements and participants were asked; • • •

Does the CCG have the right priorities? Do these fit with your views on quality and what is important? What would good/improvement look like?

Feedback and discussions were recorded by facilitators on each table and by a graphic scribe who recorded themes pictorially on a white board. The clear messages that came out of the workshop were: • • • • • •

Ask me what I want Improve education of patients, carers and staff in direct verbal and written communication Remember I am a whole person not just a diagnosis Improve communication in need to know where to go or who to ask and I want professionals to share information about me Improve co-ordination and integration of care including use of all voluntary and statutory services I need access to care when I want it and I need to know where to go for it

These have been included in the strategy. There will be further PPI and Stakeholder review and engagement as the strategy is completed and signed off. Those protected characteristic groups who were unable to take part in the event were sent a draft of the strategy and asked for their comments. There will be further consultation with these groups. Demographics The Quality Strategy similar to the Strategic Commissioning Plan utilises the data from the JSNA for Surrey which indicates that generally North West Surrey has low levels of deprivation and levels of premature mortality are at the better end of the best quartile for of the area: CCGs when compared nationally. However there are a number of particular areas (Stanwell North, Ashford North, Stanwell, Maybury and Sheerwater) as well as specific groups of people such as carers and BME groups who experience the poorest health outcomes in the area. There is work in place with Surrey County Council Public Health team to target these areas and communities with the highest risk factors of certain 38

diseases. The CCG is working with Health and Wellbeing Partners from the local authorities and has worked through the steps outlined in Commissioning for Prevention: • • •

Analyse key health problems (emerging) – alongside the JSNA a local analysis of the causes of premature deaths and risk factors (smoking, obesity, physical activity) was undertaken and used to identify local priorities Prioritise and set common goals (emerging) – local priorities include tackling smoking, alcohol, obesity, teenage conception and early detection of disease (particularly diabetes, and AF for stroke prevention). Addressing the health needs of carers and providing support to prevent carer breakdown/crisis are also a priority area. Identify high impact programmes (emerging/mature) both primary and secondary prevention initiatives have been identified and will be delivered through joint commissioning with public health including early identification for diabetes and stroke and the delivery of NHS health checks.

A number of lifestyle factors have been identified that have a big impact on health outcomes some of which are more prevalent in the protected characteristic groups than in the general community such as smoking, obesity, alcohol, and key actions include work targeted at these communities in the most deprived areas. There is a broad population approach on those who need support most, to reduce health inequalities, focussing on targeted communities. Over the next five years interventions are to be rolled out to the wider NW Surrey population where possible. The Quality Strategy links closely with the Strategic Commissioning Plan which sets out how the CCG intends to commission services over the next five years. Findings:

The Quality Strategy seeks to ensure that the best care is provided to all. This high level strategy sets out the quality standards the CCG expects its provider organisations to achieve for all patients including people from the protected characteristic groups. The strategy demonstrates how the organisation will meet the EDS2 goal of Better Health Outcomes- ‘Services are commissioned, procured designed and delivered to meet the health needs of local communities’ which sets out the requirements on commissioners to ensure that provider organisations are themselves complaint with the general equality duties in the Equality Act 2010. The strategy sets out the responsibilities and processes for monitoring compliance with these standards. The expectations on providers and the assurance required are clear. On-going improvement in patient experience will be measured using robust and ongoing feedback such as;

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Learning from Complaints

Sharing best practice

Providers will demonstrate improvements in responding to complaints and publishing reports of themes and trends We will review complaints for quality and consistency in response We will align our work with our CCG quality and communication team approach to patient and public engagement We will work with other agencies and CCGs to identify and share areas of good practice

Friends and Family

We will ensure providers roll out the programme in line with national requirements We will support the Area Team to roll out the programme in Primary Care We will work with providers to improve response rates We will ensure providers demonstrate improvement as a result of responses

Live feedback

We will continue to develop the Talk to Us (electronic soft intelligence gathering tool) feedback from GPs We will carry out visits to our providers: walk rounds to meet staff and patients – increasing soft intelligence gathered We will increase public engagement in service re-design, supporting and attending locality groups

Staff experience and satisfaction

Improving staff responses to surveys We will ensure providers use staff feedback to improve staff experience and satisfaction

Workforce assurance and planning

We will continue to develop our monitoring framework integrating contractual requirements and best practice We will review monthly sickness absence, vacancy rates and staffing numbers We will work with providers to ensure compliance with Hard Truths and publication and transparency of staff information We will carry out six monthly reviews of all workforce assurance indicators e.g. training, appraisal and personal development, recruitment processes We will ensure alignment with the Local Education and Training Board work on provider 5 year workforce plans

Compassion in Practice

We will ensure we embed core principles of the nursing, midwifery and caring strategy into all commissioned and re-designed services and ‘live our values’ We will incorporate local implementation of the national nursing strategy to drive the national agenda 40

across the local health economy The strategy also includes the priorities based on the National Quality Board Framework and adapted by the people of NW Surrey;

Respect of patient centred values, preferences and expressed needs Clear direction and simple process which helps people access the right care at the right time Improving the physical comfort of patients in hospital, such as making sure they are warm, positioned well in bed Emotional support and alleviation of fear Proactively seeking the views of and when agreed by the patient the full involvement of family and friends Co-ordination and integration of care. Professionals talking to each other through documentation or face to face .

Recommendations: General

While this overarching approach to improving quality for all will improve standards and patient experience it is important to ensure that people from the protected characteristic groups are not disadvantaged despite an overall improvement. People can often be hidden from sight due to language or cultural differences which can make it difficult for them to complain or raise an issue of concern. Minority groups can be disadvantaged and those groups who are seldom heard often experience the greatest inequalities. Ensuring good relationships and engagement with local groups, improvements in the collection and monitoring of patient data by providers will help to demonstrate if the needs of these population groups are being met and their health improved. When reviewing the above data for assurance we must ensure that people from the protected characteristic groups are benefiting in the ways the strategy intends. As part of the Equality Objectives the CCG has set out actions to extend and improve how it works with the protected characteristic groups and to improve engagement to ensure that all groups can contribute. It is important to ensure that those groups who have not been involved in the development of this strategy have the opportunity, if they wish, to be involved in the future and that the needs of these groups and the evidence that their patient experience has improved are clearly identified in the on-going monitoring of the quality standards.

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