Quality and Patient Safety Strategy 2013-2016
WFCCG Quality and Patient Safety Strategy 2013-2016
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Contents Introduction ..................................................................................................................... 3 National Drivers ............................................................................................................... 3 Aim of the Strategy .......................................................................................................... 4 Vision ............................................................................................................................... 4 Implementing the Strategy ............................................................................................... 5 Improving Quality and Safety in Primary Care ................................................................... 8 Engagement and Communication ..................................................................................... 9 Equality, Diversity and Human Rights ............................................................................... 9 Monitoring ..................................................................................................................... 10 Conclusion...................................................................................................................... 10 NHS Wyre Forest Clinical Commissioning Group Quality Strategy on a page 2013-2016 ... 11 Learning from the Mid Staffordshire (Francis) Inquiries ................................................... 12
WFCCG Quality and Patient Safety Strategy 2013-2016
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Introduction Quality is the organising principle underpinning the current programme of NHS reforms. It is enshrined in the Health and Social Care Act 2012 and enables the NHS to: Put Patients at the heart of all NHS care Deliver improved health outcomes Empower local organisations and professionals to improve quality NHS Wyre Forest CCG as a local organisation led by local clinicians who work with and for people from their local communities is well placed to commission the highest possible quality healthcare. Ensuring the delivery of compassionate, high quality care focused on outcomes is at the heart of our clinical values and by establishing a shared understanding of quality and a commitment to place it at the centre of everything we do, NHS Wyre Forest CCG has a unique and important opportunity to continually improve and safeguard the quality of local NHS services for everyone, now and in the future. NHS Wyre Forest Clinical Commissioning Group will commission healthcare services in partnership with clinicians and the local population that reflect their healthcare needs and expectations, which involves them in commissioning decisions and which responds to their concerns. The partnerships developed with key statutory and voluntary agencies will continue to be crucial in safeguarding our population. The services we commission will ensure our local population will receive high quality, safe health care, close to home or at home delivered by staff with appropriate skills. Feedback from patients and carers will be actively sought and used to continually improve services. People’s views and experiences, whether providers or receivers of health care will be listened to, collated and analysed. This information will then be used to make measurable improvements in the areas of quality care that patients, carers and staff have identified as being the most important. This Commissioning Quality and Patient Safety Strategy is a three year strategy developed in partnership with NHS Redditch and Bromsgrove Clinical Commissioning Group and NHS Wyre Forest Clinical Commissioning Group. The strategy sets out the CCGs’ respective ambitions for their patients, together with their commitment to work together and in their individual CCGs to commission high quality health care for the patients of Redditch and Bromsgrove and Wyre Forest (See Appendix 1 Quality Strategy on a page 2013-2016).
National Drivers The strategy focuses on the three domains of quality defined in High Quality Care for All (2008): 1. Safety: ‘do no harm’ – keep patients as safe as possible; 2. Effectiveness: ‘success’ – clinically effective and cost effective treatments; and 3. Patient experience: ‘quality of caring’ – understanding patient satisfaction through their experiences.
WFCCG Quality and Patient Safety Strategy 2013-2016
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The strategy also reflects the five domains of the NHS Outcomes Framework (2011): 1. Preventing people from dying prematurely; 2. Enhancing quality of life for people with long-term conditions; 3. Helping people recover from periods of ill health or following injury; 4. Ensuring people have a positive experience of care; and 5. Treating and caring for people in a safe environment; and protecting them from avoidable harm. Quality will be the key consideration in the commissioning of services and the strategy will both support the implementation of Quality, Innovation, Productivity and Prevention (QIPP) and quality assurance of services. Implementation of the strategy will also address the quality priorities outlined in The Operating Framework for the NHS in England 2013/14. High level failures in the NHS such as those which happened at the Mid Staffordshire NHS Trust 2005-2009, Basildon and Thurrock University Hospitals Foundation Trust 2009 and more recently Winterbourne View Hospital 2010 have highlighted the perils of placing financial priorities above quality priorities. The recommendations and lessons learned from the reviews undertaken following these high level failures should not be ignored and signal a shift in how we should commission care. This strategy is also underpinned by the pledges made to patients in the NHS Constitution 2013, which sets out rights to which patients, public and staff are entitled based on the principles and values of the NHS in England. Patients’ rights in relation to the quality of care and environment are articulated including the right to expect NHS organisations to monitor and make efforts to improve the health care they commission.
Aim of the Strategy The aim of the strategy is to ensure continuous improvement of quality outcomes respective to the needs of local people and develop robust quality assurance mechanisms in order to provide assurance to the CCG Governing Body regarding the standard of quality and patient safety in commissioned services.
Vision NHS Wyre Forest CCG provides the following commitment ‘We will bring together local people, GPs and other clinical professionals to improve the quality and experience for patients of their health care. Strategic Objectives The five strategic objectives of the Commissioning Quality and Patient Safety Strategy are to:
WFCCG Quality and Patient Safety Strategy 2013-2016
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1. Create a culture of continuous quality improvement, openness, transparency and candour across the healthcare system 2. Commission services that are safe, clinically effective and support a positive care experience 3. Commission services that reflect individual needs, are accessible and delivered in the most appropriate setting; with a specific focus on the care of the most vulnerable groups 4. Encourage feedback and value the role of patients and healthcare professionals in shaping, monitoring and improving services 5. Build upon the quality framework to bring together patient safety, clinical effectiveness and care experience information from a range of sources to provide assurance regarding the quality of care delivered in commissioned services
Implementing the Strategy A number of local actions have been identified to support the achievement of each of the strategic objectives: Objective One - Create a culture of continuous quality improvement, openness, transparency and candour across the healthcare system Ensure every member of the CCG Governing Body owns the quality agenda and every member of staff understands their role and contribution to deliver quality. Create a culture of quality throughout the health care system promoting quality events and initiatives that support positive quality improvement relationship with providers Provide opportunities to share best practice and learning across commissioners and providers Improve communication methods across the local health care system that values openness and transparency at all levels. Set clear and ambitious quality improvements for patients within Commissioning for Quality and Innovation (CQUIN) and Quality Schedules, and challenge areas of poor performance and mediocrity Launch the 6c’s initiative (Care, Communication, Competence, Courage, Compassion and Commitment)across the local health care system to ensure the national vision for nursing, midwifery and care givers is implemented and monitored. Monitor the staff experience and set clear areas for quality improvement in workforce metrics within commissioned services Value, promote and support research within the health economy, working with and through the West Midlands (South) Comprehensive Local Research Network Expected Outcomes - Quality is included on all CCG Governing Body and Committee Agendas - Evaluation and learning is demonstrated from Culture of Quality events - 6Cs initiative implemented across the local health care system.
WFCCG Quality and Patient Safety Strategy 2013-2016
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Continuous quality improvement is demonstrated through CQIN scheme and the delivery of quality schedules.
Objective Two - Commission services that are safe, clinically effective and support a positive care experience Design an evidence-based dashboard for the CCG Governing Body that provides both assurance and early warning of quality concerns in commissioned services Review the quality assurance mechanisms that are in place across the range of commissioned services and ensure appropriate quality monitoring and governance arrangements in all areas Develop a systems wide professional and public communications campaign for harm free care Fully implement the Clostridium difficile reduction plan Commission 100% use of high impact intervention Work with health care regulators, the Local Authority, HealthWatch and other commissioners to share information and support continuous quality improvement Develop and implement a commissioning Infection Prevention and Control Strategy. Expected Outcomes - 90% of commissioning service specifications will include specific quality indicators that are agreed in partnership with public/patient advisory groups - Evidence of professional and public communication campaigns for harm free care on the CCG website and Primary Care. - Evidence of early warning signs through triangulation of information from Quality Dashboard Objective Three - Commission services that reflect individual needs, are accessible and delivered in the most appropriate setting; with a specific focus on the care of the most vulnerable groups Ensure continuous improvement in quality outcomes of commissioned services through the use of quality schedules, CQUINs, and learning from incidents and complaints Develop a continuous patient flow system across the health economy to promote appropriate care settings Define and agree quality outcomes and trajectories with providers to reduce harm e.g. pressure ulcers, falls and Clostridium Difficile etc. Implement a robust reporting mechanism for serious incidents across all commissioned services Develop a safeguarding adults and children strategy Embed policies and a training framework for safeguarding adults and children
WFCCG Quality and Patient Safety Strategy 2013-2016
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Support relevant Francis recommendations relating to improving safety for vulnerable groups. Work in partnership with providers, health and social care colleagues to enhance provision and access to health care for care home residents. Endorse the principles of the ‘Getting it Right for people with a learning disability’ Charter. Engagement with Learning Disability Partnership Board and associated workstreams Expected Outcomes - Safety Thermometer performance consistently maintained at 95% or above - 20% reduction in serious incidents related to pressure ulcers, falls with serious harm and VTE - CQUINs detailing discharge and reablement care plans will be achieved - Reduced numbers and duration of health care acquired infection outbreaks within inpatient settings - 95% of health care staff will undertake safeguarding adult and children training appropriate to their role and competency - Nominated Leads for safeguarding across the health economy will actively engage and support the work of Worcestershire Adult and Children Safeguarding Boards - Achieve 90% of actions within Joint Health and Social Care Home Project development plan within specified timeframe. - Adapt the Getting it Right Charter to encompass a wider range of community and vulnerable groups - Achieve 100% compliance with Winterbourne Concordat - Monitor and support providers to engage with ‘My Worcestershire Health Plan’ Objective Four - Encourage feedback and value the role of patients and healthcare professionals in shaping, monitoring and improving services Roll out the single electronic repository to report, monitor and provide feedback regarding concerns Use patient stories at all levels of the organisation to illustrate patient experience and to determine commissioning intentions. Provide a framework and training to support involvement of CCG members, lay personnel, GP practices and patients in quality assurance processes e.g. mystery shoppers and involvement in quality assurance visits Utilise Patient Advisory Groups, Patient Reference groups and other community groups to support patient experience feedback Expected Outcomes - Quality dashboard performance monitored against specific metrics. - 95% achievement against Quality Assurance Visit Programme each year - Implementation of Sentinel and associated pathway across primary care to act as single repository to report, monitor and feedback on concerns
WFCCG Quality and Patient Safety Strategy 2013-2016
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Involvement of lay members on quality assurance visits Utilisation of a variety of communication options and tools to give a voice to all groups within the CCG population Yearly audit of Governing Body members views to assess impact of patient stories on monitoring and development of services.
Objective Five - Build upon the quality framework to bring together patient safety, clinical effectiveness and care experience information from a range of sources to provide assurance regarding the quality of care delivered in commissioned services Monitor serious incidents, quality feedback, safeguarding alerts, complaints and compliments from provider organisations through a regular cycle of clinical quality review. Ensure a ‘Duty of Candour’ across provider organisations to promote openness and honesty to raise early warning signs and demonstrate evidence of learning from incidents Scope sources of patient satisfaction surveys that are already available (commissioner and provider) and develop mechanisms to provide real-time patient feedback across the range of commissioned services Expected Outcomes - Friends and Family Test consistently above 80% - Quality Assurance Framework applied against all quality assurance visits. - Identification of early warning signs from provider organisations through triangulation of information from serious incidents, quality feedback, safeguarding alerts, complaints and patient feedback - Demonstration of actions taken to improve quality and patient safety when concerns are identified.
Improving Quality and Safety in Primary Care In order for the Wyre Forest CCG quality and patient strategy to be successful in delivering its aims and effective in improving the quality of care Wyre Forest must take a whole systems approach to quality. National guidance sets out the responsibility CCGs have in relation to improving quality in primary care. To achieve the aims of integrated care, the commissioning strategic priorities and the quality strategy, Wyre Forest CCG must work in close partnership with local Practices and the NHS England Local Area Team at every level. Alongside the overarching quality aims and objectives NHS Wyre Forest CCG has described within the strategy, the CCG has a dedicated aim for ensuring and improving quality in primary care with specific objectives 1. Optimising Community Resilience
WFCCG Quality and Patient Safety Strategy 2013-2016
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The success of integrated care is dependent on Wyre Forest CCG optimising community resilience across general practice, social care, community care, intermediate care and the third sector. 2. Shared vision, shared goals This objective describes the CCGs aim to establish a common ground for provision of primary care with the space to commission and provide for local needs. This will be achieved by working closely with practices and through localities, to make the best use of available data. 3. Tackling Variation Working with our member Practices and localities to tackle variation and improve quality and standards across primary care; using data to promote peer review and constructive challenge and promote and develop best practice. The CCG will work with member practices to agree individual practice quality improvement plans and support their achievement. 4. Revalidation and registration The CCG will work with member practices to promote and support medical revalidation and registration with the Care Quality Commission
Engagement and Communication Progress against the strategy will be shared with the wider CCG communities, providers and patients through on-going CCG engagement events, Clinical Quality Review Meetings, NHS Wyre Forest CCG Advisory Group and Wyre Forest Patient Group . Engagement will continue to be sought to refresh and further develop future strategies.
Equality, Diversity and Human Rights Addressing health inequalities is a key driver for this strategy. The integration of EDS within this strategy will demonstrate performance across the protected characteristics and reduce the risk of discriminatory practices. Regular progress reports will be produced to ensure compliance with legislation. Promoting equality, valuing diversity and upholding human rights is closely related to the pursuit of quality and actions to address and reduce gaps in health inequalities. The NHS Equality Delivery System (EDS) was launched in November 2011. This is a self -assessment process that involves assessing performance for the nine ‘protected characteristics in the Equality Act 2010 (Age, disability, gender re-assignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation), and other disadvantaged groups (e.g. homeless people, asylum seekers and refugees, carers). A quality service is one that recognises the needs and circumstances of each patient, carer, community and staff member, and ensures that services are accessible, appropriate, safe and effective for all, and that workplaces are free from discrimination where staff can thrive and deliver.
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A service cannot be described as a quality service if only some patients achieve good outcomes while others do not (NHS Equality Delivery System 2011). EDS aims to ensure equal quality for patients and staff in the NHS based on the following performance goals: GOAL B Better Health Outcomes for All e
The NHS should achieve improvements in patient health, public health and patient safety for all, based on comprehensive evidence of needs and results
Improved Patient Access and Experience
The NHS should improve accessibility and information, and deliver the right services that are targeted, useful, useable and used in order to improve patient experience
Empowered, Engaged and Supported Staff
The NHS should increase the diversity and quality of the working lives of the paid and nonpaid workforce, supporting staff to better respond to patients’ and communities needs
Inclusive Leadership at all levels
NHS organisations should ensure that equality is everyone’s business, and everyone is expected to take an active part, supported by the work of specialist equality leaders and champions
Monitoring Progress against the strategy will be monitored by the CCG Governing Body and the CCG Quality and Patient Safety Committee on behalf of the CCG Governing Body.
Conclusion The strategy has defined the context for commissioning quality health care and the shared priorities across Redditch and Bromsgrove CCG and Wyre Forest CCG from 2013 to 2016. The strategy will be reviewed and updated annually. An action plan will be developed to progress the strategic objectives and the recommendations contained within the Francis Inquiry Reports (See Appendix 2) in order to support the achievement of continuous quality improvement.
WFCCG Quality and Patient Safety Strategy 2013-2016
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Appendix 1
NHS Wyre Forest Clinical Commissioning Group Quality Strategy on a page 2013-2016 NHS Wyre Forest CCG values: Ensure and improve quality throughout the patient journey The Francis Suite initiative Continuation of the Early Warning System The 6 Cs initiative Pressure Ulcer zero ambition Falls Prevention promotion Quality transfers of care
Primary Care Quality in primary care Optimising in Community Resilience Shared vision, shared goals
Secondary Care
The patient at the heart of everything we do.
Develop innovative approaches to quality improvement with a focus on improving outcomes for patients Commissioning for change improvement
Quality throughout the patient journey
Continuing Education
Commissioning for innovation
Revalidation and registration
Commissioning for quality of life
Drivers for Quality
We will be a caring and listening organisation We will serve local people, patients and practices We will value clinical input in all it does; We will aim for safe, seamless patient centred care, delivered as close to patients’ homes as possible We will value partnerships with other organisations We will look to be aware of risk and manage it, but it will not be afraid to take calculated risks if it is in the interests of local people to do so.
Local Priorities GP members Experience NICE Guidance Standards Commissioning Outcomes Framework Clinical Networks Clinical Senates National Quality Board Academic Health Sciences Network
Commissioning for integrated care
Social Care
Tertiary Care
Championing of best practice initiatives
QIPP
Work in partnership to develop and support a culture of quality improvement across the whole health economy Innovative engagement with patients and carers on a continuous cycle and in everything we do Primary Care Quality Partnership
Quality Levers
KPIs
Transparent commissioning Collaboration with key partners at all levels
WFCCG Quality and Patient Safety Strategy 2013-2016
CQUINS Page 11
Appendix 2 Learning from the Mid Staffordshire (Francis) Inquiries NHS Redditch and Bromsgrove CCG NHS Wyre Forest CCG Action Plan May 2013
Recommendation
Where we are now
What else do we need to do
Measurable outcome
By when ?
Who will lead?
1
To consider the report(s), apply to own work and publish progress in relation to planned actions
QPS team learning event held 26.04.13action plan developed. Facilitated discussion/ briefing at PPI forum, Management Teams of R&B and WF
Finalise a work plan Share the work plan with other groups including public representation
Measurable work plan available for external scrutiny
31st August 2013
2
That each CCG has at least one Executive Nurse
The Quality and Patient Safety Team for Redditch and Bromsgrove CCG and Wyre Forest CCG is led by an Executive Nurse who is part of the Governing Body for both CCGs, is a member of the Senior Management Team and leads the
Evidence of Executive Nurse (or Deputy) attendance at public Governing Body meetings.
1st April 2013
NHS RBCCGand NHS WFCCG Deputy Executive Nurse Quality and Patient Safety NHS RBCCG and NHS WFCCG Executive Nurse Quality and Patient Safety
WFCCG Quality and Patient Safety Strategy 2013-2016
Progress 4th July 2013
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Recommendation
Where we are now
What else do we need to do
Measurable outcome
By when ?
Who will lead?
Evaluate ‘Culture of Quality’ workshop and agree on-going work plan in relation to evolving actions. Plan and facilitate second follow up ‘Culture of Quality’ Workshop for all providers and partners in October 2013 Strengthen contact between QPS Team and local CQC
Commitment of providers and partners to progress work plan Review achieved outcomes and continue health economy wide events
October 2013
NHS RBCCG and NHS WFCCG Executive Nurse Quality and Patient Safety
Evidence of information sharing between CQC Inspectors and QPS team members.
Ongoing
NHS RBCCG and NHS WFCCG Executive Nurse Quality and Patient Safety
Progress 4th July 2013
quality agenda. 3
Develop a ‘new’ shared culture in which the patient is the priority
All QPS Team committed to this and commit to promoting this amongst others. CCG has a ‘Culture of Quality’ workshop for all providers and partners in May 2013
4
Culture of openness, honesty, transparency and information sharing
Openness between CCG and providers actively encouraged via CQR.
Regular contact between QPS Team, CCG Safeguarding leads, Care Quality Team (LA). CCG representation on QSG. CQC contact via Care Quality Team and
WFCCG Quality and Patient Safety Strategy 2013-2016
Compliance Inspectors. Provide annual report to Quality and Patient Safety Committee regarding CQR
Quality Assurance Manager
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Recommendation
5
6
Widening of ‘being open’ to a ‘duty of candour’.
A single set of streamlined standards will be developed (fundamental, enhanced and developmental).
Where we are now
What else do we need to do
strategically via QSG.
themes.
QPS Team monitor ‘being open’ via RCA report quality checklist and request additional assurance of provider implementation of Being Open policy where felt necessary. CCG currently utilising standards from NHS England / NHS Operating Framework, CQUINs and local performance indicators, as well as those set by the regulator CQC.
Commissioners must apply fundamental standards monitoring for all services commissioned and will be the only source of monitoring for enhanced standards. 7
Not only encourage but INSIST on the reporting of issues of concern.
Actively pursue the reporting of areas of concern.
WFCCG Quality and Patient Safety Strategy 2013-2016
Measurable outcome
By when ?
Clarify inclusion of ‘Duty of Candour’ in provider contracts and seek evidence of assurance from providers via RCA report checklist.
Evidence of challenge when ‘Being Open’ is not implemented following serious incidents.
Ongoing
Await consultation and publication of standards by NICE. Consider what we would include in enhanced (quality) standards.
Engagement in any forthcoming consultation process regarding standards content.
Ensure that, once published, fundamental standards inform Quality Assurance evidence checklists Continue to maintain encouragement and persistence.
Who will lead?
Progress 4th July 2013
NHS RBCCG and NHS WFCCG Patient Safety Manager
NHS RBCCG and NHS WFCCG Deputy Executive Nurse Quality and Patient Safety Quality Assurance Manager
Evidence of challenge via CQR
Ongoing
NHS RBCCG and NHS WFCCG
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Recommendation
Breeches, with potential for but not resulting in harm, must be regarded as unacceptable too
Ensure that staff who raise concerns get feedback on actions taken.
8
Consideration should be given, not only to clinical outcomes, but also to the suitability and competence of staff.
CCGs should require providers to ensure that Registered Nurses and Health Care Workers within services
Where we are now
. CCG Serious Incident Policy to include escalation process within CCG if provider resistance to reporting is perceived.
What else do we need to do
Measurable outcome
By when ?
Who will lead?
Detail themes regarding reporting in CQR Annual report to QPS Committee
Quality Assurance Manager
Planned rollout of Sentinel by 5th August 2013 for reporting concerns and providing feedback across primary care Workforce metrics are considered at provider CQR but this only includes appraisal rates, training rates, sickness/ absence levels. Provider staff survey response and action plan will be monitored via CQR
Detail themes from Sentinel in two monthly reports to QPS Committee
Patient Safety Manager
Staff uniform and identification is incorporated into the
Incorporate staff suitability and competence checks
WFCCG Quality and Patient Safety Strategy 2013-2016
Need to consider how we measure the impact of training and appraisals- is monitoring staff survey enough?
Evidence of triangulation of information from CQR provider meetings and quality assurance visits
Ongoing
Progress 4th July 2013
NHS RBCCG and NHS WFCCG Executive Nurse Quality and Patient Safety
Quality Assurance Manager
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Recommendation
are visibly distinguishable from each other (by means of uniform or other appropriate identification)
9
Assess compliance using measures that are understood by the public and patients
Have access to clear standards of acceptability for agreed metrics so that outliers can be easily identified.
Where we are now
What else do we need to do
observation checklist utilised during QA visits.
(including recruitment practices) as part of Quality Assurance visit checklist.
Briefing sheet for patients when Quality Assurance visits are undertaken
Consider publishing examples of evidence checklists used for past Quality Assurance visits on public facing page of CCG website.
The Quality dashboard provides targets for achievement for a range of metrics.
WFCCG Quality and Patient Safety Strategy 2013-2016
Working with the Commissioning Support Unit, continue to develop the quality dashboard to enable the clear
Measurable outcome
By when ?
Who will lead?
Progress 4th July 2013
Patient Safety Manager
Information available to patients, carers and general public
September NHS RBCCG 2013 and NHS WGCCG Deputy Executive Nurse Quality and Patient Safety
Evidence that Dashboard acts as early indicator of areas of concern.
August 2013
Quality Assurance Manager Patient Safety Manager
Assurance that actions to address concerns are reviewed, completed and communicated to
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Recommendation
Where we are now
10
Direct observation, direct interaction with patients, carers and staff and the audit of records is included when monitoring compliance
These aspects of quality assurance are already included in all Quality Assurance visits that take place in provider organisations and local Care Homes with Nursing provision.
11
Regulator to focus on what is wrong rather than praising what is right
QPS team provide a focus on aspects of quality and present a balanced view following CQR and QA visits to highlight both good practice and aspects requiring improvement.
12
Pay attention to local media reports for organisations that you have oversight
The CCG has a Communications Team
WFCCG Quality and Patient Safety Strategy 2013-2016
What else do we need to do
Measurable outcome
identification of areas of concern and demonstrates provider performance against comparable providers Audit Quality Assurance visits to ensure the inclusion of patient/ resident feedback, staff feedback, carer/ family feedback where available and documentation audit. QPS as part of CCGs will be the sole monitoring agency of quality (enhanced standards once finalised by NICE) within provider organisations.
CCG Governing Bodies
Other staff interested in
By when ?
Who will lead?
Evidence that Patient/carers and staff experience and feedback is reported via two monthly reports to QPS Committee
Ongoing
NHS RBCCG and NHS WFCCG Quality and Patient Safety Team
Evidence from QPS Committee minutes that it receives quality assurance visit reports and progress on actions resulting from identified concerns Circulation of daily media brief
Ongoing
NHS RBCCG and NHS WFCCG Quality Assurance manager
Ongoing
Communication Team
Progress 4th July 2013
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13
14
Recommendation
Where we are now
What else do we need to do
for
that scans local and national media and provides a daily media bulletin to key staff. Each Quality Assurance visiting team includes clinicians (all members of the QPS team who are not admin are registered nurses and at least one GP Quality Lead attends each visit). Lay representation is under development. Expert advice is sought from local CCG staff / membership, Area Teams or Local Authority representation. Strong links are developing with LA Quality review teams.
receiving the daily media bulletin can request to be added to the circulation list Lay membership representation needs further clarification and development. Quality Assurance level 3 members to be recruited and inducted.
Inspection teams should include clinicians, service user representation and those with ‘expert’ knowledge of the issue under investigation. Teams should collaborate with other agencies for conducting inspections
Complaints There should be accessible methods for raising complaints, comments or concerns that feed into a uniform
Complaints raised by members of the public are overseen by the Commissioning Support
WFCCG Quality and Patient Safety Strategy 2013-2016
Links with CQC Inspectors and reviewing nurses for FNC and CHC requires further strengthening CHC QA framework is available for consideration at QPS team QA visits CSU to be requested to submit report bi-monthly to QPS Committee
Measurable outcome
By when ?
Who will lead?
Lay members are recruited, receive support and training appropriate to their role
October 2013
NHS RBCCG and NHS WFCCG Executive Nurse Quality and Patient Safety
Lay members are included on quality assurance visits
Evidence of Bi Monthly reports to QPS Committee
Progress 4th July 2013
Deputy Executive Nurse
Ongoing
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Recommendation
Where we are now
What else do we need to do
management process (irrespective of informant’s wishes if ‘concern’ is perceived as serious).
Unit (CSU).
regarding complaints upheld and themes.
Measurable outcome
By when ?
Who will lead?
October 2013
Patient Safety Manager
October 2013
NHS RBCCG and NHS WFCCG Deputy Executive Nurse Quality
Progress 4th July 2013
NHS WF CCG Patients Group requested a ‘credit card’ which sets out how to give feedback and complain (in the new NHS) Report on the evaluation of Sentinel and roll-out system for enabling GPs to raise concerns across Worcestershire. Greater attention should be paid to complaint narrative.
Proposal for QPS team to audit a number of provider complaints on a monthly basis.
WFCCG Quality and Patient Safety Strategy 2013-2016
Service concern themes to be reported bi-monthly to QPS Committee (which includes GP Quality Leads for 3
Evidence of Themed report to QPS Committee on provider complaints
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Recommendation
Where we are now
What else do we need to do
Measurable outcome
By when ?
Worcestershire CCGs). Urgent service concerns reported may be highlighted in the weekly newsletter to GP practices. Summaries of provider responses to upheld complaints should be publically available (or shared confidentially with commissioners if person objects to public display)
Who will lead?
Progress 4th July 2013
and Patient Safety Quality Assurance Manager
Patient/ resident/ carer feedback is sought at each Quality Assurance visit.
Commissioners should require access to all complaints when they are made
15
Commissioners should pay close attention to the expressed concerns raised by patients and carers
Prior to each CQR meeting with providers, information is accessed regarding recent concerns raised via NHS Choices.
GPs should provide a ‘quality check’ role, reporting concerns on behalf of patients regarding the local acute trust
A system for enabling GPs to raise concerns has been piloted and is
WFCCG Quality and Patient Safety Strategy 2013-2016
Consider requesting detailed complaints feedback with papers for CQR (to include details of all upheld complaints including narrative and themes of all complaints). Service concern themes to be reported bi-monthly
Evidence of Themed reports to QPS
Ongoing
NHS RBCCG and NHS WFCCG
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Recommendation
Where we are now
What else do we need to do
or any local provider.
under evaluation (Sentinel).
to QPS Committee Committee (which includes GP Quality Leads for the CCGs).
Quality Assurance Manager
Urgent service concerns reported may be highlighted in the weekly newsletter to GP practices. CQUINs to be used with Hospice providers and BMI from 2014
Patient Safety Manager
GPs need to have access to patterns of concerns raised
16
Commissioners should have the capacity to incentivise and promote improvements
CQUINS framework used with main providers
Measurable outcome
Achievement of CQUIN targets
By when ?
31st March 2014
Who will lead?
Progress 4th July 2013
NHS RBCCG and NHS WFCCG Deputy Executive Nurse Quality and Patient Safety Quality Assurance Manager
Commissioners must be provided with appropriate infrastructure (and resources) to be able to apply scrutiny
QPS team now at full compliment.
WFCCG Quality and Patient Safety Strategy 2013-2016
2013-14 schedule for nursing home visits to be
2013/14 schedule completed
Ongoing
Patient Safety Manager NHS RBCCG and NHS WFCCG
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Recommendation
Where we are now
What else do we need to do
and monitor performance for ALL providers (including doing own investigations, audit and inspection)
Safeguarding and Infection Prevention and Control post holders in place to act as expert resource for CCGs
produced.
Commissioners should have access to skilled expertise and advice
17
18
Commissioners need to ensure public involvement in the work of the CCG. They need to create and maintain a recognisable identity which becomes a familiar point of reference for the community
Commissioners should have powers of intervention where sub-standard
The Governing Body of each CCG includes lay members and Patient and Public Forum representation.
All team members must continue to monitor their own capacity issues and escalate if workload starts to affect work quality. QPS team to meet regularly to discuss performance and monitoring issues raised. QPS Team to have own page on public facing website for CCG. QPS team to have active involvement in local communities including Provider Forum.
CQR provides a platform to share good practice
WFCCG Quality and Patient Safety Strategy 2013-2016
Continue to monitor performance at the
Measurable outcome
By when ?
Progress 4th July 2013
Deputy Executive Nurse Quality and Patient Safety
Evidence of regular sharing of information across Quality and patient Safety Team through team meetings. Escalation processes demonstrated and used effectively CCG receives feedback from local communities that the general public understand the work of the CCG and feel engaged and involved in influencing decision making. Escalation processes
Who will lead?
Quality and Patient Safety Team
Ongoing
NHS RBCCG and NHS WFCCG Governing Body members Chairs of CCG Public and Patient Forums
Ongoing
NHS RBCCG and NHS
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Recommendation
Where we are now
What else do we need to do
Measurable outcome
services are found and require contingency plans to protect people from further harm.
and monitor performance of quality issues. It provides opportunity to raise and escalate concerns. Themes may be collated from this monthly meeting and escalated to Senior Officers for action as required
monthly CQR
demonstrated and used effectively
Commissioners should ensure that the results and analysis of patient feedback is shared with regulators.
The QPS Team work closely with the Care Service Quality Team form the County Council to ensure that contract queries are raised with Care Homes where standards are found to be below those expected. Executive members of the CCG attend the Quality Surveillance group where strategic issues are discussed with partner agencies including the CQC.
WFCCG Quality and Patient Safety Strategy 2013-2016
By when ?
Effective sharing of information across partner agencies. Robust collaborative working to
Progress 4th July 2013
WFCCG Executive Nurse Quality and Patient Safety
Issues of poor quality are communicated to Governing Body with robust monitoring of areas to be improved,
Progress action to further strengthen links between members of the QPS Team and local CQC Compliance Inspectors to enhance the two
Who will lead?
Quality Assurance Manager
Safeguarding Leads
Ongoing
NHS RBCCG and NHS WFCCG Executive Nurse Quality and Patient Safety
Page 23
Recommendation
20
Commissioners must require convincing information to be available before accepting compliance
Where we are now
What else do we need to do
Measurable outcome
The Deputy Executive Nurse of R&B and WF CCGs co-chairs a Providers Risk Assessment Meeting (PRAM) where information regarding escalating service concerns about Care Homes is shared.
way sharing of information.
address risk and ensure public safety.
QPS Team members attend regular meetings with the Care Service Quality Team and contribute toward a monthly update that is communicated with CQC. QA visits are planned to occur on at least four occasions per year for main providers and at least once per year for Care Homes with Nursing and independent healthcare providers.
WFCCG Quality and Patient Safety Strategy 2013-2016
By when ?
Who will lead?
Progress 4th July 2013
Deputy Executive Nurse
Safeguarding Leads
Quality Assurance Manager Patient Safety Manager
Annual schedule of Quality Assurance Visits completed Database established to track progress and review process for further visits to follow up on identified concerns.
Effective information sharing with CQC Early warning signs detected and actions taken which improve quality
Ongoing
NHS RBCCG and NHS WFCCG Quality Assurance Manager Patient Safety Manager
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Recommendation
21
Series of recommendations made for nurse standards, education, recruitment and re-validation
Where we are now
Information gathered during QA visits shall be passed to the CQC for their consideration where it appears that evidence from visits contradicts a provider’s compliance with the regulator. Executive Nurse has links with Local Education and Training Board.
WFCCG Quality and Patient Safety Strategy 2013-2016
What else do we need to do
Measurable outcome
By when ?
Who will lead?
Ongoing
NHS RBCCG and NHS WFCCG Executive Nurse Quality and Patient Safety
Progress 4th July 2013
and patient safety
QPS Team members to share and disseminate developments in nursing at monthly team meeting to enable continued mindfulness of the progression of nursing practice and regulation.
Evidence of shared learning within minutes of team meetings. Access to research and professional development
Deputy Executive Nurse
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