quality strategy - enfield ccg strategy 2016-17.pdfquality strategy 2016 – 2018 . 1 ... 11 related...

QUALITY STRATEGY 2016 – 2018

1 SUMMARY The Quality Strategy sets out how the CCG intends to achieve continuous

improvement in all commissioned services, reflecting national and local priorities and reinforcing the CCG’s commitment to the development of validated quality improvement within and between care settings.

2 RESPONSIBLE PERSON: Interim Head of Governance 3 ACCOUNTABLE DIRECTOR: Director of Quality & Integrated Governance 4 APPLIES TO: All staff 5 GROUPS/ INDIVIDUALS WHO

HAVE OVERSEEN THE DEVELOPMENT OF THIS POLICY:

Director of Quality & Integrated Governance Assistant Director of Quality, Governance & Risk

6 GROUPS WHICH WERE CONSULTED AND HAVE GIVEN APPROVAL:

Quality & Risk Sub Group Clinical Reference Group

7 EQUALITY IMPACT ANALYSIS COMPLETED:

Policy Screened

N/A Template completed July 2013

8 RATIFYING COMMITTEE(S) & DATE OF FINAL APPROVAL:

Quality & Safety Committee 18 June 2016

9 VERSION: Version 5.3 10 AVAILABLE ON: CCG staff Intranet x GP Intranet x Website x 11 RELATED DOCUMENTS: Outlined in Appendix 1 (Local Policies/Drivers) 12 DISSEMINATED TO: All staff 13 DATE OF IMPLEMENTATION: June 2016 14 DATE OF NEXT FORMAL REVIEW: April 2018

DOCUMENT CONTROL

Date

Version

Action

Author

2013 1 First Quality Strategy for CCG authorisation AF - Director of Quality & Integrated Governance

09/07/14 2 First re-draft of strategy following CCG authorisation

RC - Clinical Governance Lead

11/05/15 3/4 First re-draft of strategy based on final strategy published for 2014/15

RC - CCG Clinical Governance Lead

06/04/16 5 2016-17 refresh SI - Interim Clinical Governance Lead 11/04/16 5.1 Incorporating AF

requirements SI - Interim Clinical Governance Lead

11/04/16 5.2 Incorporating BP comments

SI - Interim Clinical Governance Lead

27/04/16 5.3 Incorporating comments from Quality and Risk sub committee

SI - Interim Clinical Governance Lead

18/05/16 5.3 Approved by Quality and Safety Committee SI Interim Head of Quality

“The CCG incorporates and support the human rights of the individual as set out in the European Convention on Human Rights and the Human Rights Act 1998”

2016 17 quality strategy final (2) of 17 06/04/2016

Contents Forward................................................................................................................................. 3

The Quality Strategy on a Page ............................................................................................ 4

Introduction ........................................................................................................................... 5

National context .................................................................................................................... 6

Local context ......................................................................................................................... 8

What is quality? ..................................................................................................................... 9

Values and approach .......................................................................................................... 10

Quality commitment ............................................................................................................ 11

Quality Assurance ............................................................................................................... 12

Governance ........................................................................................................................ 14

Quality Strategy Implementation ......................................................................................... 15

Appendix 1 - National and Local Policy and Drivers ............................................................ 16


Forward

Place the quality of patient care, especially patient safety, above all other aims. Engage, empower, and hear patients and carers at all times.

Foster whole-heartedly the growth and development of all staff, including their ability and support to improve the processes in which they work.

Embrace transparency unequivocally and everywhere, in the service of accountability, trust, and the growth of knowledge.

Professor Donald Berwick, August 2013. This document reflects Enfield CCG’s strategy to ensure that the people of Enfield have ease of access to high quality, cost and clinically effective services that have been shaped by the feedback we receive from the local population. From feedback Enfield CCG has received from service users we know that people accessing healthcare services judge those services by varying criteria including good clinical care and outcomes; effectiveness and efficiency; and ease of access. Enfield CCG will use the feedback we receive in these areas to help us commission safe and effective services that are responsive to the needs of the local population. We also know that our local population want to be treated as individuals and to be properly communicated with in a respectful and listening manner that is clear and simple. We are committed to work in a way that enables the voice of service users to be heard and that they are at the centre of decisions made about them. We will work with service providers to ensure that there is transparency and honesty in all dealings with service users and we will utilise the intelligence we receive about the experiences of patients to help us commission patient centred services. Our commitment is to work with the people of Enfield; providers of services; and other health and social care partners to continually improve the quality of services available to the people of Enfield.

Dr Mo Abedi - GP Member and Chair


The Quality Strategy on a Page The people of Enfield have a right to have a safe experience and receive effective care wherever they are cared for in NHS services. Enfield CCG will continue to use feedback about the safety and effectiveness of services to inform the commissioning decisions that we make. We will build on the successes of previous years and make changes informed by the lessons we have learned.


Introduction This Quality Strategy builds on previous strategies and outlines our continuing approach for ensuring that quality is at the heart of commissioning decisions undertaken by Enfield CCG.

The refreshed 2016-18 Quality Strategy and Quality Strategy Implementation Plan reflects the increasing requirements for greater collaboration between partner organisations to ensure that commissioned services are safe, effective and responsive services for the people of Enfield. Appendix A details the wide range of national and local policies and drivers that we used to influence the development of this strategy.


National context The Health and Social Care Act 2012 moved the responsibility for commissioning health services from the former primary care trusts to local groups of clinicians through the establishment of clinician-led clinical commissioning groups (CCGs). As commissioners of healthcare services, CCGs have a statutory duty to:

• Secure continuous improvement in the quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness; and

• To act with a view to securing continuous improvement in the outcomes that are achieved and, in particular, outcomes which show the effectiveness of their services, the safety of the services provided, and the quality of the experience of the patient.

In order to fulfil this responsibility CCGs are required to:

• Be a clinically led commissioning organisations; • Have in-depth knowledge about local health services and communities; • Receive and analyse feedback from local people using local healthcare services; • Place quality at the heart of their commissioning activities; • Work in close partnership with other commissioning and healthcare provider organisations to

get the best services for local people. The NHS Constitution, first published in March 2011, supports the 2012 Health and Social Care Act and is enshrined in law. Under the NHS Constitution CCGs has a responsibility to commission high quality healthcare that’s free at the point of need and can be accessed by all. Under the NHS Constitution, the rights of patients are:

• Be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality;

• Be treated with dignity and respect, in accordance with their human rights; • Expect NHS bodies to monitor, and make efforts to improve continuously, the quality of

healthcare they commission or provide. This includes improvements to the safety, effectiveness and experience of services;

• Be able to have access to drugs and treatments that have been recommended by NICE for use in the NHS, if their doctor says they are clinically appropriate for them.

The NHS Constitution also sets out core operating principles for quality:

• the patient and the public comes first – not the needs of any organisation; • quality is everybody’s business – from the ward to the board; from the supervisory bodies to

the regulators, from the commissioners to primary care clinicians and managers; • if we (health and care professionals, staff as well as patients and the wider public) have

concerns we speak out and raise questions without hesitation; • we listen in a systematic way to what our patients and staff tell us about the quality of care;

and • if concerns are raised, we listen and ‘go and look’.

In addition to the core operating principles for quality set out in the NHS, the NHS Outcomes Framework (NOF) sets out the national outcomes that commissioners and providers of NHS funded care should be contributing towards. Indicators in the NHS Outcomes Framework are grouped


around five domains, which set out the high level national outcomes that the NHS should be aiming to improve: Domain 1 Preventing people from dying prematurely; Domain 2 Enhancing quality of life for people with long-term conditions; Domain 3 Helping people to recover from episodes of ill health or following injury; Domain 4 Ensuring that people have a positive experience of care; Domain 5 Treating and caring for people in a safe environment; and protecting them from

avoidable harm. To provide further structure and support to commissioning and provider organisations, the NHS in England published NHS Five Year Forward View in 2014. Developed by the NHS and partner organisations, this document sets out a new shared vision for the future of the NHS based around the new models of care. Patient groups, clinicians and independent experts provided their advice to create a collective view of how the health service needs to change over the next five years if it is to close the widening gaps in the health of the population, quality of care and the funding of services.

The NHS Five Year Forward View details how the NHS will: • Back diverse solutions and local leadership; • Create aligned national NHS leadership; • Support a modern workforce; • Exploit the information revolution; • Accelerate useful health innovation; • Drive efficiency and productive investment.

In addition to the NHS Five Year Forward Plan, NHS England (responsible for holding CCGs to account) has led a number of national programmes to guide the quality and effectiveness of healthcare services. The Right Care programme is currently at the forefront of this work and is focused on maximising value:

• The value that the patient derives from their own care and treatment; • The value the whole population derives from the investment in their healthcare.


Local context Enfield Clinical Commissioning Group (CCG) became statutory body on 1 April 2013 and commissions healthcare services from providers that are registered with the Care Quality Commission (CQC). The services commissioned by Enfield CCG include the majority of NHS funded healthcare services such as:

• Planned hospital care; • Rehabilitative and continuing care; • Urgent and emergency care (including out of hours services); • Most community health services; and • Maternity, mental health and learning disability services.

Enfield CCG commissions these services on behalf of Enfield residents and primarily services are provided by:

• Barnet Enfield and Haringey Mental Health Trust • North Middlesex University Hospital NHS Trust • Royal Free London NHS Foundation Trust • London Ambulance Service NHS Trust

From October 2015, the five CCGs in north central London (Barnet, Enfield, Camden, Haringey and Islington) took on formal joint commissioning responsibilities for GP services in partnership with NHS England. Together the CCGs are looking at ways of improving local services for people, including:

• Improved access to primary care and wider out-of-hospitals services, with more services available closer to home;

• Improved health outcomes, equity of access, reduced inequalities; and • A better patient experience through more joined up services.

Currently Enfield CCG is not responsible for directly commissioning primary care services, such as dental care, pharmacy, ophthalmology (optician); this is currently the responsibility of NHS England. However, the NHS Five Year Forward View sets out a clear and continued shift towards commissioning based on the specific needs of a local area and its patients. In 2016/17, NHS England will be exploring options for the possible expansion of co-commissioning into wider primary care areas and Enfield CCG will be fully engaged in any work undertaken. The NHS Enfield Clinical Commissioning Group Constitution details how the organisation will discharge its statutory duties set out in the Health and Social Care Act 2012 and the NHS Constitution. In particular, the NHS Enfield CCG Constitution details how the CCG will:

• Promote a comprehensive health service; • Meet the public sector equality duty; • Work in partnership with the London Borough of Enfield to develop joint strategic needs

assessments and joint health and wellbeing strategies • Work with the local population and partners to collect local intelligence to inform

commissioning decisions; • Secure continuous improvement in the quality of services commissioned; • Support the improvement of quality in general practice.

This Quality Strategy and the annual Quality Strategy Implementation Plan form part of the CCG internal governance framework that supports the delivery of the NHS Enfield CCG Constitution and


assists the organisation to meet its statutory requirements for commissioning safe, effective and responsive healthcare services.

What is quality? Local people have told Enfield CCG they expect consistently high quality health care services but we know that quality can mean different things to different people. Therefore, to help the CCG measure the quality of services and to support us to communicate quality outcomes it is essential for us to have a clear and transparent model of quality.

The CCG uses a model for quality which embraces the three domains of quality first set out in High Quality Care for All in 2008 following the NHS Next Stage review led by Lord Darzi. We believe this model, which has been embraced across the NHS, sets out three domains of quality that encompass the expectations of the people of Enfield.

1. Clinical effectiveness – quality care is delivered according to the best evidence available

that demonstrates the most clinically effective options available that are likely to improve a patient’s health outcomes.

2. Safety – quality care is delivered in a way that reduces the risk of any avoidable harm and risks to a patient’s safety.

3. Patient experience – quality care provides the patient (and their carers) with a positive experience of receiving and recovering from the care provided, including being treated according to what the patient (or their representatives) wants or needs, and with compassion, dignity and respect.

The three domains of our quality model, including and how these sit across the five domains of the National Outcomes Framework, are shown below.


Values and approach The values of the NHS are set out within the NHS Constitution and are:

• Working together for patients; • Respect and dignity; • Commitment to quality of care; • Compassion; • Improving lives; • Everyone counts.

Enfield CCG has adopted these values as we believe they provide the foundations for the quality improvement work we have already commenced and are planning to undertake. How we have applied these to assist us in monitoring the quality of the services we commission is shown below.

Intelligence we receive whilst we are monitoring the quality of services is analysed and used to inform each stage of the commissioning cycle. An overview of how we use the intelligence we receive is shown below.


Quality commitment Enfield CCG is committed to building on previous work to improve the safety, effectiveness and of healthcare services available to Enfield residents and to ensuring that patients have a positive healthcare experience. To help measure the safety, effectiveness and patient experience for the services commissioned by Enfield CCG we continue to benchmark ourselves against three key principles identified by Professor Donald Berwick, August 2013, in A Promise to Learn – A Commitment to Act: Improving the safety of patients in England. Patient safety Patients, the local population and partner organisations tell us that

commissioned care intended to help did not cause harm. Clinical effectiveness Patients, the local population and partner organisations tell us that

commissioned services have contributed to an improvement in health outcomes.

Patient experience Patients tell us they are active partners in their healthcare and always

are treated as such by those providing their healthcare. Patients and Enfield residents are present, powerful and involved at all

levels of Enfield CCG. In order to continue to deliver the quality commitment of Enfield CCG we will continue to: Patient safety Work with partners to maintain a positive, open and transparent

culture that safeguards vulnerable children and adults; Utilise national safety tools and other best practice tools to monitor

safety of commissioned services. Clinical effectiveness Commission innovative services focused on improving health

outcomes; Monitor commissioned services for compliance with nationally

mandated standards, performance measures and best practice guidance;

Implement local quality improvement goals underpinned by best practice and research.

Patient experience Ensure patient rights under the NHS Constitution are being promoted; Listen to and act on patient and public feedback, ensuring the patient

and carer voice is heard and directly influences commissioning decisions.

Enfield CCG will continue to produce a year on year improvement plan to help us deliver the quality commitment and we will continue to monitor our performance against these plans.


Quality Assurance As a statutory organisation, Enfield CCG is responsible to the organisation’s Governing Body for the delivery of both statutory and constitutional duties, and improvements in the health outcomes of the local population. NHS England has a responsibility to seek assurance that the CCG is fulfilling all statutory and constitutional duties and does this through the implementation of an assurance framework. NHS England is introducing a new CCG Improvement and Assessment Framework in 2016/17 to replace both the existing CCG assurance framework and CCG performance dashboard. This new framework provides a greater focus on assisting improvement alongside our statutory assessment function. It aligns with NHS England’s mandate and planning guidance, with the aim of unlocking change and improvement in a number of key areas. This approach aims to reach beyond CCGs, enabling local health systems and communities to assess their own progress from ratings published online. The framework is intended as a focal point for joint work and support between NHS England and CCGs, and was developed with input from NHS Clinical Commissioners, CCGs, patient groups and charities. It draws together the NHS Constitution, performance and finance metrics and transformational challenges and will play an important part in the delivery of the Five Year Forward View. The components of the assurance framework are shown below.

A key focus within the NHS England assurance framework will be how well Enfield CCG:

• Delivers improved services; • Maintains and improves quality; and • Ensures better outcomes for patients.


In addition to the NHS England assurance framework, Enfield CCG will maintain the organisation’s internal quality assurance processes so that standards of care and expected outcomes are effectively demonstrated and monitored including:

• Ensuring that standards for quality improvement are the founding principles on which the organisation delivers its business;

• Continuing to support and improve quality across all care pathways and with all providers to address patient need;

• Reducing variation and tackling unwarranted variation by striving for continuous quality improvement;

• Preventing harm and keeping people safe through robust governance processes that the CCG has put in place to assure quality and safety, especially in relation to safeguarding of children and adults at risk;

• Ensuring that innovation, research and clinical audit outcomes inform commissioning decisions;

• Measuring quality through the three key quality domains patient safety; clinical effectiveness and patient experience.

For commissioned services, the mechanisms through which Enfield CCG will seek assurance on service quality are:

• Defining and monitoring clear expectations of quality; • Regular provider monitoring; • Provider visits; • Quality accounts.

Where appropriate ‘deep dives’ will be undertaken to analyse data and information to gain a greater understanding of the provider or associated service. Any concerns will be highlighted and remedial actions agreed. Services provided by Enfield CCG are also subject to scrutiny and report on quality compliance via the governance process set out in the next section of this report. These services are:

• Medicines Management; • Continuing Healthcare; and • Enfield Referral Management Service.

The CCGs Quality Strategy also incorporates its approach to clinical audit, research & innovation. The CCG promotes research and innovation through the:

• Inclusion in service specifications a caveat that requires providers to engage in research and innovation;

• Oversight of NICE guidance and research implemented and conducted by provider organisations, and ways in which innovation is promoted, through provider reports at Clinical Quality Review meetings.

Within the CCGs Transformation Team, NICE is routinely reviewed in the development process of pathways and service specifications.


Governance The Constitution for NHS Enfield Clinical Commissioning Group (30 April 2015) details the overarching governance arrangements in place within the CCG. This includes how the CCG will discharge its quality duties set out in the Health and Social Care Act 2012 in the following areas:

• Securing continuous improvement to the quality of services, including the use of clinical audit;

• Promoting the involvement of patients, their carers and representatives in decisions about their healthcare;

• Acting in a manner that enables patients to make choices by ensuring robust, appropriate arrangements for safeguarding children and adults;

• Promoting innovation and research. The governance structure, shown below, was established to support the CCG to discharges its duties set out in the Health and Social Care Act 2012.

The above governance structure supports the reporting and escalation of concerns about the quality of commissioned service and services provided by Enfield CCG. In line with these established governance arrangements, implementation of the Quality Strategy will be monitored by the Quality and Safety Committee on a quarterly basis and a progress report will be provided to the Governing Body on an annual basis. In addition to the internal governance arrangements, Enfield CCG is a member of the North Central and East London Quality Surveillance Group. The Quality Surveillance Group brings together commissioners, regulators, local Healthwatch representatives and other bodies on a regular basis to share information and intelligence about quality across the system. This enables system wide actions to be taken to when quality issues arise.


Quality Strategy Implementation An annual Quality Strategy Implementation Plan will focus on the year on year actions required to achieve our quality ambitions set out in this strategy. The Quality and Safety Committee will receive quarterly reports on the progress made against the Quality Strategy Implementation Plan. This will include our approach to research and clinical audit. The 2016/17 Quality Strategy Implementation Plan will also incorporate outstanding actions from the 2015/16 Clinical Audit Action Plan.


Appendix 1 - National and Local Policy and Drivers National Report/Drivers

Key themes which have informed the Quality Strategy

A Call to Action (NHS England)

A request to patients, public, staff and partners to join a national conversation about the future demand on NHS services, the impact of changing health needs and how we will meet these challenges. The Key themes of the CCGs’ public and staff call to action consultation events are included in the introduction of this strategy.

Everyone Counts (NHS England) Planning for patients 2014-18.

A new strategic five-year approach to local commissioning planning, using outcome ambitions to set trajectories and twice-yearly operating plans. Quality is as much about behaviours and attitudes to patients as human beings as it is about the transactions we need to make to ensure services improve. Three non-negotiable items the NHS expects to be part of every relationship between a commissioner and provider: 1. Lessons from Francis report and recommendations included in Hard Truths, and drive for right staff, right skills, right place and right time approach (NQB nurse staffing report) 2. Recommendations of the Berwick report (patient safety and culture of the NHS) 3. Transforming Care: A national response to Winterbourne View Hospital – delivering the core principles of commissioning for people with learning disabilities.

The NHS Operating Framework

This includes five domains as below. See section 3 and appendix A of this policy 1. Living longer lives 2. Enhancing quality of life for people with long term conditions 3. Helping people to recover from episodes of ill health or following injury 4. Ensuring that people have a positive experience of care 5. Caring for people in a safe environment and protecting them from avoidable harm.

The Francis Report 1. Putting patents first 2. Common culture 3. Standards of service 4. Complaints handling

5. Openness and candour 6. Performance and Information 7. Leadership

Hard Truths 1. Preventing problems: duty of candour, new patient safety collaborative 2. Detecting problems quickly: outliers, surveillance and listening to patients 3. Taking action promptly: national ratings and risk assessment framework 4. Ensuring robust accountability: consequences for failure (sanctions) 5. Ensuring staff are trained and motivated: engagement and morale, leadership

The Keogh Report 1. Reduce avoidable deaths 2. Use data in pursuit of improvement 3. Involve patents and public in design and assessment of services 4. Patients and staff play an active part in inspections

5. No hospital will be an island 6.Staffing levels/skill mix reflect caseload 7.Junior doctors to be clinical leaders today and tomorrow 8.Understand the impact of happy, engaged staff on patient outcomes

The Berwick Report

1. Reduce harm by embracing learning 2. Put patient safety above all else 3. Empower patients/carers to be involved 4. Staffing levels driven by safety needs 5. Quality science part of basic training

6. Capacity for learning created 7. Quality data available and transparent 8. Patent and carer voice 9. Regulation – simple and consistent 10. Criminal sanctions rare

Compassion in Practice (6C strategy)

The 6Cs - care, compassion, competence, communication, courage and commitment.

Better Care Fund The transfer of NHS funding to Adult Social Care to enable better integrated health and social care;

- Providing an opportunity to improve the lives of some of our most vulnerable people in our society, giving them control

- Placing them at the centre of their own care and support, and, in doing so, providing them with a better service and better quality of life.

Five Year Forward A new shared vision for the future of the NHS based around the new models of care.


View Right Care Right Time

Maximising the value that the patient derives from their own care and treatment and the value the whole population derives from the investment in their healthcare.

NHS Standard Contract

Mandated by NHS England for use by commissioners for all contracts for healthcare services other than primary care

Care Quality Commission

Fundamental Standards of Quality and Safety to regulate providers of health and social care, evaluated through data monitoring and visits, and also licences professionals and providers in order to provide regulated services legally.

National Institute for Health and Care Excellence (NICE)

Provides national guidance, advice, quality standards and information services for health, public health and social care. Also provides resources to help maximise use of evidence and guidance.

Local Drivers The CCG has drawn on many additional sources of local information and data to determine its quality strategy. Key local documents that have informed this strategy include:

• The CCGs’ communications and engagement framework • The Human Resources Policy Framework (including training and whistleblowing procedures) • The CCGs Risk Management Strategy/Policy, Board Assurance framework and Risk

Registers • The CCGs’ policies for safeguarding adults and children • Infection control and prevention plan • The Enfield Health and Well Being Strategy • The Enfield Joint Strategic Needs Assessment • Plus a wide range of evidence from health provider quality contract monitoring • Incident & Serious Incident Policy • Complaints Policy


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