scheme 1a. friends and family test - service users

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Extract from Joint Clinical Commissioning Group Contract 2014/15

Schedule E. Commissioning for Quality and Innovation (CQUIN)

Scheme 1a. Friends and Family Test - Service Users

Indicator number 1a

Indicator name Friends and Family Test – Service Users

Indicator weighting

(% of CQUIN scheme

available)

0.2%

Description of

indicator

Continued implementation of Friends and Family Test across inpatient and community services:

improved staff and service user engagement with the FFT

improving response rates in community services

i) Improved Staff and Service User Engagement

Achievement to be measured against delivery of quarterly reporting to local CPMG of:

a) FFT response rates and scores b) Collation of themes and issues arising from

comments c) Evidence of actions taken in response to

feedback d) Evidence of sharing local FFT information with

service users locally:

Displaying of information in wards and reception areas including scores and numbers of responses

Displaying comments and actions taken in response to comments

Sharing FFT information with service user and carer groups to support action planning

ii) Community Response Rates

Baseline performance at end March 2014

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Agreed trajectory to improve to 12% at Trust level by the end of Q3 2014/15

Numerator Number of completed surveys (3 month period)

Denominator Number of discharges and care reviews (3 month period)

Rationale for

inclusion

To improve the experience of patients in line with Domain 4 of the NHS Outcomes Framework. The Friends and Family Test is designed to provide timely, granular feedback from NHS patients about their experience.

Data source Meridian and AWP Quality Information System

Frequency of data

collection

Monthly

Organisation

responsible for data

collection

AWP Provider

Frequency of

reporting to

Commissioner

Quarterly

Baseline period/date End March 2014 for Community Response rate

Baseline value NA

Final indicator

period/date (on

which payment is

based)

End Q3 2014/15

Final indicator value (payment threshold)

12% response rate for community services to be achieved at Trust level by the end of Q3 2014/15. *See note below.

Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to Commissioner)

Final indicator reporting date

CQPM February 2015

Are there rules for any agreed in-year milestones that result in payment

*National FFT Guidance for Mental Health Services is currently in development. If new guidance is mandated in relation to the national methodology for the calculation of response rates the response rate element of the CQUIN will be replaced with the implementation and adaptation of AWP systems and process to meet the new requirements.

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Are there any rules for partial achievement of the indicator at the final indicator period/date?

NA

Date/period milestone relates to

Rules for achievement of milestones (including evidence to be supplied to Commissioner)

Date milestone to be reported

Milestone weighting (% of CQUIN scheme available)

4

Scheme 1b. Friends and Family Test - Staff

Indicator number 1b

Indicator name Friends and Family Test – Implementation of Staff FFT

Indicator weighting (% of CQUIN scheme available)

0.2%

Description of indicator Implementation of staff FFT as per guidance, according to the national timetable

Numerator Not applicable

Denominator Not applicable

Rationale for inclusion National CQUIN scheme

Data source Local provider response to local commissioners

Frequency of data collection Check on implementation at end of June 2014

Organisation responsible for data collection

Provider

Frequency of reporting to commissioner

One off

Baseline period/date Not applicable

Baseline value Not applicable

Final indicator period/date (on which payment is based)

Q1 2014/15


Provider to demonstrate to commissioner that staff FFT has been delivered across all staff groups as outlined in guidance

Final indicator reporting date Response from providers to commissioners by 30 June 2014

Are there rules for any agreed in-year milestones that result in payment?

Funding payable once June 2014 indicator achieved


Not applicable

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Scheme 2. Safety Thermometer Indicator number 2

Indicator name Safety Thermometer

Indicator weighting

(% of CQUIN scheme available)

0.2%

Description of indicator Monthly To collect and submit monthly data from Older Age Psychiatry Wards as per the National Harm Free Care programme for the ‘Classic Safety Thermometer’ which includes the following four elements:

pressure ulcers

falls

VTE

urinary tract infection in patients with a catheter.

End of Q1 To review the nationally held data set and provide a report to the Commissioners Contract, Quality and Performance Meeting (CQPM) that provides an analysis and interpretation of the Trust level data and identifies any Trust actions that will be taken in response. End of Q3 update report to CQPM on progress with any actions and a review of current data set.

Numerator Number of months per quarter for which a complete record of NHS Safety Thermometer survey data covering all older age psychiatry inpatients for all relevant measures is submitted

Denominator Total number of relevant months in the quarter (usually three)

Rationale for inclusion National CQUIN scheme.

Data source Part 1 - Provider submission to the Information Centre which publishes the data at

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http://www.ic.nhs.uk/services/nhs-safety-thermometer

Frequency of data collection One day per month agreed locally

Organisation responsible for data

collection

AWP provider

Frequency of reporting to Commissioner Quarterly

Baseline period/date NA

Baseline value NA

Final indicator period/date (on which

payment is based)

Not applicable based on quarterly achievement for three quarters to end December 2014

Final indicator value (payment threshold) Not applicable based on quarterly achievement for three quarters to end December 2014


Commissioners will satisfy themselves of the appropriate completion and submission of the data collection for each provider by reference to the Information Centre’s publication of Safety Thermometer results for each provider.

Final indicator reporting date February CQPM 2015


NA


Submission of data representing 3 surveys for the 3 consecutive months in each quarter will trigger 25% of the yearly total possible payment. Three complete quarters therefore equaling 75%.

The remaining 25% payment for sharing and reporting against the data.



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Milestones (only to be completed for indicators that contain in-year milestones)


Rules for achievement of milestones (including evidence to be supplied to Commissioner)



Quarter 1 Report to Commissioners on data and improvement actions

July 2014 12.5%

Quarter 1 A complete survey for each month in the quarter is submitted to the Information Centre

July 2014 25%


October 2014

25%


January 2015

25%

Quarter 3 Report to Commissioners on data and improvement actions

January 2015

12.5%

Total: 100%

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Scheme 3 : Improving physical healthcare to reduce premature mortality in people with Severe Mental Illness (SMI) (from CQUIN Guidance section 8) The CQUIN will be judged along the same lines as counterparts in view of plans that are in infancy nationally to review the criteria for data collection and the assessment for the cardio metabolic assessment half of the scheme.

CARDIO METABOLIC ASSESSMENT FOR PATIENTS WITH SCHIZOPHRENIA

Indicator number 3

Indicator name Cardio Metabolic Assessment for Patients with Schizophrenia


0.2%

Description of indicator To demonstrate, through a national audit process similar to the National Audit of Schizophrenia, full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in patients with schizophrenia The audit sample must cover all relevant services provided by the provider

Numerator As set out in the National Audit of Schizophrenia

Denominator As set out in the National Audit of Schizophrenia


Data source National audit process

Frequency of data collection One-off, expected to be during Quarter 3 of 2014/15


Provider


One-off, through a national audit process, expected to be during Quarter 4 of 2014/15




October – December 2014


90.0%

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Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner)

The provider’s results from a national audit demonstrate that, for 90% of patients audited, the provider has undertaken an assessment of each of the following key cardio metabolic parameters (as per the 'Lester tool'), with the results recorded in the patient's notes/care plan/discharge documentation as appropriate, together with a record of associated interventions (eg smoking cessation programme, lifestyle advice, medication review, treatment according to NICE guidelines or onward referral to another clinician for assessment, diagnosis, and treatment) The parameters are:

Smoking status

Lifestyle (including exercise, diet alcohol and drugs)

Body Mass Index

Blood pressure

Glucose regulation (HbA1c or fasting glucose or random glucose as appropriate)

Blood lipids

Final indicator reporting date 30 April 2015


No


Yes – see below

Rules for partial achievement at final indicator period/date

Final indicator value for the partial achievement threshold

% of CQUIN scheme available for meeting final indicator value

49.9% or less No payment

50.0% to 69.9% 25 % payment

70.0% to 79.9% 50% payment

80.0% to 89.9% 75% payment

90.0% or above 100% payment

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COMMUNICATION WITH GENERAL PRACTITIONERS

Indicator number 2

Indicator name Communication with General Practitioners


0.2%

Description of indicator Completion of a programme of local audit of communication with patents’ GPs, focusing on patients on CPA, demonstrating by quarter 4 that, for 90% of patients audited, an up-to-date care plan has been shared with the GP, including ICD codes for all primary and secondary mental and physical health diagnoses, medications prescribed and monitoring requirements, physical health condition and ongoing monitoring and treatment needs.

Numerator The number of patients in the audit sample for whom the provider has provided to the GP an up-to-date copy of the patient’s care plan, which sets out appropriate details of all of the following:

all primary and secondary mental and physical health diagnosis, including ICD codes;

medications prescribed and monitoring requirements; and

physical health condition and ongoing monitoring and treatment needs.

Denominator A sample of 100 patients who are subject to the Care Programme Approach and who have been under the care of the Provider for at least 100 days at the time of the audit


Data source Local audit

Frequency of data collection Two audits, one in Quarter 2, one in Quarter 4


Provider


Reports required in respect of Quarter 2 and Quarter 4




January – March 2015

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90.0%

Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner)

Quarter 4 audit demonstrates that, for 90% of patients audited during the period, the provider has provided to the GP an up-to-date copy of the patient’s care plan, which sets out appropriate details of all of the following:




Final indicator reporting date 30 April 2015


Yes – see below


Yes – see below

Milestones


Rules for achievement of milestones (including evidence to be supplied to commissioner)



Quarter 2 Audit methodology and sampling approach agreed, baseline audit completed and findings reported

31 October 2014

30%

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Quarter 4 Final audit demonstrates that, for 90.0% of patients audited during the period, the provider has provided to the GP an up-to-date copy of the patient’s care plan, which sets out appropriate details of all of the following:




30 April 2015 70%

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Rules for partial achievement at final indicator period/date This provides for a sliding scale of payment in relation to the 70% element of the indicator which is payable on the basis of the actual audit results for Quarter 4.

Final indicator value for the partial achievement threshold


49.9% or less No payment

50.0% to 69.9% 25 % payment

70.0% to 79.9% 50% payment

80.0% to 89.9% 75% payment

90.0% or above 100% payment

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Scheme 4: Implementation of Alcohol Use Disorders Identification Test Consumption tool (AUDIT)

Indicator number 4 – B&NES System Wide

Indicator name Implementation of Alcohol Use Disorders Identification Test Consumption tool (AUDIT)


1.5%

Description of indicator The systematic use of the AUDIT screening tool in specified community mental health services to support the identification of people who would benefit from reducing or ceasing drinking. The information will then be used to support the development and implementation of brief intervention advice and relevant signposting to specialist services where this is required. For people transferring between services the tool would be completed once. Milestone 1 (Q1/Q2)

1. Identified teams to train on the use of the AUDIT-C and full AUDIT tool as an initial screening tool

2. Training on brief intervention advice for relevant people identified as risk or zone level 1 or 2 as indicated in WHO advice.

Risk Level Intervention AUDIT score Zone I Alcohol Education 0-7 Zone II Simple Advice 8-15 Zone III Simple Advice plus Brief Counselling and Continued Monitoring 16-19 Zone IV Referral to Specialist for Diagnostic 20-40

3. Establishment of informatics systems to support implementation and monitoring.

4. Agreement of final percentage achievement levels.

Milestone 2 (Q3/4) Application of the screening tool within specified community mental health services at key points. By end of Q2 to have provided baseline data of the following three measures and to agree realistic and achievable improvement trajectories to be met at end of Q4:

Number of people screened at assessment

Number of brief interventions offered to those

identified as risk level 1 and 2 to have received

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brief intervention advice

Number of people identified at risk level 3 and 4 referred for counselling and/or specialist advice

Milestone 3 Outcomes reviewed and assessed to inform service development

Numerator Agreed number of staff completing training on AUDIT tool. (Agree by Month 2) Agreed number of staff completing Brief intervention training (agree by Month 2) Screening completed on identified number of people, to be confirmed – End Q2 Number of people identified at risk level 1 and 2 to have received brief intervention advice

Number of people identified at risk level 3 and 4 referred for counselling and/or specialist advice

Denominator n/a

Rationale for inclusion Excessive alcohol consumption is recognised to cause substantial risk to the individual. It has been identified as a major cause of breakdown in relationships, trauma, hospitalisation, prolonged disability and early death. Evidence has highlighted that the majority of excessive drinkers are undiagnosed, and often people present with symptoms or problems that would not normally be linked to their drinking. The implementation of the AUDIT–C tool as a screening tool in key services will indicate the potential impact of alcohol related problems and risks in community settings.

Data source Provider

Frequency of data collection Quarterly


Provider

Frequency of reporting to Commissioner

Quarterly

Baseline period/date End Q2

Baseline value n/a


Quarterly based on rules

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Based on rules


Tool developed along with resource pack. Final

measure – end Q2

Training of identified frontline staff completed

Final measure - end Q2

Final agreement on percentage achievements

below

Application of screening tool to 80% (TBA end

Q2) of new referrals/admissions within identified

teams. Final calculation end Q4

80% (TBA end Q2) of people identified through

screening with AUDIT tool with an identified risk

of 1 and 2 who receive brief intervention advice.

Final calculation End Q4

90% (TBA – end Q2) Number of people with an

identified risk of 3 and 4 referred for specialist

investigation. Final calculation End Q4

Final indicator reporting date End March 2015


See above


To be determined

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Scheme 5. System wide Bristol: Inpatient Services

Indicator number 5

Indicator name Inpatient services


1.5%

Description of indicator This CQUIN will focus on inpatient services with the aim of delivering inpatient care locally. The planned outcome will be for Bristol to support individuals who require inpatient care in such a way that it maintains overall activity within the commissioned bed base for Bristol Clinical Commissioning Group. This will include improved joint working with external partners to plan discharge and minimise length of stay to a median LOS. It will include working closely with Section 136 staff, community teams and other providers to inform planning and support for those individuals identified as experiencing repeat admissions or requiring complex discharge planning. It is acknowledged that AWP and Bristol’s aspiration is that, as a result of the joint work on the inpatient review, savings on inpatient services of around £1.5m for the Bristol community could be forthcoming.

Numerator Report the time spent on non-patient contact activities

Assessment and initial recovery plan within 48 hours of

admission in quarter 1 & 2, moving to within 24 hours in

quarter 3 & 4, to include:-

o Purpose of admission

o Initial treatment plan

o Estimated date of discharge

o Details of the psychological interventions required

during the inpatient stay

Within one week of admission the service user to have a

detailed recovery plan with involvement from appropriate

external organisations such as housing or the Police and

service users wherever possible. This detailed recovery

plan to include discharge arrangements, including barriers

to discharge

Recovery Plans to be updated regularly, particularly when

circumstances change and following untoward incidents,

with the involvement of appropriate external organisations

such as the Police wherever possible. For example, after

a service user has absconded or has been absent without

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leave.

The number of out of area placements for Bristol

residents and reason for placement.

The number of people who are out of CCG area beds as

part of a whole system reporting to all CCG’s

Formal monitoring and bed management escalation

process in place by May 2014

The number of delayed admissions and Community

Treatment Order recalls

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Denominator

The agreed definition of assessment described above will be

used to monitor and improve the number & % of service

users receiving an initial recovery plan within 24/48 hours

of admission and a detailed recovery plan, involving

external agencies within a week, across 7 days

Report of changes to the proportion of time spent on non-

patient and patient contact activities as a result of lean

working, productive ward and better use of technology by

the end of quarter 2

Review date is agreed with patients to support discharge

planning and is integrated into recovery planning and

evaluation processes.

Reduce the number of out of area placements and length of

stay of placement

Rationale for inclusion To develop a proactive, intensive intervention approach,

which is outcome and recovery focused with an expected

date of discharge

Psychologically informed environment provided 7 days a

week

Improved bed management processes monitored against an

85 to 90% occupancy rate to understand system

blockages.

Improved joint working with external partners to plan

discharges, using green to go methodology and with

weekly in reach from community teams, to facilitate timely

discharge

Data source AWP RIO

Frequency of data collection

Availability of a next day bed report which includes bed

occupancy rates through bed management reporting


AWP and Bristol CCG to agree reporting parameters by end

of April 2014


Monthly updates at the Bristol CCG local AWP Contract

performance quality group with quarterly progress reports

Baseline period/date 31st March 2014

Baseline value


1st March 2015

Final indicator value

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(payment threshold)


March 2015 (local CPQM)


Miles stones to be suggested by the local project team and

signed off by Bristol CCG and AWP by 31st March 2014

as part of the scoping work underway.


Quarterly payment against agreed outcomes set out in joint

project plan for inpatient services developed in line with

this CQUIN. Q4 reconciliation in line with AWP contract

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Scheme 6a: System Wide North Somerset - Physical and mental health service partnership working

Indicator number 6a

Indicator name Physical and mental health partnership joint working

Indicator weighting

(% of CQUIN scheme

available)

0.75 % of contract value

(30% of total CQUIN value)

Description of indicator 1. Partnership working with NSCP to ensure the physical health needs of service users are fully assessed and met.

The two providers will be asked to work together to agree specific teams for this piece of work. Once agreed between the providers, the commissioners will need to agree.

2. For NSCP and AWP (and where appropriate North Somerset Council (NSC)) to offer reciprocal training to support the achievement of 1 (above) and to use existing specialist skills to improve knowledge and skills in both organisations. The two providers will both be asked to complete a training needs analysis for specific teams including NSC staff where appropriate, identified in their own organisations. This will then be shared with the other provider organisation in order that a training package can be devised and planned.

Numerator 1 NA

2 AWP will run a minimum of 6 training sessions for NSCP and NSC staff where appropriate, and to ensure 95% attendance at any training offered, agreed and provided by NSCP / NSC

Denominator NA

Rationale for inclusion Continue to develop strong partnership working

To broaden the potential intended benefit of CQUIN 8 (improving physical healthcare to reduce premature mortality in people with severe mental illness) to other mental health groups

To ensure mental health needs of patients in community services are considered and addressed

To improve health outcomes across the mental and physical health domains

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Data source Quarterly reports on progress to the contract meetings

Frequency of data

collection

Ongoing

Organisation responsible

for data collection

AWP

Frequency of reporting to

Commissioner

Quarterly

Baseline period/date See milestones set out below

Baseline value NA

Final indicator period/date

(on which payment is

based)

Q4


See milestones below


February 2015


Quarterly milestones will have to be achieved for the providers to qualify for payment at the end of each quarter


Because a stepped approach is planned, payment will only be made for achievement of each milestone

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Milestones





Quarter 1 Providers to work together identify and agree areas where further development of partnership working will have greatest impact. At this stage they will also agree specific outcomes (eg development of pathway or protocol), which will be signed off by the commissioners. This will include appraisal of the potential value of using an appropriate physical health tool, such as FOPSAT,

Completed training needs analysis for own organisation to be submitted to other provider (AWP/NSCP) and NSC as appropriate.

End Q1 2014/15

25%

Quarter 2 Providers to complete a jointly owned action plan for improved partnership working in the areas identified. Work towards achieving this action plan to start in Q2 and continue into Q3 and Q4. Complete training delivery plan and share with other provider to allow both organisations to plan for training delivery in Q3 and Q4

End Q2 2014/15

25%

Quarter 3 Progress against action plan to be reported, with trajectory of achievement of action plan by end of Q4. Recommendations for ongoing development of partnership working which can be carried forward into the 2015/16 contracts should be made at the end of Q3 Training delivery (minimum 3 sessions)

End Q3 2014/15

30%

Quarter 4 Final report and evaluation to be completed. Training delivery (minimum 3 sessions)1

Q4 2014/15 20%

1 Providers may wish to concentrate training in Q3, but cannot concentrate it in Q4, as it is

anticipated that the training will support the partnership working and help achieve the

outcomes specified for delivery of improved health outcomes.

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Scheme 6b : System wide North Somerset - CCG Partnership

working with Weston Area HealthTrust Indicator number 6b

Indicator name Partnership working with Weston Area Health Trust

Indicator weighting


0.5% of contract value


Description of indicator To translate the evaluation and lessons learnt of the winter monies psychiatric liaison service into a service development/ action plan for 2014/15 and implement this plan in year. This should include:

Training provision for WAHT Staff

Identify innovative ways of working to meet the needs of patients with mental health needs in Weston General Hospital

Identify which initiatives within the psychiatric liaison extension could continue in some form within current resources (whilst not putting core services under pressure) to optimise patient flow through the health and social care system.

Development of robust business cases in conjunction with the commissioners for where additional investment could deliver QIPP benefits

Numerator NA

Denominator NA

Rationale for inclusion To build on the success and progress made with the short term extension to the psychiatric liaison service incorporating dementia and care home liaison

Data source Progress against action plan

Frequency of data collection Ongoing


collection

AWP


Commissioner

Quarterly


25

Baseline value NA

Final indicator period/date (on

which payment is based)

Q4 2014/15


Final indicator reporting date February 2015


Milestones must be met as set out below, although timeframes can be negotiable depending on detail of action plan when produced


No

Milestones





Quarter 1 Develop action plan and get commissioners sign off

End Q1 2014/15

25%

Quarters 2-3 Implement action plan End Q2 2014/15

50%

Quarter 4 Report on in year progress with evaluation to inform future commissioning intentions

Q4 2014/15 25%

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Scheme 6c: System Wide North Somerset - Transition

Indicator number 6c

Indicator name Partnership working with AWP-CAMHS and NHS England to ensure optimal transition arrangements are in place across all mental health services.

Indicator weighting




Description of indicator Partnership working with multi-agencies, including CAMHS, North Somerset Council and NHS England to ensure optimal transition arrangements are in place across all mental health services. This will include:

Reviewing and evaluating existing policies, protocols and pathways across children’s and adults mental health services.

Working with the appropriate agencies to develop new policies, protocols and pathways where appropriate

Identify and meet any training needs associated with the implementation of new policies, protocols or pathways, in conjunction with other agencies.

At the least this work should include PCLS, Intensive Team, Early Intervention Team and patients in inpatient settings (including individual placements/ Tier 4), and psychiatric liaison.

It should encompass patients known to the CAMHS and also patients presenting to mental health services for the first time who are age 16 – 18.

Numerator NA

Denominator NA

Rationale for inclusion To identify and address unmet need in transition, ensure safe and effective pathways are in place and improve the transition experience for young people with mental health problems

Data source Quarterly progress report

Frequency of data collection Ongoing

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collection

AWP


Commissioner

Quarterly


Baseline value NA

Final indicator period/date (on

which payment is based)

Q4 2014/15


Final indicator reporting date February 2015


No


no

Milestones





Quarter 1 Review existing protocols/policies/pathways, identifying any gaps

End of Q1 2014/15

20%

Quarter 2 Develop new protocols/policies/pathways as required and submit for commissioner sign off

End of Q2 2014/15

40%

Quarter 3 &4

Implement new protocols/policies/pathways with appropriate staff training in partnership with and across all relevant agencies

Q4 2014/15 40%

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Scheme 7a. System Wide South Glos CCG. Autism Early Intervention Service Pilot

Indicator number 7a

Indicator name Autism Early Intervention Service Pilot


0.50

Description of indicator

System pilot involving AWP Bristol Autism Spectrum Service (BASS), AWP LIFT Psychology and appropriate AQPs, South Gloucestershire Council and Primary Care. Pilot of early psychosocial intervention, supported self-triage and outcome monitoring for people referred for an autism diagnostic assessment.

Numerator Number of people who have accessed the early intervention pilot

Denominator Number of South Gloucestershire residents open to the BASS diagnostic service 2014/15

Rationale for inclusion

The South Gloucestershire commissioned Autism service has a waiting list of 29 referrals and waiting times are greater than 9 months. People referred are therefore not receiving a service for a significant period of time. We know that people’s functioning difficulties can exacerbate. This pilot will use the principles of early intervention to explore the impact of earlier contact and trying to meet the needs of individuals referred using commissioned services. Monitoring will take place pre and post pilot to understand the impact of the service and to triangulate the outcomes with people who have also received a diagnostic assessment in the same period. The current services do not meet the requirements set out in the NICE quality standards for Autism (2014).

Nice Quality Standards 51 Autism quality statements:

Statement 3. People with autism have a personalised plan that is developed and implemented in a partnership between them and their family and carers (if appropriate) and the autism team.

Statement 4. People with autism are offered a named key worker to coordinate the care and support detailed in their personalised plan

Statement 5. People with autism have a documented

http://publications.nice.org.uk/autism-qs51/quality-statement-3-personalised-plan

http://publications.nice.org.uk/autism-qs51/quality-statement-4-coordination-of-care-and-support

http://publications.nice.org.uk/autism-qs51/quality-statement-5-treating-the-core-features-of-autism-psychosocial-interventions

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discussion with a member of the autism team about opportunities to take part in age-appropriate psychosocial interventions to help address the core features of autism.

Statement 7. People with autism who develop behaviour that challenges are assessed for possible triggers, including physical health conditions, mental health problems and environmental factors.

It is recognised that quality statements 3 and 4 are not obtainable within the current levels of service investment by the CCG and SGC for the majority of people with autism. Exceptions would be for people with autism who are open to either the Community Team for people with a learning difficulty or secondary mental health services. However, a key outcome from the CQUIN is a comprehensive report detailing the impact of the early intervention pilot in terms of service user outcomes. Quality statement 5. The focus of this aspect of the CQUIN is to improve the accessibility of IAPT services including joint provision between between the BASS social workers and IAPT. A key product will be a guide for IAPT providers to reasonable adjustments to ensure accessibility of interventions for people with autism.

Data source AWP RiO


Monthly


AWP – joint project group to agree reporting parameters


Monthly updates at the South Gloucestershire local AWP Contract performance quality group with quarterly progress reports

Baseline period/date 31st March 2014

Baseline value


1st March 2015


Achievement of products and outcomes


3rd March 2015 (local CPQM)


PDSA Autism Early intervention pilot Plan Quarter 1

April 2014 agreement of audit proforma

Baseline audit of all South Gloucestershire BASS assessments within RiO 2013/14 to include needs

http://publications.nice.org.uk/autism-qs51/quality-statement-7-assessing-possible-triggers-for-behaviour-that-challenges

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identified / actions taken / outcome as a result of intervention

Involvement of people with Autism in co-designing the Advice Service – communication with stakeholders of new service

Do Quarter 2 - 4 All referrals for a BASS assessment will be given details of / contacted by the Autism Advice Service Records kept of identified needs on RiO South Gloucestershire resources directory for people with Autism. Early interventions :- - vocational support SGC

- housing SGC - finances / benefits debt – SGC - IMCA/ IMHA advocacy – SGC. Peer advocacy care forum

CCG. Emotional wellbeing

- Joint assessment within LIFT - Referral to LIFT / AQP (LIFT/AQP Tariffs + budget) - Lifestyles, smoking cessation, weight management – Public

Health activities - Advice Service – venue costs SGC - LIFT assessment capacity – CQUIN contribution

Review stage records- Are needs being met or is a full diagnostic assessment required? Exploration of self -triage with support Yes diagnostic assessment required – keep on BASS waiting list Needs currently being met – Keep door open to advise service option and advise future referral route as required

Study Q4 - RiO audit of needs / actions / outcomes Numbers who have had needs assessment met without a full diagnostic assessment Production of guide to support IAPT providers in making reasonable adjustments for people with autism. Act Development of sustainable early intervention service specification for 2015/16 commissioning round.

Are there any rules for partial achievement of the indicator at the final

Yes

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Milestones





Quarter 1 Completion of in-year milestones identified in rationale

July 2014 25%


October 2014 25%


January 2015 25%


February 2015 25%

indicator period/date?

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Scheme 7b. System Wide: South Glos CCG. Autism Waiting List

Initiative

Indicator number 7b

Indicator name South Gloucestershire Autism Waiting List Initiative


1%

Description of indicator Innovation in achieving a waiting time of less than 18 weeks. Step target to achieving the 3 month target identified in the NICE Quality standards.

Numerator Number of people receiving diagnostic assessment

Denominator Number of people on waiting list KPIs:

- Referral to first diagnostic appointment - Diagnosis to post-diagnostic group appointment - DNA / post-diagnostic group drop out monitoring

Rationale for inclusion South Gloucestershire residents are currently waiting over 9 months for an autism diagnostic assessment. Public Health analysis in the joint strategic needs assessment indicates that the numbers of people on the autistic spectrum is increasing. The current service model is not sustainable, whilst the quality of the assessment is excellent the waiting time is too long and there is no existing alternative to offer to people who may require support but not a formal diagnosis.

The waiting list initiative will operate alongside the South Gloucestershire Early intervention to autism pilot. Current waiting time 9 months

- Within operational plan to achieve 18 weeks - Referral to treatment time <18 weeks by March

2015 - Current waiting times are 9 months - BASS to run local post diagnostic support sessions

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- JSNA rising numbers of adults referring for autism assessment

NICE quality standards for Autism 2014.

Statement 1. People with possible autism who are referred

to an autism team for a diagnostic assessment have the

diagnostic assessment started within 3 months of their

referral.

Data source - GP referral rate by practice and GP - NHS Health Check offered – Public Health - RiO BASS Waiting List -> Assessment ->

signposting referrals - Post diagnosis assessment - MH caseload – supposed assessment


Monthly


AWP


Monthly at local CPQM

Baseline period/date 1st April 2014

Baseline value Confirmed waiting list at 1st April 2014.


1st March 2015 to include projected scheduled assessments in March 2015


Minimum 90% of waiting list. See differential for 90% achievement and 100% achievement


3rd March 2015


Yes


Yes

Milestones

http://publications.nice.org.uk/autism-qs51/quality-statement-1-diagnostic-assessment-by-an-autism-team

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Quarter 1 15% of waiting list < 18 weeks July 2014 25%

Quarter 2 40% of waiting list < 18 weeks October 2014 25%

Quarter 3 70% of waiting list < 18 weeks January 2015 25%

Quarter 4 Achievement of sustainable waiting list < 18 week duration.

February 2014 10% for 90% waiting list achieved 25% for 100% waiting list achieved

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Scheme 8. System wide Swindon CCG. Mhl support for discharge urgent care pathway

In each locality a local CQUIN has been agreed between the respective CCG and the Provider for the 14/15 contract. In relation to Swindon the document below identifies the domains and key elements of their proposed local CQUIN and this will be refined and agreed locally in year.

Suggested KPI's increasing quality and flow Dec 2013.xlsx

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Scheme 9. System wide Wiltshire CCG - Review & Redesign in Partnership with Commissioners. Indicator number

9

Indicator name Wiltshire AWP Community System Wide Review & Redesign in Partnership with Commissioners. ‘Making Recovery a Reality’



Description of indicator

This project contains 4 main project elements, they are;- 1) Review of AWP community services model, including

Intensive, PCLS, Recovery and Memory Clinics. To establish where the gaps and weaknesses are, including:

the impact of the disaggregation of the Social workers from the AWP teams and what could be done to address them?

balancing the individual needs of services users, carers and the need to meet targets?

Do the existing structures, processes and procedures allow/encourage recovery and service users to take responsibility for their own care and wellbeing?

How can RIO and IQ better support recovery models of care?

How could acute mental health services provided by AWP link better with LIFT and other mental health services commissioned from other providers.

With particular reference to the Intensive Team-

Need for 24/7 coverage in both teams and better ways of using resources.

Locations and support to Liaison Teams.

Staying well plans post discharge

Earlier intervention to avoid crisis – home treatments?

Can remit be expanded to deliver for older people.

Assurance on appropriate thresholds for discharge/step down.

With particular reference to PCLS-

To what extent can short term interventions be done and proportion of time spent triaging patients.

Ensuring internal referral to right place first time. With particular reference to Recovery Team-

Assurance on appropriate thresholds for discharge/step down.

Linkages with other MH providers, health and social care.

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Providing appropriate levels of case management to Forensic and out-of-area placements.

Access to DBT and services for people with bipolar.

Working with families.

Easy access to known service users.

With particular reference to Memory Clinics-

As activity reduces – how do we best use spare capacity?

Ensuring smooth pathways with CIT

Support to Primary Care. 2) Dual Diagnosis Users with Comorbidity-

To develop an audit tool jointly with Substance Misuse service to support co-morbidity patients in the most appropriate way.

3) Maternal Mental Health –

Reviewing direct access by midwives & Health Visitors

Engagement with perinatal & early infant mental health pathway.

Working effectively with women who require support from Specialist Commissioning – e.g. before and after admission.

4) Transition from CAMHS to Adult Mental Health.

to undertake a sample audit with Oxford Health in respect of transfers from CAMHS to adult mental health, reviewing threshold criteria, access to services and need for additional services

Numerator N/A

Denominator N/A

Rationale for inclusion To improve effectiveness of interventions, better pathways for patients and smooth pathways between providers.

To identify gaps in provision

To improve health outcomes across mental health pathways.

Data source Quarterly reports on progress together with monthly project highlight reports.


Ongoing


AWP


Monthly project highlight reports and quarterly formal progress reviews.

Baseline period/date See milestones sections below

Baseline value N/A



4 equal quarterly payments with the option of the first payment up front in order to support the recruitment of additional AWP

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expertise if required.


Q4


See milestones


See below

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Milestones





Quarter 1 AWP to produce a project plan to be agreed with commissioners and have begun reviews in line with the project plan timetable. Progress report by end of Q1

By end of June 2014.

25% (payable up front if requested)

Quarter 2 AWP to have completed all project reviews by end Q2 and presented findings to Commissioners.

By end of September 2014.

25%

Quarter 3 AWP to have worked with Commissioners to develop to action plans and new pathway designs for all projects where appropriate. AWP to have produced a implementation plan by end Q3 (agreed with commissioners)

By end of November 2014

25%

Quarter 4 AWP to have begun implementing any agreed changes in line with an implementation plan, and to be on track against plan by end of Q4

By end of March 2015

25%

Rules for partial achievement at final indicator period/date Final indicator value for the partial achievement threshold


Completion of all project 1 actions. 50% of total CQUIN

Completion of all project 2 actions 16.66%



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NHS England CONTRACT CQUINS 2014/15

Scheme Applicable to Requirements

National Physical health audit

All patients in-patient beds between August 1st and

September 30th who have psychostic illnesses, including schizophrenia , schizoaffective disorder, bipolar disorder and

drug induced psychosis

Within the NHSE commissioned services, this is likely to be

applicable largely to forensic services but MBU and EDU will also need to consider whether

they have any patients who meet the inclusion criteria

This is also a CQUIN in the main contract and S&S services will need to work with the Trust lead xxxxxxx on implementation

16 Jun – 11 Jul

Service providers register via the online form

By August 1st start using the physical health screening tool for all eligible patients

1 – 31 Oct

Service providers generate a list of all patients who meet the eligibility criteria and submit to the CQUIN team (guidance and template will be provided)

24 – 28 Nov

The CQUIN team generates random sample of 100 patients for inclusion in the CQUIN and returns list to service providers

1 – 23 Dec

Service providers collect data and prepare for data submission

5 – 16 Jan

Service providers submit data online

Mar 2015

Publication of data collection results by NHS England

Friends and Family Test

This is also a CQUIN in the main contract and S&S services will need to work with the Trust lead on implementation

Dashboard Specialist dashboards to be submitted quarterly for secure,

Services to confirm that they have submitted their dashboard

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ED and MBU. within the specified deadline and to provide a summary of key

issues identified and how benchmarking feedback from the previous submission has

been used within each service

Collaborative risk assessment

Secure services only Secure providers to develop and implement an education

package on collaborative risk assessment for patients and

qualified staff.

Report on the education package to be submitted in Q2

Report in Q4 evidencing that 90% of qualified staff have

received the training and that it has been offered to all service

users

Supporting carer involvement

Secure services only CQUIN aims to support the involvement of carers of patients

in secure care.

Q2 Submit a written strategy for engaging with carers to

encourage the maintenance of good communication with their relatives in secure care. Include

regular carer satisfaction surveys and carer support.

Develop a carer satisfaction tool or an interview schedule for

individual carer interviews using advocacy services.

Q4 demonstrate that each

service user has had the earliest opportunity to identify key and

meaningful family members and that they have been invited to attend CPA meetings (with the

users agreement). Demonstrate the provision of clear information for carers. Demonstrate that the service has used carer feedback

to improve service provision

Eating disorder outcome measures

ED Services only ED services to systematically collect outcome measures for in-

patients at admission and discharge

To provide a quarterly report

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(using template) of all discharges during the quarter

detailing EDEQ & BMI on admission and discharge and

LOS

To provide a composite report at Q4 with recommendations for

further action

Eating disorder optimising resources

ED Services only ED services to identify and report on all patients who have

been on the unit for over 10 months

All day and in-patients that meet the criteria to be reported (using

template) each quarter to commissioners

Perinatal infant mum relationship

MBU only Implementation of at least daily recorded assessments of mother – infant care and

interaction and the need for supervision and assistance

Quarterly reporting (using

template) showing, the number of mothers admitted with their babies, the number of mothers

with a daily record of interactions with their baby and

a record of their need for supervision and assistance

scheme 1a. friends and family test - service users

Documents