What is Quality?
Quality Assurance within the NHS is made up of the three components Patient Safety, Patient Experience and Clinical Effectiveness. The Quality Team reviews detailed information and intelligence in each of these domains to gain assurance on the quality of services provided to the people of county and, working in collaboration with colleagues within the CCGs and across the Northamptonshire Health and Care Partnership (NHCP), to improve and transform services.
Our Quality Priorities are:
Through our quality priorities, we are focused on making the care we commission safer and more effective and improving the experience for our patients. Our three overarching strategic quality priorities are:
- Patient safety is monitored across the county to ensure the risk of adverse outcomes for patients are minimised and when they occur lessons are learnt, shared and embedded.
- Patient experience of NHS care across the county is monitored to ensure lessons are learnt, shared and embedded.
- The team will work to secure continuous improvement in the quality of services provided and 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 understand and monotone progress on these properties we have a well-developed system of quality assurance and early warning processes in place which provides information about the safety, effectiveness and patient experience of services we commission for our community. This enables us to be proactive in identifying early signs of concerns and take action where standards fall short of expectation. It also helps to inform our commissioning decisions at all stages of the commissioning cycle.
A key part of our assurance processes is the countywide strategic clinical quality review meeting (SCQRM). This well-established meeting works collaboratively to support delivery of the Northamptonshire Health and Care Partnership (NHCP) to improve the quality of care for specific cohorts of patients. This enables us to share good practice, achievement and innovation so there can be improvement for patients and carer outcomes across the county; identify common themes from operational CQRMs, which the group can seek then to resolve in a collaborative fashion and to develop a common approach to quality assurance and improvement across the county.
The format of the meeting includes sharing of patient stories to identify gaps in pathways with agreed plans on how to improve these across the system.
A NHCP quality improvement framework has been developed to support the:
- Delivery of the clinical priorities identified in our NHCP Clinical Strategy as set within each of the six work streams (Urgent & emergency care; Primary, community and social care; Mental health; Cancer; Health and Wellbeing; Children and young people)
- Identification, development, commissioning and provision of best practice and innovation.
- Achievement and maintenance of excellent performance against minimum national and local standards
- Support improved patient experience and outcomes through the delivery of high quality, responsive and sustainable services
Each organisation will still have its own individual quality framework with appropriate governance arrangements and priorities; this document is not intended to replace these but to ensure that as a system we collectively set out how we intend to support the delivery our key local system clinical priorities and will become an appendix to the NHCP clinical strategy.
A system wide quality impact assessment tool has also been developed that will form part of the NHCP quality framework to ensure consistency of approach across partner organisations.
For 2019/2020 the CCGs have developed an innovative countywide quality schedule based upon the domains of patient safety, patient experience, clinical effectiveness, safeguarding and collective working. The requirements for each domain are consistent for all providers. As such this is the first year that a collaborative meeting with each of the trusts to agree the schedule has been possible. It is intended that the schedule will promote further development of collaborative working between organisations and support those areas in which this ethos is already well established.
The team monitor provider quality information and data for trends and themes, compliance with local and national requirements (all providers of NHS care including: acute hospitals, care homes (nursing and residential), community and mental health services, independent hospitals and domiciliary care agencies. We undertake detailed analysis, interpretation and triangulation of hard and soft intelligence. The team triangulates the information from both the data and from regular announced and unannounced visits to providers to inform key lines of enquiry for follow up with providers at quality review meetings and where necessary to escalate any immediate or emergent issues and concerns. Most services commissioned by NHS Nene CCG are required to be registered with the Care Quality Commission (CQC).
The team work closely with providers to ensure that all patients are protected from avoidable harm. Serious Incidents are investigated by providers and learning from these and other patient safety incidents are shared at the Countywide Patient Safety Forum. Within Primary Care Significant Event Audits are undertaken to learn from any untoward events that have occurred. The aim of the safeguarding professionals within the team is to ensure that commissioned services promote and protect individual rights, independence and well-being and secure assurance that the child or adult thought to be at risk, stays safe. Also that they are effectively safeguarded against abuse, neglect, discrimination, embarrassment or poor treatment. The team lead on issues of safeguarding across the health economy and provide expert advice and participate in case review processes.
NHS Nene and NHS Corby Clinical Commissioning Groups (CCGs) have set out in this safeguarding strategy how they plan to ensure all services they commission comply with statutory safeguarding requirements. For the first time the entire Northamptonshire NHS safeguarding economy has worked together to agree the contents of a commissioning safeguarding strategy.
The strategy is set out in the same way that the CCGs have set out their Quality Strategy. As such our view, and belief, is that every person deserves a quality and safe experience wherever they are cared for in NHS commissioned services. We believe an integrated approach between the CCGs Quality and Safeguarding team serves to protect those most vulnerable to abuse and helps to identify where safeguarding practice can be improved to prevent and reduce the risk of abuse and neglect to both adults and children.
The strategy, together with the priorities jointly identified across the health economy, reflects learning from local and national serious case reviews and is consistent with the business plans of both the Northamptonshire Safeguarding Children’s Board and Safeguarding Adults Board. Can be found here.
The team provide quality advice and training to providers and quality expertise to contract meetings, develop, negotiate and monitor CQUIN schemes and quality schedules with providers and work with contracting colleagues to ensure contractual compliance payment / penalties are applied. We also ensure that there are performance and assurance controls in place for healthcare providers in relation to safeguarding which are monitored and reviewed.
An example of guidance for healthcare staff for making children safer in Northamptonshire can be downloaded here.
The work of the team is not just about monitoring the services that we already commission. They are central to the whole Commissioning Cycle and provide expert advice to inform both commissioning and contracting for prospective services. All Patient Experience work undertaken by the team is reviewed by the Patient Congress. The work of the team is overseen by the NHS Nene and NHS Corby Clinical Commissioning Groups (CCGs) Joint Quality Committee.
If you would like to learn more about the team please contact Sue Davis, Team administrator via email on email@example.com
The Quality Schedule forms part of the formal contracting process
Providers are required to report against both indicators on a periodic basis (there is a timetable of reporting, monthly, quarterly and bi-annually according to the indicator), on aspects of the Quality Schedule which is reviewed and updated annually.
There is a set of nationally mandated indicators which all providers are expected to achieve. There are nationally set consequences for non-achievement of these, some of which are financial penalties. Nationally set indicators include targets such as 90% of admitted patients starting treatment within 18 weeks of referral and 95% of patients being admitted, discharge or transferred within four hours of arrival at A&E.
Locally set indicators fit under the headings of:
- Preventing People Dying Prematurely
- Enhancing the quality of life for people with long-term conditions
- Helping people to recover from episodes of ill-health and injury
- Ensuring people have appositive experience of care
- Treating and caring for people in a safe environment and protecting them from unavoidable harm
In 2015/16 Locally agreed indicators include ensuring that provider organisations are learning from nationally produced reports, audits, complaints and incident investigations, that organisations are listening to patients and taking action on the feedback they have received and that organisations are taking actions to keep patients safe.
Commissioning for Quality and Innovation (CQUIN)
The CQUIN schemes are intended to deliver clinical quality improvements and drive transformational change and are consistent with the NHS Five Year Forward View Next Steps, the NHS Mandate and the Planning Guidance.
There are currently two parts to the scheme:
Clinical quality and transformational indicators which have been defined which aim to improve quality and outcomes for patients including reducing health inequalities, encourage collaboration across different providers and improve the working lives of NHS staff.
Supporting local areas - a proportion of the CQUIN funding has been earmarked to support the development of Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) – reinforcing the critical role local partners have to deliver system wide objectives.
The Quality Team works with providers to support the implementation of the nationally mandated schemes and to monitor compliance with the milestones for achievement.