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What is Quality?

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.    

 

 

What we do?

What we do?

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.

 

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 sue.davis12@nhs.net

 

What is Safeguarding?

What is Safeguarding?

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.

Safeguarding Children and Adults Annual Report 2017-2018

Looked After Children Annual Report 2017-2018

Safeguarding Children and Adults at Risk Policy

What is a CQUIN?

What is a CQUIN?

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.  

What is a Quality Schedule?

What is a Quality Schedule?

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:

  1. Preventing People Dying Prematurely
  2. Enhancing the quality of life for people with long-term conditions
  3. Helping people to recover from episodes of ill-health and injury
  4. Ensuring people have appositive experience of care
  5. 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.

Advice and Training

Advice and Training

When undertaking quality visits recommendations for improvements in practice are made, these recommendations will be based on national guidance, surveys and audits such as those undertaken by National Institute for Health Care and Excellence (NICE) and National Confidential Enquiry into Patient Outcome and Death (NCEPOD)

The team works closely with De Montfort University, Health Education East Midlands, (HEEM), the Local Education Training Board, (LETB) and Education for Health bidding for funding and developing bespoke training for nursing care homes throughout Northamptonshire.

The training package covers the following areas:

Management and Leadership

  • Facilitation training, (train the trainer)
  • Diabetes/nutrition management
  • Pressure ulcer and wound management
  • Venepuncture/anaphylaxis
  • Sub-cutaneous fluids
  • Delirium assessment
  • COPD management
  • Falls management
  • How to undertake difficult conversations

 

NHS Corby and NHS Nene Clinical Commissioning Groups are currently funding ‘The Frail Elderly Toolkit’ training for ten nursing care homes and ten residential care homes. The training has been designed by the CCGs’ quality team following the analysis of monitoring visit outcomes and is delivered by De Montfort University.

The aim of the training is:

  • to improve service provision and outcomes for our patients
  • reduce avoidable admissions and conveyance

A joint Memorandum of Understanding (MOU) was signed by the CCGs and Northamptonshire County Council (NCC), to allow the CCGs’ quality team access into the ten residential care homes and enable quality review visits to be undertaken in a bid to develop these homes in combination with the training.

Quality Information and Data

Quality Information and Data

The quality team will gather information and data about services from a range of sources. Examples of the types of data that the team will use can be seen in the grid below.  Further detail about this information can be found through the links below.  The team regularly review the data for all providers at an organisational level and for our main providers at a ward and/or team level to determine if there are any areas of concern.

Patient Safety

Patient Experience

Clinical Effectiveness

Patient Safety Thermometer

NHS Choices

NICE Guidance

Serious Incident Investigations

Patient surveys

CCG Outcomes Indicators

Never Events

Friends and Family Test

Learning from national reports e.g. NCEPOD

Summary Hospital Mortality Indicator (SHMI)

Patient Reported Outcomes Measures (PROMS)

Learning from national organisations e.g. CQC Quality & Risk Profiles

Who are the Care Quality Commission?

Who are the Care Quality Commission?

The role of the CQC is to make sure that hospitals, care homes, dental and general practices and other care services in England meet national standards to provide people with safe, effective and high-quality care. The CQC do this through a registration process against a series of minimum standards of quality and safety and then periodically inspecting services and publishing the results on their website to help people make better decisions about the care they receive. You can see the latest CQC reports for services, or can tell them about your experience of services at https://cqc.org.uk/

What is the Quality Committee?

What is the Quality Committee?

What is the Joint Quality Committee?

The Quality Committee is a joint committee between NHS Nene and NHS Corby CCGs. The remit of the committee is to:

  • Provide assurance that commissioned services are being delivered in a high quality and safe manner, ensuring that quality sits at the heart of everything the commissioning organisation does  
  • Ensure that the quality assurance data is used to inform commissioning decisions and drive improvements in quality. Commission any reports or surveys it deems necessary to help it fulfil its obligations
  • Receive and scrutinise independent investigation reports relating to patient safety issues and agree any further actions
  • Provide oversight of decision making processes for the various groups that monitor safety and quality. Monitor progress in the delivery of the NHS Outcomes Framework
  • Provide assurance to the governing bodies that the quality and safety of services is being robustly monitored and action is taken when required to make improvements
  • Ensure considerations relating to safeguarding children and adults are integral to commissioning services and robust processes are in place to deliver safeguarding duties.

 

What is a Quality Visit?

What is a Quality Visit?

NHS Nene and NHS Corby CCGs aim to commission services of excellent quality, ensuring users and their families experience the best care, in the right place at the correct time. In order to assess and assure quality standards and performance, Quality Visits to contracted services are undertaken. These visits seek to evaluate the service against a pre-determined set of criteria. All Care Homes will receive a minimum of one Quality visit per year. Other providers will be risk assessed and where appropriate will receive a minimum of one quality visit per year. 

The quality team is working closely with patient congress and Healthwatch to engage ‘experts by experience’ to participate in quality visits to providers.  

What is a Serious Incident?

What is a Serious Incident?

A serious incident requiring investigation is defined nationally as an incident that occurred in relation to NHS-funded services and care. The NHS England Serious Incident Framework defined serious incidents as events in health care where the “potential for learning is so great, or the consequences to patients, families and carers, staff or organisations so significant, that they warrant using additional resources to mount a comprehensive response.”

Serious incidents can extend beyond incidents which affect patients directly and include incidents which may indirectly impact patient safety or an organisation’s ability to deliver ongoing healthcare.

Assurance as to outcomes is from investigations into never events are sought through Clinical Quality Review Meetings (CQRMs) and Serious Incident Assurance Meetings (SIAMs) with providers.

Management of Serious Incidents and Never Events Policy Serious Incident Policy

What is a Never Event?

What is a Never Event?

Never Events are patient safety incidents that are wholly preventable where guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and have been implemented by healthcare providers. Each Never Event type has the potential to cause serious patient harm or death. However, serious harm or death does not need to have happened as a result of a specific incident for that incident to be categorised as a Never Event.

Never events are reported and investigated as serious incidents. Assurance as to outcomes from investigations into never events is sought through Clinical Quality Review Meetings (CQRM) and Serious Incident Assurance Meetings (SIAM) with providers. More information about what constitutes a Never Event can be found at https://improvement.nhs.uk/resources/never-events-policy-and-framework/#h2-revised-never-events-policy-and-framework-and-never-events-list-2018

Significant Event Audits (SEAs)

Significant Event Audits (SEAs) 

Nene CCG aims to commission safe, high quality care for local residents. Significant Event Audits (SEA) are undertaken by GP practices. The requirements for revalidation suggest that doctors will need to use significant event audits to demonstrate learning. Effective SEAs allow practitioners and their team to highlight and learn from both strengths and weaknesses in the care they provide.

Useful documents from National Patient Safety Agency: National Reporting and Learning Service (NRLS):

To report a patient safety incident to the NRLS please click here. 

Patient Safety Forum

Patient Safety Forum

Patient Safety Forum

The Patient Safety Forum works in partnership with key health and social care professionals, with patient and public involvement to:

  • Ensure patient safety, by protecting health and reducing rates of all avoidable pressure ulcers
  • Reviewing actions and learning in relation to incidents reportable on safety thermometer
    • Identify and review serious incident trends across the county and share learning/best practice
    • Collaborate on investigations and jointly monitor action plans and offer shared learning
    • Ensure effective communication and closer working with all partner organisations
      • Share outcomes of completed investigations through this forum to ensure learning across the county

Sign up to Safety

Sign up to Safety  

 

NHS Nene CCG are signing up to the NHS England 3 year ‘Sign Up to Safety’ objective to reduce avoidable harm by 50% and save 6,000 lives. 

The CCG are pledging to:

  1. Put safety first. Commit to reduce avoidable harm in the NHS by half and make public the goals and plans developed locally.
  2. Continually learn. Make their organisations more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe their services are.
  3. Honesty. Be transparent with people about their progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.
  4. Collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.
  5. Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.

 

Please click here to download a document outlining how the CCG will achieve this objective. 

For more information http://www.england.nhs.uk/signuptosafety/  

 

Patient Experience

Patient Surveys

Patient Surveys

The CQC plans to undertake the following patient surveys in 2013/14

 

Lead sector

Survey

Fieldwork timing

Expected month of publication

Acute trusts

Maternity survey

April to August 2015

December 2015 (TBC)

Acute Trusts

Emergency & elective inpatients

September 2015  to January 2016

April 2016 (TBC)

Mental Health Trusts

Community mental health survey

February to June 2016

September 2016 (TBC)

 Results of Previous Patient surveys can be found here.

Eliminating Mixed Sex Accommodation (EMSA)

Eliminating Mixed Sex Accommodation (EMSA)

The revised NHS Operating Framework for 2010-2011 made it clear that NHS Organisations are expected to eliminate mixed-sex accommodation, except where it is in the overall best interest of the patient, or reflects their personal choice. Trusts are required to publish a yearly declaration of compliance in the provision of single sex accommodation on their website.  Compliance is a contractual requirement that is monitored by Commissioners. More information about EMSA can be found here.

Quality Accounts

Quality Accounts

A Quality Account is a report about the quality of services provided by an NHS healthcare service. The report is published annually by each NHS healthcare provider, including the independent sector and made available to the public.

 

Most organisations that provide healthcare arranged and funded by the NHS need to produce a Quality Account. This includes independent sector and charitable organisations. Organisations that are classed as 'small providers' (the organisation’s total income from NHS services is not more than £130,000 per annum and it employs less than 50 staff) are not required to produce a Quality Account. Currently, Quality Accounts do not need to be produced about primary care or NHS continuing healthcare.

Quality Accounts must be published by 30 June following the end of the reporting period. They should be published electronically on NHS Choices. The latest Quality Accounts can be found here.

Complaints

Complaints

Should you wish to make a complaint please email northants.complaints@nhs.net or telephone 01604 651102  advice and support to help you do this can be obtained from:

NHS Complaints Advocacy

VoiceAbility

Mount Pleasant House

Huntingdon Road

Cambridge

CB3 0RN

Tel: 0300 030 5454

Textphone: 0786 002 2939

Fax: 0330 088 3762

 

A copy of the NHS Nene and NHS Corby CCG Complaints policy can be found here.

Equality, Inclusion and Human Rights

Detailed information regarding our strategy and policies regarding Equality, Inclusion and Human Rights can be found here.               

Who are the Patient Congress?

Who are the Patient Congress? 

The Patient Congress is a formal sub-committee of NHS Nene Clinical Commissioning Group (CCG) Governing Body. The role of the Patient Congress is to take a strategic oversight of patient and public engagement.

 

Quality Strategy 2017-2021

Quality Strategy 2017-2021

This strategy outlines the framework for ensuring that quality is at the heart of everything we do. It is built around the priorities identified by NHS Nene and NHS Corby Clinical

Commissioning Groups (CCGs) for commissioning high quality healthcare services for its residents. More information can be found here.