Quality Improvement Priorities 2016-17 Consultation Draft V0.4 - Qgc.docx

Focussed measurement, more improvement: Our front line Quality Improvement Priorities for 2016/17 V0.4 February 2016

Consultation document You can comment on any part of this document. Specific consultation questions also appear in red at the end of each section. Please send us your comments by 22 February 2016. Email [email protected] Twitter: #SSOTPQuality Contact: Robin Sasaru, Quality and Effectiveness Manager Edric House Wheelhouse Road Rugeley, Staffordshire WS15 1UW Telephone 01889-571539 For information on our consultation events email us: [email protected]

Front line Quality Improvement Priorities for 2016/17 – consultation V0.4

Focussed measurement, more improvement: Our front line Quality Improvement Priorities for 2016/17 Consultation document

About quality priorities The Quality Account is our public annual report about the quality of our services. The Account must include quality improvement priorities for the coming year. To produce our Quality Improvement Priorities, we must ensure that we: 

Involve and engage all with an interest in the Partnership Trust

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Reflect at least the three domains of quality (Safety, Effectiveness and Experience)

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Demonstrate continuity over time

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Demonstrate quality improvement successes in subsequent years

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Include how what we will do to achieve the priorities

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Show how we will monitor and measure our progress

We aim to have between three and five priorities, in line with national guidance.

Developing our quality priorities Our 2016/17 draft priorities are in this consultation document are based on our current priorities, with learning from: 

National guidance, notably the NHS mandate and planning guidance 2016/17 – 2020/21.

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Health economy developments, including the transformation of our service configuration started by our Multi-Specialty Community Provider pilots

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Feedback from our Care Quality Commission inspection (November 2015) including the warning letter sent to us in December 2015

After reviewing the information above we are suggesting some changes to streamline our existing priorities. Our service portfolio has substantially changed this year, and we have improvement requirements from our recent CQC inspection. We will have a set of focussed quality indicators that are meaningful to service users and every frontline team, so we all put quality first. Our support teams must develop new ways in 2015/16 to support frontline teams to improve these quality priorities. From 1 to 22 February 2016 we will consult with staff, service user groups, and other stakeholders on changes to our quality improvement priorities. We will publish a consultation report with all the comments we receive.

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Table: Our quality priorities link to our values: Priority

Organisational Value

1: Safe – reduce avoidable harm

We take Responsibility

2: Caring – improve customer experience

We focus on People

3: Effective – improve our outcomes

We put Quality First

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Priority 1: Safe – Reduce avoidable harm Aim: Improve our safety culture and workforce, eliminating avoidable harm of all types This priority aligns with the CQC KLOE around Safe Services. Links to organisational value: We take Responsibility Our progress 2015/16 so far This year, and previous years, we have focussed on avoidable grade 3/4 pressure ulcers developed in our care. 

From April to September 2015 we had no reported community hospital pressure ulcers developed in our care

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From April to October 2015 we had 20 avoidable pressure ulcers in community services developed in our care.

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From April to September 2015 there were nine serious incident falls in our care settings – all were reviewed as unavoidable.

Sign up to Safety’s 3-5 year objective1 is to reduce avoidable harm by 50% and save 6,000 lives across the NHS. We joined this campaign in 2015/16. In line with our Sign up to Safety commitment, we want to half all avoidable harm by 2018. The feedback from the Care Quality Commission has influenced our quality improvement priorities for 2016/17, notably to focus on safe staffing as part of our safety priority. This year we continued to present safe nurse staffing figures at our Trust Board. We also reviewed our staffing establishment in summer 2015 and made some changes to our skill mix of staff as a result. We have developed a buddy scheme for our Integrated Local Care Team leaders, to assist with team development, which is supported by team development plans. We developed a central bank staffing team, and looked at improving our recruitment times. In November 2015 the CQC found that, in relation to our workforce, our systems to assess, monitor, and mitigate risks to people receiving care are not operated effectively. We took immediate action in December 2015 to improve our services. We will continue our focus on safe staffing through 2016/17. We have developed our incident reporting system to be easier for staff to use, while providing better information on incidents to teams and managers. We have also reviewed our reporting of incidents to external bodies, so that we are now in line with the average reporting benchmark for Community Trusts. We are developing a Trust Early Warning System, to amalgamate performance, staffing, quality and finance data, giving us a better overall picture of our teams.

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See http://www.england.nhs.uk/signuptosafety/whos-signed-up/staff-stoke/ Page 4 of 26

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What we will do in 2016/17 We will continue to looking at harm caused within the process of our care and work with our health economies to improve the safety of overall patient pathways. We will continue our pressure ulcer prevention programme, “react to red”, proactively reducing the severity of pressure damage. We will continue to develop our buddy scheme, team development plans, and early warning systems for performance, quality and staffing data. We will continue to develop our escalation and early warning systems so that our front line teams can clearly flag any quality issues.

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Measures for 2016/17 Proposed measures for 2016/17

Why this is important

Number of avoidable and We want to half attributable grade 3 and 4 avoidable harm by pressure ulcers 2018. developed in our care

Target

Reduction, in line with Related to NHS our aim to half avoidable outcomes framework harm by 2018 domain 5 Zero grade 3 and 4 avoidable and attributable pressure ulcers developed in our care in community hospitals Minimum 10% reduction the incidence of avoidable and attributable community grade 3 and 4 pressure ulcers developed in our care (i.e. a tolerance of 21 cases maximum in community services)

Number of serious incident falls reported whilst in our care

2 3

Links to

Safety Strategy Related to our Sign up to safety pledge2 NHS mandate 2016/173

Reduce serious incident falls in all our care settings, by a minimum of 10% for 2016/17 (i.e. a tolerance of 11 cases maximum in our community hospitals and bed-based rehabilitation services)

See http://www.england.nhs.uk/signuptosafety/whos-signed-up/staff-stoke/

See https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/486674/nhsemandate16-17.pdf Page 6 of 26

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Proposed measures for 2016/17

Why this is important

Target

Links to

Safety is everyone’s Our ambition is to increase NHS Outcomes job; staff on the the number of incidents Framework 5.6 lookout to improve reported by 10%, Safety Strategy (Aligned to indicator 5.6 in safety will see and compared to all incidents report more reported during 2015/16. the 2015/16 NHS mandate) incidents and “near misses”. We want all staff to be “quality inspectors”. Total number of adverse incidents reported (all incidents)

Services that report more “near misses” have a better safety culture.4 Percentage of reported serious incidents applicable to the Trust

If a team has an Reduction in proportion of NHS Outcomes increasing proportion serious incidents from all Framework 5.6 of serious incidents reported incidents Safety Strategy (Aligned to indicator 5.6 in there may be a safety issue. the 2015/16 NHS mandate) Services that report more incidents, with a low proportion of serious incidents, have a better safety culture. Safe staffing dashboard Our Staffing TBC baseline to be Safety Strategy (Community nursing and escalation policy developed, then reduction Traffic light system as part of having a safe hospitals): includes the workforce Number of RED flag safe requirement to report staffing occurrences RED staffing levels. instigated via safe staffing dashboards Consultation questions: 1. Are the measures above the most relevant for safety – reducing avoidable harm? 2. Are our targets and ambitions for reducing avoidable harm achievable? What are the barriers to achievement? What do we need to do differently? 3. Is the safety measure above meaningful to front line teams? If not, what is needed to make it meaningful?

See A promise to learn – a commitment to act, available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226703/Berwick_Report .pdf Page 7 of 26 4

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Priority 2: Caring – improve customer experience Our aim: Sustain and maintain our overall customer experience This priority aligns with the CQC KLOE around Caring Services. Links to organisational value: We focus on People Our progress 2015/16 so far From April to November 2015, around 97% of our service users would recommend our services, and less than 1.8% would not recommend us. Our carer friends and family test is even more positive. When asked specifically around 85% of service users are extremely satisfied with the quality of our care (April – November 2015). Our “Friends and Family Test” tells us the overall experience and satisfaction of our services. We use other data to uncover the details behind this high-level indicator. We will continue to monitor our complaints, compliments, Patient Advice and Liaison Services (PALS) processes, but we want to focus this priority on improving customer satisfaction for all our service users. What we will do in 2016/17 In line with the NHS mandate 2016/17, we will 

Maintain and increase the number of people recommending services in the Friends and Family Test (FFT) (currently 88-96%), and ensure its effectiveness, alongside other sources of feedback to improve services.

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Work with partner agencies, contributing to a plan with specific milestones for improving patient choice by 2020, particularly in our end-of-life and palliative care services (including to ensure more people are able to achieve their preferred place of care and death).

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Building on the FFT, develop proposals about how feedback could be enhanced to drive improvements to services at clinical and ward levels.

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Measures for 2016/17 Proposed measures for 2016/17

Why this is important Target

Links to

Friends and Family Test

The Friends and More than 90% would Family Test has been recommend our services to in use across many their friends and family if parts of the NHS since they needed similar October 2013. It is treatment, and less than 5% now in use in almost would not recommend us. all NHS services. Each Operational Team will Feedback gathered be monitored monthly to can be used to improve their individual stimulate improvement scores. Monthly in our services. 5 recommendations from our

Indicator 4c (Friends and Family Test) from the 2015/16 NHS outcomes framework

service users experience will be incorporated into each Operational Teams actions of improvement. Feedback from service users and carers on the quality of care that they have received from our services.

In 2014/15 we consulted with our service users and carers; this was a core theme from their feedback.

At least 90% of our service users and carers are extremely satisfied with the quality of our services.

Related to Domain 4 (Ensuring that people have a positive experience of care) of the 2015/16 NHS outcomes framework

Consultation questions: 4. Are the measures above the most relevant for Experience? 5. Should we amend or remove any of the measures above? 6. Are the experience measures above meaningful to front line teams? (If not, what is needed to make them meaningful?)

5

See http://www.england.nhs.uk/ourwork/pe/fft/ Page 9 of 26

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Priority 3: Effective – improve our outcomes Our aim: Improve the outcomes and personalisation of our services This priority aligns with the CQC KLOE around Effective Services. Links to organisational value: We put Quality First We want to provide effective services with positive outcomes for our service users. We know that quality improves when we focus on the outcome – “the end result” – for the service user. To focus on the outcome means to focus on individual needs and preferences, not simply tasks. Our progress 2015/16 so far Of our therapies teams involved in outcome measures in 2014/15, 26 teams continue to monitor 37 outcome measures. In addition, seven new outcome measures are now being monitored. Our Integrated Local Care Teams are reviewing their use of outcome measures to identify a standard set of measures that can be utilised. We are also building outcomes monitoring into our electronic care record systems. To refocus this priority on front line teams, we recognise that one outcome indicator will not easily apply to our whole range of services. Also, some teams already use multiple outcome indicators to measure their quality. We will continue focussing our outcomes work on encouraging teams to use and improve their own outcome measures, sharing best practice across the Trust. Our teams will also include audit of outcomes on their 2016/17 Practice Audit Programme. We also want our integrated adult health and social care teams to focus on giving service users choice and control over the shape of the support we give them. This is called “personalisation”. We want to ensure our service users have choice and control over the shape of health and social care support we provide. We have achieved our aim for increasing the use of e-marketplaces; access to information is available via the e-marketplace, and awareness of e-marketplaces has been raised with the relevant staff groups. Throughout September 2015 a series of workshop events have been held with front line social care staff to raise awareness and provide information on Staffordshire Cares, Assistive Technology and the emarketplace. We are working with Staffordshire County Council to determine usage statistics for the e-marketplace system. We have delivered training in personalisation. 74 staff have been trained over Q1 and Q2, and we are working to establish baseline and compliance requirements, so that all relevant staff have received training. Staffordshire County Council are also delivering six ‘Person Centred Planning-Policy Into Practice’ workshops during Q4. Some of the key personalisation measures for 2015/16 were related to specific development actions during that year (personalisation training, and the emarketplace). Also, the measurement and monitoring of personalisation is necessarily qualitative in nature. We want to focus our priority for personalisation on the front line, and we recognise that a single set of metrics will not easily apply to every team. However, some indicators will be applicable to the majority of teams so we have included these in this priority. Page 10 of 26

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What we will do in 2016/17 We will continue our work on outcome measures from 2015/16:    

Our teams will focus on using outcome measures in their everyday practice so they can demonstrate improvements for individual service users. We will make use of Practice Audit (including clinical and social care audit) as a method for frontline teams to review and improve their outcomes, using their established outcome measures. We will continue the development of outcomes monitoring in our electronic care records project We will develop monitoring and improvement of identified outcome measures for our Integrated Local Care Teams, building in our development work on the Multispecialty Community Provider model.

What we will do around personalisation in 2016/17 

We will continue training in personalisation, monitoring the uptake of our emarketplace. We will also develop our social care quality framework, ensuring that personalisation becomes part of the fabric of social care provision.

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We will develop our care plan audit protocol to encompass as many teams as possible.

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We will look at the quality of our care planning processes, to ensure our care plans are personalised.

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Measures for 2016/17 Proposed measures for 2016/17

6

Why this is important

Target

Number of teams demonstrating improvement in their outcome measures

Focussing on outcomes reflects a whole-systems approach to health and social care.

All frontline teams collect and analyse outcome data, and have plans for improving the outcomes of their service.

Care plan audits: proportion of people receiving a copy of their care plan or equivalent care plan information

The ADASS national survey highlighted good practice around copying care plans to service users, compared with our 2014/15 baseline audit

The baseline audit result for 2014/15 was 55%

Feedback from service users and carers that they feel involved in decisions regarding their individualized plans of care.

In 2014/15 we consulted with our service users and carers; this was a core theme from their feedback.

Links to

Quality Framework goal: Effective Outcomes6 and Effectiveness Strategy 7.9

Related to Adult Social Care Outcomes Audit result for 2015/16 Framework domain 3 was 63% Target: increase to and maintain 95% April – November 2015 NHS Standard we scored between Contract section 12 96% and 98% 2015-2016. Maintain at least TBC% of our service users and carers agree that they feel involved in decisions regarding their individualised plans of care.

NICE guidance: % compliance with relevant NICE guidance (Apr 2013 to date)

Increase to 100%

Mortality

Measure TBC

Target and baseline TBC

Related to Domain 4 of the 2015/16 NHS outcomes framework

Effectiveness Strategy NICE policy

Effectiveness Target & baseline TBC Strategy NICE policy

See http://www.staffordshireandstokeontrent.nhs.uk/About-Us/quality-framework.htm Page 12 of 26

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Consultation questions: 7. Are the measures above the most relevant for Effectiveness? 8. Are there any other measures we could use to monitor our progress in improving outcomes? 9. Are these effectiveness measures meaningful to front line teams? (If not, what is needed to make it meaningful?)

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How we will make improvements Embedding our quality priorities at the front line Why the front line? We want to focus our quality priorities on our frontline teams and service users for 2016/17: 

Using a smaller number of focussed indicators

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Using indicators that are applicable to all of our services

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Ensuring that each indicator is meaningful to frontline staff

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Ensuring that each indicator measures quality of care for our service users as directly as possible

Streamlining our priorities We have condensed our current five quality priorities into three: 

This aligns our priorities directly with our three strategies for quality

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Priorities are also aligned with the CQC key lines of enquiry

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Priorities are simplified, so that they are easier to remember and apply

Table: consolidating our 2016/17 priorities 2015/16 priorities

2016/17 proposed priorities

Priority 1: Safety – Reduce avoidable harm (2 indicators)

Priority 1: Safe – reduce avoidable harm

Priority 5: Safety - workforce and safety culture (11 indicators)

Aim: Improve our safety culture and workforce, eliminating avoidable harm of all types 5 top-line indicators

Priority 2: Experience – Improve customer satisfaction (14 indicators)

Priority 2: Caring – improve experience Aim: Sustain and maintain our overall customer experience 2 top-line indicators

Priority 3: Effectiveness – improve our outcomes (1 indicator)

Priority 3: Effective – improve our outcomes Aim: Improve the outcomes and personalisation of our services

Priority 4: Effectiveness - support independence by personalised care (5 indicators)

4 top-line indicators

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Focussing our measures In 2015/16 we had 5 priorities and 33 indicators. Some of these indicators focussed on internal governance processes (e.g. the number of complaints reviewed by our independent complaints panel). While it was useful to monitor progress with these important developments, some of the indicators did not cover the whole organisation or directly measure quality of care. By refocussing our measures on the frontline we hope to 

Embed an ethos of continuous quality improvement and safety awareness

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Help our teams to improve the quality of their services

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Provide assurance about the quality of our services, from the frontline

The quality priorities for 2016/17 now contain eleven top-line indicators that each focus on frontline quality of care. How our frontline teams will monitor quality Frontline teams will use a Frontline Quality poster to record and review the priorities. Instructions and training will be provided by the quality team. The poster and instructions will be tested and refined during Q4, 2015/16. Figure 1: Example frontline quality A3 poster example

Frontline Quality Priorities 2016/ 17 Safe

Caring

For Q __ we had:

Effective

For Q __ our Friends and Family test was

____ grade 3 / 4 pressure ulcers developed in our care ____ serious incident falls reported w hilst in our care ____ incidents and ____% were Serious Incidents

What w e learned from our team discussion: Review your d ut y of can dour let t ers f or each incident Use root cause analysis t o learn w hat you ca n improve

____% positive ____% negative and feedback on quality of care was:

___% had a copy of t heir care plan and ___% felt involved with t heir care

____% positive ____% negative

What w e learned f rom comment s, complaint s, compliment s, and cards:

Teams on the lookout for safety report more incidents We want to half all avoidable harm by 2018

The one t hin g we wi ll do next is:

For Q __ our team outcomes ___________________

Complaints give valuable insights to help us improve

The one t hin g we wi ll do next is:

A d d t h is to yo u r t eam d evel o p men t p l an

What w e learned from our outcome data: Compare w it h last quart er, evidence base, and w it h your peers

Focus on personalisation, giving the user choice and control, and the outcome—the “ end result” for the service user

The one t hin g we wi ll do next is:

A d d t h is to yo u r t eam d evel o p men t p l an

A d d t h is to yo u r t eam d evel o p men t p l an

We have three Quality Improvement Priorities.

How to escalate issues:

Where can I get my data?

Read our priorities on our i nter net site.

Team leader

Your area manager has t he information for your team, and you can co ntact [email protected] if you need any more info.

What can I do to help? 

Discuss all the priorities in your team meeting each Quarter.



Ask: What has gone w ell? What did w e learn? How can w e improve?

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Get your team to t hink about ways to improve quality - lots of little improvements all add up.

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Note your team learning and actions o n the sheet

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Post t his sheet o n your notice board

Area M anager

You can find key infor mation o n t he i ntranet [insert intranet site address] Quality Team: [email protected]

Join our yammer discussion gr oup: Quality M atters Contact us: [email protected]

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How our frontline teams will improve quality We will ensure that regular prompts in Trust communications ensure that teams regularly reviews information on the quality of care they provide. Training, awareness raising and other communications from the quality team Work will be coordinated with the buddy scheme, team development plans, and the Implementing Change programme, to ensure that improvement takes place at the frontline. The benefits of this approach 

Our service users can have confidence that each front line team is focussed on improving core aspects of quality

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our front line teams have a clear understanding of the core organisational quality priorities, and their performance in relation to them

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Commissioners can be assured that we are looking at the quality of our services at team level, fulfilling our contractual requirements

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Our front line teams will regularly be discussing how they can improve, which will lead to more improvement ideas, innovation, and learning at the front line

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Our support teams will be focussed on helping frontline improvement

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This approach will increase demand for high quality information at team level, which will be fulfilled via the upcoming service line reporting systems

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Supporting strategies The safety, effectiveness, and experience strategies have been revised and reworked to focus on frontline improvement:    

Key measures for each strategy are based on the quality priorities for 2016/17 Each strategy has been condensed to a single A3 page The revised strategies will be included in the Quality Priorities 2016/17 consultation The focus of each strategy is on quality improvement at the frontline, so that teams are supported by the organisation to improve quality

The revision of the safety, effectiveness, and experience strategies also takes full account of the developments outlined in this review. The focus of these strategies is the improvement of quality at the frontline, maintaining compatibility with future operating model / structure developments.

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Other methods we will use to improve quality Our strategies for quality7 are the main way we will address our quality improvement priorities. We will continue to use these other methods to improve quality: 

Each of our front line teams will monitor their progress against the priorities by means of the poster and workbook



We will act on the recommendations of the Care Quality Commission inspection (November 2015)

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We will work to create a more open and honest culture in the NHS, including supporting our staff to speak out to raise concerns8.

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Our Service Improvement Managers will provide intensive training for service and quality improvement.

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Our Organisational Development and Leadership team will provide tailored leadership development and support for team leaders, in line with our team development governance framework.

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Our Business Development team will help each of our divisions to develop their service priorities, including reviewing the impact of service developments on quality.

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Our Performance team will develop the reporting platforms to improve the speed of reporting, on line access and the accuracy of data reported.

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Our IT team will lead on the development of service line reporting, allowing our frontline teams to see integrated finance, performance and quality information.

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Our Professional Leads will provide leadership, support and advice to frontline staff, helping them to promote best practice and excellent customer service.

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Our Research and Innovation team will manage and promote our research portfolio, helping our staff to contribute to the evidence base for health and social care.

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Our Quality Assurance work, including regular quality visits and team selfassessments, will ensure our services are Safe, Caring, Responsive, Effective, and Well-led.

Monitoring our progress The Quality Governance Committee is the principal committee charged by our Trust board to lead on quality. This committee, and Its Safety and Effectiveness Subcommittee, will review our progress against these priorities regularly. Also, each of our divisions has a Safety and Effectiveness Operational Group. These groups will also review all areas of quality in their own divisions.

7

See our Safety, Effectiveness, and Experience strategies on our website here:

http://www.staffordshireandstokeontrent.nhs.uk/About-Us/quality-framework.htm 8

See our information on raising concerns, on our website here: http://www.staffordshireandstokeontrent.nhs.uk/About-Us/raisingconcerns Page 18 of 26

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The way that we make improvements and monitor our progress aligns with the CQC KLOE around Well-led services. Consultation questions: 10. Are there any other methods we should use to ensure we achieve our quality priorities? 11. Is there anything else we should do to monitor our progress?

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Appendix 1: Factors affecting our choice of priorities Delivering the Forward view: NHS planning guidance 2016/17 to 2020/219 “Local NHS systems will only become sustainable if they accelerate their work on prevention and care redesign. We don’t have the luxury of waiting until perfect plans are completed. So we ask local systems, early in the new year, to go faster on transformation in a few priority areas, as a way of building momentum.” As part of the 5 year view, local health economies will need to develop Sustainability and Transformation Plans (STPs) during 2016/17. While developing these plans, there are also national ‘must-dos’ for 2016/17: The nine ‘must dos’ for 2016/17 for every local system: 1. Develop a high quality and agreed STP, and subsequently achieve what you determine are your most locally critical milestones for accelerating progress in 2016/17 towards achieving the triple aim as set out in the Forward View. 2. Return the system to aggregate financial balance. 3. Develop and implement a local plan to address the sustainability and quality of general practice, including workforce and workload issues. 4. Get back on track with access standards for A&E and ambulance waits 5. Improvement against and maintenance of the NHS Constitution standards that more than 92 percent of patients on non-emergency pathways wait no more than 18 weeks from referral to treatment, including offering patient choice. 6. Deliver the NHS Constitution 62 day cancer waiting standard 7. Achieve and maintain the two new mental health access standards 8. Deliver actions set out in local plans to transform care for people with learning disabilities, including implementing enhanced community provision, reducing inpatient capacity, and rolling out care and treatment reviews in line with published policy. 9. Develop and implement an affordable plan to make improvements in quality particularly for organisations in special measures. In addition, providers are required to participate in the annual publication of avoidable mortality rates by individual trusts. The Trust Development Authority will measure progress through a new CCG Assessment Framework. NHS England will consult on this in January 2016, and it will be aligned with this planning guidance. The framework is referred in the Mandate as a CCG scorecard. It is our new version of the CCG assurance framework, and it will apply from 2016/17. Its relevance reaches beyond CCGs, because it’s about how local health and care systems and communities can assess their own progress. Technical guidance on planning includes the requirement to take account of the fundamental quality and safety standards published by the CQC. Providers are required to select three quality priorities for 2016/17 and outline their approach to

9

See http://www.ntda.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-2021.pdf Page 20 of 26

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quality improvement with the intention of providing safe, high-quality care and achieving a good or outstanding CQC rating. To meet these standards, providers should set out their quality priorities, connected to the needs of the local population and to the NHS mandate, in a quality improvement plan for the year. They should do this by considering: 

national and local commissioning priorities, including the recommendations in the Academy of Medical Royal Colleges’ 2014 report Guidance for taking responsibility: accountable clinicians and informed patients



the provider’s quality goals, as defined by its strategy and quality account, and any key milestones and performance indicators attached to them



an outline of existing quality concerns (from CQC or other parties) and plans to address them



the key quality risks inherent in the plan and how these will be managed

All providers should also participate in the annual publication of avoidable deaths per trust.

NHS Mandate 2016/17 NHS England is responsible for arranging the provision of health services in England. The mandate to NHS England sets the Government’s objectives and any requirements for NHS England, as well as its budget. In doing so, the mandate sets direction for the NHS, and helps ensure the NHS is accountable to Parliament and the public. Every year, the Secretary of State must publish a mandate to ensure that NHS England’s objectives remain up to date. This year, the mandate is not solely for the commissioning system, but sets objectives for the NHS as a whole. This mandate sets out objectives to 2020, sets requirements relating to the Better Care Fund, and sets NHS England’s budget for five years. 1. Through better commissioning, improve local and national health outcomes, particularly by addressing poor outcomes and inequalities. 2. To help create the safest, highest quality health and care service. 3. To balance the NHS budget and improve efficiency and productivity. 4. To lead a step change in the NHS in preventing ill health and supporting people to live healthier lives. 5. To maintain and improve performance against core standards. 6. To improve out-of-hospital care. 7. To support research, innovation and growth.

Multi-Specialty Community Provider model Currently the Trust is pursuing the development of a Multi-Specialty Community provider model, with at least two pilot sites confirmed for go-live by 1 April 2016. The model will focus on: Page 21 of 26

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    

Providing integrated, person centered care in a range of settings and environments preferred by our service users. Wrapping and integrating community and social care around primary care provision for a practice population of betweem 30-50,000 patients using skills and capacity of primary and community care to develop new ways of working reducing non-elective admissions by means of risk stratification, case management developing proactive and preventative patient pathways, making better use of telehealth, patient activation, and self-care

The MSCP model will be developed in partnership with several groups of commissioners and GP practices, each of whom have different perspectives and requirements. Therefore we will develop an approach with core and customisable features to allow for local design flexibility. Key to success will be full involvement from service users, GPs, and our frontline teams. Programme arrangements will include a governance workstream.

Social Care Governance development As part of our agreement with Staffordshire County Council, we are accountable for the quality of our social care provision. A framework will be in place through which we will focus on what needs to be in place to ensure that the experience of people who use our services meets or exceeds their expectations. The draft Adult Social Care Quality Assurance Framework is currently in development. It has the following objectives:      

To apply quality standards across the Operations Directorate; To take a consistent approach to monitor and evaluate quality; To implement clear and robust governance arrangements for quality assurance; To celebrate good practice and success; To take action to support quality improvements when necessary; To contribute to organisational learning.

The following methods will be used to provide quality assurance of adult social care:         

Performance measures for adult social care Supervision Audit Practice standards Audit Documentation (record keeping) audit Safeguarding Audit Caseload and workload Audit Practice observation National standards for employers of social workers Annual Audit Social Work Task Force Annual Health Check process Page 22 of 26

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

Thematic practice reviews (e.g. “deep dives”)

Development and implementation of the framework will be through the existing Trust governance structure, and will be led by the Chief Operating Officer for Social Care. The development is expected to continue through Q4 2015/16, and will include consultation, testing and ratification phases.

Care Quality Commission (CQC) visit, initial feedback and warning letter The Care Quality Commission inspected Staffordshire and Stoke on Trent Partnership NHS Trust (SSOTP) during the last week of October and the first week of November 2015. They provided their initial feedback on 13th November, identifying a number of areas of good practice. They saw that our staff were passionate about the services they provided, and caring. They saw good patient interactions and received many positive comments from patients. They also provided initial feedback on areas requiring remedial action. On 15 December 2015, the Care Quality Commission issued a warning notice under Section 29A of the Health and Social Care Act 2008. It is the view of the Care Quality Commission that the quality of health care provided requires significant improvement in four areas: 1. We do not have processes in place to enable us to ensure that consent is lawfully obtained before any care and treatment is provided 2. Our systems to assess, monitor, and mitigate risks to people receiving care are not operated effectively 3. Our systems to assess, monitor and improve the quality and safety of the services we provide to people are not operated effectively 4. We do not have processes in place to enable us to make the robust assessments required by the Duty of Candour requirement We have to demonstrate improvement in the second area by the end of December 2015 and in the other three by 29th February 2016.

Clinical and Social Care Strategy Development During October and November 2015 the Trust consulted on an Integrated Clinical and Social Care Strategy for 2015 to 2020. The working draft strategy focuses on how staff can shape and support the future direction of clinical and social care services of the Trust and is designed to ensure that we always put quality and patients first. The strategy sets out sore aims and objectives for how we will deliver care over the next five years with built-in flexibility to regular reviews as well as having the agility to respond to the local and national needs of the NHS. The strategy additionally looks at collaborative working with our key stakeholders to enable better joined up working across the local health economy. The strategy is still in development, but the draft strategic outcome goals have a clear overlap with the quality framework and its supporting strategies: Page 23 of 26

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Goal 1 – we care about our service users and carers 

Patient experience will be collected, analysed and continually improved.

Goal 2 – delivering effective services at the right time, at the right place to the right person 

Quality of life for people with long term conditions

Goal 3 – we deliver what we promise 

Equality in quality and access

Goal 4 – we will build on our reputation in delivering safe services   

We will learn from mortality We will improve our services to prevent illness We will deliver harm free care and deliver excellence in patient safety

Goal 5 – our leaders will deliver the best 

We will make effective use of NHS resources

Interim report – accelerated access review The NHS mandate requires NHS England to implement the agreed recommendations of the Accelerated Access Review in 2016/17. An interim report was published in October 2015. The interim report describes the review’s progress in preparing proposals to improve the current system for developing, evaluating and adopting innovative medical technology for the benefit of patients, the health system and the life sciences industry. Building on extensive responses from stakeholders during an initial period of engagement, which is summarised in the supporting evidence documents, the report sets out 5 main propositions which will form the basis of the review’s next phase of engagement. The five propositions in the report are: 1. Putting the patient centre stage 2. Getting ahead of the curve 3. Supporting all innovators 4. Galvanising the NHS 5. Delivering change Early feedback on these propositions and provisional conclusions, in particular on potential gaps, is welcomed. The review intends to publish its final report with more detailed recommendations by April 2016. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/47156 2/AAR_Interim_Report_acc.pdf

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Consultation questions: 12. For our priorities, have we appropriately considered all the factors in this appendix? 13. Are there any other factors that we should take into account?

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Appendix 2: measures and responsibilities Proposed measure for 2016/17

Responsible Director

Who provides monitoring information

Number of avoidable and attributable grade 3 and 4 pressure ulcers developed in our care

Kieron Murphy (Director of Operations)

Duncan Kett (Head of Safety & Risk) Sue Mason (Tissue Viability Nurse Specialist Lead)

Number of serious incident falls reported whilst in our care

Kieron Murphy (Director of Operations)

Rose Goodwin (Interim Director of Nursing & Quality)

Rose Goodwin (Interim Director of Nursing & Quality)

Duncan Kett (Head of Safety & Risk)

Total number of adverse incidents Kieron Murphy (Director of Operations) reported to the Trust (all incidents) Rose Goodwin (Interim Director of Nursing & Quality)

Duncan Kett (Head of Safety & Risk)

Percentage of reported serious incidents applicable to the Trust

Kieron Murphy (Director of Operations)

Duncan Kett (Head of Safety & Risk)

Safe staffing escalation incidents: Number of Incidents reported related to staffing levels being inadequate to manage team needs, in line with the staffing escalation policy.

Kieron Murphy (Director of Operations)

Friends and Family Test

Kieron Murphy (Director of Operations)

Rose Goodwin (Interim Director of Nursing & Quality)

Rose Goodwin (Interim Director of Nursing & Quality)

Rose Goodwin (Interim Director of Nursing & Quality) Feedback from service users and carers on the quality of care that they have received from our services.

Kieron Murphy (Director of Operations)

Care plan audits: proportion of people receiving a copy of their care plan or equivalent care plan information

Kieron Murphy (Director of Operations)

Feedback from service users and carers that they feel involved in decisions regarding their individualized plans of care

Kieron Murphy (Director of Operations)

Number of teams demonstrating improvement in their outcome measures

Kieron Murphy (Director of Operations)

Rose Goodwin (Interim Director of Nursing & Quality)

Measure in development – responsibilities TBC

Marie Allen (Head of User and Carer Experience)

Marie Allen (Head of User and Carer Experience)

Robin Sasaru (Quality and Effectiveness Manager)

Rose Goodwin (Interim Director of Nursing & Quality) Marie Allen (Head of User and Carer Experience)

Rose Goodwin (Interim Director of Nursing & Quality)

Rose Goodwin (Interim Director of Nursing & Quality)

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Robin Sasaru (Quality and Effectiveness Manager)