1. Improving the Quality of Local Healthcare Services: Improving the Quality of Local Healthcare Services: The role of commissioning Julia Barton, Chief Quality Officer

2. Purpose of the session To share information about how the CCG works on behalf of the public to secure high quality services To explain the range of quality improvement approaches To share a recent innovation to capture quality information from GPs

3. Patient & public quality expectations Seamless, continuity of care Improved partnership working across health and social care providers Variation in quality of services is reduced Being open and honest when things do not go as planned and putting things right for those affected Services are delivered with care and compassion Care is personalised; people want to be treated as individuals People wish to receive more care out of a hospital setting, such as in their own homes or community facilities The CCG should ensure there are enough staff to deliver services and that they are valued in their work.

4. Quality defined? “As a patient I will be less likely to suffer harm. I will feel confident in local healthcare services because there will be lower levels of harm e.g. from preventable falls, pressure ulcers and infections.” “As a patient, relative or carer, I will have a voice and be listened to. I will know how to provide feedback and I am confident that I will be listened to and told what has been done to improve local healthcare services.” “As a patient I will have high levels of confidence in the treatment and care I receive and know the risk of complications has been reduced. My treatment will be timely and reliable and not dependent on healthcare setting. I will experience seamless transitions through health and social care services.”

5. Our quality goals Reducing risk and actual harm Responding to individual needs Local early warning systems Standardising processes & reducing variation

6. The CCG Quality Duty Health and Social Care Act 2012 Section 23 and Section 26 – high quality, safe services - continuous improvement

7. Responsible/accountable INDIVIDUAL HEALTHCARE PROVIDER ORGANISATION CCG

8. What is the CCG approach? Assurance Improvement Individual Provider level (normally) NHS Contracts/service specifications Monitoring Measurement Seeking assurance Managing risk Escalation e.g. to CQC Across the system & patient pathways Multiple providers Distinct improvement projects

9. Quality improvement activities Enablers Clinical Quality Visits Provider contracts & incentives Bench- marking & triangulation Quasar Improvement Programmes CQC Inspections and Regulation Monitoring and assurance Lay member assurance and scrutiny

10. The Quasar System Quasar provides quality surveillance and monitoring tools for commissioned healthcare services

11. Quasar: The Vision CCG Strategic Objective 5: improving quality and reducing variation. An electronic data capture system for collating quality measures and intelligence To enable early learning of service failure and intelligent systems reporting. We talk a lot about surveillance - this tool enables us to actually do it! Spotting priority areas for improvement will help us focus efforts on the right things

12. Quasar: Realising our Ambition Increasing levels of trust and confidence across healthcare providers Creating a culture of transparency and openness for the benefit of patients and the whole population (post Mid Staffordshire Hospitals) Collating intelligence and feedback from health care professionals, and soon ….patients and the public Systematic approach to triangulating hard data & soft intelligence Turning text/words into useful data

13. Quasar: The Modules Healthcare professional feedback Incident management Complaints management Serious Incident management/STEIS Safeguarding module Comms. & Media module Analytics & reporting - Triangulation of “hard” quality data and soft intelligence – early warning function Cross module functions = TAGS, ACTIONS, NOTES & FILES

14. Quasar: Triangulation : data collected locally via Quasar is combined with national datasets

16. Quasar: Top 6 themes from feedback ThemeIssues Communications discharge summaries - the number are reducing outpatient letters notification of death although relatively small numbers Clinical Treatment Biochemistry - potassium blood tests the highest concern Admissions and Discharges cancelled operations inadequate discharge planning failure to convey - delayed ambulance and patient transport. Appointments cancelled appointment failure to provide follow up waiting time at appointment and inability to gain appointment. Medication Safety relating to medication, prescribing errors; dispensing errors and administration errors. Admin/policies/ procedures incidents relating to the administration of documents or patient care

17. Quasar: New Models of Care Quality data across whole patient pathway Real-time principles Gets data down to the lowest possible level Empowerment of front line clinical staff Data for improvement not judgement Cross provider quality data unit Linking corporate and clinical data & triangulating with soft intelligence

18. Build on analytics and reporting function – draw down national data sets into system Roll out HCP module to other providers Use of incident/complaints reporting module for primary care – Gosport 4 – SEH and F&G CCG Practices NHSE Primary Care Intelligence Tool Website and Guides Uploading incidents to NRLS from system Development of new modules 2016/17 : Quasar Developments

19. Quasar: patient and public feedback? We use the system to record feedback from patients and the public e.g via Community Engagement Committees, patient consultation events & the media That information is then triangulated with other sources of quality data We would like to develop a direct patient and public feedback form on the website. Would this be useful?

20. Questions Welcome