Alison Jamson, Head of Quality & Clinical Standards NHSMK&N Commissioning Support Hub

Transcription

1 Enc 11/10f Subject: Meeting: NHSMK CQUIN Schemes MK Commissioning Board Date of Meeting: 13 December 2011 Report of: Alison Jamson, Head of Quality & Clinical Standards NHSMK&N Commissioning Support Hub 1. Purpose of Paper The purpose of this paper is to: provide the MK Commissioning Board with an overview of the current CQUIN Schemes in place in 2011/12 make recommendation on the suggested course of for each of these schemes seek agreement on the content of CQUIN schemes for 2012/13 prior to further development 2. Background In the past CQUIN (the mechanism to financially incentivise quality improvement by providers) has run parallel to the main contracting process, and as a result has not always helped us apply focus to the big areas of change we want to see happen. For 2012/13 CQUIN will be fully integrated in the contracting process and will be used to leverage improvement in key areas. We anticipate aligning CQUIN rewards to fewer, more impactful areas where we want to see quality improvement. 3. Current CQUIN s 3.1 MKFT Table 1 provides a summary of the current CQUIN indicators included in the contract with and a suggested for each indicator where possible has been provided for consideration the board. Table 1 Current MKFT CQUIN indicators: National/ Title (brief) Detail CQUIN paper Dec 11 AJ Page 1 of 9

2 National 1 National 2 Title (brief) VTE Prevention Patient Experience personal needs End of Life Care Normal Birth Rate Pressure Ulcer Prevention Safeguarding Adults Detail Reduce avoidable death, disability and chronic ill health from Venousthromboembolism (VTE) Improve responsiveness to personal needs of patients There is evidence of advance care planning where patients are given opportunity to voice their preference for their preferred place of care/ death Increase the normal birth rate and eliminate unnecessary Caesarean Sections To continue the work started in previous years on the reduction of newly acquired grades 3 & 4 pressure ulcers and to: 1. Improve training 2. Improve investigation processes and share learning from these 3. Maintain the low levels of pressure ulcers reported during 2010/11 To ensure the safety and wellbeing of those patients who are less able to protect themselves from harm, neglect or abuse, for example, due to impaired mental capacity, physical or learning disability or frailty brought about by age. Acute COPD Reduce Unnecessary Attendances at A&E for COPD as an ACS condition: To personalise and improve community based care for people with COPD through To continue with further stretch To continue with further stretch Will become part of National CQUIN on use of Safety Thermometer Keep with further stretch CQUIN paper Dec 11 AJ Page 2 of 9

3 Title (brief) Detail joint working across health and social care using Domestic Oxygen Initiative, MetOffice Healthy Outlook approach, Early Discharge Scheme, Inhaler Technique and Pulmonary Rehab initiative. 3.2 MK Mental Health Services Table 2 provides a summary of the current CQUIN indicators included in the contract with MKCHS Mental Health Services and a suggested for each indicator where possible has been provided for consideration by the Board. Table 2 Current MK Mental Health CQUIN indicators: National/ Title (brief) Detail 1a 1b Improving the safety of people being cared for as an inpatient during an episode of acute mental illness Improving the safety of people being cared for as an inpatient during an episode of acute mental illness Mental Health Service to use nationally recognised formal risk assessment and risk management tools in the care of service users to improve the safety of people being cared for as an inpatient Review the patient experience of being cared for whilst on heightened observations using patient stories and use the results to support the training of staff. Review to be undertaken of how observation policy (and underpinning decisions) have been implemented. Service will be tested to ensure compliance with national guidance. Continue but with further stretch to include all MHS and participation in peer review Move to National 2 with further stretch CQUIN paper Dec 11 AJ Page 3 of 9

4 1c Title (brief) Improving the safety of people being cared for as an inpatient during an episode of acute mental illness Detail Mental Health Service to join the Leading Improvement in Patient Safety (LIPS) Programme for Mental Health. 2a Single Point of Access Number of assessments undertaken 2b Single Point of Access Number of people receiving short term treatment 3 Memory Screening The establishment of a fully functioning memory assessment service covering all of MK population. The service will offer early intervention and work closely with primary, secondary and tertiary care in relation to the management for people in early stage of dementia (all ages) by March Move this CQUIN to quality schedule but consider how to incorporate national CQUIN on dementia care 3.3 MK Community Services Table 3 provides a summary of the current CQUIN indicators included in the contract with MKCHS and a suggested for each indicator where possible has been provided for consideration by the Board. Table 3 Current Milton Keynes Community CQUIN indicators: National/ Title (brief) Detail 1 Pressure Prevention Ulcer To continue the work started in previous years on the reduction of newly acquired grades 3 and 4 pressure ulcers and to: Will become part of National CQUIN on use of Safety Thermometer 1. Improve training CQUIN paper Dec 11 AJ Page 4 of 9

5 Title (brief) 2 End of Life Care Detail 2. Improve investigation processes and share learning from these Maintain the low levels of pressure ulcers reported during 2010/11 That there is evidence of advance care planning where patients are given opportunity to voice their preference for their preferred place of care / death. 3 Patient Experience The experience of patients using MK Community Health Services will be sought and analysed on a regular basis by service providers and the outcome will be shared with the commissioners 1a The Patient Experience Strategy and supporting campaigns document will be reviewed for 2011/12 contract year to include: development of Community Health Services Patient Panel, work towards real time patient experience monitoring, Essence of Care benchmark audits and Copying letters to patients initiative. Continue with further stretch as part of national CQUIN scheme 4 Health Visitor Implementation Plan 1b The provider will communicate effectively with service users about service transformation and service reduction in line with CQC requirements Delivery of Universal Plus and Universal Partnership Plus in line with the Health Visitor CQUIN paper Dec 11 AJ Page 5 of 9

6 Title (brief) Detail Implementation Plan Community COPD Reduce Unnecessary Attendances at A&E for COPD as an ACS condition. To personalise and improve community based care for people with COPD through joint working across health and social care using Domestic Oxygen Initiative, Met Office Healthy Outlook approach, Early Discharge Scheme, Community Pulmonary Rehab and inhaler technique initiatives. Keep with Further stretch 4.0 CQUIN Schemes for for consideration 4.1 Operating Framework The 2012/13 Operating Framework stated that the amount that providers can earn has been increased to 2.5% on top of actual outturn contract value. The two national goals on VTE risk assessment and on responsiveness to personal needs of patients will continue with the addition of a third goal on improving diagnosis of dementia in hospitals and a fourth goal to incentivise the use of the NHS Safety Thermometer. A minimum of 0.5% of the 2.5% must be applied to the nationally mandated CQUIN schemes. Where a CQUIN scheme has been used previously to achieve a higher standard of quality, that funding may be made recurrent through CQUIN only where the commissioner is satisfied it is the necessary means to maintain the improvement. All providers subject to a standard national community contract will be eligible for involvement with CQUIN schemes. 4.2 CQUIN Scheme Proposals CQUIN paper Dec 11 AJ Page 6 of 9

7 Description of indicator Rationale for inclusion Main Provider Applied to Suggested Value VTE Assessment Nationally Mandated CQUIN 0.125% Patient Experience Improving diagnosis of dementia in hospitals Incentivise the use of the NHS Safety Thermometer. Right care, right place (Unplanned Care) Right care, right place Nationally Mandated CQUIN - Learning from patient experience is a key mechanism for learning and receiving assurance about the quality of care provided. This CQUIN will be applicable to all providers Nationally mandated CQUIN MKFT to work jointly with MHS to develop process which will ensure assessment and diagnosis of patients presenting with clinical signs/symptoms of dementia leading to an improvement in the timely diagnosis of people with dementia. Nationally Mandated CQUIN - The Safety Thermometer is the central data collection tool for measuring baseline information about risk assessment, risk management and outcomes for each of the four harms being focussed on by safety express to include zero tolerance to pressure ulcers and build on the work started in 2011/12. This CQUIN will be applicable to all providers Reduce clinically unnecessary nonelective admissions to ensure that patients are receiving the right care, in the right place at the right time. To include: 1. Mental Health & Learning Disabilities - ensure integrated pathway between MH & LD services. Review the role of the LD Health Action Team MKCHS MHS All other eligible providers MHS MKCHS 0.125% 0.25% 0.25% 1.25% 0.125% 0.25% 0.125% 0.25% All other eligible 1.25% providers 1.25% MHS 1.25% 2. To improve the care, safety and experience of patients with defined MKCHS 0.375% 1.5% CQUIN paper Dec 11 AJ Page 7 of 9

8 Mental Health Improving data, quality and sharing with commissioners, in development of Mental Health PbR Medication Management HIV testing long-term conditions: diabetes, COPD and heart failure. 3. Paediatric Services ensure integrated service between community and inpatient services With the mandated implementation of MHPbR, will be a critical year of transition from block contracting to payment by results To include: 1. Antibiotic stewardship - this is an important contributor to the reduction of health care associated infections 2. Insulin prescribing to ensure prescribing inline with NICE guidance 3. Low Molecular Weight Heparin (LMWH) training of patients discharged on LMWH enables patients to undertake an active role in the management of their health care needs and reduces the need for additional involvement by district nurses MK is defined by the Health Protection Agency (HPA) as having a high prevalence of HIV. There is evidence from the HPA that more than one quarter of individuals with HIV are unaware of their infection. Milton Keynes has a high late diagnosis rate with audit evidence that 12% of the newly diagnosed individuals in 2009 had missed the opportunity for earlier diagnosis whilst inpatient at Milton Keynes hospital. MKCHS 0.125% 0.5% MHS 0.75% Conclusion & Recommendations CQUIN paper Dec 11 AJ Page 8 of 9

9 Members of the Board are asked to review the proposed CQUIN Schemes above and provide an opinion of which should be developed further for inclusion in the CQUIN schemes. CQUIN paper Dec 11 AJ Page 9 of 9