Quality Strategy

Transcription

1 Quality Strategy

2 Contents 05 Foreword 06 Introduction 06 Equality & Diversity 07 Context for this Strategy 08 Definition of Quality 10 Quality Objectives 10 Strategic Quality Objectives 16 Quality Improvement Priorities 18 Commissioning for Quality Improvement 18 Sign Up to Safety 19 How It All Fits Together 20 How We Measure Quality Improvement 22 Data Quality Assurance 24 Quality Governance 24 Clinical Services Annual Quality Audit Plan 25 Identifying and Managing Key Risks to Quality 27 National Guidance and Legislation Informing CHCP s Quality Strategy 02 03

3 Foreword Our number one strategic goal is to provide quality, safe, effective care to all of our service users. Achieving this is the responsibility of all of us, so that everyone works to the same common purpose focused on quality improvement. Achieving high quality care is about ensuring that we have the right people, in the right places, doing the right things at the right time. As an organisation we realise that this must be coupled with rigorous assurance, risk management and governance arrangements that provides us with the evidence to demonstrate that we are delivering a good service or alternatively provides us with an early identification process that indicates when we need to take action. Our Quality Strategy sets out our ambitions and objectives for high quality services at City Health Care Partnership CIC and how we are going to achieve them. It recognises that at its core, high quality care is care that is safe, clinically effective and results in a positive service user experience. This isn t about a sole focus on systems and processes but about equipping our colleagues with the knowledge and skills to get on and do what they need to do with and for our service users. The Operations & Delivery Board is absolutely committed to working with staff to nurture a culture that supports and empowers everyone to deliver continuous improvements that are based on evidence and the best clinical practice and in turn give assurance to the Executive Board. This strategy demonstrates how we work within the National Quality Governance Framework and sets out our local quality framework to measure service user outcomes for quality, safety and effectiveness. It shows how a series of quality dashboards at team and service level relate back to our overarching quality framework. Ultimately this quality strategy is about people. It is our plan to improve quality for and with our service users, create an effective work-life balance for our staff to and to support and enable the organisation to deliver high quality care first time, every time. Andrew Burnell, Chief Executive 04 05

4 Introduction Equality & Diversity Context for this Strategy At City Health Care Partnership CIC our overarching vision is to lead and inspire through excellence, compassion and expertise in all that we do. In achieving the vision our purpose is to deliver integrated health care services that empower our service users to make the most of their lives. We care for people at all stages of health and at end of life including the provision of; direct treatment and management plans, facilitating recovery or re-ablement and endeavour to equip them with the knowledge and confidence they need to stay as healthy as possible. Our values are as follows: Service and excellence Equality and diversity Creativity and innovation Co-operation and partnership At the heart of who we are and what we stand for is quality and this strategy sets our stance that Improving quality is all about making health care services safe, effective, caring (patient centred), responsive and well led. City Health Care Partnership CIC is committed to Equality, Diversity and Inclusion and ensures its compliance with national strategies and frameworks including the Equality Act 2010 and Public Sector Duty. To support with this compliance the organisation works to national standards including Workforce Race Equalities (WRES) and the Equality Delivery System (EDS2). The organisation also works within a number of equality incentives and has achieved accreditation for Investors in Diversity, White Ribbon and is a Disability Confident Employer. Quality has been a central theme and driver for change within many key government publications. As a provider of NHS funded care our approach to quality is framed within the NHS Health & Social Care Bill (2012) which brings together what staff, service users and members of the public can expect from healthcare organisations. In 2013 the public enquiry into the failings of Mid Staffordshire NHS Foundation Trust refocused the attention on the importance of maintaining high quality and safe care. The Berwick Report (2013) emphasised that every organisation must deliver a culture and commitment to ensure patient care is safe, effective and high quality and in 2014 NHS England published a Five Year Forward View confirming its commitment to safe, high quality care, irrespective of healthcare provider, seven days a week As a healthcare provider CHCP CIC must maintain its registration with the Care Quality Commission and ensure that Safe, Caring, Responsive, Effective and Well-led care is delivered to all who use our services. This strategy is applicable to all areas of CHCP CIC and adherence will be included in all contracts inclusive of those for outsourced or shared services. The overall aims of this strategy is to ensure that there is a robust quality governance framework in place which will assure the Board, key stakeholders, partners and external inspectors that the organisation is compliant with essential standards and levels of quality via a continuous improvement methodology. Our mission statement is simple: To grow a socially responsible commercial business that contributes to the wider wellbeing of the communities in which we provide services We have recently been advised that our application for NHS Employers Partnership Programme has been successful and we have been chosen to be a Diversity and Inclusion Partner for 2017/18. From which the high quality and safe services delivered are personally responsive, caring and inclusive of all And where people love to work

5 Definition of Quality Safe People are protected and safe from avoidable harm As a diverse organisation CHCP CIC recognises that quality can mean different things to different people. Safe People are protected from avoidable harm and abuse In 2008 Lord Darzi developed a single definition of quality for health services as part of his review High Quality Care for All Quality care is: Care that is safe Care that is clinically effective Care that provides the best possible experience for service users As of the 1st of April 2015 the Care Quality Commission (CQC) adopted Darzi s definition and added a further two domains to quality to create its five key lines of enquiry. Effective People s care, treatment and support achieves good outcomes, promotes a good quality of life and is evidence- based where possible Experience (Caring) We involve and treat people with compassion, kindness, dignity and respect Responsive Services are well structured and effective so that they meet people s needs Well-led Leadership, management & governance of the organisation assures the delivery of high quality person-centred care, support learning & innovation, promoting an open & fair culture CQC Quality Domains Effective Peoples care, treatment & support achieves good outcomes, promotes good quality of life & based on best available evidence We base our definition of quality on the CQC Fundamental Standards of Care Framework (2014) in recognition that the combination of performance in each of the domains determines the overall quality of the healthcare that we provide. Well Led Leadership, management and governance of the organisation assure the delivery of high quality person centred care, support learning and innovation and promote an open and fair culture Caring Staff involve & treat people with compassion, kindness, dignity & respect Responsive Services are well organised so that they meet peoples needs 08 09

6 Quality Objectives The Organisation has aligned its quality objectives to the five domains illustrated above which provide us with a clear framework to guide, monitor and measure our quality improvement activity. These quality objectives are threaded through to service level via our business and service development plans which supports the translation of the strategy into direct clinical care. Each year we will review our progress and redefine our targets to ensure that we are focused upon our identified priorities and the areas where improvement is most needed. Our priorities for quality improvement sit under the following headings; Service User Safety To improve service user safety and reduce avoidable harm. Strategic Quality Objectives City Health Care Partnership CIC (CHCP CIC) is an organisation that prides itself on the quality of the care and services that are delivered by our staff. The organisations strategic objectives state that we will; Put our customers and customer satisfaction at the heart of what we do Quality Domain Safe Quality Objective Action Outcome Measure To reduce avoidable harm across our services by 25% in 2017/18 in; Pressure Ulceration Medication Errors (defined when we signed up to Sign up To Safety ) To establish baseline through statistical analysis of collated safety data in respect of; Pressure Ulceration Medication Errors Measure - % reduction of 25% of avoidable harm 2017/18 Measure - % reduction of 15% of avoidable harm 2018/19 Measure - % reduction of 10% of avoidable harm 2019/20 Our goals are set out below under each of the five quality domains. The targets which support delivery of these goals have been developed for year one of the strategy ( ). Service User Experience To increase service user involvement in designing services. Clinical Effectiveness To ensure that clinicians receive, review and consider the best available evidence to support care delivery. Be an excellent provider of health care services Ensure we are able to compete in a competitive health care environment Be an employer of choice These objectives have quality embedded within them, and this Quality Strategy is produced to demonstrate both our commitment and the reality, that quality drives all that we do by setting out our definition, vision and the direction for quality improvement within the organisation. We have identified clear quality objectives against each of the 5 quality domains along with outcomes for measuring progress and improvement year on year. These are: To ensure all care plans are indicative of person centred care planning and record keeping inclusive of a full nursing assessment where appropriate Include person centred care planning as part of the Quality Matters 2 Programme Clinical record keeping to be a component of clinical supervision Measure - % of service users with a person centred care plan recorded within 24 hours of assessment Measure - Review clinical records indicate service user engagement Measure -% of clinical records where capacity to consent is documented 10 11

7 Quality Domain Effective Quality Domain Responsive Quality Objective Action Outcome Measure Quality Objective Action Outcome Measure To ensure all of our staff have the skills and competencies to deliver high quality, evidence based care based on; Mandatory training, Annual appraisal Clinical supervision Professional revalidation Service specific clinical competencies To ensure that service users receive the best possible evidence based care To implement a community health competency framework to demonstrate professional learning alongside further development of the Learning Academies Disseminate NICE standards across the organisation monthly Focus on evidence based care within service reviews Measure - % staff completing mandatory training % staff having an annual appraisal % staff accessing clinical supervision % professional staff successfully revalidating and registered to practice % of all clinical areas to produce competency framework for all clinical staff Measure - % of services that receive and acknowledge receipt of NICE guidance Measure - % of services that demonstrate implementation of NICE guidance To ensure that all service specified response time To give all service users every opportunity to feedback their experience of care within our services Quarterly review and monitoring of performance indicators To reintroduce the comments cards for all services Complete annual patient survey Continue to monitor the 4Cs Continue to Capture the Family & Friends Test To provide opportunities for service user feedback as part of our evaluation methodologies Measure - % of performance indicators achieved Measure - % of comments cards received Produce action plan to respond to findings Publish findings from above in the annual Quality Accounts Service reports and plans demonstrate service user inclusivity Qualitative analysis of service review findings presented in service specific reports 12 12

8 Quality Domain Caring Quality Domain Well Led Quality Objective Action Outcome Measure Quality Objective Action Outcome Measure To ensure that all clinical staff adhere to their code of professionalism are registered appropriately and validate successfully as required Discuss code application at the Francis 2 Steering group Develop and implement action plan in accordance with Francis 2 response Measure - % of successful revalidation submissions for registered staff To be open and honest when things go wrong and work with our patients and staff to continually improve our services To ensure Duty of Candour principles are considered within our response to incidents % of Duty of Candour disclosures are made to service users Staff are caring and compassionate in all of their contacts with service users, families/carers, peers and visitors Capture incidents that report issue around staff attitude Measure - % of incidents reported around staff attitude To demonstrate learning from incidents and complaints To continue to regularly present Lessons Learnt at the full company business meeting Ensure learning for incidents is disseminated across the organisation Measure - % of team action notes and minutes that demonstrate incident learning is a standing agenda item Ensure that we maintain and retain our Investors in People GOLD award ensuring that we are an organisation where people love to work Continue to monitor our performance against the Investors in People Gold standards Utilise the colleague survey to highlight personal/professional issues for the workforce. Develop action plans to address all issues To ensure that staff have a yearly Developmental Review to support both personal and professional development Measure - Investors in People Gold award retained Measure - 70% return rate to ensure a true reflection of staff moral and work/life balance Measure - 90% of staff will have a developmental review To ensure that systems and processes demonstrate assurance of high quality services To advance the Quality Improvement agenda through leadership and commitment at all levels Development and implementation of a refined quality dashboard to produce assurance at all levels To appoint a Quality Improvement lead for the organisation supported by Senior Clinicians Ensure that Quality Improvement is threaded through the Leadership Hub Introduce Quality Champions across the organisation Measure - 100% of dashboard use across the organisation Quality Improvement and Senior Clinicians recruited Review of curriculum demonstrates quality improvement inclusion Measure- % of teams able to identify a quality champion 14 15

9 Quality Improvement Priorities Every year we work with our Staff, Service Users, Partners and Key Stakeholders to identify annual quality priorities. The priorities are selected using a variety of information including; incidents, concerns, complaints, duty of candour declarations and internal performance measures as well as national initiatives, e.g. Sign Up To Safety Campaign. We have also included evidence based and national best practice guidance such as NICE to inform our decision making. We measure our progress against the quality priorities through a range of metrics and quality indicators which will be shared with all the staff via team meetings and the relevant safety and quality forums. The quality priorities for 2017/18 are; Safety We will promote safe staffing levels within the community teams and bedded areas across the organisation Indicators Patients feel involved in their care and there is evidence of patient centered care planning There is a reduction in community acquired pressure ulcers grade 3 or above There is a reduction in medication errors across the organisation Service User Experience Indicators Clinical Effectiveness Indicators Using a lessons learned approach we will explore the findings from investigations, service reviews and serious incidents and share beyond the team involved to improve the experience of our service users Explore innovative and new ways of sharing learning across the organisation All teams will be aware of upward trends and learn from issues that have arisen outside of their own service We will support staff to implement NICE quality standards with accessible user friendly guidelines, policies and standard operating procedures to enable the delivery of high quality evidence based care to our service users Systematic review of existing clinical guidelines to ensure that they are evidence based and support quality improvement in practice Clinical audits will be aligned to NICE Guidance Annual audit plans will evidence the changes in practice as a result of lessons learned All actions arising from NICE quality standards will be implemented within the agreed timescales 16 17

10 Commissioning for Quality Improvement Sign Up to Safety How It All Fits Together Incentive Schemes Through the contracts we hold for the delivery of services, commissioners have a range of incentives which are used to support the development of quality improvement and delivery of quality services. These indicators are agreed at the start of the contract year with reporting milestones throughout the rest of the financial year. The outcomes are focused on quality improvements the implementation of which is evidenced through quarterly reporting. Commissioning for Quality and Innovation (CQUIN) CQUINs were introduced in 2009 to make a proportion of provider s income conditional on demonstrating improvements in quality and innovation in specified areas of patient care. This means that a proportion of our income depends on achieving quality improvement and innovation goals, agreed between ourselves and our NHS commissioners. National CQUINs are developed across a range of areas for use by NHS commissioners and any applicable schemes can then be included in the CHCP contracts. Commissioners may also choose to develop local CQUINs should the national schemes not be applicable to organisations. Quality Incentive Schemes / Local Incentive Schemes These schemes are very similar to the CQUIN scheme in that proportion of our income is made dependant on achieving quality improvement and agreed milestones. The schemes are agreed locally between commissioners and ourselves and are usually based on the developments in services that commissioners and our organisation wish to put into practice. City Health Care Partnership has made a commitment to the NHS England Sign Up to Safety campaign with the aim of reducing avoidable harm across the organisation by 50% over the next 3 years. Our Quality Improvement priorities outline what we will do to reduce harm and save lives by working to reduce the cause of harm and adopt a preventative approach. The plan is linked to our quality priorities and central to this quality strategy with set priorities to improve the safety of service users year on year. The circle below (See Fig.1) has been developed to capture our governance process to ensure that improving quality is linked and flows right through from both the Executive Board, the Operation and Delivery Board, via various committees, groups and forums to facilitate the delivery of high quality, safe and effective Person Centred Care. The circle below demonstrates how it all fits together alternatively known as The Weave of our organisational quality improvement strategy. Fig. 1 The key aim of the CQUIN framework is to secure improvements in the quality of services and better outcomes for patients, carers, staff and the wider health economy

11 How We Measure Quality Improvement Measurement is a key component of assessing whether high quality care is being provided and quality improvement is supported. The Executive Board must be assured of the established organisational reporting structures and that associated quality improvement programmes are being supported and monitored across the care groups. A revised set of quality metrics is being introduced and incorporated into a quality dashboard report that will be reviewed at team, locality directorate and Executive Board level. The content of this dashboard will be agreed by the Safe Quality Services Committee with appropriate clinical engagement to ensure that the metrics are relevant and linked to our quality improvement priorities as outlined in the strategy. The report adopts an exception based approach and where exceptions or areas of concern are identified a more detailed report will be included. This approach will focus attention on the reason for the exception along with actions that have been taken to improve performance. Areas of good practice will also be reported as we recognise the importance of positive feedback to our colleagues. Exception reports will be produced at a team/service level and discussed at team meetings to ensure that a meaningful narrative is produced. CHCP CIC recognises that these metrics need to be meaningful to all staff and therefore we have linked them to internal and some national benchmarking where applicable. Longer term we are going to link with other Community Interest Companies to facilitate comparative assessments to be made and enable a proactive and inclusive approach to service delivery and quality improvement. The revised dashboard is linked to the CQC key lines of enquiry and will measure performance each month that includes; performance against national standards, indicators to demonstrate service user safety, clinical effectiveness, services that are caring via the 4Cs (Compliments, Comments, Concerns and Complaints) and Serious Incidents. We will monitor our risk ratings and support this with robust qualitative exception reporting. Comparisons with target levels of performance will also be included. The revised dashboard will also incorporate National and local commissioning incentives, external benchmarking exercises, research & Development metrics as well as other nationally reportable concerns. CHCP CIC recognises the significant value of learning that comes from advance warning indicators, serious incident reporting and patterns of complaints and incidents. These will all be incorporated into the dashboard and scrutinised for themes and trends which may be indicative of a decline in the quality of the service. The dashboard will be encircled by a suite of more granular reports including Safeguarding Report Incident Report 4Cs Report NICE Reports Central Alerting System (CAS) HR Reports Learning & Development Reports Infection Control Report Information Governance Report Data Quality Report The information held within the reports and our Quality Accounts will be monitored and reviewed via various Boards, Committees and Forums (See Fig.2); Quarterly Reports to the Executive Board Quarterly Reports to the Operations & Delivery Board stating progress against our quality priorities Quarterly Reports to the Safe Quality Services Committee Bi-Monthly Reports at the Safety & Quality Forum Fig. 2 Annual Quality Accounts Reports from unannounced and announced CQC Inspections Monitoring of 4Cs Speak Up Guardian referrals, Duty of Candour 20 21

12 Data Quality Assurance Data quality has a direct impact on health care. We recognise that high quality, safe service user care depends on good quality data. Poor quality data can disrupt funding, damage the reputation of organisations and individuals and lead to flawed clinical, administrative and planning decisions. Improving data quality improves patient care and enables the delivery of effective value for money services.. Data Quality is everyone s responsibility and is essential to maintain patient safety. We recognise that the combination of staff awareness, effective leadership, vigilance, good processes and verification procedures provides the framework needed to embed and instil a culture of high data quality within the organisation. CHCP CIC has a duty to ensure that the data it records is timely, accurate and up to date. This is to ensure compliance particularly with the Fourth Principle of the Data Protection Act Failure to record data accurately could lead to Enforcement Notices being placed on the organisation to amend inaccuracies or at worst face prosecution. Health care professionals have a Duty of Care demonstrated through their relevant codes of professional conduct and guidelines to ensure that their record keeping meets the minimum professional standards described within the guidelines. Information in the quality reports is constantly being reviewed to ensure that the data is clear and concise. The Data Quality Policy and Procedure has been reviewed and updated to formalise the organisations approach to data quality and describes the Data Quality Assurance Framework (DQAF) to be adopted, which includes: Assessment - assessing data against six key dimensions of; Accuracy Validity Reliability Timeliness Relevance Completeness Audit - the outcome of the data assessment will be used to inform the Data Quality Audit Plan (DQAP) Improvement following audit the recommended improvement actions will form part of the Data Quality Improvement Plan (DQIP) Reporting - The DQAF will be managed by the Business Intelligence Team reporting to the Information Governance Committee. The newly designed Executive Board Integrated Quality Dashboard will include the current data assessment rating to give board members assurance in relation to data quality. We already compare our performance against historical data and moving forward plan to benchmark ourselves against both national and external data. Inspections and Service Reviews Independent reviews on the implementation of CQC action plans are undertaken by the Head of Quality Improvement and Compliance and the Lead Practitioner for Quality Improvement assisted by other members of the Quality Team. The reviews are focused on ensuring that evidence of the implementation of actions exists, is available, that the actions are achieving the desired outcomes and are also embedded in practice. Follow up reviews and audits are also performed to further support areas which are not fully compliant and findings are reported to the Safe Quality Service Committee, whilst status of the live action plans is updated at the Board. Independent Service reviews are to be initiated following triangulation of the 4Cs and incidents. The reviews focus on the current service delivery, identify areas of good practice along with issues and gaps to ensure a holistic picture and are undertaken with team members and managers of the service. A report is compiled in conjunction with an action plan which is monitored through the Safe Quality Services Committee. Follow up audits are then completed to ensure that evidence of the implementation of actions exists and is available and that the actions are achieving the desired outcomes. This is also monitored through the Quality Improvement and Compliance team to ensure that incidents, comments, concerns and complaints are reducing. As well as the specific areas in the quality domains identified in this strategy, the performance of the organisation against national quality standards will be evidenced through our internal and external mechanisms such as the Quality Dashboard, performance against our Commissioning for Quality Improvement Schemes, outcomes of external inspections and effective and robust clinical governance systems including the management of risk

13 Quality Governance Clinical Services Annual Quality Audit Plan Identifying and Managing Key Risks to Quality The Operation and Delivery Board sets the culture and oversees the quality of care delivered across the organisation, seeking assurance that quality and positive health outcomes are being achieved. However we recognise that effective governance requires the Executive Board to give equal scrutiny and attention to the management of the organisations finances and resources. As an organisation we have a robust framework in place that complies with national guidance and offers assurance to our shareholders, staff, public, commissioners and stakeholders of our ability to monitor quality and the performance of our services. The governance and Performance structure has been thoroughly revised and refreshed with clear Executive and Non-Executive Director (NED) roles and responsibilities. Membership of the board was reviewed in 2017 to improve the level of challenge inclusive of the appointment of an Executive Nurse. Clinical Audit is fundamentally a quality improvement process and is used to provide a level of assurance about the quality of services delivered within the organisation. Clinical audit has a high profile within healthcare sectors and links to many initiatives such as CQUINS and NHSLA requirements. In addition to the corporate quality objectives the following clinical audit programmes form the main basis of clinical services annual quality audit plan; Quality standards related to the whole organisation e.g. Quality Matters 2 Programme (QMP) Requirements to meet external standards e.g. National Institute of Care Excellence (NICE) which are produced throughout the year Any priorities highlighted by regulatory bodies during the preceding year e.g. Care Quality Commission (CQC) Requirements to meet quality tariffs Infection Control Audits Safeguarding Audits Alongside the quality improvement programme CHCP CIC have also refreshed and reviewed our risk management strategy. The organisation has a systematic approach to risk management that ensures the identification and escalation of both operational and strategic risk via a risk register. The risk register identifies the key risks that may disrupt or prevent CHCP CIC from achieving our strategic and quality goals and objectives. The risk register is owned by the care group directors and monitored by the Executive Board via quarterly reports. The Board receives a quarterly risk management report on the highest scoring risks (i.e. 15 or above) affecting the delivery of the organisation s objectives. The Operation & Delivery Board receive reports to inform them of the distribution of risk across the organisation, significant changes to the risk profile and progress against action plans. The care group safety and quality forums receive a risk report specific to the services they are responsible for with a narrative that will cover the risk source, description, current risk, main controls an date for review. The risks are owned by the relevant director and are subject to regular review by the Quality Improvement and Compliance Team. Monitoring the Quality Strategy Each year we will review our progress and redefine our targets to ensure that we are focused upon our identified priorities and the areas where improvement is most needed taking into account significant change in national guidance or requirements. Monitoring of application of the strategy will be undertaken annually by external auditors to capture compliance and outcomes measurements. Communicating the Quality Improvement Strategy As an organisation we are extremely diverse (See Fig.3 - page 24) and cover a large geographical area across the whole of Hull and the East Riding. We have also been successful in securing contracts to deliver services in the North West of the country including Knowsley, Wigan and St Helens. This Quality Strategy will be regularly monitored and reviewed to reflect any significant change to national guidance, policy and contractual requirements. The overall aim of the strategy is to help all staff whatever the discipline, role or responsibility understand what excellent quality looks like and to continually reinforce their learning and knowledge in the key area of quality improvement, establishing a robust ethos for quality improvement within CHCP CIC. We will produce an annual quality communication plan developed to support the successful achievement of the quality priorities. Quality Matters will be introduced as a newsletter and published whenever we are sharing information or embarking on quality improvement initiatives to assist staff in making the connection between quality and their everyday practice. The strategy will also be available to all staff via the intranet and be regularly reviewed at team meetings

14 Fig. 3 National Guidance and Legislation Informing CHCP CIC s Quality Strategy The Healthy NHS Board 2013 principles for good governance (NHS Leadership Academy) Recognises the NHS organisations duty to secure continuous improvement of quality that is the responsibility of the board The NHS Outcomes Framework sets out to drive up quality throughout the NHS by encouraging a change in culture and behaviour focussed on health outcomes not process The Mid Staffordshire NHS Foundation Trust Public Enquiry: Robert Francis QC (Feb 2013) Review into the quality of care and treatment provided by 14 Hospital Trusts in England: Professor Sir Bruce Keogh KBE (July2013) A Promise to Learn, A Commitment to Act: Improving the safety of patients in England: Don Berwick (August 2013) Compassion in Practice (January 2013) saw the launch of the Chief Nursing Officer s vision for nursing underpinned by six fundamental values: care, compassion, competence, communication, courage and commitment (6Cs ) to support professionals and care staff to deliver excellent care The report of the Morecombe Bay Investigation by Dr Kirkup published 3rd March 2015; an independent investigation into maternity and neonatal services in Morecombe Bay makes far reaching recommendations to prevent future unnecessary deaths with 18 recommendations for the Trust and 26 for the NHS CQC Regulation 5 Fit and Proper Persons directors- to ensure that people who have director level responsibility for the quality and safety of care, and for meeting the fundamental standards are fit and proper to carry out the role and Regulation 20, Statutory Duty of Candour for health and adult social care providers ( November 2014 ). Providers will have to demonstrate that they are open and transparent with service users about their care and treatment, including when things go wrong Freedom to Speak Up review ( March 2015) Sir Robert Francis set out 20 Principles and Actions which aim to create the right conditions for NHS staff to speak up, share what works right across the NHS and get all organisations up to the standard of the best and provide redress when things go wrong in the future CQC Fundamental Standards of Care April 2015 replace the 2010 Regulations and are in response to the Second Francis Report into the events in Mid Staffordshire. This dovetails with the requirement in the Health and Social Care (Quality and Safety) Act 2015 which requires the Secretary of State to make any regulations considered necessary to secure that services cause no avoidable harm to those that use them 26 27

15 Contacts City Health Care Partnership CIC 5 Beacon Way Hull HU3 4AE Telephone City Health Care Partnership CIC is an independent for better profit and co-owned Community Interest Company responsible for providing local health and social care services. Registered in England No: