Sustainable & Accessible Services. Strong Partnerships X X X

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1 SUMMARY REPORT ABM University Health Board Quality and Safety Committee Date of Meeting: 23 rd February 2017 Agenda item: 5.1 Report Title Prepared by Approved and Presented by ABMU Older Persons Assurance Framework Update Amanda Hall, Interim Director of Therapies and Health Science Christine Morrell, Director of Therapies and Health Science Purpose To provide an update, interim reporting arrangements and proposed assurance plan. Corporate Objectives Healthier Communities Executive Summary Excellent Patient Outcomes & Experiences Sustainable & Accessible Services Strong Partnerships Decision Approval Information Other Fully Engaged & Skilled Workforce X X Effective Governance X X X The Health Board s Older Persons Assurance Framework is currently undergoing a major overhaul with a number of new features being incorporated. This paper outlines the key elements of the new Framework and provides an update as to progress made with this to date. Key Recommendations The Quality and Safety Committee note the progress made in relation to providing assurance. Assurance Framework Quality and Safety Committee Next Steps To finalise the development of the Older Persons Assurance Framework 1

2 MAIN REPORT ABM University Health Board Health Board Date of Meeting:23 rd February 2017 Agenda item :5.1 Subject Prepared by Approved and Presented by Development of ABMU Older Persons Assurance Framework Amanda Hall, Interim Director of Therapies and Health Science Christine Morrell, Director of Therapies and Health Science PURPOSE The purpose of this Report is to provide an update with regard to the development of an Assurance Framework regarding ABMU wide Older Person s care. KEY ISSUES ABMU Health Board is committed to improving the quality and care for older people across all areas. As described in an earlier report, there is a lack of cohesion and accuracy in regard to aligning quality, practice and service data. Previous data sets have often been high level and gleaned from a variety of sources and lack Unit specificity which leads to a disjoint in the system to learn from feedback and put things right. Therefore, we are developing a bespoke Older Persons Governance Framework and Charter for Older People, which will assist in generating measurable and meaningful outcomes and assurance. As reported at the previous meeting it is expedient to develop an assurance framework to ensure we focus on: Gathering and aligning appropriate data against meaningful measures Measures which have internal and face validity (rather than proxy measures wherever possible) Incorporating the 12 standards set by the Wales Commissioner for Older People alongside our extant Trusted to Care standards Learning and building on the Comprehensive Ward Assurance Review Pilot to include the revised Ideal Ward Toolkit and explore its specific applicability to older people Improving Patient Experience Reporting and capturing patient narrative especially when things go wrong Ensuring we focus on the whole system (e.g. to include the Review of the Mental Health and Learning Disabilities Unit) ABMU Older Persons Assurance Framework Background This was reported in detail at the previous committee meeting. Developing the Ward Assurance Toolkit and Assurance Model

3 The latest new development in the generic governance framework is a cohesive Ward Assurance model for ABMU, which is being piloted in the first instance at Morriston Delivery Unit where the approach and process, which started in November 2016 for a 3-month period, is being tested. The Pilot is currently testing the Ward Assurance Toolkit in an Electronic Format (Excel Programme) and electronic tablet devices. Once the data format contained within the Toolkit is tested and agreed, it is anticipated that it will be transferred into an electronic application written by our in house Information Technology Dept, which will be compatible with the Electronic Nursing Assessment (currently being developed in-house). Implications regarding additional resources will also be evaluated and it is predicted at this stage that we will need additional resources to gather, manage and analyse the data with IT systems in place to ease the process. Although limited in its scope due to winter hospital pressures this project has shown promising results. It is planned that all wards across ABMU will have one comprehensive review undertaken by a multi-disciplinary team (MDT) on an annual basis by the Delivery Unit using the revised Ideal ward toolkit, which has now been aligned to our Values, the Nursing and Midwifery (NMC) Code of Conduct, Health & Care Standards Themes and also incorporates the Older Persons Standards in addition to the requirements of the Older Person s Commissioner. The key features of this integrated approach are as follows: A report highlighting key findings and actions will be reported by each delivery unit at the Quality and Safety Forum on a quarterly basis For Planned Visits notice will be given to the areas prior to the review and intelligence information will be gathered to inform the team, this will include HCS annual audit, monthly care indicators, performance data, workforce data, complaints and incidents A comprehensive review may also be commissioned and will be undertaken without prior notice by a corporate MDT team for those wards/ units demonstrating poor compliance across a substantial number of indicators in the Intelligence Bundle, a threshold is to be agreed. The 15 step challenge will continue to be undertaken by members of Quality and Safety Committee to determine progress against these standards. Recognition of exceptional achievement will be facilitated via the Chairman's Awards. Unannounced Spot Check Reviews (e.g. Safe Care) will be undertaken by the Delivery Units where the ward is demonstrating poor compliance against specific Themes & Standards over a three-month period where no improvement has been made. A minimum of two unannounced spot checks are expected to be undertaken per month. The revised Quality Assurance Ideal Ward /Team Tool Kit has been developed to be utilised to provide a fully comprehensive audit ( a deep dive ) or can be broken down into single units to provide assurance of improvements where areas of concern are identified (i.e. Safe Care, Dignified Care). We have now formalised that an audit using the new Toolkit should be conducted to measure standards, and feedback provided to the chosen wards, with an aim to provide healthcare staff with information to allow them to assess and adjust their performance.

4 We are currently in the process of refining reporting arrangements which are meaningfully aligned to our Standards, have internal validity and provide best evidence of safe practice. In addition, we have begun the process of separating out the data which has been generic in the past to ensure we are tapping into older peoples experience and to increase the strength of our analysis we have extended the data collection to those above 50 (in keeping with the Welsh Government definition of the older person). We hope to delineate the data and the analyses in accordance with age bands above 50 (60+/70+/80+/90+). We are currently testing this facility to ensure accuracy. Developing the Older Persons Assurance Framework Following the re-organisation of the Health Board into Unit Structures we are in the process of developing an Older Persons Framework Group to ensure that we oversee the management of the care of the Older Person across the Health Board. We have reviewed and revised the Clinical Sub Groups to represent the new Unit structures to include: Dementia Falls Continence Nutrition Tissue Viability End of Life Care These newly re-constituted groups, which meet regularly, are setting the strategic direction, policy development and implementation and ensuring best practice and cohesive service models across the whole system. The Units are currently in the process of creating effective structures to oversee and manage the Older Persons agenda and will report to the above sub groups on a regular basis. There is likely to be revised metrics for measurement of the above elements of care (e.g. severity of fall) following the implementation of the Nurse Staffing (Wales) Act 2016, which will be incorporated into the framework. These reformed and revised groups have new Terms of Reference and refreshed visions and strategic directions aligned to the priorities of the Health Board and national directives. Each group will have the responsibility of overseeing implementation on both a pan Health Board and individual Unit basis and will report directly on the Older Persons standards on a regular basis to either the Quality and Safety Forum or the Quality and Safety Committee. Patient Experience Feedback We are taking into account the developments and impact the Health Board review of Volunteering and the implementation of Ward Hostesses will have on data gathering, patient experience and qualitative measurement of patient feedback. We are revising the internal volunteering vision and aligning it to priorities within the Health Board which will include gathering data directly from patients using the Friends and Family test. We are in the early stages of developing a monthly audit day starting with Singleton Hospital to ensure that we target older patients on our wards on a systematic basis we will also build in the gathering of qualitative data and narrative as per the Older Person Commissioner for Wales requirements.

5 The next phase of our older persons experience feedback initiative is to use incidents and complaints in a systematic manner to triangulate the information we glean from data sources. The Older Persons Charter To strengthen our commitment to being a Rights-Based Health Board we are currently developing the Older Persons Charter. We launched this initiative at a Changing for the Better event on the 8 th December with 200 people in attendance. Following this event we held 4 locality based stakeholder events and have a few smaller events organised during February we are in the process of collating the engagement event comments and creating the Charter. Once ratified and launched the Charter will guide us in our service delivery and create a greater senses of what is important to the people we treat we will then be held accountable as a Health Board and formal outcome measures will be agreed as to how to evaluate success. The Older Persons Dashboard We have reviewed the Older Persons Dashboard and have aligned the KPIs against the standards in a more meaningful and robust way. We have systematically removed a number of the KPIs and have added new ones where appropriate. Our greatest challenge as a Health Board is patient engagement numbers and data sourcing. We are hoping to address the former by lowering the age limit to 50 and by conducting monthly feedback audits as previously described. Whilst the latter is complicated because we have a range of data sources to manage: SNAP11 Datix Health and Care Standards audit Myrddin Patient Experience feedback CHKS Mortality Reviews Stage 1 Therefore it is an imperative to improve the data source against the standard being evaluated and to date we are testing the face and internal validity of the newly refined dashboard. Closing comments Pulling this together we will then align all the components of the aforementioned with the key performance indicators and standards and measurement changes into a revised reporting arrangement for the Quality and Safety Committee with a refined dashboard which captures higher acuity validated data. This process should be finalised with full reporting arrangements agreed by June 2017 and it is envisaged that the new reporting system will be in place and ready to be presented in its new format to the Quality and Safety Committee in August In the interim the Committee will receive regular updates as to progress of this phased development and implementation of the Older Persons Assurance system. RECOMMENDATIONS The Quality and Safety Committee note the above developmental assurance plan

6 and timeline update and approve the interim arrangements.