Supplementary Schedule: Improve Quality This schedule provides additional commentary on the Improve Quality section to the Performance Analysis report An essential part of our role is to make sure that health services provided in Camden are safe, effective, well led, responsive and uphold the Health and Social Care Act 2012. Our commissioning draws on strong clinical understanding, is evidence-based and focused on the principles of quality improvement, measurement, monitoring and reduction in variation. Our culture has been one of working with our statutory partners and providers on quality improvement, which has included local medicines management outcomes and the delivery of safeguarding children and vulnerable adults. The CCG gains its assurance on quality of care at its Quality and Safety Committee; the QSC s forward planner accommodates the forthcoming 12 months of agenda items that includes: Reports on health (NHS and Independent) and care Providers triangulated from the discussions at regular clinical quality review group meetings (CQRGs), patient and public feedback through received directly and from NHS Choices, quality alerts from GP practices and safeguarding referrals. Reports relating to Looked after Children, safeguarding children and safeguarding adults. Focused reports on, for example, Serious Incidents, maternity, and locally commissioned services. Directorate Risk register CQRGs are held regularly with those Trusts for whom the CCG is a lead commissioner with a 12 month forward planner agreed with the respective Providers. Agenda items cover the 3 domains represented in quality oversight patient safety, clinical effectiveness and patient experience. The CCG is also represented at CQRGs where Camden is a substantive associate commissioner. Examples of collaborative working between the CCG and UCLH (University College London Hospital NHS FT) during 2017-18 which have led to quality improvements includes the timely investigation and quality of root cause analysis reports of serious incidents (SIs). The improvement is evident in the SI key performance metrics and the Trust wide learning communicated to staff in the Trust s Quality and Safety News Bulletin. Another area of focus was the improvement in the Trust s SSNAP (Sentinel Stroke National Audit Programme) results, and the CCG gained assurance through an annual quality visit of the Hyper acute Stroke Unit (HASU) and Stroke Unit (SU). UCLH has achieved one of the best door to needle time to receive thrombolysis. The Trust worked with the CQRG patient representative to build a patient experience report that provides triangulation of complaints, patient family and friends test (FFT), staff FFT and feedback received on NHS Choices, local and national surveys and Volunteers. This has allowed the Trust to identify specific issues to target and improve rather than considering aspects of patient experience in isolation. Similar joint working with the Medicines Management Team has resulted in the Trust achieving its antimicrobial CQUIN (commissioning for quality and innovation) targets. Throughout the year there has been an integrated approach to managing avoidable harm related to managing pressure ulcers, an area targeted by our community services provider Central and Northwest London (CNWL). CCG quality and clinical effectiveness (QCE) staff are a member of the CNWL pressure ulcer board supporting development of mechanisms for involving and empowering patients and their Carers in managing and preventing pressure ulcers. This involved personalised care planning, structured education and training, and access to specialised advice. Progress was reported at CQRG and included how the learning

from these incidents is shared with key stakeholders across the health and social care Providers. Tavistock and Portman NHS FT (T&P) required improvement in embedding its Living Well CQUIN. Working in partnership with the CCG QCE staff the Trust achieved the CQUIN; the positive impact on staff and service users is evident in the feedback provided by both groups, and also by the physical health nurse responsible for delivering the programme. The Trust regained its focus on the management of serious incidents after the issuing of a contract performance notice issued in response to the continuous failure to achieve the required level of quality and timeliness of investigation of these incidents. The CCG s designated professional for safeguarding adults has supported T&P to enable the Trust to achieve 85% for its Workshop to Raise Awareness of Prevent (WRAP). This is an important milestone for the Trust to achieve in its patient cohort. The CCG continues to work with colleagues in Camden Council, to support the quality and safety of services commissioned across Care Homes and Domiciliary Care. The CCG QCE staff and Camden Local Authority (LA) commissioning team have undertaken joint visits to Care Homes to gain assurance on the quality of care. This has resulted in identifying aspects of care that requires improvement, and we will are currently scoping regular Provider forums where QCE staff will target quality improvements such as safe and secure handling of medicines, preventing and managing pressure ulcers, falls prevention, and managing incidents. The teams from the LA will target case management and safeguarding, including improved understanding of deprivation of liberty (DoLs) and mental capacity act (MCA) assessments. In its first year of undertaking delegated co-commissioning of primary care, the CCG QCE and Primary Care teams with NHS England s team have visited GP practices to gain assurance on quality of care and support practices in planning quality improvements. The effective relationship with GP practices and the CCG s medicines management team (MMT) is evident in the achievement of clinically effective and cost efficient prescribing. The CCG continues to achieve one of the best antimicrobial resistance performance.