Lincolnshire Partnership NHS Foundation Trust Draft Quality Strategy 2017 2019
Contents 1 Introduction...3 2 The Trust Who we are and what we do...4 3 LPFT The Big Picture...5 4 Annual Quality Priorities...6 4.1 Continuous Quality Improvement...7 5 The Quality Agenda National Context...7 6 Roles and Responsibilities...8 7 Strategy Implementation, Monitoring and Assurance...9 2 P a g e
1 Introduction Lincolnshire Partnership NHS Foundation Trust (the Trust) is passionately committed to improving quality and safety, recognising the importance of being able to evidence this by positive outcomes and continuously improving services. The Quality Strategy explains what we are doing to improve services for patients/service users, carers and families. It is one of the ways the organisation ensures that there is a proper focus on continuous development and improvement of our services. It forms part of a series of plans which allow the Trust to demonstrate it is accountable and governed well. It is produced and informed by consultation with Trust employees, patients/service users, carers and key stakeholders. This strategy can only be achieved by working in partnership with service users/patients, carers, staff, governors and key partners to secure the delivery of the highest standards of patient safety, patient experience and clinical effectiveness. The Trust recognises that the services will only ever be as good as the dedicated and skilled workforce employed and invested in. We are committed to ensuring every staff member is supported to achieve their very best, to feel valued and involved and to be themselves inclusive of the protected characteristics of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sexual orientation and sex (Equality Act 2010). 3 P a g e
2 The Trust Who we are and what we do Our community services are based in Boston, Gainsborough, Grantham, Lincoln, Louth, Skegness, Sleaford, Spalding and Stamford. Inpatient services are primarily based in the three major conurbations of Boston, Grantham and Lincoln. There is also a county-wide inpatient unit for the child and adolescent mental health service (CAMHS) in Sleaford. Adult community mental health division Adult community mental health steps2change (improving access to psychological therapies) Recovery College Volunteers Section 75: including direct social care Best interest assessors Complex and forensic community mental health services Psychology Eating disorders Specialist psychology Perinatal services Adult mental health inpatient division Single point of access (SPA) Acute inpatient wards Crisis resolution and home treatment Mental health triage car Sexual assault referral centre (SARC) Independent sexual violence adviser (ISVA) Mental health rehabilitation Low secure mental health inpatient unit Section 136 suite Ministry of Defence and veteran services Pan Trust Community support networks Pharmacy support Specialist services division Learning disabilities Community child and adolescent mental health services (CAMHS) CAMHS inpatient unit Lincolnshire young person s secure unit (LSU) Older adult mental health division Community and inpatient services for people with dementia Specialist older adult community and inpatient Mental health hospital liaison Neuropsychology Psycho-Oncology Chronic fatigue syndrome/me 4 P a g e
3 LPFT The Big Picture The Trust has determined a set of key working principles as set out in its purpose, vision and core values. These underpin everything that the Trust does in order to support the quality of care provided. The quality strategy defines the Trust s ambition for the delivery of improving service quality. Key Facts about the Trust: 5 P a g e
4 Annual Quality Priorities Each year the Trust Board agrees a set of quality priorities for delivery. These priorities are selected taking into account a number of information sources including but not limited to: Patient/service user, carer, governor and staff feedback Department of Health national priorities CQC feedback from visits National surveys including patient and staff experience Reporting requirements of national bodies such as NHSI Commissioners requirements and feedback Equality Delivery System 2 Healthwatch Lincolnshire feedback Serious incidents, complaints, coroner and serious case review feedback (local and national) In determining the priorities the Trust Board seeks to ensure that the organisation continues to stretch and strengthen its delivery of high quality and safe services. The priorities are subject to close monitoring throughout the year. The following priorities have been agreed for 2017-19. For each of the priorities identified the Trust sets out targets which provide a measure of success. Patient Safety Patient Experience Quality Priority Q1. Physical Health for people with Severe Mental Illness Q2. Improved ligature risk assessment, management and understanding for inpatient areas. Q3. Improving services for people with Mental Health needs who present to A and E Q4. Ensure the overall experience of patients/service users, carers and staff is positive and consistent across all Trust services Why it is important This priority builds on previous work to improve physical health care for people with severe mental illness (SMI) in order to reduce premature mortality in this patient group. Collaborative working with partner agencies supported by Neighbourhood Teams will ensure parity of esteem for this patient group. This priority supports the ongoing work of LPFT in the reduction and management of ligature risks for our patients. It will ensure that concerns raised during the comprehensive CQC inspection (December 2015) remain a high priority for LPFT and levels of safety are improved. The identification and management of both fixed and unfixed ligatures in our inpatient areas enhances the methodology and culture of safe and responsive services. This priority seeks to build upon the progress made during 2016/17 as a local CQUIN. Working together with partners to ensure that people presenting at A and E with primary or secondary mental health needs have these needs met more effectively through an improved, integrated service offer. The prevention and early intervention for patients in mental health crisis reduces unnecessary hospital admissions and out of area placements. Patients and carers need to be valued and respected, listened to and communicated with effectively with information in accessible formats. Staff engagement is a measure of employees emotional attachment to their job, colleagues and organisation which influences their experience at work and their willingness to learn and develop. 6 P a g e
Clinical Effectiveness Q5. Develop and implement a robust Quality Improvement methodology. Q6. Preventing ill health caused by the use of alcohol and tobacco Establishing a Quality Improvement methodology promotes a culture which is led collaboratively by front line employees and patients will ensure that sound improvements are identified and made where they are needed, when they are needed and by those who can own and influence the change. This priority seeks to help deliver on the objectives set out in the Five Year Forward View (5YFV), particularly around the need for a radical upgrade in prevention and to incentivising and supporting healthier behaviour. 4.1 Continuous Quality Improvement The Trust s Quality Improvement Plan (QIP) focusses upon key national and local priorities, taking account of the Sustainability and Transformation Plan (STP), the Mental Health Five Year Forward View and the Trust s comprehensive CQC inspection (November/December 2015) findings. The improvements will be driven by the most appropriate service areas and individuals, and wherever possible collaboratively with patients, carers and other key stakeholders. Priorities will include achieving sustained quality improvements to key areas, such as serious incident investigations and subsequent learning, same sex accommodation, medication management and assessment and management of ligature risks. Increased investment has also been agreed to expand Early Intervention services and LPFT is actively working with commissioners and other providers to increase access to psychological therapies. This plan is taken down to an operational level for individual services to confirm their role in the delivery of the priorities, and also to personalise the elements which are of key importance to improving their services. These plans are led by the Divisional Management Teams and provide the opportunities for the services to receive input from their service users/patients and carers. Achievement of the quality priorities outlined above will be central to the overall improvement of quality outcomes for those accessing services in 2017/18 and 2018/19. Progress and assurance will continue to be monitored through the Trust s quality governance framework. 5 The Quality Agenda National Context Over the years there have been a number of key national documents published which provide NHS Trusts with guidance on where priorities should be set. Some of the documents which are specific to the work of this Trust and to the quality agenda are detailed as follows. NHS Next Stage Review, Department of Health 2008. This document provided an accepted definition of quality as set out by Lord Darzi, and subsequently used in the Health and Social Care Act 2012. It clearly states that quality is made up of three domains: patient safety, patient experience and clinical effectiveness. As the economic landscape continues to challenge the resources available to the NHS it is important to note that the quality agenda is required to be delivered within available resources. Also published in 2008 the document High Quality Care for All (Department of Health) identified the seven steps to delivering quality as: 1 bring clarity to quality 2 measure quality 3 publish quality performance 4 recognise and reward quality performance 7 P a g e
5 provide leadership for quality 6 safeguard quality 7 stay ahead These steps have been adopted into the work of NHS Trusts nationally, and provide an additional focus for ensuring that quality improvements, such as those set out on the Trust Continuous Quality Improvement Plan are clearly stated, measured and evidenced. The Trust needs to ensure that it keeps up to date on any improvements and learning from national independent investigations and services reviews such as: Winterbourne View Time for Change, Transformation Care and Commissioning Steering Group, chaired by Sir Stephen Bubb 2014. This report has a focus on transforming the commission of services for people with learning disabilities and/or autism. Independent investigations into homicides (sometimes referred to as mental health homicide reviews) were the purpose is to review thoroughly the care and treatment received by the patient. The NHS Outcomes Framework is published by the Department of Health on an annual basis and sets out clear indicators and improvement areas against the following five domains: Domain 1: preventing people from dying prematurely Domain 2: enhancing quality of life for people with long-term conditions Domain 3: helping people to recover from episode of ill health or following injury Domain 4: ensuring that people have a positive experience of care Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm National Quality Regulation - regulation of the quality of health care services has risen to the top of the health agenda following the publication of Robert Francis s final report on the failings at Mid Staffordshire NHS Foundation Trust and the subsequent Keogh and Berwick reports. The Care Quality Commission (CQC) the independent regulator of health and adult social care in England changed to the way it works and started a new approach to inspection. The CQC uses professional judgement, supported by objective measures and evidence to assess services against their five key questions: Are they safe? Are they effective? Are they caring? Are they responsive to people s needs? Are they well-led? 6 Roles and Responsibilities The Chief Executive will ensure staff adherence to legislation, guidance and policy, through appropriate management chains. The Director of Nursing and Quality has a multi-faceted responsibility for quality: Director lead for patient safety which includes acting as the lead director for the management of incidents and complaints and ensuring that the Trust responds in timely manner, maximising opportunities for improvement and learning. Director lead for quality. The Board of Directors have the responsibility for ensuring that the services they are responsible for are delivered in line with the quality requirements and strategy of the organisation The Quality Committee, as a formal sub committee of the Board of Directors, has been established to: shape quality improvement, culture and organisational development within the Trust, and to provide assurance to the Board that appropriate and effective governance mechanisms are in place for all aspects of quality including patient experience, health outcomes and compliance with national, regional and local requirements. A full breakdown of the responsibilities for the Committee are detailed in the Committee Terms of Reference. 8 P a g e
The Divisional Management Teams are responsible for determining the quality work streams within their operational areas, development and delivery of work plans, and providing assurance to the quality team, trust committees and commissioners. The Head of Quality and Safety is responsible for seeking assurance of delivery from the operational/divisional and corporate teams and providing reports as required to the Trust Committees, Board and Commissioners. 7 Strategy Implementation, Monitoring and Assurance It is critical that the Trust enables and provides monitoring information on delivery of the quality strategy. There are three key forums which provide the opportunity to confirm and challenge the information being presented, whether it is robust and achieving the delivery of the quality priorities. These forums are: The Trust Patient Safety and Experience Committee (reports to the Trust s Quality Committee); The Trust Quality Committee (formal sub-committee of the Trust Board); and The Quality Review Meeting held between the Trust and lead commissioners The quality priorities form part of the annual Quality Report which is published on the Trust website. The Continuous Quality Improvement Plan provides a centralised and shared plan for the actions determined as key to the delivery to the Trust quality priorities. 9 P a g e