WIGAN CQUINs 2016-17 March 2017 All CQUINs on track and green except uptake of flu vaccine CQUIN which is red as did not meet the target of 75% Borough Wigan National CQUIN1a Introduction of health and wellbeing initiatives Option A Achieving a 5 percentage point improvement in each of the 3 staff survey questions on health and wellbeing, MSK and stress. Providers will be expected to achieve an improvement of 5% compared to 2015 staff survey results for each of the three questions in the NHS Annual Staff survey outlined below. 1. Question 9a: Does your organisation take positive action on health and wellbeing? Yes, definitely/ Yes, to some extent/ No response. 2. Question 9b: In the last 12 months have you Paula Woods Question 9a there was a 6% improvement Question 9b there was an 8% improvement Question 9c there was a 6% improvement
experienced musculoskeletal problems (MSK) as a result of work activities? Yes/No response. Question 9c: During the last 12 months have you felt unwell as a result of work related stress? Yes/No response Wigan National CQUIN 1b Healthy food for NHS staff, visitors and patients N/A Bridgewater to submit nil return N/A Wigan National CQUIN 1c Improving the uptake of flu vaccinations for front line staff within Providers Improving the uptake of flu vaccinations for frontline clinical staff Achieving an uptake of flu vaccinations by frontline clinical staff of 75% Number of front line healthcare workers (permanent staff and those on fixed contracts) who have received their flu vaccination by December 31 2016 Peter Morgan Bridgewater wide scheme Vaccine available from October 2016, vaccination continued throughout the flu season. Achievement of the CQUIN to be based on percentage achieved by the end of December 2016. Target of 75% was not met. Vaccination rate achieved was 50% which was an improvement on 2015-16 of 39.41% Wigan Learning Disabilities: Enhancing Increased signposting of annual health checks by Community Learning Disability Teams (CLDT) for Ian Spur/Miche lle Heyes GP Practices provide Annual Health Checks for adults with Learning Disabilities. Routine health checks lead to the early identification
Access to Health Checks & Health Action Plans: people with learning disabilities Increased number of health action plans developed for people with a learning disability who have had an annual health check of health issues and support early treatment, improving outcomes and quality of life. This CQUIN encourages community providers to increase awareness and promote take-up of these checks in targeted GP practices. This CQUIN was designed to support GP practices through: Awareness raising sessions Bespoke education package ( ie tailored to what GP practice requires based on their request/ knowledge of the team ) Mechanisms to support with DNA rates A total of 12 training sessions were delivered to General Practice Staff covering Learning Disability awareness, supporting access to Annual Health Checks, Health Action Plans and The Mental Capacity Act, supporting decision making. A total of 187 Practice staff attended the sessions and a post training evaluation identified a satisfaction rate of between 98-100% Wigan Transition years in Learning Disabilities Raising awareness of the needs of young people with learning difficulties or disability to support transition between children's and Gail Mann Safety for young people with Learning Disability goes hand in hand with how comfortable and confident they feel with all aspects of accessing adult services. This
adult health services. includes how well they are prepared, supported to understand and supported to reduce their anxiety levels. This project has involved implementing activities which have: 1. Helped those delivering health care to adults, and especially younger adults with Learning Disability, to understand the concerns and challenges for young people and families and are encouraged to make reasonable adjustments to support them. This has included promoting a film created in partnership with young people with LD in Wigan which includes their recommendations for health professionals. Wigan Improving access to Adult Social Care Targeted Early Improving access to targeted early intervention and prevention and health improvement services for those attending district nursing Anne Finney Supported preparation for the transition to adult health services, including hospital preparation tours and promotion of Annual Health Checks and the value of Health Action Plans The aim of this CQUIN was to improve the signposting of patients into the Adult Social Care Targeted Early Interventions and Preventions Health Improvement Service by
Intervention and Prevention and Health Improvement Services treatment rooms through identification of need and referral on. District Nursing (DN). Focusing on DN staff working in a treatment room setting, a targeted training session was developed and delivered to raise awareness of early intervention services. As a result staff are now actively promoting the early intervention services and supporting referral. There has been an increase between Q3 and Q4 of approximately 50% against the following numerators with the exception of referral to community link workers which saw and increase of 98%: The number of people who have been assessed for Early Interventions and Prevention and Health Improvement Services The number of people who would benefit for referral into Early Intervention and Prevention Health Improvement Services The number of people who decline referral / further contact from Early Intervention and Prevention and Health Improvement Service
The number of people who subsequently attend for Early Interventions and prevention and / or Heath Improvement Services Wigan Pressure area care training & education to support safe & effective prescribing of pressure relief equipment. Review skills and knowledge of pressure ulcer management and implement NICE Guidance CG179. For community nursing staff within the District Nursing Service who prescribe pressure relieving equipment for patients known to the district nursing caseload. Anne Finney/ Karen Patterson This CQUIN has been fully completed and the final report has been submitted to the Clinical Commissioning Group. The scheme focused on increasing the knowledge and skills of district nurses in equipment prescribing for pressure ulcer prevention and management. As a result of the scheme all district nurses responsible for prescribing equipment have received update training. This is supported by guidance documents to include a prescribing pathway consistent with NICE guidance to support decision making. Evaluation of the training utilising a pre and post session evaluation approach identified an improvement in knowledge and confidence against each of the standards. The findings of this CQUIN will now be presented to the Trust wide Harm Free Care Group (Pressure Ulcers) to ensure full
evaluation and, where appropriate, adoption of lessons learned and recommendations. Wigan Reporting Outcomes of Care in relation to children s speech and language therapy, audiology, OT and physiotherapy services. For 2016/17 a CQUIN to support the implementation of this questionnaire in Wigan Children s Specialist Services There will be two parts to this CQUIN. 1. The team will use the feedback from the Outcomes of Care questionnaire to inform service provision, e.g. contacting sample families to get more in depth feedback, discussion in team meetings, brief case studies for continuous improvement 2. reports will be made available to teams on a quarterly basis so they can review the data from parent responses. The services that will be involved in delivering the CQUIN are therapies (SLT, OT and physio) and audiology Gail Mann This CQUIN has been successfully completed, with the final reports due to arrive with teams at the beginning of May 2017; reflecting Quarter 4 data. This CQUIN was designed to support the implementation of the Outcomes of Care questionnaire and a new Team reporting and action planning process. The Outcomes of Care questionnaire was previously codesigned with parents, through the use of in depth interviews, highlighting what was important to and for them when accessing services. Each quarter, each clinical team receives a report identifying their scores for the quarter as well as narrative feedback from parents. Each team takes ownership of their own feedback and are encouraged to use it to inform service provision, e.g. contacting sample families to get more in depth feedback, discussion of themes in team
meetings, brief case studies for continuous improvement. An additional survey was completed with both team leaders and team members, so that they could comment on the questionnaire, its implementation, and the reporting process. This provided useful feedback and will support us in our development of the tool and reporting process, ensuring that it works effectively for our practitioners, and provides them with the feedback which will help them to develop services. The feedback from families has been largely positive, but we have also found that the tool is sensitive enough to pick up concerns, which enables teams to respond. It has also been helpful to have comparative data from the same clinical service in a different localities, and different clinical services in the same locality, to help understand what the data is telling us. This CQUIN has been successful and discussions are progressing about the
viability of implementing the questionnaire and process on a longer term basis. Wigan Shared decision making in relation to adult SLT Implementing a different type of conversation and decision making, making use tools such as motivational interviewing, shared care planning. Structured learning for relevant staff will be facilitated through motivational interviewing training, leadership and SDM development programme and feedback from patients and carers. Elizabeth Piggott There are many different ways of talking about shared decision making, but essentially it is about, in each clinical scenario, establishing a shared understanding with the patient/ parent/ carer about what their concerns are, how their needs are impacting on everyday life, and taking a collaborative approach with them to identify goals and agreeing how to go about achieving these in the unique context of that person's life, wishes, personal resources and circumstances. This CQUIN project focused on implementing a different type of conversation and decision making, making use of tools such as motivational interviewing, shared care planning and therapy outcome measures (TOMs) with a cohort of 6 patients. The implementation and engagement with patients has resulted in positive experience whilst also providing a framework to demonstrate good therapy outcomes.
The implementation of the TOMs has been received with positive reaction from staff, however some have encountered challenges using the TOMS framework for those who lack Mental Capacity i.e. Advanced Dementia, where the person was unable to actively engage with the shared decision making conversation. There are some settings outside of a routine clinical setting, including the residential and nursing home environment where it may not be accurate to reflect clinical judgement. Similar limitations have been documented in the current evidence base of the difficulty of using the TOM score within acute settings for those with dysphagia (RCSLT 1 )