Joint Committee Meeting 26 January 2016 Title of the Committee Paper Framework Update Executive Lead: Director of Nursing & Quality Assurance Author: Director of Nursing & Quality Assurance Contact Details for further information: carole.bell@wales.nhs.uk Purpose of the Committee Paper The aim of the following paper is to provide the committee with an update regarding the progress on the implementation of the quality framework. Joint Committee / Committee Resolution (insert ) to: APPROVE ENDORSE SUPPORT NOTE Recommendation Members are asked to: NOTE the contents of the report; SUPPORT the implementation plan Governance Link to WHSSC Strategic Objective(s) Quality Assurance Performance Monitoring Risk & Safety Link to Integrated Commissioning Plan Supporting evidence Quality & Safety and aligned to the 3 year integrated plan WHSSC Quality Framework Framework Update Page 1 of 9 Joint Committee Meeting
Engagement Who has been involved in this work? Assistant Medical Director Head of Business Development Chair Quality & Safety Finance, Data & Planning Representatives This paper has been considered and supported by: Finance Clinical Evidence Evaluation Group Programme Team Corporate Directors Group Management Group Joint Committee Other Commissioner Health Board affected Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hywel Dda Powys Provider organisation affected NHS Wales (please state) Other NHS Other private Summarise the Impact of the Committee Paper Equality and diversity Legal implications Population Health Quality, Safety & Patient Experience Resources Monitoring and application of agreed standards and approach will provide equitable access to high standards of health care and consistency for providers. Where performance falls below an expected standard then escalation and de commissioning of may have legal implications. Implementation of the Quality Framework will undoubtedly ensure that the aim of WHSSC in providing on behalf of the seven Health Boards equitable access to safe, effective, and sustainable specialist services for the people of Wales. WHSSC recognises that providing high quality patient centred care is central to the aims of the organisation. Implementation of the framework will strengthen and enhance the patient experience by ensuring that there is a robust process in place for monitoring and improving. A commitment will be required to support the infrastructure that will be required to deliver the quality agenda. This may have a financial consequence as there is no dedicated team Framework Update Page 2 of 9 Joint Committee Meeting
Risks and Assurance Health and Care Standards Workforce supporting this function at present. Some may be identified within the current organisational structure however there may potentially be a need for additional investment once structure mapping is complete. It is also recognised that there will be a time resource required for staff to attend training workshops however it is envisaged that this will be within their current work time and not in addition to hence there will be no financial consequence. Implementation of the quality framework is key to ensuring that safe commissioned services are in place. This framework will strengthen the current systems and hence reduce the risk for both providers and commissioners alike. All Health & Care Standards. Quality Assurance and Improvement Framework(QAIF). NHS England Outcomes. Consideration needs to be given to the structure within WHSSC that is required to deliver the quality agenda and ensure monitoring of the data submitted by providers. A further paper will be submitted once clarification is provided around the commissioning processes to describe this in more detail. Framework Update Page 3 of 9 Joint Committee Meeting
1.0 Situation One of the aims of Welsh Health Specialist Services is to strive to improve the quality of specialist services provided and ensure that the highest possible standards are achieved. The aim of the following report is to provide an update on progress and present a plan for the implementation of the quality framework. 2.0 Background As a commissioning organisation, Welsh Health Specialised Services is responsible for ensuring that providers deliver services of the highest possible standards of quality and safety. In order to achieve this, there needs to be the consistent application of the framework across both providers and commissioned services. Although quality if everyone s business it is essential that there are mechanisms in place to agree quality indicators with providers, monitor the outcomes and hold them to account for assurance purposes. In implementing the Quality Assurance Framework, the organisation will ensure that the contracting process utilises quality schedules, standards and clinical quality indicators to support effective healthcare delivery, quality improvement and innovation across the health system for specialised services. The monitoring and sharing of outcome indicators will provide benchmarking data for services, improve clinical outcomes and more importantly enhance the patient experience. 3.0 Assessment Steady progress has been made to ensure the implementation of the given framework. Over the last quarter, a number of actions have taken place to aid the implementation and these are summarised as follows: Internal workshops with staff to increase level of understanding and encourage discussions re implementation. Quality workshop on December 1 st with Management Group to discuss the quality framework and proposed implementation plan. The quality framework has been presented and received positively at the audit and outcome days for Cardiac services, IVF, BMT and Paediatric surgery. Ongoing discussions with providers at all SLA meetings. Framework Update Page 4 of 9 Joint Committee Meeting
Development of level 2 service dashboard specifically for Bone Marrow Services which will be replicated across specialist services (Appendix 1). Proposal for quality assurance reporting template against given indicators (Appendix 2). Ongoing discussions to develop/agree level 1 indicators with service providers. Letter to each provider requesting meeting to facilitate discussions to agree and incorporate into service level agreements/contracts. Mapping of current providers, current contract status and quality reports received. 3.1 Integrated Medium Term Plan (IMTP) There is a section within this years IMTP to reflect the quality agenda. This was positively peer reviewed at a workshop held on the 15 th December. The high level implementation plan is structured within the plan as follows: High-level Implementation Plan Year Actions 2014/15 Appointment of an interim Director of Nursing and Quality to lead the development of a Quality Framework. Engagement of key stakeholders to inform the development of the Quality Framework. Quality Framework approved by the Joint Committee in January 2015. 2015/16 Discussions with providers regarding the inclusion of quality assurance in future contracts. Limited quality indicators included in 2015/16 provider contracts. Appointment of a substantive Executive Director Nursing and Quality to provide executive leadership on the implementation of quality assurance across the organisation. Full implementation plan in the process of being developed. Phased approach agreed at Joint Committee to initially test the implementation model across a number of providers and service groups. This will include further prioritisation and roll out based on internal and Health Boards risk registers. Patient engagement approach developed to include the capturing of patient stories to inform quality assurance Framework Update Page 5 of 9 Joint Committee Meeting
and improvement. Mapping exercise undertaken to benchmark quality assurance across Wales and England to ensure unnecessary duplication is avoided and gaps are identified. Baselining current quality assurance data that is currently received within the organisation. Mapping national clinical audit data to inform framework. Engagement with quality leads in Health Boards and providers to review good practice and ensure implementation plan builds on evidence based practice. Formal connection made with NHS England Quality Team in Specialised Commissioning and agreement reached to work in partnership to share good practice and reduce unnecessary duplication. Refresh Quality Assurance Framework in light of new Health and Care Standards, Quality and Outcomes Framework and Operating Framework. Develop a consist approach to annual audit days to allow for appropriate comparison and benchmarking to inform quality improvement. Consideration of internal structures necessary to deliver the above framework. 2016/17 Quality schedules included within all provider contracts. Service specific quality indicators developed in partnership with providers for inclusion in contracts. Inclusion of patient outcomes in contracts as well as activity and finances. Resource implications and skill and competency requirements for quality team outlined and option appraisal developed. Internal validation of all quality data to inform discussions with providers. Consistency of approach implemented across all SLA reviews including processes to hold providers to account, escalation and site visits, thus mitigating unnecessary duplication or omissions. Workforce development to ensure competency and capability to deliver quality assurance and support a shift in culture from reactive and retrospective to proactive and partnerships. Integrated quality reports to be presented to relevant committees and groups. Framework Update Page 6 of 9 Joint Committee Meeting
3.2 Quality Toolkit Service/site visits are a vital component of the quality framework and a method of checking in on services. They consist of observations of care and discussions with patients and staff and will be seen as a key part of developing the commissioner/provider relationship. The Quality Check toolkit launched by 1000 lives in December 2015 will be used to capture the visits and will include both a clinician and a lay representative. Providers will also be asked to share reports of any external visits that have taken place with relevant action plans to prevent duplication and built on existing information. 3.3 Supporting Structure for the Framework Both the recent Health Inspectorate Wales (HIW) and the Good Governance Institute (GGI) reports (2015) have outlined a number of concerns and made a number of recommendations in relation to the Quality Framework and the processes required to support its implementation. An action plan has been drawn up and the Director of Nursing and Quality will lead on the specific recommendation relating to quality. A specific recommendation was the need for the organisation to ensure that there is a fully resourced structure in place to support the full utilisation of the framework. This work is ongoing and will be supported by the Executive Team. Consideration will be given to the existing internal structures within departments, how they interface with one another to identify the current resource and ascertain any gaps. There is a potential opportunity to consider current vacancies as a means by which new ways of service delivery can be identified to bridge some deficits thereby strengthening current processes. An options appraisal will be presented to the Committee at the next meeting. 3.4 Next Steps Over the next 18 months WHSSC will develop and embed systems and processes for quality assurance with the aim of achieving significant level of assurance both for our patients, partners and key stakeholders. We have continued to consolidate our current arrangements and in order to secure a higher level there are specific actions that we will need to take. These actions, along with the planned developments to set up a quality assurance team, form the basis of our 2016/17 work programme which will run alongside the day to day work of the team. Framework Update Page 7 of 9 Joint Committee Meeting
3.4.1 Implementation Plan Objective Action Responsible and by When Quality schedules included in contracts Baselining current quality assurance data that is currently received within the organisation. Development of Quality Assurance Scorecard. Development of a process to collect patient stories and agree mechanism for sharing these within WHSSC, QPS and JC Discussions with providers regarding the inclusion of quality assurance in future contracts. Agree with specialist areas quality indicators to be included in specifications. Agree process for collection of data, analysis and interpretation. Limited quality indicators included in 2015/16 provider contracts. Map all quality data currently received by the organisation and the route in which it enters the organisation. Ensure future process is streamlined and effective. Develop a draft scorecard for testing and comment. Engagement with quality leads in Health Boards and providers to review good practice and ensure implementation plan builds on evidence based practice. Ensure the scorecard will deliver the required information in a useable format. Undertake consultation on the scorecard with JC members and planners. Agree process including how stories will be presented and used: Pilot approach. Agree rollout. Executive Nurse and Director Finance. Phase 1 2016/17 completed for all contracts 2017/18. Executive Nurse Feb 2016. Executive Nurse. First draft Jan 2016. Agreed March 2016. Executive Nurse Jan March 2016 April Jun 2016 Jun Dec 2016 Framework Update Page 8 of 9 Joint Committee Meeting
Mapping national clinical audit data to inform framework. Develop collaborative approach NHS England. Ensure Quality Assurance Framework is relevant and up to date. Development of a consistent approach to annual audit days to allow for appropriate comparison and benchmarking to inform quality improvement. Develop appropriate level of capacity to manage quality assurance within WHSSC. Identify all national clinical audit data across all programme areas. Undertake analysis of appropriate utilisation of the information. Formal connection made with NHS England Quality Team in Specialised Commissioning. Agreement reached to work in partnership to share good practice and reduce unnecessary duplication. Refresh Quality Assurance Framework in light of Health and Care Outcomes & Operating Framework. Review all recent audit days undertaking a SWOT analysis. Consideration of internal structures necessary to deliver the above framework Planners for each programme area reporting to Executive Nurse Jan 2016. Medical Director and Executive Nurse ongoing. Executive Nurse Feb 2016. Director of Planning and Executive Nurse June 2016. Executive Team March 2016. 4.0 Recommendations Members are asked to: NOTE the contents of the report; and SUPPORT the implementation plan Framework Update Page 9 of 9 Joint Committee Meeting