A. Commissioning for Quality and Innovation (CQUIN)

A. Commissioning for Quality and Innovation (CQUIN) CQUIN Table 1: Summary of goals Total fund available: 3,039,000 (estimated, based on 2015/16 baseline) Goal Number 1 2 3 4 5 Goal Name Description of Goal Goal weighting (% of CQUIN scheme available) Making Our Services Safer (MOSS) year 2 Strengthening Community mental health services Improved service user flow in acute mental health services Communication with GPs/primary care Improving physical healthcare to reduce premature mortality in people with severe mental illness (national CQUIN 4a and 4b) To improve the safety of inpatient care across the Trust. To improve the safety and stability of community mental health services, so that service users and carers receive consistent high quality care, based on continuity of care and robust care coordination To improve the admission and flow of service users and their discharge experience by ensuring systematic admission and discharge using best practice in the acute mental health services. To improve the communication and working relationship between clinicians in HPFT and GPs; one of the planned outcomes is also to join up the physical and mental health care of people with mental health problems. To demonstrate full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in inpatients with psychoses and community patients in Early Intervention psychosis teams Expected financial value of Goal ( ) 14 425,460 Safety Quality Domain (Safety, Effectiveness, Patient Experience or Innovation) 14 425,460 Safety; Effectiveness, Patient Experience 14 425,460 Effectiveness 14 425,460 Effectiveness 20 607,800 Effectiveness 6 7 Improving diagnoses and re-attendance rates in A&E (national CQUIN 8a and 8b) Greenlight toolkit (year 2) Part 6a acute hospitals to improve diagnosis data recording and reporting Part 6b mental health trusts to reduce re-admission to A&E and urgent care 10 303,900 Effectiveness 14 425,460 Effectiveness Totals: 100.00% 3,039,000

1 - Making Our Services Safer (MOSS) year 2 Name of scheme Making Our Services Safer Trust HPFT Indicator weighting 14% Outcome intended This is Year 2 of the MOSS CQUIN an ambitious programme of practice development designed to improve the safety of inpatient care across the Trust. The focus is on full implementation of the Making Our Services Safe strategy. This includes: Implementation of the strategy as a whole, including the programme of MOSS training, communication and awareness raising across the Trust Reduction in inpatient incidents of actual and threatened violence service user/staff and service user/service user Wider adoption of the Safe Wards (Institute of Psychiatry) approach so that staff are confident in how to establish and maintain strong therapeutic relationships with those they serve Implementation of co-produced project with service users to better understand what feeling safe means to them, with demonstrable improvement in numbers of inpatients feeling safe Background HPFT has relatively high numbers of reported incidents of actual or threatened violence and staff have reported high levels of stress. This programme began in early 2014. It sets out to respond to these concerns and at the same time incorporate best practice (Safe Wards, Positive Behavioural Support, Reducing restrictive practices). This strategy, supported by a detailed programme of actions, sets out to significantly improve inpatient safety by April 2016. Specific outcomes or actions required 1. Progress reports showing implementation of the strategy 2a. 10% reduction by Q4 in both service user/service user and service user/staff incidents 2b. Implementation of the patients experiencing violence element of the NHS Safety Thermometer by Q3 3. Adoption of Safe Wards on 5 inpatient units by the end of the year 4. Implementation of the feeling safe project on acute units with demonstrable improvements in patient safety Baseline Denominator Numerator Final year-end target 1. n/a 2a. service user/service/user 363, service user/staff 472 2b. n/a 3.2. 4. n/a n/a n/a 1. Evidence of satisfactory implementation of the MoSS strategy 2a. 10% reductions (327,425) 2b. Full use of this element of the NHS ST 3. Adoption of Safe Wards on 5 inpatient units by the end of the year 4. Implementation of the feeling safe project on acute units with demonstrable improvements in patient safety 2

Quarterly targets Q1 12% of overall CQUIN value 1. Progress report with evidence of strategy implementation (4%) 2a n/a 2b n/a 3.Progress report (4%) Q2 12% of overall CQUIN value 4. Progress report (4%) 1. Progress report with evidence of strategy implementation (4%) 2a n/a 2b n/a 3.Progress report (4%) 4.Progress report (4%) Q3 18% of overall CQUIN value 1. Progress report with evidence of strategy implementation (4%) 2a n/a 2b Evidence of full use of this aspect of NHS ST(6%) 3.Progress report (4%) 4.Progress report (4%) Q4 58% of overall CQUIN payment 1. Progress report with evidence of strategy implementation (4%) 2a Evidence of 10% reductions (20%) 2b Evidence of full use of this aspect of NHS ST (4%) 3.Evidence of adoption of Safe Wars on 5 units (20%) Other comments 4. Evidence of successful completion of project (10%) Partial Payment 2a: Over 8% reduction will lead to partial payment of 15% 3: Adoption on 4 wards will lead to partial payment of 15% 2 - Strengthening Community Mental Health Services Name of scheme Trust Strengthening Community Mental Health Services HPFT Indicator weighting 14% Outcome intended This CQUIN indicator seeks to improve the safety and stability of community mental health services, so that service users and carers receive consistent high quality care, based on continuity of care and robust care co-ordination. 3

Background Specific outcomes or actions required Following a year of significant change in community mental health services, the period of stabilisation is not yet complete. Recruitment and retention of staff remain an issue, so that it has been difficult to ensure that the service functions all the time at maximum effectiveness. This CQUIN aims to incentivise: 1. a. A range of actions to improve retention of staff b. Reduced turnover rate as shown in Q4 2. a. A range of actions to support staff as care co-ordinators b. Reduction in the proportion of new referrals on CPA without a care co-ordinator 3. a. Maintenance of the improved performance with regard to regular individual risk assessments over all quarters b. Improvement of the quality of CPA risk assessments in terms of involvement of service users and carers and other quality standards demonstrated through audit in Q4 1a. Development of CMHS recruitment and retention plan with quarterly reports evidencing progress. 1b. 3% reduction in turnover rate in Q4. 2a. Development of plan to better allocate and support care co-ordinators with quarterly reports evidencing progress. 2b. Reduction in % of those on CPA with no care co-ordinator allocated 28 days after assessment. 3a. Maintenance of Q4 performance with regard to % service users with a risk assessment in the past 12 months. 3b. 75% service users on CPA risk assessments show evidence of achieving quality standards -standards to be agreed in Q1 Baseline 1b. tbc 2b tbc 3a tbc 3b 39% Denominator Numerator Final year-end target Defined in outcomes section Defined in outcomes section 1a. Evidence of effective actions taken to improve retention of staff in CMHS. 1b. 3% reduction in turnover rate (e.g. 15% to 12% or below). 2a. Evidence of effective actions taken to support staff in their care co-ordinator role. 2b. Achievement in Qs 3 and 4 of target re. new referrals on CPA without care coordinator target tbc. ( if baseline is over 50% target will be 90%). 3a. Maintenance of Q4 performance with regard to % service users with a risk assessment in the past 12 months. Quarterly targets 3b. 75% service users on CPA risk assessments show evidence of achieving quality standards -standards to be agreed in Q1 4

Q1 12% 1a. Recruitment and retention action plan to be shared (3%) 1b. n/a 2a. Plan to better allocate and support care co-ordinators to be shared (3%) 2b.n/a 3a. Maintenance of baseline performance or above re completion of risk assessments (6%) 3b. Risk assessment quality standards to be established and audit methodology agreed Q2 12% 1a. Progress against agreed action plan (3%) 1b.n/a 2a. Progress against agreed action plan (3%) 2b. n/a 3a. Maintenance of baseline performance or above re completion of risk assessments (6%) 3b. n/a Q3 22% 1a. Progress against agreed action plan (3%) 1b.n/a 2a. Progress against agreed action plan (3%) 2b. Achievement of target (10%) 3a. Maintenance of baseline performance or above re completion of risk assessments (6%) 3b. n/a Q4 54% Other comments 1a. Progress/completion of agreed actions (3%) 1b. 3% reduction achieved (20%) 2a.. Progress/completion of agreed actions (3%) 2b. Achievement of target (10%) 3a. 90% of patients to have a completed risk assessment( (6%) 3b. 75% of all CPA risk assessments to contain all elements of agreed risk assessment as shown in completed audit (12%) This goal relates to community mental health services (STTs and TTTs) county-wide. Commissioners will apply appropriate tolerances where necessary if sufficient evidence of exceptions and mitigating factors is provided by HPFT Partial Payment 1b. 50% payment if 2% reduction is achieved 3b. 50% payment if 57% to 75% is achieved 5

3 - HPFT Improved service use flow in acute mental health services Name of scheme Improved safety and service user flow in acute mental health services Trust HPFT Indicator weighting 14% Outcome intended To improve the admission and flow of service users and their discharge experience by ensuring systematic admission and discharge using best practice in the acute mental health services. Background The Trust in recent years has developed its acute care pathway, with fewer beds and more community options including CATTs, two ADTUs and host families. However, in the past year pressures on these services has increased with a particular problem of private sector beds being used with an adverse effect on effectiveness and continuity of care. This remains a key quality priority for the Trust going into 2015/16. The Trust will work to ensure that acute mental health care is effective and safe for those who use it. Specific outcomes or This scheme outlines defined inputs that if delivered will result in enhanced service user actions required flow through HPFT. The enhanced flow will make a positive contribution to improved quality of care for service users. For the purpose of this CQUIN, the SAFER bundle has been used as the basis of improvement. SENIOR REVIEW 90% of service users to have a senior review (consultant/senior medical staff with decision making authority and nurse in charge) by 11am Monday to Friday using Patient status at a glance board and reviewing progress against PDDs. ASSESSMENT All service users will have an estimated discharge date (PDD) set within 72 hours of admission that service users are aware of. PDD should also be agreed by the clinical teams, captured and updated on the electronic service user record, in the service users medical notes and on the patient status at a glance board All service users will achieve their PDD or have clear documented reasons why not All service users staying longer than 72 hours will have an admission checklist completed within 72 hours of admission. All service users being discharged will be accompanied by clear and accurate discharge notification FLOW No service user to be moved more than once during one hospital stay, without clinical justification. EARLY DISCHARGE No service users (90%) to be discharged after 8pm No service users (95% target) over the age of 80 years old to be discharged after 8pm (unless clinically appropriate eg. transfer to Acute Hospital). Baseline Denominator Numerator REGULAR REVIEW All service users to have a discharge planning meeting prior to discharge from acute care pathway, with interagency attendance as required; to include crisis plan and advanced decision offer. As identified in Q1 audit As identified in Q1 audit As identified in Q1 audit 6

Final year-end targets 90% of service users to have a senior review (consultant/senior medical staff with decision making authority and nurse in charge) by 11.00 am Monday-Friday. 95% of PDD to be set and service user advised within 72 hours of admission 95% of service users will have an admission checklist completed within 72 hours of admission. 95% achievement of no service users being moved more than once during a hospital stay, without clinical justification. 95% of service users to have a discharge planning meeting prior to discharge from acute care pathway, with interagency attendance as required. This must include a crisis plan and advanced decision offer. This excludes those who take their own discharge against medical advice. 90% of all service users identified for discharge to be discharged by 8pm 95% of service users over the age of 80 years old to be discharged before 8pm Quarterly targets Q1 20% of overall CQUIN value Q2-15% of overall CQUIN value Q3-15% of overall CQUIN value a. Baseline audit to be undertaken to establish: % of service users that have had a senior review (consultant/senior medical staff with decision making authority and nurse in charge) by 11 am Mon- Fri. Audit data to be broken down to show designation of medical staff. % of service users who have had an PDD set within, 24, 48 and 72 hours, which has been communicated to the service user. % of service users achieving their PDD. 95% of service users will have an admission checklist completed within 72 hours of admission. % of service users who have not been moved without clinical justification more than once during their admission. % of service users that have had a discharge planning meeting prior to discharge from acute care pathway, with interagency attendance as required; to include crisis plan and advanced decision offer. % of service users discharged before 8pm. % of service users over 80 discharged before 8pm. b. Implementation Plan outlining milestones with timescales for each of the CQUIN criteria to be provided. Q2 narrative report to demonstrate progress against implementation plan Q3 narrative report to demonstrate progress against implementation plan 7

Q4 50% of overall CQUIN payment a. Narrative report of progress with implementation plan (10%) b. Audit to demonstrate achievement of: 90% of service users that have had a review (consultant/senior medical staff with decision making authority and nurse in charge) by 11am Mon- Fri. Audit data to be broken down to show designation of medical staff. (5%) 95% of service users who have had a PDD set within 24, 48 and 72 hours, which has been communicated to the service user. (5%) To be confirmed following Q1 audit. (5%) 95% of service users will have an admission checklist completed within 72 hours of admission. (5%) 95% of service users who have not been moved without clinical justification more than once during their admission. (5%) 95% of service users that have had a discharge planning meeting prior to discharge from acute care pathway, with interagency attendance as required; to include crisis plan and advanced decision offer. (5%) 90% of service users discharged before 8pm. (5%) 95% of service users over 80 discharged before 8pm. (5%) Other comments Partial Payment Partial payments for % achievements in Q4 will be applied to each of the 8 bullet points in (b) above : Achievement of 50% in any of the indicators no payment (of the 5% weighting) Above 50% - payment to be proportionate to achievement (of the 5% weighting) 4 - Communication with GPs/primary care Name of scheme Trust Communication with GPs/primary care Hertfordshire Partnership University NHS Foundation Trust Indicator weighting 14% Description/ Specific This CQUIN indicator seeks to improve the communication and working relationship outcomes or actions between clinicians in HPFT and GPs; one of the planned outcomes is also to join up the required physical and mental health care of people with mental health problems. HPFT will undertake a piece of work in Quarter 1 to collect GP feedback regarding the current communication and joint working and develop an action plan to address this; the remainder of the time period will demonstrate steady improvement on the issues raised, based on the GP feedback. An essential requirement of the CQUIN will be improvements in timeliness of formal written communication between the Trust and General Practice. HPFT will consider the benefit of links between CMHTs and GP surgeries as part of this CQUIN. 8

Timely communication between psychiatrists and GPs regarding people receiving mental health services, particularly regarding CPA notifications and reviews Discharge notifications and summaries to be completed and sent to GPs in agreed timescales Rationale/Background (e.g. guidance, quality issue to resolve) Denominator (the number/group of patients who could/should receive the intervention etc.) Numerator (the number /group of patients who actually receive the intervention etc.) What data will be used & who owns it Data frequency For people who use mental health services, the flow of information between primary and secondary care clinicians is essential to ensure continuity of care and effective joint working between GPs and HPFT clinicians. This will include improvements in the physical health care offered to people with mental health problems, through inclusion of physical health care summaries in CPA documentation N/A N/A HPFT will undertake an exercise to establish a baseline from GP surgeries regarding the current effectiveness of communication regarding service users with mental health problems questions should include commentary on discharge summaries and notifications; maintenance of service users physical and mental wellbeing; access to mental health expertise (to be agreed with commissioners). This can be through survey; use of Joint Commissioning GP leads or alternatives agreed with commissioners. HPFT will use this to develop an action plan which will make clear improvements. As described Time period after each quarter end & year-end that data will be available Baseline if relevant Final year-end target to be achieved & evidence required to show this Quarterly targets & recommended %age payments each quarter (if relevant) Q1 40% Within one calendar month of quarter end Baseline audit of timeliness of discharge notifications (24 hours), discharge summaries (14 days) and CPA letters (10 working days) Final report summarising actions undertaken following GP feedback on communication Final audit to measure: Discharge notifications sent within agreed timescales in 90% of cases 10% increase from baseline in discharge summaries sent within 14 days Following CPA meetings, letters (to include summary of physical health checks) sent to GP within 10 working days in 90% of cases Q1 Summary report of key issues of current experience in General Practice regarding communication with HPFT and recommendations/action plan agreed with commissioners (10%) Discharge notifications and summaries sent within agreed timescale baseline established (10%) GP letters sent on time after CPA reviews baseline established (20%) 9

Q2 10% Q2 Progress against action plan as a narrative report Q3 10% Q3 Progress against action plan as a narrative report Q4 40% Q4 Action plan implementation complete and report to GP Leads and commissioners for agreement of progress (10%) Audit to measure: Discharge notifications are sent within agreed timescale in 90% of cases (10%) 10% increase in the number of discharge summaries sent within 14 days (10%) GP letters, to include summary of physical health, sent on time after CPA reviews in 90% of cases (10%) Might the trust partially achieve this item & if so, what are the partial payment targets? Partial payments or negotiation regarding final targets can be agreed following the establishment of baselines for discharge notifications and summaries and GP CPA letters Any other comments 5 - Cardio Metabolic Assessment and Treatment for Patients with Psychoses IMPROVING PHYSICAL HEALTHCARE TO REDUCE PREMATURE MORTALITY IN PEOPLE WITH SEVERE MENTAL ILLNESS IMPROVEMENT GOAL SPECIFICATION Indicator number 5 [national Cquin 5a and 5b] Indicator name Cardio Metabolic Assessment and Treatment for Patients with Psychoses Indicator weighting 5a and 5b total weighting 20% 5a = 80% of total funding Description of indicator To demonstrate full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in inpatients with psychoses and community patients in Early Intervention psychosis teams. Numerator As set out in National Audit of Schizophrenia. Denominator As set out in National Audit of Schizophrenia. Rationale for inclusion National CQUIN scheme. Data source Audit data collected via a national process which will be notified early in 2015 Frequency of data collection Separate audits for inpatients and EIP, with data expected to be submitted during Quarters 2 and 3 of 2015/16 results to be available in Quarter 4. Organisation responsible for Provider data collection 10

Frequency of reporting to commissioner Baseline period/date Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Audit reporting requirements as set out above. Additional direct reporting to commissioners locally in Quarters 1, 3 and 4. Not applicable Not applicable January March 2016 90% (inpatients), 80.0% (EIP) Quarter 4 audit results demonstrate that, for 90% of patients audited during the period (inpatients) or for 80% of patients audited during the period (community EIP), the provider has undertaken an assessment of each of the following key cardio metabolic parameters, with the results recorded in the patient's notes/care plan/discharge documentation as appropriate, together with a record of associated interventions (e.g. smoking cessation programme, lifestyle interventions, medication review, treatment according to NICE guidelines and /or onward referral to another clinician for assessment, diagnosis, and treatment) The parameters are: Smoking status; Lifestyle (including exercise, diet alcohol and drugs); Body Mass Index; Blood pressure; Glucose regulation (HbA1c or fasting glucose or random glucose as appropriate); Blood lipids. Provider supplies evidence of systematic feedback on performance to clinical teams. Final indicator reporting date 30 April 2016 Are there rules for any Yes see below agreed in-year milestones that result in payment? Are there any rules for partial Yes see below achievement of the indicator at the final indicator period/date? Indicator 5a Milestones Date/ period milestone relates to Quarter 1 Rules for achievement of milestones (including evidence to be supplied to commissioner) Implementation plan covering: Board commitment sign-up identified clinical leadership detailed project plan planning for training for all clinical staff systematic feedback process for individual clinical teams planning for implementation of electronic healthcare records data collection of physical health assessment and measurable outcomes with a view to going live in 16/17 (assessed locally by commissioners) Date milestone to be reported 31 July 2015 20% Milestone weighting (% of CQUIN scheme available) 11

Date/ period milestone relates to Quarter 2 Quarter 3 Quarter 4 Rules for achievement of milestones (including evidence to be supplied to commissioner) No milestone Clinical staff training plan fully implemented (assessed locally by commissioners) Electronic recording of outcomes fully implemented Results of national Royal College audit - separate samples for: inpatients community early intervention patients (See sliding scales below for payment details.) Evidence of systematic feedback on performance to clinical teams (assessed locally by commissioners) Date milestone to be reported 31 January 2016 20% Milestone weighting (% of CQUIN scheme available) 29 April 2016 60% in all, made up of: 30% 20% 10% Rules for partial achievement at final indicator period/date The two tables below provide for a sliding scale of payment in relation to the element of the indicator which is payable on the basis of the actual audit results for Quarter 4. Audit of inpatients Final indicator value for the partial achievement Q4 threshold % of CQUIN scheme available for meeting final indicator value 49.9% or less No payment 50.0% to 69.9% 25% payment 70.0% to 79.9% 50% payment 80.0% to 89.9% 75% payment 90.0% or above 100% payment Audit of community EIP patients Final indicator value for the partial achievement Q4 threshold % of CQUIN scheme available for meeting final indicator value 39.9% or less No payment 40.0% to 59.9% 25% payment 60.0% to 69.9% 50% payment 70.0% to 79.9% 75% payment 80.0% or above 100% payment 12

IMPROVING PHYSICAL HEALTHCARE TO REDUCE PREMATURE MORTALITY IN PEOPLE WITH SEVERE MENTAL ILLNESS (SMI) IMPROVEMENT GOAL SPECIFICATION Indicator number 5b Indicator name Communication with General Practitioners Indicator weighting 5a & 5b total weighting 20%: 5b = 20% of weighting for this indicator Description of indicator 90% of patients should have either an updated CPA i.e. a care programme approach care plan or a comprehensive discharge summary shared with the GP. A local audit of communications should be completed. Numerator Denominator Rationale for inclusion Data source Frequency of data collection Organisation responsible for data collection Frequency of reporting to commissioner Baseline period/date Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Completion of a local audit of communication with patents GPs, demonstrating that, for 90% of patients audited, an up-to-date care plan and/or discharge summary has been shared with the GP, which meets the standards of the Academy of Royal Colleges and includes NHS number, ICD codes for all primary and secondary mental and physical health diagnoses, medications prescribed and monitoring requirements, physical health conditions and ongoing monitoring and treatment needs and Recovery focussed healthy lifestyle plans. The number of patients in the audit sample for whom the provider has provided to the GP an up-to-date copy of the patient s care plan or a discharge summary which sets out appropriate details of all of the following: NHS number; All primary and secondary mental and physical health diagnosis, including ICD codes; Medications prescribed and monitoring requirements; an Physical health condition and ongoing monitoring and treatment needs; Recovery focussed healthy lifestyle plans. A sample of a minimum of 100 patients who are subject to the CPA and who have been under the care of the provider for at least 100 days at the time of the audit. National CQUIN scheme Local audit One audit in Quarter 2 Provider Reports required in respect of Quarter 2. NA NA Audit undertaken in Q2, July September 2015. 90.0% 13

Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Final indicator reporting date Are there rules for any agreed in-year milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? Quarter 2 audit demonstrates that, for 90% of patients audited during the period, the provider has provided to the GP an up-to-date copy of the patient s care plan or a comprehensive discharge summary for patients with no CPA initiated. Quarter 2 audit demonstrates that, for 90% of patients audited during the period, the provider has provided to the GP an up-to-date copy of the patient s care plan, which sets out appropriate details of all of the following: NHS number; All primary and secondary mental and physical health diagnosis, including ICD codes; Medications prescribed and monitoring requirements; an Physical health condition and ongoing monitoring and treatment needs; Recovery focussed healthy lifestyle plans. 31 October 2015 No Yes see below Rules for partial achievement at final indicator period/date Final indicator value for the partial achievement threshold % of CQUIN scheme available for meeting final indicator value 49.9% or less No payment 50.0% to 69.9% 25% payment 70.0% to 79.9% 50% payment 80.0% to 89.9% 75% payment 90.0% or above 100% payment 14

6 - Improving Diagnoses and Re-attendance Rates of Patients with Mental Health Needs at A&E This goal changed later in the year as we were unable to participate in the national audit This is a two part indicator. Part 6b can only be implemented following completion of part 6a. 6a Improving Recording of Diagnosis in A&E UEC: IMPROVING DIAGNOSES AND RE ATTENDANCE RATES OF PATIENTS WITH MENTAL HEALTH NEEDS AT A&E IMPROVEMENT GOAL SPECIFICATION Indicator number 6a [national Cquin 8a and b] Indicator name Improving recording of diagnosis in A&E Indicator weighting 10% Description of indicator To be agreed with acute providers): Where required, improve diagnosis recording in the A&E HES data set so that the proportion of records with valid codes (either A&E 2 digit diagnosis codes or 3 digit ICD-10 codes) is at least 85%. For this purpose, codes 38 Diagnosis not classifiable and R69 Unknown and unspecified causes of morbidity will be classed as invalid. Only where 6a is achieved should 6b be addressed. In some local areas 6a will already be achieved. Numerator Denominator Where trusts have already met 6a, commissioners should recognise this achievement through a reward via CQUIN. Number of records with a valid diagnosis code (either A&E 2 digit diagnosis code or 3 digit ICD-10 code - for this purpose, codes 38 Diagnosis not classifiable and R69 Unknown and unspecified causes of morbidity will be classed as invalid.) All records of A&E attendances within the last month Rationale for inclusion This indicator has been developed to incentivise better data recording and encourage improved and timely communication and intervention between acute trusts and mental health providers to improve outcomes for those with MH conditions seeking urgent and emergency care. Data source Hospital Episodes Statistics Frequency of data collection Monthly Organisation responsible for data Acute trust collection Frequency of reporting to To be agreed locally commissioner Baseline period/date 2014-15 Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) To be agreed locally using nationally available data. The data completeness specified should be met for at least one month s data before the payment is made and the level of completeness should be maintained throughout 2015-16. To be agreed locally 15

Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) To be agreed locally Final indicator reporting date 16 May 2016 Are there rules for any agreed in-year NA milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? Exclusions % of CQUIN scheme available for meeting final indicator value: 49.9% or less No payment 50.0% to 69.9% 25% payment 70.0% to 79.9% 50% payment 80.0% to 89.9% 75% payment 90.0% or above 100% payment Providers with less than 500 MH A&E attendances in the baseline period should not be included. If CCGs are setting a CQUIN for part of the activity of a provider then the size of that element should exceed 500 MH A&E attendances. The reason for including this criterion is that where the number of MH A&E attendances is small, the change in the rate of the proposed measure will be more susceptible to random variation and may not actually reflect a true change in the level of the measure. The minimum threshold set is designed to mitigate this. 6b Reduction in A&E MH Re-attendances UEC: IMPROVING DIAGNOSES AND RE ATTENDANCE RATES OF PATIENTS WITH MENTAL HEALTH NEEDS AT A&E IMPROVEMENT GOAL SPECIFICATION Indicator number 6b Indicator name Reduction in A&E MH re-attendances Indicator weighing To be agreed locally Description of indicator To be agreed with MH providers: Reduce the rate of mental health reattendances at A&E in 2015/16. The time over which this applies will be agreed locally and will depend on how soon in the reporting year data quality reaches an acceptable level (i.e. part 1 criteria). Numerator Denominator Rationale for inclusion Data source Frequency of data collection Only where 6a is achieved should 6b be addressed. In some local areas 6a will already be achieved. The number of times a re-attendance occurred (for any reason at any A&E) within 7 days following attendances specified in the denominator. See technical specification below. Number of attendances at A&E where the diagnosis identified is MH. Commissioners should determine locally what codes to use to define MH depending on local data quality and recording but should include psychosis and adult poisoning as a minimum. See technical specification below. This indicator has been developed to incentivise better data recording and encourage improved and timely communication and intervention between acute trusts and mental health providers to improve outcomes for those with MH conditions seeking urgent and emergency care. Hospital Episodes Statistics Monthly 16

Organisation responsible for data collection Frequency of reporting to commissioner Baseline period/date Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Acute trust To be agreed locally To be agreed locally depending on when 6a is met. The baseline period will need to include at least 500 MH A&E attendances (see note below) and therefore is likely to cover at least one quarter. To be agreed locally using nationally available data. To be agreed locally. The final period will need to include at least 500 MH A&E attendances (see note below) and therefore is likely to cover at least one quarter. To be agreed locally To be agreed locally Final indicator reporting date May 2016 Are there rules for any agreed in-year NA milestones that result in payment? Are there any rules for partial achievement of the indicator at the final indicator period/date? Exclusions % of CQUIN scheme available for meeting final indicator value: 49.9% or less No payment 50.0% to 69.9% 25% payment 70.0% to 79.9% 50% payment 80.0% to 89.9% 75% payment 90.0% or above 100% payment Providers with less than 500 MH A&E attendances in the baseline period should not be included. If CCGs are setting a CQUIN for part of the activity of a provider then the size of that element should exceed 500 MH A&E attendances. The reason for including this criterion is that where the number of MH A&E attendances is small, the change in the rate of the proposed measure will be more susceptible to random variation and may not actually reflect a true change in the level of the measure. The minimum threshold set is designed to mitigate this. Indicator 6 Technical Specification 6a: For the data quality component, the first 2 and 3 digits of the raw DIAG_01 field in HES will be matched against a list of valid 2 character A&E diagnosis codes and valid ICD-10 codes. 6b: For the re-attendance component, all patients with an A&E 2 character diagnosis of 14 or 35 or with an ICD-10 diagnosis in the range F00-F99, G30, T36-T51 or X40-X49 should be included within the denominator. The numerator is then the number of these patients who re-attend ANY A&E for ANY reason within 7 days (inclusive) of the attendance in the denominator. 17

7 Green Light Toolkit, year 2 Indicator number 7 Indicator name Green Light Toolkit Indicator weighting 14% (% of CQUIN scheme available) Description of indicator The Green Light Toolkit is a guide to auditing and improving mental health services so that they are effective for supporting people with learning disabilities and autistic spectrum disorders. The NHS Confederation, supported by the Department of Health, commissioned the NDTi to produce materials for organisations to audit themselves. Commissioners are proposing that this CQUIN is undertaken over 2 years and is collaboration between HPFT s mental health and learning disability services. The NDTi make an offer to organisations to support their audit and improvement plan; commissioners would support HPFT in using this offer. A representative of the Secondary Health and Social Care Commissioning Team will support the implementation of this CQUIN by being a member of any project group that is established. Numerator N/A Denominator N/A Rationale for inclusion People with learning disabilities and autistic spectrum disorders are more likely than the rest of the population to experience mental health problems. Mainstream mental health services should be able to demonstrate equal access to and outcomes from their services for people requiring reasonable adjustments. During an audit of specialist pathways for people with learning disabilities, the NDTi noted that HPFT s specialist learning disability services are of a good quality but that access for mainstream services is limited to pockets of good joint working. Commissioners are keen to see mainstream mental health services open up for people and deliver the same quality. Data source Frequency of data collection Organisation responsible for data collection Frequency of reporting to Commissioner Baseline period/date Baseline value Final indicator period/date (on which payment is based) Final indicator value (payment threshold) Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to Commissioner) Commissioners recognise the significant work and culture change that making services accessible to people with learning disabilities and/or ASD entails. For this reason, the CQUIN is over two years, and the final programme of audit (which are the issues accepted as the most difficult to change) and a multi stakeholder action plan is the end point for delivery of the CQUIN. HPFT As per milestones HPFT Quarterly as per milestones N/A N/A As per milestones As per milestones As per milestones 18

Final indicator reporting date Are there rules for any agreed inyear milestones that result in payment Are there any rules for partial achievement of the indicator at the final indicator period/date? As per milestones Yes No Milestones Date/period milestone relates to Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 Rules for achievement of milestones (including evidence to be supplied to commissioner) Clear action plan, with milestones for delivery against the better audit. Delivery against action plan, with milestones met Delivery against action plan, including evidence of improvements made as a result Complete the Best audit with results and action plan reported to commissioners and project group Date milestone to be reported July 15 25% October 15 25% February 16 25% April 16 25% Milestone weighting (% of CQUIN scheme available) 19