Newham I-QAF Newham Integrated Quality Assessment Framework
Background Developed in early 2014 Joint working agreement Newham I-QAF implemented in July 2014 for the older people care homes 2
What is the Newham I-QAF A comprehensive and joined up approach to assess quality and contract monitor services in a holistic way Integrated LBN and CCG Collaborative Intelligent and smart data Virtuous Cycle Continuous improvement 3
Key Framework Components ASC & CCG requirements CQC domains Quality Metrics Quality Dashboard Co production Quality Assurance Group Joint visits Annual Performance Reviews 4
Initial Challenges Strong Stakeholder engagement Data requirements Mechanisms to engage providers? Information flow pathways Foster continuous improvement 5
Quality Assurance Group Identified Key Stakeholders Contract monitoring leads; Quality Leads; Safeguarding leads; Commissioner leads; Clinical leads such as GP, District nurse; Medicine Management leads; Falls Management leads; CQC; London Ambulance Service; Healthwatch; Integrated service leads. 6
The Quality Metric Resident count Throughput and breakdown on service type Care Planning Life history, end of life, social activity Safety Hospital admissions, falls, pressure ulcers, safeguarding Clinical effectiveness Audits, infection control, medicine management Resident experience Complaints, relatives meetings Dignity and choice Slide 7
The Quality Dashboard High visual impact Captures the most significant data Measures performance and sets local benchmarks Trends and patterns Versatile single reporting tool Feeds into the Stakeholder Quality Group Informs decision making Provides care homes with comparable data Detects early warning signs Concerns and areas of improvement Workforce gaps Slide 8
Involving Providers Sharing of the Quality Dashboard Preparing for inspection Reducing duplication Focus the care homes attention to quality 9
Approach Quality Metrics Quality Dashboard Improvements Provider Feedback Quality Assurance Group 10
Action taken as a result of the I-QAF Targeted support provided to care homes Shared good practice Identification of high risk services Provider newsletter and care home forum CCG GP clinical lead interventions Investigation into a high concerning areas CCG nursing care home review Changes to pathway/models of care End of life group 11
Data analytics London Ambulance Service call outs A & E Admissions 700 600 500 400 300 200 100 589 473 600 500 400 300 200 100 253 220 0 2014/15 2015/16 0 2014/15 2015/16 12
Key Trends 20% reduction in London Ambulance call outs 13% reduction on A & E admissions 31% reduction of falls over the last 9 months 4 care homes with improved CQC ratings 13
Benefits of Collaborative working Knowledge sharing Access to experienced multi-disciplinary network of staff Efficiency through effective working solutions Joint reporting mechanism Supports safeguarding, pre-empt failures and pro-active solutions Faster problem resolution Joined oversight and ownership of challenges Targeted support Better results Through synergy and whole-systems approach 14
Nursing Review Care Home managers to become a part of CEPN Model for enhanced medical support to care homes to be defined Better end of life care support to be provided to care homes Improved GP support to be reinforced 15
Stakeholder feedback Head of Commissioning, London Borough of Newham The i-qaf has been an invaluable tool in helping to understand the pressures the homes are working.., giving us early insight into workforce gaps in knowledge such as fall management... allowed us to tailor training and development initiatives raising staff competence and avoiding safeguarding incidents. One of the key strengths of the IQAF is the multi-agency meeting which allows not only CCG and LA to share information but also the CQC and London Ambulance service, this means all services are working together to highlight good practice and manage risks. 16
Stakeholder feedback cont. Safeguarding It has been possible to reduce risks in some instances because of the shared intelligence available at this forum.having the level of rich detail available is extremely useful. Care home the good thing about is that it gives a summary and percentage on each section and this help us to look in to the matter and try to do something about it in improving it, this also helps when CQC do their inspection Care home when I see the LAS incidents figures in the Quality Dashboard it has raised my awareness and now I think carefully before calling for an ambulance to ensure it is only called when appropriate. 17
Stakeholder Feedback Cont. Associate Director of Integrated Care CCG some of the key benefits have been about understanding, considering and addressing the holistic needs of the residents with regard to health and social care and addressing whole system pathways collectively. Its allowed for KPIs from both organisations to be considered and reflected on in order to get a better sense of the drivers and bottlenecks.. it has enabled us to have a far better understanding of the key aspect of requirements and has encouraged us to think through new approaches to old problems. It s helped us shape service provision taking into account overlaps and gaps. The impact has been in changes to service specifications and model of care and closer working relationships across organisations and with the home providers. 18
Next steps Provider incentives Roll out across other services 19
Questions? 20
Thank you For more information on the Newham I-QAF Sarbjit.rai@newham.gov.uk Chetan.vyas@newhamccg.nhs.uk tristan.brice@londonadass.org.uk London ADASS 21