Quality Accounts: Corroborative Statements from Commissioning Groups Quality Accounts are annual reports to the public from providers of NHS healthcare about the quality of services they deliver. The primary purpose of Quality Accounts is to encourage boards and leaders of healthcare organisations to assess quality across all of the healthcare services they offer. It allows leaders, clinicians, governors and staff to demonstrate their commitment to continuous, evidence-based quality improvement, and to explain their progress to the public. Nottingham NHS Treatment Centre - Corroborative Statement NHS Nottingham City Clinical Commissioning Group (CCG) was the lead commissioner for Nottingham NHS Treatment Centre during 2012/13 on behalf of a number of commissioners. In this role the CCG had responsibility for monitoring the quality and performance of services at Nottingham NHS Treatment Centre throughout the year. The CCG is satisfied that the information contained within this quality account is consistent with that supplied to us throughout the year. There are a number of ways in which we review and monitor the performance and quality of the services we commission. This includes visits to services, monthly quality and contract review meetings and continuous dialogue as issues arise, for example patient safety incidents or patient feedback. These mechanisms allow us to triangulate and review the accuracy of the information being presented to formulate opinions about the quality of services provided to patients at both organisation and service level. Nottingham NHS Treatment Centre has worked constructively with commissioners and other partners to respond to local commissioning intentions and develop integrated care pathways that improve the health of the local community. These include participating in the national cancer peer review programme to improve the quality of service provided to cancer patients and reducing waiting times for appointments which have improved patient experience and safety. Quality goals and indicators are jointly agreed in order to reduce health inequalities and improve the health of Nottingham and Nottinghamshire residents. Commissioners have seen a number of initiatives which have resulted in changes to culture, practice and patient outcomes and these are reflected in this quality account. Nottingham NHS Treatment Centre has also shown commitment to and achieved quality priorities which are important to commissioners for example, the stop the line and the Patient 1 st campaign. Nottingham NHS Treatment Centre continues to demonstrate a high level of commitment to improving patient, carer and staff experiences of the organisation. A number of robust mechanisms for receiving real time feedback have been established and it is clear that this feedback is treated seriously and genuine efforts are made to improve services in the light of it. The Family and Friends Test was introduced in 2012 2013 and this will continue in 2013 2014. We are pleased to see that Nottingham NHS Treatment Centre continues to recognise the importance of reporting patient safety incidents and are assured that when they occur (including those reportable under the Department of Health criteria for Independent Sector Treatment Centres) robust investigations are undertaken with a focus on learning and 1
improving. The themes from incidents reported during 2012 2013 have been used to inform the quality improvement priorities for 2013 2014. Commissioners would like to note that they were pleased to see that not only has each service contributed to setting priorities for the organisation but that in addition, each service has its own distinct objectives to improve quality. This approach is to be commended as it makes clear what needs to be achieved and enables progress to be reported upon openly in 2013-2014 at service level Work will continue with the Nottingham NHS Treatment Centre in 2013 2014 to ensure the continual quality of the services provided and to monitor achievement of targets, indicators and priorities. Nottinghamshire Healthcare Trust - Corroborative Statement NHS Nottingham City Clinical Commissioning Group (CCG) is the lead commissioner for Nottinghamshire Healthcare Trust on behalf of a number of commissioners. In this role the CCG is responsible for monitoring the quality and performance of services at Nottinghamshire Healthcare Trust throughout the year. The CCG is satisfied that the information contained within this quality account is consistent with that supplied to us throughout the year. There are a number of ways in which we review and monitor the performance and quality of the services we commission. This includes visits to services, monthly quality and contract review meetings and continuous dialogue as issues arise, for example patient safety incidents or patient feedback. These mechanisms allow us to triangulate and review the accuracy of the information being presented to formulate opinions about the quality of services provided to patients at both organisation and service level. Nottinghamshire Healthcare Trust has worked constructively with commissioners and other partners to respond to local commissioning intentions and develop integrated care pathways that improve the health of the local community. These include responding to the findings of local bed utilisation reviews and reducing the length of stay for service users in a number of in-patient services which have improved patient experience. Performance in relation to the delivery of the Improving Access to Psychological Therapies (IAPT) service has been below the standards commissioners would have expected this year and we will be working with the Trust in 2013 / 2014 to resolve this. Commissioners have seen a number of initiatives which have resulted in changes to culture, practice and patient outcomes and these are reflected in this quality account. The Trust have also shown commitment and achieved quality priorities which are important to commissioners for example, Commissioning for Quality Innovation (CQUIN) targets during most of the year although Commissioners were concerned that in quarter four, targets set for physical healthcare, recovery planning, and delayed transfers of care were not achieved. However, it is welcome that the Trust has committed to achieving these and that they are included in the Trust s priorities. The Trust has worked hard to achieve its aim of eliminating avoidable Stage 2, 3 and 4 Pressure Ulcers by embedding systems and processes and undertaking a wide range of 2
actions. This needs to be continued in 2013 2014 and commissioners are pleased to note that this area has been included as a quality priority for the coming year. We are pleased to see that the Trust continues to recognise the importance of learning from patient safety incidents and that when they occur, robust investigations are conducted with independent and expert reviews commissioned when required with a focus on learning and improving. The lessons learned from these are shared in an open, transparent and systematic way with both staff and those affected and monitored appropriately. The actions detailed in priority two for 2013 2014 will provide further assurance to the Trust and commissioners that patients are being protected from avoidable harm in a safe environment, including that from unexpected death. This work will be enhanced by the health economy work required in relation to the reduction of suicide and self - harm. The Trust continues to demonstrate a high level of commitment to improving service user, carer and staff experiences of the organisation. A number of robust mechanisms for receiving real time feedback have been established and it is clear that this feedback is treated seriously and genuine efforts are made to improve services in the light of it. The Trust agreed to include the Family and Friends Test in 2012 2013 and this has been continued as a CQUIN for 2013 2014. The Trust has made concerted efforts to improve standards of record keeping and care planning this year. Clearly these improvements must be sustained to further improve the quality of services and commissioners welcome the Trust s plan for delivering this on-going assurance. We will continue to work with Nottinghamshire Healthcare Trust in 2013 2014 to assure ourselves of the continual quality of the services provided and to monitor achievement of targets, indicators and priorities. Nottingham University Hospitals: Corroborative Statement Clinical Commissioning Groups have in place a collaborative commissioning arrangement for which Nottingham West CCG is the coordinating commissioner for NUH on behalf of a number of clinical commissioning groups. We have shared the Quality Account with a number of the CCGs and this narrative is a collective response. The commissioners have in place a number of measures for monitoring the quality of services we commission. This includes a schedule of regular visits to all areas of the hospital. These can be in response to patient safety incidents or patient feedback. These visits in conjunction with our regular contract reviews provide commissioners with real time data from which we can form a judgement about the quality of services NUH offer. It is pleasing to see a number of successful quality initiatives have improved patient safety and patient experience. Through CQUIN we have been able to see a real improvement in patient safety through increasing the number of patients who receive the sepsis care bundle and understand why cardiac arrests occur and what needs to done next to further improve patient safety. NUH have exceeded the requirements for some CQUIN measures, such as sepsis, but unfortunately were unable to complete the CQUIN for Dementia. We are pleased to see this is a priority for the coming year. 3
We were concerned that there were a number of never events reported by the trust this year. However we have worked closely with NUH to understand why these have happened and what measures need to be in place to prevent them happening again. NUH have a good reporting culture and should be commended for this however work continues to reduce the number of never events through their work on culture. NUH have shown an improvement in the number of falls and harm from falls however far too many people suffer avoidable harm and we are pleased to see a continued focus in this area. The MRSA and c.diff limits are challenging for the trust. We are working together to drive the number of healthcare acquired infections down. We are pleased to see this as a priority this year and wish to see an ambition to improve further. We are seeing a number of poor patient experiences involving discharge or transfers of care. We have noted inconsistencies in the quality of transfers and would wish to see further emphasis on improving arrangements in order to eliminate poor patient experiences. We are therefore pleased to see that Better Communication is a priority next year. We would encourage the trust to extend this to improve the communication with commissioners; in particular General Practitioners. Improvements here would improve the patient journey over all. We do see a number of excellent examples of care and quality services however we also hear from patients whose experience is less than good and therefore we would like to see greater emphasis on achieving and maintaining consistency across all services. Cancelled operations was a priority last year and we are pleased to see an improvement. Commissioners, supported by the Trust, also want to see a zero tolerance to waits over the national target of 18 weeks for all operations. No patient should have to wait longer than necessary for an operation. However we appreciate the challenges for the Trust in meeting this standard in some speciality areas. The Trust has improved significantly in relation to the CQC standards. Clearly this needs to be sustained and commissioners welcome the Trust s plan for delivering this. There is evidence of the Trust engaging with patients and staff in developing of the quality priority areas, however commissioners feel this can be further improved. We will work with the Trust to develop a mechanism for commissioners to be more actively involved in priority setting in the future. Sherwood Forests NHS Foundation Trust : Corroborative Statement The CCGs have worked closely with the trust during 2012/13 to monitor and improve the quality of patient care. We noticed an increased board focus on patient safety and governance as the year progressed. The trust has experienced a number of high profile quality challenges during 2012/13. We support the continued prioritisation of improvements in mortality rates and quality governance. Sustaining and building on change will be essential to deliver 2013/14 objectives. Hospital doctors and GPs are working together to improve 4
patient care across settings. We envisage that this will be further strengthened in 2013/14. We welcome comments about the need for cultural changes and we will be active partners in initiatives to improve patient care. EMAS: Draft Statement from Co-ordinating Commissioner Erewash Clinical Commissioning Group (CCG) on behalf of 22 associate CCGs General Comments NHS Erewash CCG, in its role as co-ordinating commissioner, has led the commissioning arrangements for the EMAS contract since October 2012. Prior to this the commissioning had been led by Derbyshire County PCT. As a provider of emergency and urgent ambulance services EMAS receives a lot of attention for the challenges surrounding the delivery of the national response targets. As a commissioner the delivery of these targets is of high importance, whilst also working with EMAS to ensure that the services delivered are of a high standard, with the best clinical outcomes and patient experience possible, and at the same time also keeping patients safe. Priorities and Reporting from 2012/13 In addition to acknowledging the improvements made against the Review of Quality Performance we would also like to highlight: An in year improvement on the number of referrals made for both children and vulnerable adult safeguarding demonstrating an increased awareness of understanding amongst frontline staff. Demonstrating learning and improvements/change as a result of feedback from patient experience and patient safety processes such as PALs, complaints and incidents. We also note the steps taken by EMAS to improve/increase their incident reporting levels. During the 2012/13 year EMAS were subject to a detailed inspection from the Care Quality Commission (CQC). The outcome of this inspection was that EMAS was declared as not compliant against 3 of the national outcomes (details of this is included in the body of their Quality Account). The Commissioning Team and the 22 CCGs will continue to support and challenge EMAS throughout 2013/14 as it takes forward the corrective actions identified with the aim of achieving full compliance once again. Looking Forward to 2013/14 Undoubtedly the delivery of the national targets has been a challenge for EMAS and has led to a lot of scrutiny throughout the year from commissioners. We congratulate their achievement of the Category A target of achieving over 75% of the life threatening calls in 8 minutes or less. We also support the statement that there is further work to be carried out and will continue to work with EMAS to achieve this. In addition to improving response times overall there is the focus of improving the consistency with which the targets are met across the various counties. The 22 CCGs involved in the contract have supported an additional 3.4million funding. The key elements which will deliver this are outlined in their Quality Management Systems section. Whilst there have been some small improvements in the delivery of the national Clinical Quality Indicators (Section: A brief overview of our Trust), Commissioners would like to see this improvement continued and this will be followed up with EMAS throughout 2013-14. 5
Commissioners would support the priorities for improvement identified and would encourage EMAS to ensure that clear and deliverable outcomes are identified for all these work streams. All Quality accounts can be found on NHS Choices web site. http://www.nhs.uk/pages/homepage.aspx At this time EMAS had not uploaded their Quality Account. 6