QUALITY ACCOUNT
80%
of people achieved or mostly
achieved their personal priority
‘top goal’ through short term
support for independent living
(6,369 individual goals set)
Unsolicited
compliments
outstrip complaints 4:3
The quality of the services we offer across the UK is of
great importance to us. We want to put people in crisis
at the heart of our services by delivering accessible,
high quality, integrated care and support. In 2014 we
continued to develop and improve how we measure
performance against quality indicators and implemented
a number of new ways in which we can demonstrate
the quality of our services and the positive difference
we make to people’s lives.
A new focus on accountability and transparency
within the care sector reflects our own ambitions.
We understand that to be successful in delivering
our wide ranging services across the UK and supporting
changing and increasingly complex needs, we need
a culture that is open, transparent and encourages
learning. Within this context we have published our first
quality account.
Within the timeframe of our five year strategy we want
to be in a position where individual services across the
UK can develop to meet the needs of people in crisis,
working with partners and those who commission our
services. A core framework of standards and a common
approach to measuring them will ensure that whether
we are delivering services in the Outer Hebrides or
central London, supporting someone after a major
incident or helping someone to live independently,
the quality of care they receive will be assured through
our comprehensive national standards.
How quality is managed in the British Red Cross
A dedicated quality and outcomes team works to ensure our services meet the
regulatory requirements of the four countries and crown dependencies in which we
operate. The team supports staff and volunteers to deliver person-centred services
that are safe, effective, high quality and provide a positive experience for the service
user. A number of important cross-service functions are managed by the team:
Safeguarding: The head of quality and outcomes is the safeguarding lead for UK
services. Two development officers support the network of individual safeguarding
officers in each of our operational areas. The team provides specialist advice as well
as supporting policy design and training across the UK.
Complaints, compliments, comments: The quality and outcomes team supports
our customer experience manager in ensuring that direct feedback from people who
use our services is encouraged, reviewed, receives an appropriate response and
that learning is acted on.
Experience and outcomes measurement: The team leads on the collection,
monitoring and reporting of the service user experience; not only how the support
provided met their individual requirements, but also the wider organisational
intentions such as ‘reducing distress’, and ‘increasing resilience’.
Our services are delivered across 20 operational areas. A linear management
structure provides a clear line of sight and accountability from the frontline of service
delivery to the board of trustees.
In addition to this linear structure, each core activity has corporate leadership in the
form of our heads of service. They are supported by small teams of subject experts
and they set the expectations and standards for services and support areas in their
implementation. For those services in England registered with the Care Quality
Commission, the heads of service for independent living and for ambulance support
are also the ‘nominated individual’ for overseeing and supporting the individual
registered managers to ensure services are safe, caring, effective, responsive and
well led.
Quality governance
Whilst the performance accountability structure for operations is clear, it is important
that there is a mechanism of governance and assurance separate from line
management that encourages standards to be developed based on evidence and
best practice.
A key quality governance role is undertaken by the clinical governance and patient
safety committee. The committee reports directly to the board and is trustee led.
The committee provides a mechanism through which the organisation can focus
on continually improving the quality of services, with clear lines of responsibility and
accountability to the board for the quality of clinical care delivered.
Meeting four times a year, the committee examines the performance of activities
through audit reports, quality assurance reviews (including external review), training
compliance, complaints handling and incident management. The committee also
reviews investigations when things don’t go so well and seeks satisfaction that any
improvement actions are thorough enough and sufficiently implemented.
Our independent living services are some of our fastest growing services,
responding to need in communities across the UK. Our independent living
programme board exists to ensure that the growth is built on solid foundations
of quality and sustainability and is tasked with ensuring that services are designed
to meet the needs of individuals, whilst developing core standards and operating
models that ensure services are safe, effective and compliant.
Four advisory groups (which report to the clinical governance and patient safety
committee) help the heads of service and their teams ensure their core services are
delivering evidence based services, using appropriate equipment and underpinned
through good quality training. These groups are:
Clinical advisory group. With members drawn from both the volunteer and staff
base, this group brings professional expertise together to consider developments
in health and social care, both in terms of formal guidance (e.g. from NICE) and best
practice. The group makes recommendations and supports the heads of service
in understanding the requirements.
National equipment & standards advisory group, with a wide membership
of volunteers and staff, reviews new equipment to market and seeks solutions
through equipment and practice to support services across the UK.
Training governance group has a remit to challenge and seek assurance
around the quality of our training packages, the delivery of training and of
assessment activity.
The ambulance specification and fleet management group unites technical
and clinical expertise to bring a standardised approach to design and management
of these valuable and complex assets.
WHAT WE ACHIEVED IN 2014
Top three goals
The Red Cross introduced the ‘top three goals’ approach in early 2014 as a way
of measuring the difference we make to people using our independent living
services. The outcomes-focused approach asks the service user about their
individual goals and maps these to British Red Cross outcome domains. This forms
the basis of the support plan and once the period of support is over a discussion
takes place to establish what progress the person feels they have made.
This approach is generating much interest and support from our partners and
commissioners and has allowed the Red Cross to make a significant step forward
in the way it measures success in its independent living services. Instead of
measuring solely the numbers of people we support – backed up by a few individual
stories to demonstrate the difference we make – we now have a unified approach
that captures the difference we make for every individual who uses our services.
Complaints, compliments and comments
Acknowledging low complaint rates and a gap in our ability to gather and analyse
this valuable type of feedback at a national level led to the introduction of a new
complaints, compliments and comments system. The new approach encourages
people to tell us what they think – both about the positive things and those we don’t
always get right.
Individuals can contact us through the web, via email or a centralised telephone
number. A common central platform then directs the information to the appropriate
area to be managed locally. This ensures that our area teams are able to respond
quickly and directly to those contacting us and retain local accountability.
The new system allows data analysis to draw out common themes, helping us
to improve our services, inform service design and address issues. The system also
allows performance management of the complaints process, ensuring we respond
within the organisation’s agreed timelines and that key actions are followed up.
With the scrutiny provided by the clinical governance and patient safety committee,
the organisation has started to see a clearer picture than ever before about the
views of people who use our services. In the first reported quarter (Q4, 2014) it is
worth noting that whilst numbers of complaints captured rose with the new system,
unsolicited compliments outnumbered complaints at a ratio of 4:3. This system will
continue to be refined through 2015, with a particular focus on making reporting
more streamlined and able to provide meaningful data effectively to ensure the
organisation is able to be responsive in a timely fashion.
The Quality Standards Framework
The quality standards framework was developed in 2013 and fully implemented
in all our independent living services in 2014. Providing a core set of standards,
the framework clearly sets out what a ‘good’ service looks like for each of the
objectives, through a detailed set of descriptors, allowing services to assess their
performance against them. The framework also sets out the evidence required
to demonstrate quality performance.
At the end of 2014, each service was asked to carry out a detailed self-assessment
against the objectives in the framework and reported on them using an online data
capture system. Services were asked to consider the evidence they had to support
their assessments and finally to ‘rate’ their services. To be confident that the selfassessments were accurate and consistent, a programme of peer review took place
towards the end of the quarter, with a wide cross section of Red Cross staff visiting
the services, challenging the self-assessments and reviewing the evidence available.
The peer review process has been especially well accepted across the organisation
as it has been a powerful way of sharing good practice and allowing ‘check and
challenge’ in a supportive and positive way that focuses on helping services find
solutions. The quality and outcomes team are looking at the data and the feedback
from all who took part in the self-assessments and reviews to see if there is potential
to develop this approach more widely in the organisation.
Policy and procedures governance group
Inevitably, as in any large and complex organisation, a substantial range of policy
and procedure underpins the way we provide services and behave. Like many
organisations, it has been challenging to ensure that those who need to know the
policies and procedures that relate to them do so, without becoming overburdened
with information that does not relate to their role.
Furthermore, our procedures can sometimes be challenged by the specific needs
of individual commissioners or very specific local circumstances under which
we operate. This has led to the development of procedures in isolation from the
other core activities, resulting in some missed opportunities to link work, ensure
consistency and avoid duplication.
In late 2014 a cross-service policy and procedures governance group was set
up to review the approach to policy and procedure across UK services and ensure
that a more joined up approach takes place and that wherever possible procedures
are consistent across services.
Working with colleagues in our information and digital technology teams, we are
making headway in developing systems that will enable us to direct people in
individual roles to the policy and procedure that matters to them and provide
an evidence trail where required to show that they have read key documents.
2014 CHALLENGES
2014 presented us with a number of challenges as well as successes. For the first
time since growing our regulated services we were found to be non-compliant by
the Care Quality Commission (CQC) in one inspection against one standard. This
related to a discrepancy in the way we carried out background checks on our
volunteer workforce. We responded swiftly and rectified the procedure, sending
clear guidance to recruiting managers and the volunteer support staff in areas.
Furthermore we embedded the process into our electronic people-managementsystem so that we could be sure that any new volunteer would be appropriately
recruited, the proper checks made and an audit trail created.
When the CQC made fundamental changes to the way services in England are
inspected and rated, we were also presented with the largest overhaul concerning
any regulatory body to date. Instead of being required to comply with essential
standards, services will now be inspected around five fundamental questions
(Are services safe, caring, responsive, effective and well led?). This change led us
to undertake a review of the evidence we have around our quality performance
and the way we capture and record that evidence. A project manager has been
contracted to support registered managers through the changes and ensure that
our legal obligation as well as organisational obligations are met.
Throughout 2014, the NHS and ambulance services faced increasing difficulties in
A&E and hospital discharges. As an organisation that already provides services to
alleviate these pressures we were faced with increasing numbers of calls to further
support these services and in some cases develop new services, rapidly, to meet
this growing need. In line with our organisational mission, refusing to ignore people
in crisis, we have endeavoured to meet this demand wherever possible. Whilst
we are confident that services are safe and providing high quality care, the need
to scale up services quickly has tested some of our internal processes, such as
procurement, training and other internal support functions.
AMBITIONS FOR 2015
Introduction of an incident reporting system
Currently the Red Cross operates a paper based system for capturing accidents,
incidents and near misses across the UK. Whilst the current system has served
a purpose, it is cumbersome and presents many challenges from both an
operational and governance perspective. In 2014 the senior management team
agreed we should explore the implementation of an electronic reporting and
management system, to allow for more ‘real time’ information and more robust
governance about how we manage our response to each and every report.
We do not underestimate the complexities of introducing such a system and we
want to make sure it is well managed, has user acceptability and meets the local
service and area requirements as well as corporate governance requirements.
Such systems have been embedded in NHS organisations for a considerable time
and there is a wealth of evidence that such systems can streamline and improve
governance. The head of health and safety will be working closely with the quality
and outcomes team to manage a project that will oversee the procurement of
a system and the implementation of a successful roll-out across the organisation.
Implementing duty of candour
One of the recent changes in legislation and regulation in England is the introduction
of a ‘duty of candour’ for services registered with the Care Quality Commission and/
or commissioned by the NHS in England. This duty is also being consulted on in
Scotland for services delivering health and/or social care, although application of the
principles are already an expectation.
The duty of candour requires organisations to take positive steps and proactively
engage with people and where appropriate their families, when an act or omission
may have caused them significant or persistent moderate harm, including
psychological harm. The duty also requires organisations to apologise where they
may have caused harm and to offer appropriate support to people, as well as being
open and transparent about what went wrong and what is being done to minimise
further harm to the individuals and others.
Whilst only some of our services are registered with regulatory bodies, the senior
management team considered the best approach would be to apply the
principles of the duty of candour to all services in all parts of the UK, demonstrating
our commitment to developing an open and transparent culture throughout
the organisation.
User experience
Listening to the voices of the people who use our services helps us to
continuously improve the services we offer and keep our service users at the
heart of what we do. In 2015, we are revising the way we gather solicited
feedback about our services. Most of the services we deliver across the UK
offer a short term response to individuals in crisis and over the years
we have tried a variety of methods for capturing the person’s experience
of using our services. Our methodology has been varied, often with poor
return rates and difficulty in drawing meaningful data at both a local and
corporate level when considering how future services might be delivered.
A new approach to gathering service experience will tailor feedback
questions to individual services and make the process simpler for people
to engage with. The new feedback questions will include the friends and
family test, a quality measurement used by the NHS and a requirement for
our NHS-funded services in England. The Red Cross has decided to adopt
the friends and family test across all our services as a standard of best
practice and will publish the results on our website.
User-friendly monthly reports to support local success and identify service
improvement requirements will be produced and trends and learning will be
reviewed annually by the quality and outcomes team working in partnership
with service teams.
Closing statement
The British Red Cross is a large organisation that responds to people
in crisis, both internationally with large scale humanitarian needs, but also
across the UK every day – in people’s homes, communities, hospitals and
at public events. We deliver a wide range of services in an increasingly
complex environment. The regulation of services and the expectations
of individuals and service partners are becoming more exacting.
We are challenging ourselves to integrate our services and meet the
needs of individuals and our partners, particularly in the fields of
health and social care. In an increasingly complex sector, there
is a need to constantly review our approach to promoting and
measuring quality in our UK services and demonstrating the
difference we make. We are committed
to meeting these challenges.
All 20 operational areas
peer reviewed and
157
service assessments completed
for independent living services
in 2014.
63%
increase in adult safeguarding
referrals after a policy refresh and
training roll-out
British Red Cross
44 Moorfields
London
EC2Y 9AL
Tel 0844 871 1111
Fax 020 7562 2000
redcross.org.uk
Published 2015
Photos: © Simon Rawles
The British Red Cross Society, incorporated by Royal Charter 1908, is a charity registered
in England and Wales (220949), Scotland (SC037738) and Isle of Man (0752).
Email production@redcross.org.uk
Tel 020 7877 7029