Consultation on
Quality
Improvement
Priorities 2014/15
Report
January - February 2014
Consultation on Quality Improvement Priorities 2014-15
Staffordshire and Stoke on Trent Partnership Trust
Consultation on Quality Improvement Priorities 2014-15 report
January - February 2014
Robin Sasaru, Quality Team Manager
Chris McKeown, Effectiveness Officer
Contents
Aim....................................................................................................................................... 2
The consultation .................................................................................................................. 3
General comments received for each strategy .................................................................... 6
Priority 1: Safety – Reducing Avoidable Pressure Ulcers .................................................... 8
Consultation measures and questions.............................................................................. 8
Responses........................................................................................................................ 9
Priority 2: Experience – Customer Satisfaction .................................................................. 14
Consultation measures and questions............................................................................ 14
Consultation responses .................................................................................................. 15
Priority 3: Effectiveness – Improving Outcomes ................................................................ 21
Consultation measures and questions............................................................................ 21
Consultation comments .................................................................................................. 22
Priority 4: Effectiveness – Supporting Independence by Personalised Care ..................... 28
Consultation measures and questions............................................................................ 28
Consultation comments .................................................................................................. 29
Priority 5: Safety – Workforce ............................................................................................ 33
Consultation measures and questions............................................................................ 33
Consultation comments .................................................................................................. 34
Aim
The aim of this report is to


log all comments received during the consultation for the Quality
Improvement Priorities 2014-15
highlight the Trust response to all comments received
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Consultation on Quality Improvement Priorities 2014-15
The consultation
The consultation ran from 20 January to 20 February 2014, and made use of the following
mechanisms to disseminate and gain comment on the Quality Improvement Priorities
2014-15 consultation report:

Emailing stakeholders and inviting them to comment and forward the documents to
their colleagues

Holding consultation sessions that included Partnership Trust staff, Clinical
Commissioning Group leads, partner agencies and Trust members

Posting the consultation documents on the Trust internet site.
The substance of each consultation response is copied into this report, correcting for
spelling where appropriate.
Names of respondents are not included, although comments have not been altered to
strictly preserve anonymity unless explicitly requested.
Comments were aligned with the closest matching consultation question where possible.
Where possible all comments were incorporated into the final version.
Table 1 logs the individuals and groups that were contacted for the consultation. In
addition to the consultation comments, the Quality team made additional amendments to
the draft to refine the measures and objectives, and check for consistency, readability and
grammar.
We thank everyone who commented on these priorities.
We appreciate the many insightful comments received that have
strengthened our approach to quality improvement.
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Consultation on Quality Improvement Priorities 2014-15
Table 1: Consultation summary
Cohort
Who was contacted
Staff, committees
and groups
Effectiveness Group
EMT
Articles in “the word” and Trust internet site via communications
Chief Operating Officers
Professional Leads
Quality Team
Equality & Inclusion Manager
Engagement & Membership Manager
Trust Members
Service user
representatives
Community Health Voice, HealthWatch Stoke, HealthWatch Staffordshire
Partner
organisations
Keele University
Staffordshire University
Shropshire and Staffordshire Area Team
South Staffordshire and Shropshire Healthcare NHS Foundation Trust
Burton Hospitals NHS Foundation Trust
Mid Staffordshire NHS Foundation Trust
North Staffordshire Combined Healthcare NHS Trust
University Hospital of North Staffordshire
West Midlands Ambulance Service
Age UK (South Staffs), Chase Council for Voluntary Service, Lichfield &
District Community and Voluntary Sector Support, Tamworth Centre for
Voluntary Service, The Community Council of Staffordshire, South
Staffordshire Community and Voluntary Action, Newcastle under Lyme
Community and Voluntary Support, Staffordshire Moorlands Community
and Voluntary Services, Voluntary Action Stoke on Trent (VAST), East
Staffordshire Community and Voluntary Service, Lichfield and District CVS,
Newcastle 50+ Forum, DEAF Vibe,
Children and Young People's Voice Project, Children with Disabilities,
Jigsaw, Staffordshire Fire and Rescue, Staffordshire Girl Guiding,
Staffordshire Police 100 Club/Citizens Panel, Staffordshire Thru Care,
Staffordshire UK Youth Parliament, Staffordshire Youth Action Kouncil
(YAK), Staffordshire Youth Offending Service, Staffordshire Council for
Youth Voluntary Services, North Staffs Young Carers, Newcastle Young
People's Association (NYPA), Youth of the Moorlands Action Council
(YOMAC), Rona Borland, Tamworth Early Years, West Midlands
Consortium of Travellers, East Staffs District Forum, South Staffordshire
District Youth Council (DYC), Stafford and Stone District Youth Forum,
Tamworth District Youth Forum (TDYF), VOICE (Cannock Chase District
Youth Forum), Young People Today (Lichfield District Youth Forum),
Children & Young People (CYP) Partnership
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Consultation on Quality Improvement Priorities 2014-15
Cohort
Who was contacted
Werrington Patient Participation Group
Stafford and Surrounds PPG
Kingsbridge Medical Practice PPG
East Staffordshire PPGs
Trent Meadows PPG
Weeping Cross PPG
The Donna Louise Children's Hospice Trust
St Giles Hospice
Katharine House Hospice
Douglas Macmillan Hospice
HMP Stafford
HMYOI Brinsford
HMYOI Swinfen Hall
HMP Featherstone
HMYOI Werrington
Commissioning
Stafford and Surrounds Clinical Commissioning Group
North Staffordshire Clinical Commissioning Group
Stoke on Trent Clinical Commissioning Group
East Staffordshire Clinical Commissioning Group
NHS South East Staffs and Seisdon & Peninsula Clinical Commissioning
Group
Cannock Chase Clinical Commissioning Group
Leicester City Clinical Commissioning Group
Staffordshire Council
Stoke on Trent City Council
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Consultation on Quality Improvement Priorities 2014-15
General comments received
Comments
Response
All priorities link together and need to. A
prologue is needed to say how they all are
measured together/ against each other
As last year, our Quality Account 2013/14
will have information on how we decided our
quality priorities, and this section will show
how they link together.
Need to consult with patient groups alone –
freedom to speak openly – current meeting
imbalanced? May be different comments –
staff, patients, commissioners.
We recognise the need to fully engage with
service users, maximising their
opportunities for involvement.
How are you going to address improving
services for people with mental health
conditions? – How are these priorities going
to evidence this? – This is stated in the
document.
Although this is an important area, we did
not consider this to be one of our 5 quality
improvement priorities for the Trust this
year.
Nothing to object wouldn’t disagree with
priorities BUT may be some gaps?
Complaints (see notes)
(See the section on complaints)
Issue with ambulance service – arriving in
time, early and late
This comment related to services that we do
not provide.
Partnership working – whole patient
journey. Transition.
Our focus on outcomes and personalisation
will assist us in improving our services
across the whole patient journey.
[Business
This comment related to services that we do
not provide.
Development Priorities] The
Staffordshire Neurological Alliance would
support all these as they were all shown to
be improvement opportunities following our
Quality Neurology audit in 2010.
Particularly better post diagnostic
counselling and psychological services are
important in reducing excess morbidity in
people with chronic neurological disorders
[Clinical Commissioning Group intentions New pathways and models of care for Long
term Conditions] These should include
neurological conditions.
Document could be shorter/ snappier
Further work will be undertaken to increase
service user involvement in future
consultations.
This comment was felt to be directed at
commissioners.
We will endeavour to ensure future
consultation documents are concise.
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Comments
It is very adult focussed, and at times adult
community hospital focussed, which
contradicts the introduction talking about
prisons/children’s/expansion in sexual
health services etc. Thought will need to be
given about how some of this is translated
in other directorate
Response
Do your quality efforts have to fall within
guidelines handed down through the NHS
hierarchy together with the approaches to
employee and customer involvement and
monitoring of results?
Priorities for staff:
more robust management of attendance
procedures
Priorities for partners:
to ensure performance measures accurately
reflect the business & performance
measures of both organisations
National Quality Accounts guidance
contains some minimum requirements for
Quality Accounts.
We feel that the most of the priorities apply
to all our services, and we will work with our
Children’s services and Specialist Services
to develop service-specific actions for these
priorities.
We have picked these priorities, based on
our Quality Framework, supporting
strategies, and current business
development priorities. National direction
and commissioner intentions have also
influenced our priorities.
Need to pick priorities we would benefit from
and choose ourselves rather than the ones
we need to.
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Consultation on Quality Improvement Priorities 2014-15
Priority 1: Safety – Reducing Avoidable
Pressure Ulcers
Consultation measures and questions
Proposed measures for 2014/15
Proposed 2014/15 target
1A Number of pressure ulcers reported as
grade 3 and 4 pressure ulcers and reported
as serious incidents
Aim for Zero grade 2/3/4 avoidable
pressure ulcers developed in our
care1
1B Number of pressure ulcers reported as
avoidable grade 3 / 4 pressure ulcers
developed in our care and reported in our
care and reported as serious incidents.
Zero grade 2/3/4 avoidable
pressure ulcers developed in our
care2
1C All pressure ulcers for people in our care
and reported as adverse incident
Increase in number of incidents
reported and reduction in the
proportion of serious incidents / all
reported incidents
Other measures we will use for Safety
1D Total number of adverse incidents
reported (all incidents)
Quarterly increase in number of
incidents reported
1E Percentage of reported incidents
classified as serious incidents
Quarterly reduction in proportion
of serious incidents / all reported
incidents
Q1.1: Is the measure for ‘pressure ulcers reported as adverse incidents’ already covered
by the more general measure ‘total number of adverse incidents reported’?
Q1.2: Do you agree with the minor changes made to the Quality Improvement Priority
around Safety?
Q1.3: Should we include other measures? Should we delete any measures that are no
longer appropriate?
1
Specific trajectory to be determined
2
Specific trajectory to be determined
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Consultation on Quality Improvement Priorities 2014-15
Responses
Priority
Comments
Response
1
Medication error reporting –
harm decreases.
1
Consider adding medication
errors, reporting and levels of
harm – In Clinical
Commissioning Group
planning guidance.
The overall measures around numbers of
incidents reported will also capture medication
errors. Medication error information will be
reviewed by our Medicines Management
Committee.
1
Should be measuring on
outcomes not processes and
be accountable for the
measures.
We agree. A Grade 3/4 avoidable pressure ulcer
developed in our care is a reflection of failure in
our services. The number of adverse incidents
reported is used as a measure of our safety
culture.
1
“Eliminate” is the key word
and needs to be worded to
highlight this
We have changed the wording of the aim to
“eliminate avoidable grade 3/4 pressure ulcers”
1
This is how we did against
previous year – count as a
reduction so would naturally
expect this year’s result to [be
less].
We will continue with our aim of eliminating
avoidable pressure ulcers, and agree a tolerance
as for 2013/14.
Use prologue to sell yourself.
Our Quality Account will openly and transparently
show our progress against our priorities.
1
Transparency is the focus at
the minute.
Our Quality Account will outline our progress in
reducing avoidable pressure ulcers.
1
Achieve numbers and shows
numbers but so what? What
does this mean for pressure
ulcers?
We feel that reducing avoidable pressure ulcers
reflects an approach to care that is safety
focussed, demonstrates that we implement
learning and reflect on our practice.
1
Is it fair? Is everybody
recording the same way?
Inclusion of avoidable but not
attributable has been
included now but what teams
know about this?
Our Tissue Viability Panel scrutinise all grade 3/4
pressure ulcers developed in our care, to ensure
consistency of reporting. Feedback to teams is
via our Safety and Effectiveness Operational
Groups and all-staff communications, including
our internal newsletter, “Quality Matters”.
We directly notify the team involved if we find an
avoidable pressure ulcer developed in their care.
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Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
1
NICE guidelines on Pressure
Ulcers in April 2014 due what changes will need to be
made as a consequence of
this.
We have reviewed the draft guidance on
prevention and management of pressure ulcers
and sent our comments to NICE for
consideration.
Intravenous fluid therapy?
Risk of administration, has
this been addressed? NICE
could provide more details [if]
wanted.
There are important safety considerations around
the use of Intravenous fluid therapy,
Order of proposed measures
should be changed 1C, 1A,
then 1B.
We have changed the order of the measures
accordingly.
1
1
We do not feel that the guidance will change our
overall aim to eliminate avoidable pressure
ulcers.
On consideration, this was not deemed as one of
our top five improvement priorities for 2014/15.
1C should be first
1A
What is avoidable/
unavoidable?
We adhere to national definitions for avoidable /
non-avoidable pressure ulcers as set out at
www.patientsafetyfirst.nhs.uk 3
1A
Stronger prevention.
We have changed the wording of the aim to
“eliminate avoidable grade 3/4 pressure ulcers”
We have a Zero-tolerance action plan for
eliminating pressure ulcers, which we will refresh
for 2014/15.
1A
Feeding back to source of
lesion.
We provide feedback to teams and partner
agencies as part of our incident reporting system.
We also work closely with our partner agencies,
including University Hospital NHS Trust (North
Staffordshire) to monitor care of patients with
pressure ulcers, using our incident reporting
system. We also use the TRAC (Track Report
Analyse Communicate) system to monitor
pressure ulcers across our health economy.
3
See
http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/PressureUlcers/Defining%20a
voidable%20and%20unavoidable%20pressure%20ulcers.pdf
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Priority
Comments
Response
1
How is learning from Root
Cause Analyses and Tissue
Viability panel changing
practice? We really need to
link priorities to demonstrate
partnership working across
same journey. Link to wider
health economy. Need to be
explicit about deterioration of
pressure ulcers.
The learning from our Tissue Viability panels
feeds into our Safety and Effectiveness
Operational Groups, and is disseminated via our
internal newsletter, “Quality Matters”.
Are figures of Pressure
Ulcers only taken from
incident reporting?
Our incident reporting system is our primary
record of pressure ulcers.
Requires consistency around
grading of pressure ulcers –
especially grade 2. Depends
to some degree on patient/
service user compliance.
We provide ongoing training for our staff on
Pressure Ulcer identification, reporting and
management.
Keep in as grade 2 being
removed want to keep focus
on Pressure Ulcer reporting.
We feel that the reporting of grade 1/2 Pressure
Ulcers is as equally important, as a reflection of
our care.
1B
Q1.1
Q1.1
We will report learning and improvements for
2013/14 in our Quality Account.
We also use the NHS safety thermometer to
measure the prevalence of existing pressure
ulcers.
As for all incidents, we are looking to see
increased reporting for lower grade pressure
ulcers, which demonstrates that our staff are
providing safer care.
We want the number of grade 1/2 pressure ulcers
reported to increase, as our staff’s knowledge and
awareness of pressure ulcer care increases, and
they work to prevent these progressing to more
serious Pressure Ulcers.
Q1.2
Yes
We are concerned with eliminating all avoidable
pressure ulcers developed in our care.
Q1.2
Providing reporting of 2 and
3’s is consistent.
Q1.2
Yes but grade 2 pressure
ulcers increase if grade 3 and
4 are reduced. If not including
grade 2 we need to be more
explicit about them.
We want the number of grade 1/2 pressure ulcers
reported to increase, as our staff’s knowledge and
awareness of pressure ulcer care increases, and
they work to prevent these progressing to a more
serious Pressure Ulcer.
We will continue to capture data via our incident
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Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Q1.2
Why have we excluded grade
2’s? Because it isn’t
achievable? What are our
aims for grade 2’s?
Response
reporting system for grade 2 pressure ulcers, and
act to prevent these becoming more serious.
Techniques such as root cause analysis can help
us to achieve this.
Grade 2 pressure ulcers show as relatively
superficial damage to the skin and can happen
very quickly even when care is in place. We want
the number of grade 1/2 pressure ulcers reported
to increase, as our staff’s knowledge and
awareness of pressure ulcer care increases, and
they work to prevent these progressing to more
serious Pressure Ulcers.
Q1.3
Community and hospitals
should be separatedcommunity can’t eliminate
can only reduce. Need to be
more explicit about
community point of view.
We feel that a goal of eliminating avoidable
pressure ulcers developed in our care should
apply to our hospital and community services,
and we recognise that eliminating avoidable
pressure ulcers in the community is a more
challenging ambition.
Our Quality Account will provide information
about avoidable pressure ulcers in hospital
services and in the community.
Q1.3
Could the organisation be
more transparent about
Pressure Ulcers in particular
these that are attributable to
the organisation and to other
organisations/
We regularly report this through our governance
structures. The measures include avoidable
grade 3/4 pressure ulcers developed in our care.
Q1.3
Need to be aware of issues
regarding obtaining pressure
relieving equipment in
community and hospitals. –
Consistent across the trust
We agree.
Q1.3
Issues around workforce
capacity regarding review of
individuals and equipment
provided.
We feel that our processes of care are also an
important factor in improving quality, as well as
ensuring adequate workforce capacity.
Q1.3
Measures to demonstrate we
are treating them well – time
to heal.
The focus of this measure is around safe
processes of care that mean our service users do
not suffer from avoidable grade 3/4 pressure
ulcers.
We are continually improving the effectiveness of
our pressure ulcer care (and other types of skin
care). Our Tissue Viability service has produced
papers on the effectiveness of therapeutic
devices.
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Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
1B
Acquired in care is more
difficult in community settings
when patients may not be
compliant with advice – or
would this be then deemed
‘unavoidable’
We adhere to national definitions for avoidable /
non-avoidable pressure ulcers as set out at
www.patientsafetyfirst.nhs.uk 4
According to this definition, if “the individual
person refused to adhere to prevention strategies
in spite of education of the consequences of nonadherence” this would not be an avoidable
pressure ulcer.
We recognise the increased challenges of
eliminating avoidable pressure ulcers in the
community.
1C
If we are reducing pressure
ulcers then there will be a
reduction in reporting I would
have thought?
A reduction in reporting of grade 3/4 pressure
ulcers must be in the context of an overall
increase in incident reporting – this demonstrates
that an organisational safety culture is in place.
Q1.1
Not if we want to reduce total
pressure ulcers as that will
presumably reduce reporting
of these kinds of incidents as
they will no longer occur.
An increase in the number of reported grade 1/2
pressure ulcers should demonstrate that our staff
are more proactive in providing high quality care
of pressure ulcers.
Q1.1
Is number of incidents as
important in demonstrating
that we do something about
those that are reported?
Should there be a measure
around action plans in place
for SUIs?
It is important that we have robust systems for
acting on incidents, including the development of
action plans. However, we do not feel that
measuring the number of action plans in place in
itself will correlate with improvement in quality.
We feel that a grade ¾ avoidable pressure ulcer
developed in our care is a reflection of failure in
our services.
On reviewing the comments we decided to make the following amendments to the Safety
priority:


Focus the reporting on grade 3/4 avoidable pressure ulcers developed in our care,
which is a clearer single indicator of the safety of our care than the three previous
overlapping measures.
We will continue to measure the total number of adverse incidents reports, and
percentage of reported incidents classified as serious incidents, applicable to the
Partnership Trust, which is in line with our current reporting to the Trust Board.
4
See
http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/PressureUlcers/Defining%20a
voidable%20and%20unavoidable%20pressure%20ulcers.pdf
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Consultation on Quality Improvement Priorities 2014-15
Priority 2: Experience – Customer
Satisfaction
Consultation measures and questions
Proposed measures for 2014/15
Proposed 2014/15 target
2A Friends and family test (Net Promoter
Score)
Achieve and sustain +70 for
all services
2B Health and social care compliments
received by the Partnership Trust
Year on year increase in the
number of compliments
received
2C Percentage of complaints acknowledged
within three working days
100% (health)
2D Percentage of complaints responded to
within complaints NHS regulations
timescales
100%
2E Patient Experience Surveys within Health
and Social Care
At least 1000 responses each
month from surveys in Health
and at least 98 responses
each month from surveys in
social care for Integrated
Health and Social Care
Teams.
2F Implementation of comment cards for
community services where service users
don’t wish to use technological solutions
Comment cards available in
all places where care is
delivered
2G Number of complaints that were not
responded to within 60 days
0
2H Percentage of complaints that are
reviewed by our complaints panel
All high risk complaints
100% (social care)5
5% of all other complaints6
Q2.1: Do you agree with the changes made to the Quality Improvement Priority around
Experience?
Q2.2 Rather than just report an overall friends and family score, should we also report by
division? Should we also set a target for each division?
Q2.3: Should we include other measures? Should we delete any measures that are no
longer appropriate?
5
Separated reporting for Health and Social care complaint due to differing systems and responsibilities for
social care complaints.
6
Target to be confirmed with complaints panel
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Consultation on Quality Improvement Priorities 2014-15
Consultation responses
Priority
Comments
Response
2
May be some gaps – how do we
ensure that patients / service users
know who to talk to when raising
issues? – in particular when services
are provided by different
organisations. – is there a clear
complaints system? – How do we
ensure that organisations separate
process collaborate?
Our complaints and PALS teams are
publicised across the Trust and help
service users to make complaints when
these cross over organisational
boundaries.
2
All about scores! Needs to be
qualitative not just quantitative.
Writing baseline data but so what?
Needs to be written differently
Our Quality Account also provides
qualitative information on service user
experience, including complaint themes
and trends.
2
Set Measures on outcomes – Be
more patient explicit and treat patient
not just the condition – patient
feedback you said, we did. Staff
feedback should then link to patient
feedback to give a clearer picture.
We have “you said we did” display boards
along with feedback for each teams net
promoter score for public facing areas as
part of our Experience strategy.
How can you capture results when
providers collect the data in different
ways?
Our experience team has been developing
consistent methods for gaining service
user feedback across all Trust services,
and will continue this work in 2014/15.
2
The Trust is subscribed as an active
partner within the Health Economy MultiAgency Protocol for complaints. Within this
process complaints are case managed
through a collaborative investigation and
response by the nominated Lead Provider
for the health economy complaint.
We will look to develop our staff Net
Promoter Score in 2014/15 and link this
information to service user feedback.
The Trust does provide monthly reporting
in accordance to the national reporting of
the Health and Social Care Complaints
Regulations.
2
Would like to know how many people
we have surveyed vs population.
Working out a “population” figure for our
variety of services may be problematic,
and would not necessarily be comparable
across our range of services.
We do not feel that a sample vs population
calculation would add significant value to
this quality improvement measure.
However, each community team has a set
monthly sample target.
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Priority
Comments
Response
2
Define a complaint.
We adhere to national guidance on
definitions of complaints, and we also
report on PALs concerns which are
resolved in 24 hours.
2
Need to ensure that the method of
collection is robust – eg when you
ask the question during intervention
Our experience team has been developing
consistent methods for gaining service
user feedback across all Trust services,
and will continue work to ensure our
methods are robust in 2014/15.
2
Need to be open about data – in
particular broken down by service.
We will show our experience and
complaints data by Division in our Quality
Account.
2
Need to ensure the voice is heard
rather that focus just on complaints.
We provide monthly Experience data on
PALs concerns, Complaints, Comments
and the User and Carer experience of our
services to our Trust Board and
Operational Groups.
2A
Friends and Family Test- more than
score feedback follow on comments
and actions
Each team receives monthly feedback on
their Friends and Family test score along
with user and carer’s feedback for
improvement. We will report on highlights
of actions taken as a result of service user
feedback in our Quality Account.
We do not feel that measuring the number
or completion of actions in itself will
correlate with improvement in quality.
2A
Needs more appropriate phrasing of
the [question]
The Friends and Family Test is a national
mandatory requirement for all NHS
Providers. The question can now be
framed for services or operational teams in
accordance to the national parameters.
2A
What does +70 mean to the
layperson?
As with previous Quality Accounts, we will
provide a brief explanation of the Net
Promoter Score calculation in the account.
2A
Is this accurate? Eli-lite breakdown
and ability to use. Challenge of nonEnglish speaker to complete.
Our Experience Team will work to increase
the availability of non-English survey tools
and report on this in our Quality Account
2014/15
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Priority
Comments
Response
2A
Is F&F test reported / displayed at
each service? Meaning of this score
displayed?
Each team receives monthly feedback on
their Friends and Family Test score. We
will report on highlights of actions taken as
a result of service user feedback in our
Quality Account.
We display “you said we did” boards along
with feedback for each individual team.
The net promoter score is displayed in
public facing areas as part of our
Experience Strategy
2A
If negative score – would not
recommend – need a follow up
question – why? Also actions to
address concerns and implement
change.
We include follow up questions as part of
our survey systems.
2A
Challenge is relating to privacy/
confidentiality for negative detractors.
Can patients use?
We recognise the limitations of our realtime feedback system in allowing service
users to confidentially enter negative
feedback, and we will expand the use of
comment cards and our website as
alternative feedback methods.
Comment cards far more appropriate
in many settings compared to Elilites.
2A
Benchmarking against staff friends
and family test.
Staff surveys will be introduced with the
2014/15 CQUIN indicators negotiated with
our commissioners.
2C
[Complaints] includes written and
verbal
Our complaints reporting includes written
and verbal complaints
2D
Why use the NHS regulations
timescale and not the Trust’s own?
The NHS Regulations timescales are
national reporting requirements for
complaints. The NHS regulations timescale
empower the complainant to remain in
control of their complaint handling through
agreed timescales. The regulations are
user-focussed measures and enable the
complainant to be fully engaged in the
process.
2D
Transparency if offering extensions
[to complaints timescales]
We will report on the timescales for
resolving complaints.
Every complaint is risk scored dependent
upon the severity score of each individual
complaint. Additional timescales are
allocated dependent upon the complexity
and severity score of every complaint.
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Priority
Comments
Response
2F
How used? So What? What target
shows actual quality?
We will analyse feedback from our
comment cards, in comparison with our
other feedback routes.
We feel that the F&F test is a useful
barometer of quality (user experience) of
our services.
2F
Very positive
2F
Comment card needs to be able to
capture positive and negative
comments.
Comment cards are designed as a simple
generic feedback mechanism to allow
comparisons between services.
2F
Could there be prompts on comment
cards to cover aspects re informed
decisions – service effectiveness.
They capture positive and negative
comments.
2F
No comment cards seen by any of
this group? Needs re launched,
certainly NOT in all places where
care is delivered. “You said, we did”
gap in community? % in hospitals,
again needs re-launched. Not sure if
all current patient feedback tools
have been to [the Experience Team]
i.e. eclectic. Historical tools in use.
The Comment cards have been introduced
through a staged approach. The initial roll
out programme of the comment cards have
been implemented in community teams
2F
More focus on comments v
complaints and how that is dealt with
We provide monthly reports on comments
along with compliments which are reported
to each community team. The PALS,
Complaints, and Experience Teams work
in collaboration with Operational teams to
develop actions of improvement.
2H
Is this in place yet? Still a feeling that
pressure on clinical/ corporate staff to
do complaints as part of their day job.
Do we need to look at a separate
team to handle them?
Our Customer Service team have
introduced complaint case handlers who
will assist and support staff who are
investigating complaints, as part of the
complaints process.
Our experience team has been developing
consistent methods for gaining service
user feedback across all Trust services,
and will continue this work in 2014/15.
It is imperative that Managers and Team
Leads capture the experience of users and
carers accessing our services. Complaints
should be viewed as a positive learning
experience to drive actions of quality
improvements.
Q2.1
Yes
Page 18 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
Q2.2
Yes to both, otherwise corrective
action is difficult
We report monthly data on the Friends and
Family test by division.
Q2.3
Friends and Family Test should be
service focused NOT organisation
focused.
We provide monthly reports on comments
along with compliments which are reported
to each community team. The PALS,
Complaints, and Experience Teams work
in collaboration with Operational teams to
develop actions of improvement
Q2.3
Issues around capacity of
investigating officers to undertake
responses in the responses Could
complaint investigators be
outsourced?
All our staff are expected to learn from
complaints in their area, including assisting
with investigations and developing
improvement plans as required.
It is imperative that our staff investigate,
act on and learn from complaints.
Complaints are a valuable source of
feedback that can improve quality of
services.
As a Trust we have outsourced internal
complaint investigations for independence
of complex complaints. Following lessons
learnt through the introduction of
Independent Investigations the Trust will
still need to appoint an internal complaints
lead who will provide support to the
Independent Investigating Officer.
Q2.3
Excellence in customer service?
The Trust is required to demonstrate
compliance with 57 standards of the
Customer Service Excellence. Independent
validation of teams is reviewed by annual
Independent onsite Customer Service
Excellence assessors.
Q2.3
Do you have measures of “near
misses” which may indicate
organisational systemic weaknesses.
If so what is the trend?
Our Safety priority includes the overall
measure of number of incidents reported,
(including “near misses”).
How will these be collected, who will
be collecting these and from what
time and funding will these come from
i.e. budgets and who's time to hand
out, explain, collate and manage?
Comment cards have been designed with
self-addressed envelopes which glue at the
sides into an envelope. Comment cards
will be collated and analysed by the
Experience team, and results will be fed
back to each frontline team.
2F
We analyse our incident data to look for
systemic issues on a regular basis, and
report significant findings to our Quality
Governance Committee.
Page 19 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
Q2.2
Yes I do think we need a divisional
score but do we need targets
NO!!!!!!!!! the results you get from
your scores should indicate what
needs to be happening, make
decisions from that data do not start
out with more than can be managed.
this is a repeated issue, a new idea is
set out, we must implement it,
measure it and it must reach a target,
all of this needs time and money to
put in to place properly and that does
NOT happen therefore it is only done
half-heartedly and it becomes another
example of not completely... just take
the scores, measure and report them.
If a problem becomes obvious then
take that data and make the next
objective from there.
Our desire is to improve the experience of
our service users, and our measures and
targets are driven by this desire.
We agree that measurement alone is not
sufficient for improvement, and the burden
of measurement must be minimised. We
will use the NHS change model to help
improve our services.
The set monthly target for our Net
Promoter score / Friends and Family Test
on our performance has been set by our
Commissioners. This is included in the
quality schedule for the Trusts
commissioning contractual requirements.
Setting a reasonable target for each
service will ensure that areas of lower
quality are not “hidden in the average”
overall Trust score.
Page 20 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority 3: Effectiveness – Improving
Outcomes
Consultation measures and questions
Proposed measures for
2014/15
3A Number of teams
demonstrating improvement in
their outcome measures
Proposed 2014/15 target
All teams currently developing their outcome
measures will have moved to their next level by
the end of 2014/15 and will have as a minimum
started collecting and analysing outcomes data
(level 2a). Applicable teams:

Allied Health Professional teams

Therapy services teams

Children’s clinical teams
New teams will be participating in the outcome
measures programme, and will have as a
minimum a plan to develop evidence based
outcome tools (level 1). Applicable teams:
3B Average length of stay in
community hospitals7

Integrated Local Community Teams

Specialist Services teams
Monthly data not to exceed a median of 23 days
throughout the whole year
Q3.1: Do you agree with the changes made to the Quality Improvement Priority around
Effectiveness?
Q3.2: Should we include other measures? Should we delete any measures that are no
longer appropriate?
7
This measure is routinely looked at as part of the Trust performance management suite of indicators, but is
not directly related to outcome measures.
Page 21 of 37
Consultation on Quality Improvement Priorities 2014-15
Consultation comments
Priority
Comments
Response
3
“We want to provide effective
services with positive outcomes for
our service users.” – Is positive what
the individuals want or what we think
they want?
3
Should Improving Outcomes be
broken down into 2 sections? 1)
Improving outcomes for patient. 2)
Monitoring/ evaluating of outcomes
and what it means for staff. Quality
impact assessment, would need to do
a scoping exercise to identify
additional resources required i.e.
admin support, data base. Would it
be one outcome or a number of
outcomes?
We agree, and we feel that this
approach is covered by having two
quality improvement priorities related to
effectiveness; one for effective (servicebased) outcomes and one for
personalisation.
3
How does this link to personalised
care?
3
Linked to personalised health plan.
3A
Links to personalisation see
comments on priority 4.
Page 22 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
3
“We want to provide effective
services with positive outcomes for
our service users.” – This is important
but not conveyed in the priority
measures. In the aim but not a
measure. Could interweave with
Priority 2 (customer satisfaction) to
achieve this?
We feel that a first necessary step is to
get our teams to consistently collect
outcome data, and then move toward
improving their outcomes during
2014/15.
3
So What? What does this improve for
patients?
Many teams already use outcome
measures, to track the progress of
individual patients towards their clinical
goal. It is less common for a team to
analyse outcome measures across a
cohort of similar patients to identify what
is working well, and what improvements
can be made.
Priority 2 (satisfaction) looks at a
different dimension of quality, but some
of the mechanisms for collecting and
analysing data may overlap.
Monthly Ele-lite reports are
disseminated to every Area Manager
and Team Lead showing User
Satisfaction levels relating to
effectiveness of their services that they
have received. This also includes
involvement in care planning along with
self- management programmes of
empowerment.
3
Link to NICE priorities and best
practice
We will encourage our teams to use
outcome measures that are in line with
evidence-based practice, including
NICE priorities.
3
Are the goals well set/ set in a
SMART way, personalised. Ensure
can collect clear outcomes – refer to
priority 4.
3
Should have ambition, how to
measure the success and the
process. This priority is about the
process and how to reach the
outcomes
First, we need robust and reliable
systems to record outcomes. After this
we can analyse and understand our
outcomes, to enable improvement of our
services.
3
Public can’t see the outcomes picked
and why they have been picked.
We encourage our teams to use
outcome measures in line with
Evidence-Based Practice, and we will
report the outcome measures we use in
our Quality Account.
3
Define outcomes – Measure/ target is
large and can’t say if it has been
complete or not.
We will report progress of each team in
developing outcomes in our Quality
Account.
Page 23 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
3
What does 41 teams mean? Is it a
representative of the whole? Who is
not taking part?
For 2013/14 our Children’s and
Therapies teams participated in our
outcomes programme. These teams will
be listed in our Quality Account. We are
proposing that all Integrated Locality
Care Teams and specialist teams be
involved in outcome measurement and
improvement in 2014/15.
3
Need to understand where were we?
Where are we now? Where do we
want to be?
We regularly monitor the progress of our
41 participating teams in their use of
outcome measures, and we will report
this in our Quality Account.
3
A strength of outcome measures is
that teams can design their own.
Would this be possible if Integrated
Locality Care Teams or would they
need to work to a more generic set of
outcomes – for example “I have a
personalised support plan.”
Rarely do we need to design completely
new measures – existing indicators
have been “tried and tested” and can
help us compare across services.
3
The main concern is that Integrated
Locality Care Teams in particular
(plus Occupational Therapy) will be
subject to this separate Quality
Account. Team members will “buy in”
to relevant measures – equally quality
measures from two separate
accounts can becomes a burden, not
an enabler.
We produce one Quality Account for the
Partnership Trust.
3
Mortality review- benchmarking –
best practice – compliance, NICE
etc., Quality standards.
We feel that achieving these essential
governance processes represent “mustdo” minimum standards for all our
services, rather than quality
improvement priorities.
3A
“Applicable teams: Integrated Local
Community Teams” – Integrated
Locality Care Team?? Joint service
spec for Integrated Locality Care
Teams
Apologies for the typographical error.
We have amended the priorities to
consistently refer to our Integrated
Locality Care Teams.
3A
Communication and transition across
services.
Our Effectiveness Team will share
outcomes data with frontline teams, to
allow for shared learning, and
benchmarking where applicable.
Our method for developing outcome
measures involves frontline teams, so
that we can develop relevant measures
while minimising the burden on the
team.
Page 24 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
3A
Maybe list the teams involved now
and who needs to be included in the
future?
We will report team-by-team information
on outcomes to our Effectiveness
Group. We anticipate that all our
frontline teams will be involved during
2014/15.
3A
Need to ensure IT systems are in
place to support staff to collect and
analyse outcomes.
Our IT strategy will be looking at support
for staff.
3A
Ensuring all teams have outcome
measures. Focus on communities,
plan for teams.
Our second phase of development for
our Integrated Locality Care Teams will
include mapping of community need to
service provision.
Q3.1
Yes (x2)
Q3.1
Happy to remove (3B).
Q3.1
The risk is that team chase
improvements – Key Performance
Indicators – and not outcomes. Our
framework is required, not two.
Our Quality Improvement Priorities are
not intended to duplicate Key
Performance Indicators, or replace the
performance monitoring function. Our
Quality Team and Performance Team
will work together to ensure that work is
not duplicated.
Q3.2
Benchmarking against other
organisations, particularly with those
teams at level 4 – outwards facing
process for sharing and level 4
ambition for improvement.
We agree that benchmarking is useful to
help share best practice and learning.
Q3.2
More focus on social care - whole
very health focus (and social care
light) patient reported outcome
measures need to be linked. Also bag
of outcomes to suit everybody’s
needs not just one.
We agree that our outcomes focus
needs to encompass health and social
care, which is why we have a quality
priority looking at outcomes in terms of
personalisation. We feel that the
approach taken to develop outcome
measures across our teams gives them
flexibility to determine which set of
outcome measures is most appropriate
for the needs of their service users.
Q3.2
Service user considerations. What
the outcomes is for the patient.
We will encourage teams to develop
their outcome measures with full service
Our Effectiveness Team will provide
assistance for analysing outcomes data.
Our Effectiveness Team will encourage
shared learning and benchmarking for
comparable teams internally, and
outward facing where possible.
Page 25 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Q3.2
Need to identify what is a ‘good
outcomes’ what is realistic and
expectations. Take into account all
stakeholders.
Q3.2
Map treatment timescales for
recovery and effective outcomes for 3
/ 4 pressure ulcers (relationship to
priority 1 and 5)
Q3.2
NICE, Quality standards compliance.
Linkage PROMs.
Response
user and stakeholder involvement, and
also encourage the use of Patient
Reported Outcome Measures.
While this is an important measure of
the effectiveness of our services in
relation to pressure ulcers, we feel that
the relevant teams can include this in
their outcome measures sets, rather
than including it as a trust-wide outcome
measure.
Page 26 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
Q3.1
Services or teams must demonstrate
that outcomes have measurably and
materially improved. Outcomes based
commissioning is a fundamental part
of NHS England’s, approach
It is not within the scope of this
consultation to comment on national
policy or commissioning decisions.
I personally think this is a very short
sighted method of NHS England and
how to approach funding. This can be
very effective in a limited number of
services but this does not work well
with all services. For example I work
in adult physiotherapy, the majority of
these community outpatients are a
quick 20 min review appointment
seen treated and notes written in that
time, it’s very quick but a doable
approach to funding that 20min slot.
BUT I also work in paediatric
physiotherapy and for example I saw
a child with complex medical needs,
on this past Friday I spent over 4
hours of my work time trying to deal
with assessment, notes, letters to
other health professionals and
equipment issues for just this one
patient. HOW can you justify giving
the same sort of funding for those 2
individual physiotherapy patients?
The evidence of improvement a patient
makes towards their treatment goal is
an important measure of the care we
offer.
We feel that a focus on outcomes,
rather than solely on activity, is a key
way of measuring and improving the
effectiveness of our services.
We also feel that all of our services
should be focussing on improving the
outcomes of the care they provide for
their service users. In this respect,
appropriate benchmarking with similar
services (ie that provide services for
similar cohorts of service users) would
be a useful method of comparing the
effectiveness of care.
With regard to demo outcomes that
are measurable and materially
improved..... it’s too sweeping of a
policy and it does not apply to all
services and I don’t feel that there are
any options for those services that
don’t have easy patients or answers.
Page 27 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority 4: Effectiveness – Supporting
Independence by Personalised Care
Consultation measures and questions
Proposed measures for 2014/15
Proposed 2014/15 target
4A Service users who agree with key
statements in “Making it Real” (e.g. “I
have the information and support I need
in order to remain as independent as
possible”)
We are aiming to improve on the
baseline. How the improvement will
be measured is yet to be determined.
4B Percentage of people who receive
Achieve 70% by the end of the year
directed support and / or direct payments
4C Percentage of people who feel that
they were supported to make their own
decisions about their social care and / or
services
Maintain 85% through the whole year
4D Proportion of permanent admissions
to residential or nursing care homes8
150 per 100,000
Q4.1: Rather than have a separate priority, should we include this measure as part of
priority 3 (Effectiveness)?
Q4.2: As an Integrated health and social care organisation should we look to expanding
the principles and method of “Making it real” across all services, rather than just those with
a direct social care element?
Q4.3: Should we have a specific measure around personalisation?
Q4.4: Should we develop the effectiveness priority to include specific practice standards,
in addition to personalisation?
8
This measure is routinely looked at as part of the Trust performance management suite of indicators, but is
not directly related to personalisation.
Page 28 of 37
Consultation on Quality Improvement Priorities 2014-15
Consultation comments
Priority
Comments
Response
4
Are we being ambitious enough? Are we We develop and agree these targets
picking safe targets?
with our commissioners.
4
Needs to be clear re: current % - how it
relates to national guidance – are we
meeting it?
4
Safeguarding/ adult protection (mental
health) – how are we ensuring
vulnerable adults are safe?
Our Head of Adult Safeguarding
can provide more details on this
query.
4A
For people with dementia – these
outcomes would be relevant to main
family and carers
Our outcome measures for
personalisation include surveying
carers / relatives where appropriate.
On occasion personalisation of care
includes “best interest” decisions for
service users who lack capacity for
decision making – these are
handled according to a strict
framework taking into account input
from family and carers.
4B
Should measure 70% of people for
whom it is appropriate. Should the
measures be separate?
This target is derived from a national
indicator as part of the Adult Social
Care Outcomes Framework. Our
target of 70% reflects that not all
service users would find this
approach appropriate.
4B
Receive SELF directed support
We have corrected this
typographical error.
4B
Remove?? 70% of what? KPI not
outcomes
4B&C
Need to be clear about what the % is?
And what is the national average?
This target is derived from a national
indicator as part of the Adult Social
Care Outcomes Framework which
are provide opportunities for us to
benchmark our performance with
comparable organisations, as well
as charting improvement over time.
4B&C
Swap order.
We have changed the ordering to
suit.
4C
Agreed
4C
Should we get better? If achieving now
is this a stretch?
4C
A large portion of people may not have
capacity so it is about their family/
carers.
We are aiming for improvement in
this area, and setting a baseline of
maintenance at this point, as our
targets are to be confirmed with our
commissioners later in the year.
Page 29 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
4C
3A and 1B – surveys from county
council.
We receive our information for this
indicator from the county council
surveys and we are also looking to
increase the sample size by
additional surveys during 2014/15.
4C
Definition of this – other information
needs to be provided eg carers,
dementia etc.
This nationally defined indicator is
based on a monthly survey of
eligible clients in receipt of services.
4D
What is the current figure of proportion
of permanent admissions? (therefore
what is achievable/ Is it achievable?)
4D
There are external factors not
manageable by SSOTP that will prevent
this? Pressure from family members?
Given the comments received we
feel that it can be removed from our
top five quality improvement
priorities.
4D
Family members stuck in the middle –
care home managers vs healthcare –
users are not clear about who is
responsible for what? Podiatry – it feels
that you lose some rights to the NHS
when you enter a private nursing home.
4D
Is it about the length of stay in
permanent care?
4D
So what?! But may become more
important if care at home becomes less
affordable than care homes.
Q4.1
Interdependent of each other. Clear
personalised goal setting, clear
outcomes/ measurement – measure
service user experience – umbrella
across all = safe staffing levels.
Q4.1
Yes – as personalisation is inherent in
the life of Integrated Locality Care
Teams in a case management and
outcomes are a better measure. So
much of the KPI system measures
outputs, not outcomes. The proposed
measured about, especially point one,
are outcome measures.
Q4.1
Needs to be separate –
acknowledgement of complexity of
social care.
Page 30 of 37
This is a national indicator as part of
the Adult Social Care Outcomes
Framework, and we will continue to
monitor this measure monthly.
After consideration we decided to
keep two distinct priorities related to
Effectiveness.
We will keep the priority around
personalisation separate.
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Q4.1
Separate – delivered by somebody else
– council and social care as a statutory
requirement – needs more focus – how
we input that care. – needed internally
for integration and organisation needs to
be clear about the services we provide.
Q4.2
Yes it should be down to personal
choice. Making it real is patronising.
Q4.2
Response
“Making it real” is a national initiative
via Think Local Act Personal, which
marks progress towards
Yes, should be integrated. “making it
personalised, community-based
real has not been promoted at all in the
support. It is beyond the scope of
last year in social care, hence Integrated this consultation to comment on
Locality Care Teams would and should
whether the “making it real” term is
expand the vision of personalised
patronising.
services/ support plan to cover all
people supported via Integrated Locality See
www.thinklocalactpersonal.org.uk
Care Teams/ support plan/ case
management
We agree that the principles in
“making it real” can be extended
across all our services, and will work
towards this during 2014/15.
Q4.3
Quality life measures.
Q4.3
Yes, we need clear personalised goal
setting in order to be able to measure
outcomes linked to priority 3.
Q4.3
How do we ensure that carers are
supported as these are critical to
ensuring patients/service users stay at
home.
As part of our audit programme we
will develop measures for
personalisation during 2014/15.
We will consider quality of life as
part of these measures, as well as
personalised goal setting.
We agree. Support planning
currently includes carer
requirements. Our staff carry out
joint client and carer assessments at
the outset, and annual joint reviews.
We have a SC31 indicator that
measures our performance in this
area.
Our professional lead for social work
can provide more information on this
query.
Q4.3
For Integrated Locality Care Teams, the
number of people with personalised
support plan (including case
management) could be a “holistic”
measure across nursing and social care
and could be supported by a couple of
outcomes in the services
Page 31 of 37
We agree.
As part of our audit programme we
will develop measures for
personalisation during 2014/15.
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
Q4.4
Are any of these measures relevant to
people with dementia (their carers) for
whom daily maintenance requirements
are then met by informed carers. Should
there be a separate question for carers/
people with dementia. Needs also to link
with personalised “health budgets”
For our social care clients that suffer
from dementia, our joint
assessments recognise this.
Q4.4
Personalised goal planning, rather than
just using a tool for the sake of it. Need
to measure outcomes using appropriate
tool. Use tools/ data analysis for
continuous improvement.
We agree.
Q4.2
Yes
Q4.3
Personalisation is relevant to health and
social care
Page 32 of 37
As part of our audit programme we
will develop measures for
personalisation during 2014/15.
We agree.
Our Integrated Locality Care Teams
include health and social care
professionals.
Consultation on Quality Improvement Priorities 2014-15
Priority 5: Safety – Workforce
Consultation measures and questions
Proposed measures for 2014/15
Proposed 2014/15 target
5A Number of routine services that
deliver against clinical standards in line
with 7-day working according to national
guidance
We will determine all relevant
services that the national guidance
on 7-day working applies to, and
ensure that these services comply
with the guidance for 7-day working.
5B Publish monthly staffing levels for our
community wards, including agreed
establishment, safe staffing level in
relation to acuity, and actual staffing
levels.
Staffing is always at a safe level in
relation to shift-by shift service need,
taking into account the demand on
the service.9
5C Publish two acuity staffing
establishment reviews, which look at
safe staffing levels in community
hospitals, during 2014/15
Reviews will make use of national
guidance, professional body
guidance and best practice on
staffing levels, and will aim to
demonstrate appropriate staffing
establishment and skill mix, for the
provision of safe care.
Q5.1: Should an additional priority for Safety become a Trust Quality Improvement
Priority? If so, what targets and measures would be realistic?
Q5.2: Do you agree with the addition of a measure for safe staffing and its associated
target? What should this measure focus on?
Q5.3: Do you agree with the addition of a measure for 7 day working?
9
Details on how this will be reported are to be developed by April 2014
Page 33 of 37
Consultation on Quality Improvement Priorities 2014-15
Consultation comments
Priority
Comments
Response
5
Empowering/ supporting staff – staff survey,
“Friends and Family Test” for staff.
While we measure and
monitor these aspects of
quality, we did not consider
them part of our top 5 quality
improvement priorities.
5
Does this offer anything? We Know we have a
deficit; We have to do it anyway. Think about
how to make it unique to the Quality Account
and how it will be completed.
5
Organisation needs to define what a 7 day
service entails.
We have removed 5A as a
result of these comments,
recognising the additional
work required to design
clear indicators of our
progress toward 7-day
working.
5
Need to be clear about what 7 day working/
services means – what is the model of
delivery?
5
Is Monday – Friday the same as Saturday and
Sunday? Or is the weekend a different service
eg on call reduced working hours etc.
5
Is there demand for specific services for 7 day
– need to think about how we would provide
the service.
5A
Isn’t about individual choice/ Would people
want to see physiotherapist on a Sunday?
Wouldn’t it be better to extend working days
and have a shift?
5A
Is this about health?
5B
Should be for community teams also? Behind
this is developing local clinical nursing
leadership. Accountability. Safety culture –
linked to Keogh. Too big to do community
services in year 1.
5B&C
“community wards/hospitals” – ALL services
Q5.1
Yes
Q5.1
Staffing in community – skill mix and numbers:
demand is vital to safety targets,
Q5.1
Safety of staff and quality could be called in
jeopardy
Q5.2
Yes – additional measures for quality of staff
Page 34 of 37
We recognise the value of
developing 7-day working
across all our services,
although the high priority
areas for 2014/15 mainly
relate to our community
hospitals.
Our safe staffing monitoring
will include a professional
judgement from the frontline
on whether a service is safe,
based on the current shift
staffing and the demand on
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Q5.2
Need to move away from the target being the
numbers and keep personal e.g. if there is a
1:1 patient in. Services and staffing needs to
be flexible and competent.
Q5.2
Yes
Q5.3
Yes - there is a gap for community services
and lack of clarity around measures/ tools that
could be used to be the achievable measures.
Links in with [the Transformation Team’s]
workforce analysis tool that is being piloted in
Integrated Locality Care Teams and is
beginning to be used in therapies. Need to
ensure that streams of work are more inter
related i.e. not silo. Does everyone know for
example all the streams of work that the
transformation team are leading on and how
do they link in with the quality framework/
priorities.
Q5.3
Yes – additional measures for quality of staff.
Q5.3
The only way to keep people out of hospital
and in the community is by having a 7day
service.
We agree that our
community services play a
vital role in supporting
hospitals to deliver 7-day
working.
Q5.3
Relevant to whole organisation not just
community hospitals. What is impact of 7 days
on community services? Achievable aims for
the year.
We are taking a programme
approach for 7-day working
as we recognise the scope
and long term nature of this
work across the whole Trust.
Page 35 of 37
Response
the service.
We are taking a programme
approach for 7-day working
as we recognise the scope
and long term nature of this
work across the whole Trust.
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
Q5.2
Sounds like another situation of reporting and
think of all the ways to fiddle the results. If you
want to know how many people are on a ward
then do spot checks and make sure those that
are doing the spot checks are truthful.
Our reporting requirements
of front line staff are driven
by our priorities – not the
other way round.
I think this will just be another report that staff
will have to fill in when really what health care
staff want to do is TREAT patients and not do
more paperwork. If those that want to know
then get on a ward and find out, unannounced.
Of course we all want the reassurance that
more staff will be on a ward and that is not
where the funding is being cut back but i am
not sure this is the best method of capturing
the data.
Q5.3
I think you are ref to 7 day working across the
board in all services... health care needs are 7
day but not all services will be access no
matter what on all days of the week. Even
people that work don’t want out patient
physiotherapy on a Sunday morning.
I think it’s a cheap method of not paying your
staff in truth.
We feel that recording of
quality care is an integral
part of demonstrating and
delivering quality care.
In line with our Quality
Framework, we want to
empower our community
hospital staff to deliver high
quality, and one of the ways
we will do this is by asking
them whether they feel that
their service is at a safe
staffing level on a shift-byshift basis.
We agree that 7-day working
is not about providing all our
services every day, but
providing the right care at
point and time of need.
We feel that 7-day working
will provide our staff
opportunity for working
flexibly.
7-day working is not a costsaving initiative or way to
squeeze more work out of
our staff, but involves
providing a quality service
based on need.
Q5.1
Do you have measures of “near misses” which
may indicate organisational systemic
weaknesses. If so what is the trend?
Also measuring trends in litigation case
numbers and costs would be useful
Our incident reporting
system captures incidents,
including “near misses”, and
these are reported via our
governance structures.
We monitor incident trends
regularly, including reports
to our Trust Board.
We review trends in litigation
internally on a quarterly
basis, due to the confidential
nature of this area.
Page 36 of 37
Consultation on Quality Improvement Priorities 2014-15
Priority
Comments
Response
Q5.2
This is very hospital and nursing based – what
about other services, e.g. community nursing
where it is less easy to define ‘safe’ staffing
levels – as a community Trust it seems odd
there is no mention of this.
We recognise the value of
developing 7-day working
across all our services,
although the high priority
areas for 2014/15 mainly
relate to our community
hospitals.
Q5.3
No – we are not commissioned to deliver this in Our plans for implementing
a number of services and would require
7-day working will include
investment.
appropriate investment, and
dialogue with our
commissioners.
Our work in this area will
also be according to the
national timescales for
implementation of 7-day
working.
5
Priorities for service users:
ensuring appropriate staffing levels are
maintain in custodial healthcare settings to
ensure full delivery of contracted services
Priorities for staff:
providing cover for LTS staff in a custodial
setting for within directorate resources in
clinical community settings
Priorities for partners:
to ensure commissioners consider the impact
of H/C staffing on prison regimes within
custodial environments
Page 37 of 37
While we agree that
appropriate staffing levels in
custodial healthcare settings
are important we did not feel
this specific aspect would be
one of our top 5 quality
priorities for 2014/15.
However, we are conducting
a workforce development
review (commencing April
2014) for prison healthcare
services staffing levels and
skill mix.