Quality Improvement
Priorities for 2014/15
Consultation
V1.0
Robin Sasaru, Quality Team Manager
Chris McKeown, Effectiveness Officer
January 2014
Quality Improvement Priorities for 2014/15 – consultation
Consultation document
We want you to shape our Quality Improvement Priorities for 2014/15. To do this,
we will consult on the proposed changes to our priorities with:

Service Users

Staff

Our membership

Clinical Commissioning Groups, HealthWatch, and other stakeholders
Why we are changing our priorities
Over the last year we have completed the integration of adult health and social care
teams, developed our children’s services directorate, developed a specialist services
division, and acquired new sexual health services in Leicester. Externally, other
developments have included:

national reports in relation to the Francis Inquiry

new guidance and priorities from the Department of Health, NHS England,
and the Trust Development Authority

Revised commissioning intentions from our commissioners.
We want to ensure our Quality Improvement Priorities are still in line with
these developments.

We will record the rationale for any changes in our Quality Account 2013/14.

We will report on progress against our 2013/14 priorities in full, whether or not
we make any change for our 2014/15 priorities.
What you can comment on
We welcome comments on any part of this document. Specific questions are also
included throughout the document.
How to comment
Please email your comments to quality@ssotp.nhs.uk by 20 February 2014.
You can also call the Effectiveness Team to discuss any comments:

Robin Sasaru, Quality Team Manager: 07718-118178

Chris McKeown, Effectiveness Officer: 01889-571479

Hayley Fidler, Effectiveness Assistant: 01889-571478
We also have two consultation events discussing our quality priorities (on 30 January
and 7 February) – call us if you would like to attend.
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Quality Improvement Priorities for 2014/15 – consultation
Quality Improvement Priorities for 2014/15
Quality Accounts are annual reports to the public from providers of NHS healthcare
about the quality of services they deliver.

A Quality Account must include the organisations priorities for quality
improvement for the coming financial year.

As quality accounts are annual reports, there is an expectation of continuity
between accounts over time. Organisations should reflect and report back on
progress against priorities in future accounts. Where possible, providers
should use indicators to demonstrate success in subsequent years.1
In line with the national guidance on quality accounts, the Partnership trust is taking
a developmental approach to the Quality Improvement Priorities for 2014/15, by
suggesting amendments to the priorities based on a review of guidance, national,
health economy and service developments over the past year.
National Guidance on quality accounts
Current national guidance requires that Quality Improvement Priorities:

Are developed with all members of the organisation and local stakeholders

Reflect the three domains of quality (Safety, Effectiveness and Experience)

Demonstrate continuity over time

Include how progress to achieve the priorities will be monitored, measured
and reported
At least three improvement priorities (related to Safety, Effectiveness, and
Experience) are required for 2014/15. National guidance suggests that a three to five
priorities is a manageable amount.
Additional national guidance on Quality Accounts has not been published up to 7
January 2014.
1
Quality Accounts Toolkit 2010/11, Department of Health
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Quality Improvement Priorities for 2014/15 – consultation
Business development priorities and
commissioning intentions for 2014/15
National and local priorities from the draft 2-year operational high level
summary plan
Working towards achieving the Trust vision and model of care has placed the
organisation in a strong position to respond to the transformation challenge faced by
the NHS. Over the next two years we will build on our vision and model of care to
deliver both the Health Outcomes Framework and the national ambition of effective
integration between health and social care.
In order to achieve this ambition we will use our experience and learning to;





Further enhance our approach to supporting people with long term conditions
Ensure our Quality Priorities lead to further improvements the experience of
care and protect people from avoidable harm
Provide care closer to home by working with partners to develop services that
reduce the amount of time people spend avoidably in hospital
Improve our skills and delivery of services for people with mental and physical
health conditions
Further enhance our support of people living independently at home following
discharge from hospital
Local Priorities
We will develop our approach in line with the pressures facing our main Local
Authority and Health Commissioners in Stoke on Trent and the North and South of
Staffordshire to:

Provide integrated services

Maximise the use of resources

Maintain the quality and safety of care in line with the Francis and other
related reports

Respond to the report of the Trust Special Administrators (TSA) at Mid
Staffordshire Foundation Trust.
We acknowledge that our commissioners have different levels of financial challenge
and start from different baselines in terms of service delivery, which will result in
service reviews and strategies for the decommissioning of some services to enable
reinvestment in others. We will respond in innovative and flexible ways that support
improvements in care and the most clinically and cost effective solutions for patients.
Clinical Commissioning Group commissioning intentions
We have reviewed the commissioning intentions of all of our commissioners with our
operational divisions to align commissioning priorities and operational delivery. Key
areas of commissioner focus in the north and south include;


Focus on planned care and prevention
Evaluation and further development of ILCTs and Intermediate care
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Quality Improvement Priorities for 2014/15 – consultation







Admission avoidance and reablement across health and social care
Additional social care and domiciliary care provision
Frail complex care
Discharge systems and service reviews
The development of End of Life services
New pathways and models of care for Long term Conditions
Children’s service
We are developing our strategy for the use of assistive technology to provide
innovative ways to support the delivery of care.
In order to enable seamless care to be delivered flexibly and effectively we are
developing strategic partnerships and business cases, with other local providers, to
support joint working. We are also engaging with voluntary, independent and hospice
sectors to develop relationships centred on the prime provider model.
Divisional planning workshops
Held in the summer 2013/14, these workshops looked at a frontline perspective on
service development issues for 2014/15. Common themes align with national and
Clinical Commissioning Group intentions in the following areas:

Developing Integrated Locality Care Teams

Case management services

Admission avoidance / reablement

Developing Hospital at Home
Other significant theme areas include:

Improving IT & data quality, including paperless records

Use of digital health / assistive technology

Outcomes
Consultation questions
Are there any other national, health economy or service priorities we should take
account of?
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Quality Improvement Priorities for 2014/15 – consultation
Issues identified from the Francis report and
related reports
Six independent reviews which the Government commissioned to consider some of
the key issues identified by the Inquiry

Review into the Quality of Care and Treatment provided by 14 Hospital Trusts
in England, led by Professor Sir Bruce Keogh, the NHS Medical Director in
NHS England.

The Cavendish Review: An Independent Review into Healthcare Assistants
and Support Workers in the NHS and Social Care Settings, by Camilla
Cavendish.

A Promise to Learn – A Commitment to Act: Improving the Safety of Patients
in England, by Professor Don Berwick.

A Review of the NHS Hospitals Complaints System: Putting Patients Back in
the Picture by Rt Hon Ann Clwyd MP and Professor Tricia Hart.

Challenging Bureaucracy, led by the NHS Confederation.

The report by the Children and Young People’s Health Outcomes Forum, cochaired by Professor Ian Lewis and Christine Lenehan.
Since the Inquiry reported, the Government has already instigated a number of
significant changes which will improve inspection, increase transparency, put a clear
emphasis on compassion, standards and safety, increase accountability for failure,
and build capability.

The Care Quality Commission has consulted on a new system of ratings with
patient care and safety at its heart.

The Care Quality Commission has conducted a major consultation on a new
set of fundamental standards: the inviolable principles of safe, effective and
compassionate care that must underpin all care in the future. The
fundamental standards will enable prosecutions of providers to occur in
serious cases where patients have been harmed because of unsafe or poor
care, without the need for an advance warning notice.

For the first time, NHS England has published clinical outcomes by consultant
for ten medical specialties and has also begun to publish data on the friends
and family test.

New nurse and midwifery leadership programmes have been developed from
which 10,000 nurses and midwives will have benefitted by April 2015.
Compassion in Practice has an action area dedicated to building and
strengthening leadership.
Major new action on the following vital areas:

Transparent monthly reporting of ward-by-ward staffing levels and other
safety measures.
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Quality Improvement Priorities for 2014/15 – consultation

All hospitals will clearly set out how patients and their families can raise
concerns or complain, with independent support available from local
HealthWatch or alternative organisations.

Trusts will report quarterly on complaints data and lessons learned, and the
Ombudsman will significantly increase the number of cases she considers.

A statutory duty of candour on providers, and a professional duty of candour
on individuals through changes to professional guidance and codes.

The Government will consult on proposals about whether Trusts should
reimburse a proportion or all of the NHS Litigation Authority’s compensation
costs when they have not been open about a safety incident.

A new Care Certificate to ensure that Healthcare Assistants and Social Care
Support Workers have the right fundamental training and skills in order to give
personal care to patients and service users.

The Care Bill will introduce a new criminal offence applicable to care providers
that supply or publish certain types of information that is false or misleading,
where that information is required to comply with a statutory or other legal
obligation
Quality framework and supporting strategies
Our Quality Framework, agreed during 2012/13, is our overall 5-year quality strategy.
It sets our overall direction for quality and reiterates our core commitment to quality
in health and social care.
The Quality Framework aim is that all service users receive the highest quality of
care, by ensuring that front line teams are empowered by the organisation to provide
this. The Framework contains six quality goals, reflecting the unique makeup of our
Trust.
The Quality Framework is supported by three key strategies:

Safety: Measuring and improving the organisational safety culture

Effectiveness: Moving to Effective Outcomes

Experience: Improving service user experience and developing service user
involvement in quality improvement
These strategies and work streams detail the policies, systems and processes that
we will use to achieve our six quality goals. The Safety, Effectiveness, and
Experience strategies were agreed in 2013/14.
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Quality Improvement Priorities for 2014/15 – consultation
Priority 1: Safety – reducing avoidable
pressure ulcers
Current aim: no avoidable grade 2/3/4 pressure ulcers developed in our
care.
Current measures
Measures we will report to our Board
2013/14 target
Number of pressure ulcers reported as grade Zero grade 2/3/4 avoidable
3 and 4 pressure ulcers and reported as
pressure ulcers developed in our
serious incidents
care (max = 26 in community)
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
care
All pressure ulcers for people in our care and Increase in number of incidents
reported and reduction in the
reported as adverse incident
proportion of serious incidents / all
reported incidents
Other measures we will use to track
progress
Total number of adverse incidents reported
(all incidents)
Quarterly increase in number of
incidents reported
Percentage of reported incidents classified as Quarterly reduction in proportion
of serious incidents / all reported
serious incidents
incidents
Key points

Nationally, Trusts will continue to be encouraged to use the NHS Safety
Thermometer to help drive improvements in some key patient safety areas:
pressure ulcers, falls resulting from harm, catheter-associated infections and
venous thromboembolism. Also, NHS England will be working with other
national bodies to make patient safety data more accessible to all.

NHS England will begin to publish never events data monthly (by April 2014).

NHS England is leading work to develop proposals for ensuring every Trust
undertakes retrospective case note reviews of patient deaths according to a
consistent methodology to further encourage learning from adverse events.

Most service specifications require the Trust to adhere to national guidance
and best practice around incident management, including reporting of serious
incidents to commissioners
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Quality Improvement Priorities for 2014/15 – consultation

Improvement against the safety thermometer, particularly pressure ulcers, will
remain a national CQUIN requirement for 2014/152

The NHS National Contract 2014/15 technical guidance reinforces the
position that “… commissioners and providers should recognise the primary
importance of encouraging and supporting the reporting of incidents in order
to promote learning and the improvement of patient safety. Incident reports
must be welcomed and appreciated as opportunities to improve…”3

National Commissioning Planning guidance for 2014/15 emphasises Patient
Safety, including development of Regional and Area Team Quality
surveillance groups, a new Patient Safety Alerting System, continued zero
tolerance of MRSA bloodstream infections, and the setup of a Patient Safety
Collaborative Programme.4

Provider planning guidance for 2014/15 onwards emphasises safe services
including: reporting and learning culture, using the patient safety thermometer,
robust incident processes, duty of candour, reducing avoidable deaths, early
warning systems for deteriorating patients, safe staffing levels, and having a
clean environment to drive down MRSA and C.Difficile rates5

The Partnership Trust Safety Strategy elaborates on the 2013/14 safety
priorities: no avoidable grade 2/3/4 pressure ulcers developed in our care;
development of the Safety Thermometer; and reducing harm from falls.
2
See http://www.england.nhs.uk/wp-content/uploads/2013/12/cquin-guid-1415.pdf
3
See http://www.england.nhs.uk/wp-content/uploads/2013/12/tech-guid-1415.pdf page 44
4
See http://www.england.nhs.uk/wp-content/uploads/2013/12/5yr-strat-plann-guid-wa.pdf page 19
5
See http://www.ntda.nhs.uk/wp-content/uploads/2013/12/tda_planning_2013_final-4.pdf page 9
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Quality Improvement Priorities for 2014/15 – consultation
Recommendation for Priority 1
The Trust should make minor amendments to the current aim and measures for
2014/15.
Proposed measures for 2014/15
Proposed 2014/15 target
Number of pressure ulcers reported as grade Aim for Zero grade 2/3/4 avoidable
3 and 4 pressure ulcers and reported as
pressure ulcers developed in our
serious incidents
care6
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
care7
All pressure ulcers for people in our care and Increase in number of incidents
reported and reduction in the
reported as adverse incident
proportion of serious incidents / all
reported incidents
Other measures we will use for Safety
Total number of adverse incidents reported
(all incidents)
Quarterly increase in number of
incidents reported
Percentage of reported incidents classified as Quarterly reduction in proportion
of serious incidents / all reported
serious incidents
incidents
Consultation questions
Is the measure for ‘pressure ulcers reported as adverse incidents’ already covered
by the more general measure ‘total number of adverse incidents reported’?
Do you agree with the minor changes made to the Quality Improvement Priority
around Safety?
Should we include other measures? Should we delete any measures that are no
longer appropriate?
6
Specific trajectory to be determined
7
Specific trajectory to be determined
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Quality Improvement Priorities for 2014/15 – consultation
Priority 2: Experience – customer satisfaction
Current aim
Our aim: improve our overall customer satisfaction (Net promoter score / “Friends
and family test”)
Current measures
Measures we will report to our Board
2013/14 target
Friends and family test (Net Promoter Score)
Maintenance of existing
high scores8
Health and social care compliments received
by the Partnership Trust
Year on year increase in the
number of compliments
received
Percentage of complaints acknowledged
within three working days
100% (health)
Percentage of complaints responded to
within complaints NHS regulations
timescales
100%
100% (social care)
Other measures we will use to track
progress
Patient Experience Surveys within Health
and Social Care
At least 1000 responses each
month from surveys in Health.
Implementation of comment cards for
community services where service users
don’t wish to use technological solutions
TBC
Number of complaints that were not
responded to within 60 days
0
Key points
8

Most service specifications have a patient experience requirement

The Friends and Family Test / Net Promoter Score is a key part of the Service
User Experience Strategy.

The Clewyd-Hart report into how complaints are handled by NHS hospitals
was published in October 2013. Recommendations included development of
This target was changed from the previously published +84 by end of Q4 target.
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Quality Improvement Priorities for 2014/15 – consultation
appropriate professional behaviour in handling of complaints, taking action to
improve quality resulting from complaints, encouraging both positive and
negative feedback about services, board-led scrutiny of complaints,
publication of an annual complaints report, and establishment of clear
standards for complaints handling
9

The Friends and Family test is one of the four nationally mandated CQUIN
schemes for 2014/15

National planning guidance for 2014/15 emphasises patient experience;
“…Plans are expected to demonstrate measurable improvement in patient
experience as well as continued investment in generating feedback…” 9

A key element of the Partnership Trust Experience Strategy is to capture user
and carer feedback, reporting this regularly and acting to make improvements
in service user experience.10

The NHS Outcomes Framework 2014/15 includes a new placeholder (the
indicator is in development): Improving people’s experience of integrated
care11

The Experience Team will be continuing to develop the use of real time
reporting, linked to service improvements from feedback. The team will look at
increasing the number of ele-lite devices for providing feedback, and rolling
out integrated health and social care survey processes for our Integrated
Local Care Teams.
See http://www.england.nhs.uk/wp-content/uploads/2013/12/5yr-strat-plann-guid-wa.pdf page 20
10
See http://www.staffordshireandstokeontrent.nhs.uk/Quality%20files/Experience%20Strategy.pdf
page 11
11
See the Adult Social Care Outcomes Framework indicator 3E
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Quality Improvement Priorities for 2014/15 – consultation
Recommendation for Priority 2
The Trust should continue with the current aim and measures for 2014/15, making
minor amendments as follows.
Proposed measures for 2014/15
Proposed 2014/15 target
Friends and family test (Net Promoter Score)
Achieve and sustain +70 for
all services
Health and social care compliments received
by the Partnership Trust
Year on year increase in the
number of compliments
received
Percentage of complaints acknowledged
within three working days
100% (health)
Percentage of complaints responded to
within complaints NHS regulations
timescales
100%
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.
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
Number of complaints that were not
responded to within 60 days
0
Percentage of complaints that are reviewed
by our complaints panel
All high risk complaints
100% (social care)12
5% of all other complaints13
Consultation
Do you agree with the changes made to the Quality Improvement Priority around
Experience?
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?
12
Separated reporting for Health and Social care complaint due to differing systems and
responsibilities for social care complaints.
13
Target to be confirmed with complaints panel
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Quality Improvement Priorities for 2014/15 – consultation
Should we include other measures? Should we delete any measures that are no
longer appropriate?
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Quality Improvement Priorities for 2014/15 – consultation
Priority 3: Effectiveness – improving outcomes
Current aim: Improve the outcomes of our services
We want to provide effective services with positive outcomes for our service users.
We know that quality improves when our staff focus on the outcome – “the end
result” – for the service user. To focus on the outcome means to focus on individual
needs and preferences, not simply tasks.
During 2013/14 we focussed on outcomes for our Therapy, Allied Health
Professional, and Children’s clinical teams, linked to a two-year CQUIN initiative.
This year 41 Teams were scheduled to participate this work.
Current measures
Measures we will report to our
Board
2013/14 target
Number of teams demonstrating
improvement in their outcome
measures
41 teams will be participating in
2013/14 will have completed their
level for 2013/14 as per the table
below and move to the next level for
2014/15
Other measures we will use to
track progress
Average length of stay in community
hospitals
Monthly data not to exceed a median
of 23 days throughout the whole year
Number of
teams at this
level at start
of 2013/14
2013/14 target
Services or teams will evidence
that outcome measurement
tools are in use and systems for
data capture are fully
established.
1714
Services or teams will evidence that
outcome measurement tools are in use
and systems for data capture are fully
established.
Services or teams will evidence
that systems have been
developed to ensure that
outcome data is being
systematically collated in a
manner that will allow analysis.
12
Services or teams will evidence that
systems have been developed to ensure
that outcome data is being
systematically collated in a manner that
will allow analysis.
Outcome measures:
Level
To achieve this level each
team must:
1 - Plan to develop
evidence based
outcome tools
2a - plan systems for
capturing and
analysing outcome
data
In total there are 41 teams included within the CQUIN for 2013/14. The Sneyd
Occupational Therapy team is part of the Sneyd ward Stroke rehabilitation therapy
service.
14
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Quality Improvement Priorities for 2014/15 – consultation
Number of
teams at this
level at start
of 2013/14
2013/14 target
Services or teams must
evidence that quality outcome
data has been collected and
analysed throughout the year.
9
Services or teams must evidence that
quality outcome data has been collected
and analysed throughout the year.
Services or teams must
demonstrate that outcomes
have measurably and materially
improved.
3
Services or teams must demonstrate
that outcomes have measurably and
materially improved.
Outcome measures:
Level
To achieve this level each
team must:
2b - Collect 12 months
outcome data.
3 - plan for improving
outcomes.
Key points
15

Most service specifications from healthcare commissioners require regular
reporting of service user experience data.

National planning guidance for 2014/15 emphasises an outcome focus15. NHS
England will be reviewing funding mechanisms so that they are truly
supportive of improving outcomes, as part of the measures to close the
potential funding gap of around £30 billion by 2020/21. Outcomes based
commissioning is a fundamental part of NHS England’s, approach, and they
are encouraging stretched local ambitions for outcomes, expansion of patientreported outcome measurement, and sharing of outcome data.

The Partnership Trust Effectiveness Strategy is focussed providing the best
possible outcomes for our service users, by developing routine outcome
measures as well as the use of audit and service evaluation.16

Provider planning guidance for 2014/15 onwards emphasises effectiveness
including; better outcomes for patients, full participation in national clinical
audits, using NICE Quality Standards, supporting the prevention / reduction of
admissions and readmissions to hospital, integration with social care, working
on Every Contact Counts, 7 day working17
See http://www.england.nhs.uk/wp-content/uploads/2013/12/5yr-strat-plann-guid-wa.pdf page 23
16
See http://www.staffordshireandstokeontrent.nhs.uk/Quality%20files/Effectiveness%20Strategy.pdf
page 22
17
See http://www.ntda.nhs.uk/wp-content/uploads/2013/12/tda_planning_2013_final-4.pdf page 10
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Quality Improvement Priorities for 2014/15 – consultation
Recommendation for priority 3
Expand the measure “number of teams demonstrating improvement in their outcome
measures” to encompass Integrated Local Community Teams and Specialist
Services teams for 2015/16,
Proposed measures for 2014/15
Proposed 2014/15 target
Number of teams demonstrating
improvement in their outcome measures
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:
Average length of stay in community
hospitals18

Integrated Local Community
Teams

Specialist Services teams
Monthly data not to exceed a median of
23 days throughout the whole year
Consultation
Do you agree with the changes made to the Quality Improvement Priority around
Effectiveness?
Should we include other measures? Should we delete any measures that are no
longer appropriate?
18
This measure is routinely looked at as part of the Trust performance management suite of
indicators, but is not directly related to outcome measures.
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Quality Improvement Priorities for 2014/15 – consultation
Priority 4: Effectiveness - supporting
independence by personalised care
Current aim: ensure our service users have choice and control over the
shape of health and social care support we provide
We want our integrated adult health and social care teams to focus on giving service
users choice and control over the shape of the support we give them. We call this
“personalisation”.
Current measures
Measures we will report to our Board
2013/14 target
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.
Other measures we will use to track
progress
Percentage of people who receive
Achieve 70% by the end of the year
directed support and / or direct payments
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
Proportion of permanent admissions to
residential or nursing care homes
150 per 100,000
Key points

Continuing need to be person-centered rather than task-focussed

NHS England describes a model of delivering care that is integrated around
the individual as being essential, including integration across health and social
care, including the £3.8 billion Better Care Fund from 2015/16 aimed at
supporting the integration of health and social care.

The Partnership Trust Effectiveness Strategy cites “Making it Real” as an
approach that makes a public commitment to improving quality in social
care.19
19
See http://www.staffordshireandstokeontrent.nhs.uk/Quality%20files/Effectiveness%20Strategy.pdf
page 30
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Quality Improvement Priorities for 2014/15 – consultation
Recommendation for priority 4
The Trust should retain the existing measures for priority 4 for 2014/15:
Proposed measures for 2014/15
Proposed 2014/15 target
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.
Percentage of people who receive
Achieve 70% by the end of the year
directed support and / or direct payments
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
Proportion of permanent admissions to
residential or nursing care homes20
150 per 100,000
Consultation questions
Rather than have a separate priority, should we include this measure as part of
priority 3 (Effectiveness)?
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?
Should we have a specific measure around personalisation?
Should we develop the effectiveness priority to include specific practice standards, in
addition to personalisation?
20
This measure is routinely looked at as part of the Trust performance management suite of
indicators, but is not directly related to personalisation.
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Quality Improvement Priorities for 2014/15 – consultation
NEW Priority 5: Safety - workforce
The National Quality Board’s Safe Staffing ‘How to Guide’21 emphasises the need for
policies, systems and routine monitoring of shift-to-shift staffing levels. This should
be at Executive team level. To be open and transparent, staffing capacity and
capability should be discussed at a public Board meeting at least every six months
on the basis of a full nursing and midwifery establishment review. This is supported
by a national requirement for transparent monthly reporting of ward-by-ward staffing
levels.
The RCN “safer staffing for older peoples wards” also provided relevant guidance for
safe staffing levels.
October 2013 Board received an acuity staffing establishment reviews, which looked
at staffing levels and skill mix at community hospitals.
The Trust Development Authority is requiring that Trust Boards clearly demonstrate
work towards the introduction of 7 Day working and identify the impact this will have
both on quality and cost within the services they provide.22
With the initial focus nationally, on improving 7 day working across Urgent and
Emergency care pathways, The Partnership Trust’s senior team recognises that
where there is currently an inconsistency of access to clinical services over a seven
day period, patients do not always experience parity of access to the optimum
treatment or diagnostic tests that they should. Therefore active participation as a key
partner of the three Local Health Economy approaches to improving pathways is
considered essential.
Given the shift from hospital based care to care in the community, we require a more
flexible workforce in the health and social care system that is responsive to changing
demand and flow. It is imperative that staff have the appropriate skills and
knowledge to deliver high quality, safe care in new clinical settings and closer to
home. As such the Partnership Trust has committed to a patient centric, pathway
model of workforce planning; capturing staff skills, knowledge and competence,
fundamental to workforce re-profiling and ensuring an effective 7 day working model.
21
See http://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf
22
See http://www.ntda.nhs.uk/wp-content/uploads/2013/12/tda_planning_2013_final-4.pdf
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Quality Improvement Priorities for 2014/15 – consultation
Recommendation: consider a new “priority 5”
The Trust should consider an additional priority, based on national direction and
commissioning intentions:
Aim: Ensure that our workforce can provide safe levels of care
Proposed measures for 2014/15
Proposed 2014/15 target
Number of routine services that deliver
against clinical standards in line with 7day 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.
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.23
Publish two acuity staffing establishment Reviews will make use of national
reviews, which look at safe staffing levels guidance, professional body
guidance and best practice on
in community hospitals, during 2014/15
staffing levels, and will aim to
demonstrate appropriate staffing
establishment and skill mix, for the
provision of safe care.
Consultation Questions
Should an additional priority for Safety become a Trust Quality Improvement Priority?
If so, what targets and measures would be realistic?
Do you agree with the addition of a measure for safe staffing and its associated
target? What should this measure focus on?
Do you agree with the addition of a measure for 7 day working?
23
Details on how this will be reported are to be developed by April 2014
Page 21 of 21