Quality Improvement
Priorities for 2015/16
Consultation document
V1
January 2015
Consultation document
You can comment on any part of this
document.
Specific consultation questions also
appear in red at the end of each section.
Please send us your comments
by 28 February 2015.
Email quality@ssotp.nhs.uk
Twitter: #SSOTPQuality
Contact:
Robin Sasaru, Quality and Effectiveness Manager
Edric House
Wheelhouse Road
Rugeley, Staffordshire
WS15 1UW
Telephone 01889-571539
For information on our consultation events email us:
quality@ssotp.nhs.uk
Quality Improvement Priorities for 2015/16 – consultation V1
Quality Improvement Priorities for 2015/16
consultation
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 our
priorities for quality improvement for the coming financial year.
Current national guidance requires that Quality Improvement Priorities:

Are produced with true involvement and engagement of all with an interest in
the Partnership Trust

Reflect the three domains of quality (Safety, Effectiveness and Experience)

Demonstrate continuity over time

Demonstrate quality improvement successes in subsequent years

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 each year. National guidance suggests that a manageable
number of priorities is between three and five, although some other community
Trusts have selected a larger number of priorities.
In line with the national guidance on quality accounts, we are developing our
priorities for 2015/16 based on:

National guidance

Health economy developments

Commissioning intentions

Our current quality improvement priorities
This consultation suggests small changes to our existing priorities based on a
review of the information above.
We have also shown how the five Key Lines of Enquiry (KLOEs) from the Care
Quality Commission (CQC) align with our priorities in this document. Services are to
be Safe, Caring, Responsive, Effective, and Well-led.
How we will develop our priorities
From 20 January to 28 February 2015 we will consult with staff, service user groups,
and other stakeholders on changes to our quality improvement priorities for 2015/16.
We will publish a consultation report with all the comments we receive.
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Quality Improvement Priorities for 2015/16 – consultation V1
Priority 1: Safety – Reduce avoidable harm
Our aim: eliminate avoidable grade 3/4 pressure ulcers developed in our
care.
This priority aligns with the CQC KLOE around Safe Services.
This year, and previous years, we have focussed on avoidable grade 3/4 pressure
ulcers developed in our care.

From April to September 2014 we had no reported community hospital
pressure ulcers developed in our care

From April to September 2014 we had nine avoidable pressure ulcers in
community services developed in our care

We have improved the management of community pressure ulcers at grades
three and four. Comparing the first half of this year with last year, we expect to
reduce community pressure ulcers by 55%
We will continue to run our Tissue Viability panels to review pressure ulcers
developed in our care were avoidable, according to national definitions and
guidance.
We also will continue to measure the overall number of incidents reported, and the
proportion of serious incidents, as we view this as a measure of our safety culture.
We will report this data to our Trust Board. We also recognise that improving our
safety culture is in line with ADASS good practice to promote and embed culture
change.
This year, NHS England launched Sign up to Safety, and we have joined this
campaign1.
Sign up to Safety is designed to help realise the ambition of making the NHS the
safest healthcare system in the world by creating a system devoted to continuous
learning and improvement.
Sign up to Safety aims to deliver harm free care for every patient, every time,
everywhere. It champions openness and honesty and supports everyone to improve
the safety of patients.
Sign up to Safety’s 3-5 year objective is to reduce avoidable harm by 50% and
save 6,000 lives across the NHS.
We feel that Priority 1 should be focussed on our ongoing commitments to Sign up to
Safety and our safety strategy, notably:
1

50% reduction in avoidable harm in incidents reported (moderate harm and
above) over the next five years, specifically for falls and pressure ulcers, with
a trajectory of 10% reduction year on year

Developing our safety culture programme

Enabling staff to raise safety concerns
See http://www.england.nhs.uk/signuptosafety/whos-signed-up/staff-stoke/
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Quality Improvement Priorities for 2015/16 – consultation V1
Measures for 2015/16
Proposed measures for 2015/16
2015/16 target
Number of avoidable grade 3 / 4
pressure ulcers developed in our care
Zero grade 3/4 avoidable pressure
ulcers developed in our care in
community hospitals
Reduce the incidence of avoidable
grade 3 and 4 pressure ulcers
acquired in the community year on
year by a minimum of 10% (with a
tolerance of 23 cases maximum in
community services during 2015/16.)
Number of serious incident falls reported Reduce the incidence of serious
incident falls year on year by a
whilst in our care
minimum of 10% (with a tolerance of
12 cases maximum in community
services during 2015/16.)
Number of “near misses” reported
25% increase from 2014/15 baseline
during 2015/16
Total number of adverse incidents
reported applicable to the Trust (all
incidents)
Quarterly increase in number of
incidents reported
(Aligned to indicator 5.6 in the 2015/16
NHS mandate)
Percentage of reported serious incidents Quarterly reduction in proportion of
serious incidents / all reported
applicable to the Trust
incidents
(Aligned to indicator 5.6 in the 2015/16
NHS mandate)
Consultation questions:
1. Does Safety – reduce avoidable harm remain a key priority for us?
2. Are there any additional measures we should use to monitor our
progress?
3. Should we amend or remove any of the measures above?
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Priority 2: Experience – Improve customer
satisfaction
Our aim: Sustain and maintain our overall customer experience, as
measured by the “Friends and Family Test”
This priority aligns with the CQC KLOE around Caring and Responsive Services.
We view our overall “Friends and Family Test” Net Promoter Score as a useful
indicator of the overall experience and satisfaction of our services. We also use other
survey and involvement methods to uncover the details behind this high-level
indicator.
We continue to monitor our complaints and Patient Advice and Liaison Services
(PALS) processes, as we know that these are a can be an indicator of experience
issues.
We also want to improve our service user’s experience of personalisation2. For
example, our customers receive a copy of their care plan, the care plan involves
them, and the plan clearly identifies their needs and outcomes to be achieved.
We want to encourage improvements in our services which are identified by our
users and carers.
2
See also Priority 3.
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Measures for 2015/16
Proposed measures for 2015/16
2015/16 target
Friends and Family Test (Net Promoter
Score)
Sustain +72.5 for the whole Trust
(Aligned to indicator 4c from the 2015/16
NHS mandate)
Health and social care compliments
received about Partnership Trust services
Year on year increase in the number
of compliments received
Friends and family test (Net Promoter
Score) for carers
Sustain +80 for the whole trust
Percentage of complaints acknowledged
within three working days, in accordance
with health and social care complaints
regulations
100% (health)
Percentage of PALS concerns directly
associated to services provided by the
Partnership Trust resolved in 24 hours or
escalated to a formal complaint
100%
Percentage of complaints responded to
within timescales agreed with the
complainant, in accordance with Health and
Social Care complaints regulations
100%
Patient experience surveys within health
and social care
Sustain at least 1000 responses each
month from surveys in health
100% (social care)3
At least 98 surveys sent each month
in social care for Integrated Locality
Care Teams
Implementation of comment cards for
community services in order to expand the
methods of collecting service users and
carer feedback
Comment cards available in all places
where care is delivered
Number of Complaints that are reviewed by
our Independent Complaints Review Panel4
20 complaints reviewed by the panel
in 2015/16
Monthly reporting of feedback from
cards to all Operational Teams
3
Separated reporting for Health and Social care complaint due to differing systems and
responsibilities for social care complaints.
4
In April 2014 the Partnership Trust introduced an independent panel for the review of complaints.
Panel volunteers are offered education and training on the complaints process. Reports, with the
outcomes of the complaint along with actions of improvement, are shared across the Trust.
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Proposed measures for 2015/16
2015/16 target
List of actions taken in response to
recommendations by our Independent
Complaints Review Panel
Implement all recommendations from
the panel
Publication of complaints and outcomes of
investigations and findings of the
Independent Complaints Review Panel
First report on the Trust website in
quarter 1
Peoples experience of integrated care
(ASCOF 3E, aligned to indicator 4.9 of
the 2015/16 NHS mandate)
Improvement
Care plan audits: proportion of people
receiving a copy of their care plan
Increase
Panel to make an annual report to the
Trust Board
Consultation questions:
4. Does Experience – improve customer satisfaction remain a key priority
for us?
5. Are there any additional measures we should use to monitor our
progress?
6. Should we amend or remove any of the measures above?
7. Should we include a 2015/16 target for each of our operational divisions
to improve their friends and family test overall result, compared to a
2014/15 baseline?
8. What specific targets would be most appropriate for the last two
measures above (peoples experience of integrated care, and care plan
audits)
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Priority 3: Effectiveness – improve our
outcomes
Our aim: Improve the outcomes of our services
This priority aligns with the CQC KLOE around Effective Services.
We want to provide effective services with positive outcomes for our service users.
We know that quality improves when we 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 2014/15 we expanded our outcome measures programme across:

Allied Health Professional teams

Multidisciplinary teams, eg Falls, Rehabilitation, Pain Management

Children’s clinical teams

Integrated Locality Care Teams

Specialist Services teams
We have also focussed on the use of the EQ-5D, a standardised instrument for use
as a measure of health outcome5.
Now that many of our teams are routinely measuring and reporting outcomes, we
want to use this data to drive improvements in our services.
5
See http://www.euroqol.org/
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Measures for 2015/16
Proposed measures for
2015/16
2015/16 target
Number of teams
demonstrating improvement
in their outcome measures
All applicable frontline teams collect and analyse
outcome data, and develop a plan for improving the
outcomes of their service by the end of 2015/16
Monitoring of outcomes
specific to our integrated
health and social care
teams. (eg EQ5D or other
tool)
Analyse and publish (on our website) our
baseline EQ-5D information on outcomes
Develop and publish improvement plans for our
services
Consultation questions:
9. Does Effectiveness – improving our outcomes remain a key priority for
us?
10. Are there any additional measures we should use to monitor our
progress?
11. Should we amend or remove any of the measures above?
12. Should we include some specific outcome measures related to
telehealth or telecare? If so, what should they be?
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Priority 4: Effectiveness - support
independence by personalised care
Our aim: ensure our service users have choice and control over the
shape of health and social care support we provide
This priority aligns with the CQC KLOE around Responsive Services.
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. This is called
“personalisation”.
A recent national personalisation survey tells us “what good looks like” around
personalisation6. We will expand our work on personalisation, reflecting the priorities
in Making It Real7.
We also want to offer people up-do-date choices and easily accessible information.
We are working with our local authority to develop and promote an e-marketplace.
We want to ensure all our people receiving social care can benefit from this service.
We want to promote person-centred care for our customers, so that our staff focus
on helping them to be independent. To do this, we will ensure our staff receive
training in person-centred care.
Measures for 2015/16
Proposed measures for 2015/16
2015/16 target
Use of e-marketplaces
Work with Staffordshire County Council to
increase use of the e-marketplace for
social care
Ensure that all social care staff have
information on how to access the emarketplace, including Staffordshire
Cares
Quarter-on-quarter increase in the
number of social care staff using the emarketplaces
Ensuring our frontline staff are trained All Integrated Local Care Teams,
in reablement and personalisation
Community Intervention Service, and
Living Independently Staffordshire
philosophy.
frontline staff receive person-centred
training, as part of their Personalisation
training
6
See “ADASS Personalisation Survey 2014” in the appendix
7
We will continue to work on “Making It Real” in 2015/16, as we have done over the last two years.
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Proposed measures for 2015/16
2015/16 target
Proportion of people who feel that
they were supported to make their
own decisions about their social care
and / or services (1b proxy)
Maintain at least 85% through the whole
year*
Proportion of people who receive self- Achieve 70% by the end of the year (selfdirected support and / or direct
directed support) *
payments (SC10a-c)
Achieve 50% by the end of the year
(direct payments)
Indicator 1b: Proportion of people
using social care that have control
over their daily life
78%*
(via national annual survey)
Making it Real and Think Local Act
Personal
Complete the two cycles of Making It
Real, incorporating best practice from the
ADASS personalisation survey report and
related documents
Consultation questions:
13. Does Effectiveness - support independence by personalised care remain
a key priority for us?
14. Are there any additional measures we should use to monitor our
progress?
15. Should we amend or remove any of the measures above?
* Subject to negotiation with commissioners.
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Priority 5: Safety - workforce
Our Aim: Ensure that our workforce can provide safe levels of care
This priority aligns with the CQC KLOE around Safe Services.
Last year, we published monthly shift-by shift staffing levels, and two staffing
establishment reviews, in line with national guidance.8
We took decisive action in 2013/14 to ensure that our wards remain safely staffed.
For example, we invested more than £350,000 in new nurses for our community
hospital wards9. We also temporarily closed beds to ensure adequate staffing levels
across our community hospitals. We regularly publish information on our staffing
levels on our website10.
National guidance recommends that we move beyond numbers of staff, and focus on
care contact time in 2015/16. We will use new guidance to help our ward teams
improve the direct contact time they spend with patients in our community hospitals.
We also want to ensure our workforce can provide safe levels of care in our
community services. As with 2014/15, we will continue to look at these services to
make sure we have the right people delivering the right service at the right time,
using our workforce planning tools.
We recognise that unfilled vacancies can increase pressure on staff having to
provide cover. We intend to continue our focus on safe staffing through 2015/16.
We are continuing work in 2015/16 to develop 7-day services, so we felt that
additional focus on safe staffing as part of our quality improvement priorities would
be beneficial.
8
See http://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf
9
See
http://www.staffordshireandstokeontrent.nhs.uk/BoardMeetings/Boosttocommunityhospitalstaffingtoen
suresafe
10
See http://www.staffordshireandstokeontrent.nhs.uk/Services/safe-staffing.htm
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Quality Improvement Priorities for 2015/16 – consultation V1
Measures for 2015/16
Proposed measures for
2015/16
2015/16 target
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
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
Consultation questions:
16. Does this remain a key priority for us?
17. Should we include measures and targets around workforce development
in this priority? If so, what measures would be useful?
18. Are there any additional measures we should use to monitor our
progress?
19. Should we amend or remove any of the measures above?
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How we will make improvements
We want to empower our front line teams to deliver quality11. We know that our
frontline staff are key to improving the quality of care we provide.
Our strategies for quality12 are the main way we will address our quality
improvement priorities. We will also use other methods to support our frontline teams
to make improvements:

We will continue our work to create a more open and honest culture in the
NHS, including supporting our staff to speak out to raise concerns13.

Our new team of Service Improvement Managers will provide intensive
training for service and quality improvement.

Our Organisational Development and Leadership team will continue to
provide our tailored leadership development programme and support for team
leaders, in line with our strategy for organisational development. This, in turn,
will support our staff to improve our services.

Our Business Development team will help each of our divisions to develop
their service priorities, including reviewing the impact of service developments
on quality.

Our Performance team will develop the reporting platforms to improve the
speed of reporting, on line access and the accuracy of data reported. This will
include service line reporting, allowing our frontline teams to see integrated
finance, performance and quality information.

Our Professional Leads will continue to provide leadership, support and
advice to frontline staff, helping them to promote best practice and excellent
customer service.

Our Research and Innovation team will continue to manage and promote our
research portfolio, helping our staff to contribute to the evidence base for
health and social care.

Our Quality Assurance work, including regular quality visits, team
Healthchecks, and team self-assessments, will ensure our services are Safe,
Caring, Responsive, Effective, and Well-led.
11
See our Quality Framework, available on our website here:
http://www.staffordshireandstokeontrent.nhs.uk/Quality%20files/Quality%20Framework%20final%20v
3.5.pdf
12
See our Safety, Effectiveness, and Experience strategies on our website here:
http://www.staffordshireandstokeontrent.nhs.uk/About-Us/quality-framework.htm
13
See our information on raising concerns, on our website here:
http://www.staffordshireandstokeontrent.nhs.uk/About-Us/raisingconcerns
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Monitoring our progress
The Quality Governance Committee is the principal committee charged by our Trust
board to lead on quality. This committee, and Its Safety and Effectiveness
Subcommittee, will review our progress against these priorities regularly.
Also, each of our divisions has a Safety and Effectiveness Operational Group. These
groups will also review all areas of quality in their own divisions.
The way that we make improvements and monitor our progress aligns with the CQC
KLOE around Well-led services.
Consultation questions:
20. Are there any other methods we should use to ensure we achieve our
quality priorities?
21. Is there anything else we should do to monitor our progress?
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Appendix: Factors affecting our choice of
priorities
NHS five year forward view14
The NHS Five Year Forward View was published on 23 October 2014 and sets out a
vision for the future of the NHS.
The forward view proposes:

A radical upgrade in prevention and public health, including national action on
obesity, smoking, alcohol and other major health risks.

Patients gaining far greater control of their own care, including the option of
shared budgets combining health and social care.

Taking decisive steps to break down the barriers in how care is provided
between family doctors and hospital, between physical and mental health,
between health and social care

Supporting radical new care delivery options, such as multispecialty
community providers (integrated out-of-hospital care) and Primary and Acute
care systems (integrated hospital and primary care).

Smaller hospitals will have new options to help them remain viable, including
forming partnerships with other hospitals.

Challenging efficiency and performance expectations, compared with the
NHS’ own past, the wider UK economy and other countries health systems.
These proposals emphasise the importance of strategic planning in collaboration
with partner agencies in the local health economy. More open partnership working
locally on operational planning is also expected by NHS England.
Financial challenges15
Last year, around a quarter of NHS providers ended the year in deficit, with the
sector as whole overspending by £107 million. This year, the position looks
significantly worse. Monitor’s report for the first half of the current financial year
reveals an overall deficit of £254 million among foundation trusts, with 81 reporting
deficits, double the number at the end of 2013/14 (Monitor 2014). The NHS Trust
Development Authority’s report for the six-month period up to the end of September
recorded an aggregate deficit of £376 million among NHS trusts, with more than a
quarter forecasting end-of-year deficits (NHS Trust Development Authority 2014).
Nationally, the most optimistic of the funding scenarios outlined in the NHS five year
forward view (NHS England 2014b) depends on achieving very challenging
efficiency savings of 2-3 per cent a year.
14
See http://www.england.nhs.uk/ourwork/futurenhs/
Taken from the King’s Fund briefing in advance of the Chancellor’s Autumn statement to
Parliament. See http://www.kingsfund.org.uk/publications/articles/autumn-statement
15
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Reforming the payment system for NHS Services16
Improvements to the payment system will be critical to developing and delivering the
new care models that the Forward View describes, alongside changes in other
enablers such as contracting, technology, and workforce.
NHS England and Monitor want a payment system that supports the rapid shift to
models of care in line with the five year forward view. They will be working to develop
a new blended system of payment approaches that:

Support integrated care models such as multi-specialty community providers

Support the development of urgent and emergency care networks (with threepart payments for capacity, activity and quality)

Support high quality elective care and specialised services (including, for
example, year of care payments for looking after patients with life-long
conditions)

Develop new currencies (units of healthcare for which a payment is made) for
targeted areas of community health

Introduce a single mandated patient-level cost collection across all care
settings to improve payment regulation

Link cost, activity, and outcome data across care settings

Develop quality measures for payment purposes
Reform of the payment system is expected to take place in three broad phases over
the next five years. The pace of moving to new payment approaches will also be
dependent on the circumstances of local health economies.
The Dalton Review – examining new options and opportunities for
providers of NHS care
During 2014, Sir David Dalton led a comprehensive review to examine options and
opportunities for providers of NHS care17. The report complements the ‘Five Year
Forward View’ and provides the means by which new care models can be delivered
through a range of organisational forms. The report makes 22 recommendations to
national bodies, clinical commissioning groups, NHS leaders and wider organisations
across five themes:
1. one size does not fit all
2. quicker transformational change and transactional change is required
3. ambitious organisations with a proven track record should be encouraged to
expand their reach and have a greater impact across the sector
4. overall sustainability for the provider sector is a priority
5. change must happen – implementation must be supported
The review, which complements the NHS five year forward view, suggests that
addressing these key themes “will accelerate the transformational change that is
16
See http://www.england.nhs.uk/resources/pay-syst/reform/
17
See www.gov.uk/government/publications/dalton-review-options-for-providers-of-nhs-care
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Quality Improvement Priorities for 2015/16 – consultation V1
required to help overcome the challenges facing the NHS”. New models of care
require new organisational responses. The review emphasises the importance of
providers deliver the required transformational change in accord with the care
models that work best for their localities.
NHS outcomes framework 2015/16
As reported by NHS England, the refreshed NHS outcomes framework for 2015/16
has received limited changes, to increase alignment with the NHS Mandate, and to
improve the coverage and quality of the framework.
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, though some organisations choose a larger
number of individual priorities18.
Each year there are national updates on information required in quality accounts.
The National Quality Board is also evaluating quality accounts, to ensure that they
give the reader confidence that the board is being open and honest about the quality
of services provided across the organisation and committed to driving continuous
quality improvement.
The Keogh Review, published in July 2013, included actions to ensure that the
requirements for 2014/15 Quality Accounts begin to provide a more comprehensive
and balanced assessment of quality.
Safer staffing: care contact time19
The Chief Nursing Officer has published national guidance to optimise nursing,
midwifery and care staffing capacity and capability. The guidance expands on
previous requirements for Trusts to publish ward level staffing information and
conduct in-depth staffing reviews every six months.
Acknowledging that safe staffing is much more than just looking at the number of
staff on wards, the guidance recommends that Trusts work to make improvements to
the amount of direct care contact time, reducing non-contact time. The report also
recognises the importance of indirect patient care in building a high quality clinical
18
For example, note the Leicester Partnership NHS Trust Quality Account 2013/14, via
http://www.leicspart.nhs.uk/Library/LPT201314QualityAccountPUBLICATIONVERSIONpostboard.pdf
19
See http://www.england.nhs.uk/wp-content/uploads/2014/11/safer-staffing-guide-care-contacttime.pdf
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Quality Improvement Priorities for 2015/16 – consultation V1
environment. (E.g. attending multi-disciplinary ward rounds, liaising with families to
plan discharge, supporting students and newly qualified staff)
The guidance recommends that:

The trust board should consider undertaking a contact time assessment to
provide a baseline indication of the construction of care provided.

Care contact time should be considered on a ward-by-ward basis alongside
other indicators, recognising that appropriate care contact time will vary
according to the patient dependency and specialty.

Temperature checks of contact time should be undertaken using a
consistent methodology to assess any changes in contact time and consider
any impact this may have on patient care.

The inclusion of an understanding of the delivery and impact of care contact
time within a ward leadership training and development strategy should be
described within the Board report, with progress being monitored and reported
to the Board.
Health Education England’s (HEE) national education and training package on safe
staffing, when available, will provide trusts with materials for local use by nurses and
midwives.
Business development priorities and commissioning intentions for
2014/15
Integrated Business Plan 2014/15-2018/19
In summary our business plan covers the following areas:
• We are a major contributor to the delivery of health and social care in
Staffordshire and health care in Stoke on Trent with an effective Board,
workforce and the creativity to succeed and grow in the local health economy
in alignment with our commissioners.
•
Delivering integrated health and social care services which drive up the
quality of care and patient safety whilst delivering efficiency is central to the
Partnership Trust’s strategy.
•
Our focus is on developing a well governed organisation which is determined
to improve outcomes for the citizens we serve. We intend to offer a genuine
opportunity for public, staff and patient engagement to shape the design and
delivery of our services.
•
The Partnership Trust is a provider with the highest level of ambition, a
measured appetite for risk taking and excellent relationship management.
This is supported by a rapidly developing infrastructure to facilitate the best
governance processes.
•
Our overall aim is to transform the care offer to our patients and carers whilst
delivering best value and sustainability. Our ultimate test will be evidencing
we have improved outcomes such as reducing length of stay in a hospital
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setting, improving hospital discharge processes, supporting people to manage
long term conditions more independently and improving overall patient
experience. We are confident we can deliver on this promise.
Divisional business planning
Our Business Development team has met with area managers across each division,
to establish initial views on service developments for 2015/16. These developments
will align with commissioning intentions and broader requirements for each area,
including demography and health needs of each area.
The King’s Fund: Managing Quality in community health care services
In December 2014 the King’s Fund published findings from a small primary research
study exploring how community health service providers define, measure, manage
and improve the quality of care.
The report acknowledged that providers

“are severely hampered by a lack of robust, comparable national indicators
that would enable them to benchmark their performance”

“experience significantly growing demand and face acute workforce
challenges”
The report recommended that local service leaders:

Take the initiative locally to improve how quality is measured and monitored.

Take advantage of opportunities to compare and learn from others, including
outside the community services sector.

Continue developing provider-led initiatives to benchmark data and develop
shared indicators across the sector.

Prioritise engaging community services staff in quality, motivating them to
take responsibility for accurate reporting and supporting them with tools and
skills in quality improvement and leadership for quality.
In line with this report, the changes to quality improvement priorities in this document
focus on:

The usefulness of the measures to frontline staff in helping them
understand and improve quality of services

Using and developing measures that allow benchmarking with other
community services providers
Care Quality Commission (CQC): “Complaints Matter”
Published in December 2014, this report describes how complaints and concerns fit
into CQC’s new regulatory model, and it presents early findings on the state of
complaints handling in hospitals, mental health services, community health services,
GP practices, out-of-hours services and adult social care services.
Complaints handling is an excellent proxy for an open, transparent and learning
culture that the CQC would expect to see in well-led organisations.
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The CQC note that, for NHS acute, Mental Health and community health services
nationally, “there is far too much poor practice in NHS providers’ responsiveness and
treatment of people who make complaints. This is backed up by findings in patient
surveys.”
The CQC also noted that “the large majority of people using adult social care
services said they knew how to raise concerns, and they were very positive about
the actions of care agencies in response to complaints made. People’s feedback
about adult social care and primary care services highlighted issues with the
timeliness of investigations of complaints and responses. People felt that their
concerns were not taken seriously or adequately addressed.”
NHS mandate 2015/16
The revised mandate to the NHS was published on 11 December 2014, and
continues all of the existing objectives in the previous (2014/15) mandate.
In addition the mandate asks for further progress in key areas:

New access and waiting times commitments in mental health

Requirements to implement the Better Care Fund

Update finance objective to reflect the additional funding announced in the
Autumn Statement
As noted by NHS England, the Mandate is broadly stable, with few new national
planning requirements.
See the full document:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/38622
1/NHS_England_Mandate.pdf
Sign up to safety
This year, NHS England launched Sign up to Safety, and we have joined this
campaign20.
Sign up to Safety is designed to help realise the ambition of making the NHS the
safest healthcare system in the world by creating a system devoted to continuous
learning and improvement.
Sign up to Safety aims to deliver harm free care for every patient, every time,
everywhere. It champions openness and honesty and supports everyone to improve
the safety of patients.
Sign up to Safety’s 3 year objective is to reduce avoidable harm by 50% and save
6,000 lives across the NHS.
Staffordshire and Stoke-on-Trent Partnership NHS Trust has planned actions in
response to the Sign up to Safety 5 pledges which form the basis of their patient
safety improvement work to half avoidable harm by 50% in 3 years.
20
See http://www.england.nhs.uk/signuptosafety/whos-signed-up/staff-stoke/
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
Put safety first. Commit to reduce avoidable harm in the NHS by half and
make public the goals and plans developed locally.

Continually learn. Make their organisations more resilient to risks, by acting on
the feedback from patients and by constantly measuring and monitoring how
safe their services are.

Honesty. Be transparent with people about their progress to tackle patient
safety issues and support staff to be candid with patients and their families if
something goes wrong.

Collaborate. Take a leading role in supporting local collaborative learning, so
that improvements are made across all of the local services that patients use.

Support. Help people understand why things go wrong and how to put them
right. Give staff the time and support to improve and celebrate the progress.
Staffordshire County Council Yearly Review: 2013/1421 and strategic plan
Staffordshire County Council commissions and provides a wide range of adult social
care services. We provide adult social care services for the Council as part of our
integrated services.
In October 2014 the Council published it’s 2013/14 yearly review. The review
explains how the Council knows what kind of support is needed by Staffordshire
residents and how the council works with a wide range of organisations to offer the
right services. Some key points in the report are:

In common with the national picture, Staffordshire’s population is getting
older, and this trend is predicted to continue.

There has been an increase in people who have long term conditions such as
coronary heart disease, hypertension or diabetes. It is estimated that this may
affect as many as 250,000 people in Staffordshire, that’s almost 30 per cent of
the total population.

The number of people experiencing some mental health conditions is likely to
decrease by 2020. However, there is expected to be a rise in the number of
people suffering depression, particularly adults aged 65 and over.

There are around 16,000 adults in Staffordshire with some level of learning
disability, with over 2,000 people receiving some form of support. It is
estimated that by 2030 there will be between 400 and 1700 additional people
with a learning disability who will be eligible for social care support in the
county.

The 2011 Census indicated that there are 98,800 carers in Staffordshire; 12%
of the total population. Around a quarter of those currently provide more than
50 hours of unpaid care each week.
The Staffordshire County Council Strategic Plan 2014-1822 contains three priority
outcomes, which are that the people of Staffordshire will:
21
See http://www.staffordshire.gov.uk/health/care/Yearly-review/Yearly-Review-2013-14.pdf
22
See http://www.staffordshire.gov.uk/yourcouncil/strategicplan/strategicplan2012-2017.aspx
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
Be able to access more good jobs and feel the benefits of economic growth

Be healthier and more independent

Feel safer, happier and more supported in and by their community.
All of these ambitions relate in some way to the needs of residents who use social
care services or to the needs of their carers.
One of the key goals for the county council is to develop social care services which
are more tailored to individual needs by changing our existing systems and cultures.
It is important that anybody with a need for care or support is at the centre of every
decision. This aligns with the current Partnership Trust quality priority around
personalisation.
Service Improvement Managers
In 2014/15 we invested in a new team of Service Improvement Managers (SIMs),
who will be developing capability for service improvement, to support Quality
Improvement across the Trust:

Masterclasses will provide management leadership development to support
frontline quality improvement

An In-depth quality improvement programme, delivered in partnership with
NHS Improving Quality, will develop a cohort of experts in quality
improvement across the trust, supporting a model of distributed leadership.
Culture for continuous improvement and leadership for change will also be
addressed via the work of the SIMs. The SIMs will also work in partnership with the
healthcheck team (see below).
Trust Healthcheck Process
Our Healthcheck team, newly developed in 2014/15, work as a diagnostic to look indepth at the health of frontline teams. Using a deep-dive model, intelligence is
gathered on all aspects of team performance, including quality, performance, HR,
and complaints data, to provide a comprehensive assessment of the team. In
addition, trends across the trust will be analysed, and then themes targeted to look at
trust-wide improvements.
ADASS Personalisation Survey 2014
The Directors of Adult Social Services (ADASS) conducted a personalisation Survey,
and published a national report which represents their view of good adult social care.
The key themes from this report are around:

Promoting and embedding culture change (e.g. social worker decisions are
managed and accountable; assessment recognises carers; integrated
workforce)

Improving peoples experience of personalisation (e.g. care plan involves the
person; Care plan specifies needs, eligibility and budget; improvement
identified by users and carers)
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
Stimulating and supporting market diversity (e.g. providers respond to emarketplaces; user-led organisations involved in reviews, promoting diversity;
health workers trained for personal health budgets)

Assurance, performance, and accountability (e.g. Healthwatch tools in use;
outcomes monitored; Making it Real action plan)

Prevention and active citizenship (e.g. People who use services review
experiences and determine priorities; self-management, control and choice
promoted; customers can self-assess)
These themes are all embodied in the care act, and were agreed through Directors
of Adult Social Services (ADASS), with input from Think Local Act Personal (TLAP)
and the national co-production advisory group (NCAG) and reflect many of the
themes in Making it Real (MIR).
Other factors
In addition we have also considered the following factors from this and previous
years:

Clinical Commissioning Group intentions

The Francis Report and related Reports (Keogh, Berwick)

Our Quality Framework 2013-18 and supporting strategies
Consultation questions:
22. For our priorities, have we appropriately considered all the factors in
this appendix?
23. Are there any other factors that we should take into account?
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